Infrared low-level diode laser on inflammatory process modulation in mice: pro- and anti-inflammatory cytokines.

To evaluate the modulation of proinflammatory (interleukin-6, IL-6; tumor necrosis factor-α, TNF-α; and interferon-γ, IFN-γ) and anti-inflammatory cytokines (transforming growth factor-ß1, TGF-ß1) in the inflammation processes in vivo with low-level laser action, 50 isogenic mice were randomly distributed into three groups: control (no surgical procedure, n = 10), sham (surgical procedure with three standard cutaneous incisions, followed by an abdominal muscle incision and suture, n = 20), and laser (same procedure followed by laser exposure, n = 20). The sham group was divided into three subgroups: sham I (euthanasia and evaluation, 36 h after surgical procedure), sham II (euthanasia and evaluation, 60 h after surgical procedure), and sham III (euthanasia and evaluation, 84 h after surgical procedure). The laser group was also divided in three subgroups: laser I (a single laser session, 12 h after surgery), laser II (two laser sessions, 12 and 36 h after surgery), and laser III (three laser sessions, 12, 36, and 60 h after surgery). All animals in the laser groups received three points per session of continuous infrared laser (wavelength of 780 nm, power of 20 mW, fluency of 10 J/cm(2), exposure time of 20 s per point, and energy of 0.4 J). After euthanasia, spleen mononuclear cells were isolated and cultured for 48 h. Concentrations of IL-6, TNF-α, IFN-γ, and TGF-ß1 were obtained by enzyme-linked immunosorbent assay method. There was a significant difference between the IL-6 and TNF-α concentrations in the 60-and 84-h evaluations when the laser and sham groups were compared to the control group (p < 0.05), except for laser II in the TNF-α analysis (p > 0.05). The IFN-γ concentration analysis showed a significant difference only in sham II when compared to the control group (p < 0.05). Thus, there was a modulatory effect of TNF-α and IFN-γ in the laser group, particularly in the 60-h postoperative evaluation. There was no significant difference between the laser, sham, and control groups for TGF-ß1 analysis (p > 0.05). The low-level laser application decreased the TNF-α and IFN-γ release in vivo of spleen mononuclear cells in mice, especially after two exposure sessions. However, there was no modulation of the IL-6 and TGF-ß1 release.

Infrared low-level diode laser on serum chemokine MCP-1 modulation in mice.

The effect of the low-level laser therapy (LLLT) in the modulation of cells related to inflammatory processes has been widely studied, with different parameters. The objective was to investigate the immediate and cumulative effect of infrared LLLT on chemokine monocyte chemotactic protein-1 (MCP-1) modulation in mice. Fifty-two isogenic mice were distributed in seven groups: control (n = 10, no surgical procedure), laser I (n = 7, surgical procedure and a single LLLT exposure 12 h after the surgery), laser II (n = 7, surgery followed by two LLLT exposures, 12 and 36 h after surgery), and laser III (n = 7, surgery followed by three LLLT exposures, 12, 36, and 60 h after surgery). For each group, a sham group (n = 21) underwent surgery without laser application. The animals in the laser groups received an infrared diode continuous laser exposure (AsGaAl, 780 nm wavelength, power of 20 mW, energy density of 10 J/cm(2), spot size of 0,04 cm(2)) on three points (20 s per point), and a final energy of 0.4 J. The animals were sacrificed 36 h (laser I and sham I groups), 60 h (laser II and sham II), and 84 h (laser III and sham III groups) after surgery. The MCP-1 concentrations were measured by cytometric bead array. There was no significant difference between the three periods in the sham group (p = 0.3). There was a lower concentration of MCP-1 in the laser III group compared to the laser I group (p = 0.05). The infrared LLLT showed a cumulative effect in the modulation of chemokine MCP-1 concentration. Three LLLT exposures were necessary to achieve the MCP-1 modulation.

Calibration of low-level laser therapy equipment.

BACKGROUND: Despite the increase in the use of low-level laser therapy (LLLT), there is still a lack of consensus in the literature regarding how often the equipment must be calibrated. OBJECTIVE: To evaluate the real average power of LLLT devices in the Greater São Paulo area. METHODS: For the evaluation, a LaserCheck power meter designed to calibrate continuous equipment was used. The power meter was programmed with data related to the laser's wavelength to gauge the real average power being emitted. The LLLT devices were evaluated in two ways: first with the device cooled down and then with the device warmed up for 10 minutes. For each condition, three tests were performed. The laser probe was aligned with the power meter, which provided the real average power being emitted by the LLLT device. All of the data and information related to the laser application were collected with the use of a questionnaire filled in by the supervising therapists. RESULTS: The 60 devices evaluated showed deficit in real average power in the cooled-down and warmed-up condition. The statistical analysis (ANOVA) showed a significant decrease (p<0.05) in the real average power measured in relation to the manufacturer's average power. On average, the most common dose in the clinics was 4 J/cm², and the most desired effects were healing and anti-inflammatory effects. According to the World Association for Laser Therapy (WALT), 1 to 4 J of final energy are necessary to achieve these effects, however only one device was able to reach the recommended therapeutic window. CONCLUSION: The LLLT devices showed a deficit in real average power that emphasized a lack of order in the application of this tool. The present study also showed the need for periodical calibration of LLLT equipment and a better technical knowledge of the therapists involved.

Aferição dos equipamentos de laser de baixa intensidade / Calibration of low-level laser therapy equipment

CONTEXTUALIZAÇÃO: A laserterapia de baixa intensidade (LBI) vem sendo cada vez mais utilizada, porém ainda não há consenso na literatura quanto ao tempo em que os equipamentos devem ser submetidos à aferição ou calibragem. OBJETIVO: Analisar a potência média real (PmR) dos equipamentos de LBI na região da Grande São Paulo. MÉTODOS: Para análise dos equipamentos, utilizou-se um potenciômetro (Lasercheck), próprio para aferição de equipamentos contínuos, o qual foi programado com dados referentes ao comprimento de onda do laser a ser avaliado, obtendo-se assim a PmR emitida. Os equipamentos foram analisados de duas formas: uma, com o LBI desaquecido, e outra, após 10 minutos de uso (aquecido), sendo que três análises foram feitas para cada condição. A caneta emissora foi acoplada ao potenciômetro, o qual fornecia a PmR emitida pelo LBI. Todos os dados e informações referentes à aplicação do laser foram coletados por um questionário respondido pelos responsáveis. RESULTADOS: Os 60 equipamentos avaliados mostraram déficit na PmR com os equipamentos desaquecidos e aquecidos. A análise estatística (ANOVA) mostrou diminuição significativa (P<0,05) da PmR aferida em relação à potência média do fabricante (PmF). Em média, a dose mais empregada nas clínicas foi de 4 J/cm², tendo os efeitos de cicatrização e anti-inflamatório como os mais desejados. Segundo a World Association for Laser Therapy (WALT), para atingir esse efeito, necessita-se de 1 a 4 J de energia final, sendo que apenas um dos 60 aparelhos conseguiria atingir a janela terapêutica preconizada. CONCLUSÃO: Os equipamentos de LBI apresentam um déficit acentuado na PmR, o que mostra uma desordem na utilização desse recurso. Neste estudo, observou-se a necessidade de aferição periódica dos aparelhos de LBI bem como melhor conhecimento técnico dos profissionais envolvidos.

BACKGROUND: Despite the increase in the use of low-level laser therapy (LLLT), there is still a lack of consensus in the literature regarding how often the equipment must be calibrated. OBJECTIVE: To evaluate the real average power of LLLT devices in the Greater São Paulo area. METHODS: For the evaluation, a LaserCheck power meter designed to calibrate continuous equipment was used. The power meter was programmed with data related to the laser's wavelength to gauge the real average power being emitted. The LLLT devices were evaluated in two ways: first with the device cooled down and then with the device warmed up for 10 minutes. For each condition, three tests were performed. The laser probe was aligned with the power meter, which provided the real average power being emitted by the LLLT device. All of the data and information related to the laser application were collected with the use of a questionnaire filled in by the supervising therapists. RESULTS: The 60 devices evaluated showed deficit in real average power in the cooled-down and warmed-up condition. The statistical analysis (ANOVA) showed a significant decrease (p<0.05) in the real average power measured in relation to the manufacturer's average power. On average, the most common dose in the clinics was 4 J/cm², and the most desired effects were healing and anti-inflammatory effects. According to the World Association for Laser Therapy (WALT), 1 to 4 J of final energy are necessary to achieve these effects, however only one device was able to reach the recommended therapeutic window. CONCLUSION: The LLLT devices showed a deficit in real average power that emphasized a lack of order in the application of this tool. The present study also showed the need for periodical calibration of LLLT equipment and a better technical knowledge of the therapists involved.

Single session to infrared low level diode laser on TNF-alpha and IL-6 cytokines release by mononuclear spleen cells in mice: a pilot study.

BACKGROUND AND OBJECTIVE: The results of low-level infrared laser (LLL) systemic action on inflammatory modulation process, specifically diminishing pro-inflammatory and producing anti-inflammatory cytokines are extremely controversial in the literature. More studies are necessary to clarify the biomodulation process. The main objective was to investigate the effect of a single session of an AsGaAl laser on spleen cells interleukin-6 (IL-6) and tumor necrosis factor - alpha (TNF-alpha) release, in vivo, in mice. STUDY DESIGN/MATERIALS AND METHODS: In a pilot study, 18 isogenic mice were distributed in three groups: control (no surgical procedure, n = 6), sham (surgical procedure with three standard cutaneous incisions, followed by abdominal muscle incision followed by suture, n = 6) and LLL (same procedure followed by a single LLL exposure 12 hours after the procedure, n = 6). The animals in the LLL group received a single infrared continuous laser session (780 nm wavelength, power of 20 mW, energy density of 10 J/cm(2)) on three points (20 seconds per point), and final energy of 0.4 J. All animals of the sham and LLL groups were sacrificed 36 hours after surgical procedure; the spleen mononuclear cells were isolated and cultivated for 48 hours. The IL-6 and TNF-alpha were measured by the ELISA method. RESULTS: IL-6 and TNF-alpha concentrations released by the mononuclear cells showed significant differences between the control and sham group (P < 0.07). However, there were no differences between the control and LLL group and between the sham and LLL groups (P > 0.07). CONCLUSION: The single session of infrared LLL showed a tendency of decreasing the IL-6 and TNF-alpha release by mononuclear spleen cells in mice after application, although there was not a significant difference between the sham and LLL group. Conclusions regarding effectiveness of a single session procedure cannot be made due to the low statistical power of this pilot study.

Deficient in vitro anti-mycobacterial immunity despite successful long-term highly active antiretroviral therapy in HIV-infected patients with past history of tuberculosis infection or disease.

We evaluated the anti-Mycobacterium tuberculosis (Mtb) immune responses of HIV patients after long-term successful HAART, presenting >500 TCD4+ cells/microl, undetectable viral load, and past history of tuberculosis infection (HIV+PPD+, n=14) or disease (HIV+CTB, n=17). Their lymphoproliferative and IFN-gamma responses were compared with those from HIV-uninfected controls either PPD+ (HIV-PPD+, n=17) or with past history of pulmonary tuberculosis (n=15). Most HIV-infected patients presented normal PHA responses while responses to the Mtb recombinant polypeptides ESAT-6 and Ag85B were markedly reduced. Responses to a whole Mtb lysate (S-Mtb) in HIV+PPD+ patients were lower than in HIV-PPD+ controls, while in HIV+CTB patients these responses were similar to that of past-tuberculosis controls. Comparison between the two HIV groups also suggested better S-Mtb responses in those cured from tuberculosis. Thus, while immune responses to single Mtb proteins are depressed even after successful HAART, reactivity to S-Mtb is high, specially in those cured from tuberculosis, possibly as a result of the survival of higher numbers of mycobacteria-specific T cell clones during the immunosuppression phase, which may afford sufficient protection against new Mtb challenges.

Imunodeficiência comum variável (hipogamaglobulinemia de início tardio ou hipogamoglobulinemia adquirida): seguimento inicial de 11 casos / Common variable immunodeficiency (hypogammaglobulinemia of late onset or acquired hypogammaglobulinemia): initial follow-up of 11 cases

O presente trabalho faz a avaliaçäo clínico-laboratorial de 11 pacientes com imunodeficiência comum variável, seguidos no Serviço de Imunopatologia do HC/FMUSP. A idade destes pcientes variou de oito a 45 anos, com tempo médio de doença de 12,6 anos e de diagnóstico de 4,3 anos. Manifestaçöes infecciosas, principalmente de vias aéreas e digestivas, ocorreram em todos os pacientes. Poliadenomegalia ocorreu em sete, hepatomegalia em seis, esplenomegalia em cinco e artralgia em quatro pacientes. Todos os casos apresentaram IgG sérica < 250 mg dl. IgA < 33 mg/dl e IGM < 31 ml/dl, exceto um paciente com IgM de 176 mg/dl. Os títulos de iso hemaglutininas foram < 1/20, exceto em um paciente. A determinaçäo de linfócitos B no sangue périférico revelou níveis normais em três, elevados em um e diminuidos em cinco pacientes. Cinco apresentaram testes cutâneos tardios positivos a pelo menos um dos antígenos testados (PPD, varidase (SK-SD), Tricofitina e Levedurina). A avaliaçäo da relaçäo CD-4/CD-8 obtida no sangue periférico foi <1 em oito e > 1 em três. Observou-se também déficit da funçäo NK, paralelamente a uma depressäo da atividade proliferativa de células mononucleares estimuladas por lectinas (PHA, Con-A e PWM). A associaçäo destas duas disfunçöes foi comum, sugerindo um possível papel de linfócitos T reguladores na imunopatogênese da doença nestes pacientes. Os dados obtidos demonstraram a diversidade das manifestaçöes clínicas e imunológicas desta doença, que pode ser notada ente pacientes diferentes e mesmo no seguimento de um único paciente. Em nossos casos a doença apresentou um caráter evolutivo, com uma disfunçäo primariamente humoral seguida por distúrbios da imunidade celular que resultaron em pior prognóstico e dificuldades progressivas na terapêutica...