L-arginine supplementation increases cardiac collagenogenesis in mice chronically infected with Berenice-78 Trypanosoma cruzi strain.

Chagas disease, caused by Trypanosoma cruzi, is a major neglected tropical disease that occurs mainly as chronic infection and systemic infection. Currently, there is no suitable and effective drug to treat this parasitic disease. Administration of nutrients with immunomodulatory properties, such as arginine and nitric oxide radicals, may be helpful as antiparasitic therapy. In this study, we evaluated the effects of arginine supplementation during the acute phase of infection under the development of chronic Chagas' heart disease in Swiss mice inoculated with the Berenice-78 strain of T. cruzi. The effectiveness of arginine was determined by daily detection of the parasite in the blood and long-term serum levels of nitric oxide and tumor necrosis factor-alpha, in addition to evaluation of heart tissue damage. Arginine could flatten parasitemia and prevent elevation of tumor necrosis factor-alpha in T. cruzi-infected mice. Regarding chronic inflammatory myocardial derangements, similar findings were verified among T. cruzi-infected groups. Arginine promoted collagenogenesis in the heart muscle tissue of T. cruzi-infected arginine-supplemented group. These data show the paradoxical benefits of arginine in improving the outcome of Chagas chronic cardiomyopathy.

The architecture and spatial organization of the living human body as revealed by intratissular endoscopy - An osteopathic perspective.

This article presents an overview of research conducted by Dr Jean-Claude Guimberteau into the architecture and spatial organization of living matter and the relationship between the cells and the extracellular matrix. His research is discussed in the context of previous and current research into fascial anatomy. Andrew Taylor Still, the founder of Osteopathy, did not have access to modern research and yet his observations are proving to be surprisingly accurate in the light of recent findings. This article sets out to highlight the relevance of his insights from a purely anatomical perspective, and to draw parallels with a new way of thinking about the architecture of the living human body that is slowly emerging. Dr Guimberteau's research shows that a force applied to the surface of the skin is transmitted deep into living tissue via a continuous bodywide multifibrillar network. It also confirms the concept of the body as a dynamic functional unit, as proposed by A.T. Still. Still also proposed that structure and function are interrelated at all levels within the living human body. There is a growing body of research to support this. Intratissular endoscopy has highlighted the importance of the quality of the mobility and adaptability of the network of collagen and elastin fibers that structures the ECM in healthy living tissue. Factors such as abnormal stiffness of collagen fibers in the ECM are thought to have adverse effects on local tissue health.

Histological analysis of the association of low level laser therapy and platelet-rich plasma in regeneration of muscle injury in rats.

OBJECTIVE: Muscle injuries are common, and their treatment requires costs and time off. Platelet rich plasma and low level laser therapy have been shown to be affordable and easy to use. The aim of this study was to evaluate the associated effects of low level laser therapy and platelet rich plasma on the treatment of the soleus muscle injured by strain in rats. METHODS: Thirty-five rats were randomly allocated into five groups: Control (C), Injury Control (IC), injury PRP (IP), injury LLLT (ILT) and injury LLLT and PRP (ILTP). The strain injury was induced in the soleus muscle and the IP group received application of platelet rich plasma immediately after the lesion, while the ILT group received low level laser therapy. After seven days, all animals were euthanized and the soleus muscle removed for further histological analysis. RESULTS: The association of both treatments (ILTP) resulted in better histological aspects than the low level laser therapy and platelet rich plasma alone, when compared with the injury group (IC). The collagen analysis exhibited a significant increase in the ILT group (2.99 SD=1.13) compared to the C (1.88 SD=0.41, p=0.012) and IP (2.04 SD=0.44, p=0.018). CONCLUSION: The association of low level laser therapy with platelet rich plasma produced better results on muscle injury compared to the isolated use of these therapies. Furthermore, none of the treatments could modulate the collagen deposition in relation to injury group.

Diet enrichment with a specific essential free amino acid mixture improves healing of undressed wounds in aged rats.

Chronic wounds are a major, often underestimated, health problem for the elderly. Standard wound care products are not usually manufactured to meet the increased demand of nutrients by skin cells in order to regenerate new tissue and accelerate healing. This work was therefore undertaken to establish whether wound healing could be accelerated by nutritional supplementation with a specific mixture tailored to human need of essential amino acids (EAAs) without topical medication. To this end, using a skin full-thickness excisional model in aged rats, we compared the closure dynamics of undressing wounds in animals fed an EAAs-enriched diet or standard diet. We assessed the degree of fibrosis and inflammation, as well as relevant signaling molecules such as COL1A1, iNOS and TGFß1. The results showed wound healing was accelerated in EAAs-fed rats, which was accompanied by reduced inflammation and changes in TGFß1 and COL1A1 expression. Collectively, our findings indicate that dietary supplementation with balanced EAAs diet could serve as a strategy to accelerate wound healing without inducing fibrosis and could therefore be a simple but pivotal therapeutic approach in human also.

Can fascia's characteristics be influenced by manual therapy?

This essay looks into some fundamental properties of collagen and attempts to relate what the manual therapist does to the necessity of maintaining the collagen's strength under loads. In so doing we point out some difficulties in gathering relevant data applicable to the clinic and propose direction for further research.

Fascial hierarchies and the relevance of crossed-helical arrangements of collagen to changes in shape; part II: The proposed effect of blood pressure (Traube-Hering-Mayer) waves on the fascia.

Periodic changes in arterial pressure and volume have long been related to respiratory and sympathetic nerve activity (Traube-Hering-Mayer waves) but their origins and nomenclature have caused considerable confusion since they were first discovered in the eighteenth century. However, although they remain poorly understood and the underlying details of their control are complicated, these waves do provide valuable clinical information on the state of blood pressure regulation in both normal and pathological conditions; and a correlation with oscillatory motions observed by certain practitioners suggests that they may also have some physiological value that relates to changes in the volume of fascial 'tubes'. Part I of this paper (Scarr, 2016) described a complex fascial network of collagen-reinforced tubular sheaths that are an integral part of muscle structure and function, and continuous with 'higher-level' fascial tubes surrounding groups of muscles, the limbs and entire body. The anisotropic arrangements of collagen fibres within the walls of these tubes reflect the most efficient distribution of mechanical stresses and have been considered to coordinate changes in shape, and a proposed link between cyclic variations in arterial pressure and volume, and the behaviour of these fascial compartments is now described.

High voltage pulsed current in collagen realignment, synthesis, and angiogenesis after Achilles tendon partial rupture.

OBJECTIVE: To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. METHOD: Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. RESULTS: No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. CONCLUSION: High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.

High voltage pulsed current in collagen realignment, synthesis, and angiogenesis after Achilles tendon partial rupture

ABSTRACT Objective To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. Method Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. Results No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. Conclusion High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.

Fascial hierarchies and the relevance of crossed-helical arrangements of collagen to changes in the shape of muscles.

Muscles are composite structures consisting of contractile myofibres surrounded by complex hierarchies of collagen-reinforced fascial sheaths. They are essentially flexible cylinders that change in shape, with the particular alignment of collagen fibres within their myofascial walls reflecting the most efficient distribution of mechanical stresses and coordinating these changes. However, while the functional significance of this crossed-helical fibre arrangement is well established in other species and in different parts of the body, relatively little attention has been given to this within the fascia of humans; and the relevance of this geometric configuration to muscles and surrounding fascial tissues is described.

Efeitos do laser GaAlAs associado à microcorrentes na cicatrização por segunda intenção / Effects laser GaAlAs associated with microcurrent in the second intention healing

Introdução: A cicatrização de feridas é um processo dinâmico que envolve vários elementos celulares com propósito de restabelecer a funcionalidade do tecido lesado, muitos fatores podem interferir neste processo tornando-o complexo. O laser e a microcorrente são modalidades terapêuticas que otimizam o processo de reparo, porém são estudadas isoladas. Objetivo: Investigar a eficácia da associação da fototerapia (laser, GaAlAs, λ 656±5 nm) com a eletroterapia (microcorrente) na cicatrização por segunda intenção em ratos. Método: Foram utilizados 15 ratos submetidos à lesão dorsal direita com 8 mm de diâmetro divididos em três grupos (n=5), nominados de GC (controle), G2 (laser +30µA) e G3 (laser +160 µA). Para análises histopatológicas foi determinado p≤0,05. Resultados: A análise estatística revelou que a área de colágeno apresenta-se estatisticamente superior nos grupos tratados (G2 e G3) quando comparados com o grupo controle. Conclusão: A associação das modalidades induz ao aumento do colágeno na fase inicial do reparo tecidual.

Introduction: Wound healing is a dynamic process that involves multiple cellular elements with the purpose of restoring the functionality of the injured tissue. Many factors can interfere with this process, making it complex. Laser and microcurrent are therapeutic strategies that optimize the repair process, but have been studied in isolation. Objective: To investigate the efficacy of combining phototherapy (laser, GaAlAs, λ 656±5 nm) with electrotherapy (microcurrent) on second intention healing in rats. Methods: We used 15 rats with 8 mm in diameter lesions in the right dorsal. The rats were divided into three groups (n = 5): the CG (control group), G2 (laser+30µA) and G3 (laser +160µA). For histopathological analysis p ≤ 0.05 was determined. Results: Statistical analysis revealed that the area of collagen was statistically higher in the treated groups (G2 and G3) compared with the control group. Conclusion: A combination of methods induces increased collagen in the initial phase of tissue repair.

A unifying neuro-fasciagenic model of somatic dysfunction - Underlying mechanisms and treatment - Part II.

This paper offers an extensive review of the main fascia-mediated mechanisms underlying various therapeutic processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the several fascial influences that may come into play during and after manual treatment. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying neuro-fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of manual therapeutic effects as being partially, if not entirely, mediated by the fascia. By taking into consideration a wide spectrum of fascia-related factors - from cell-based mechanisms to cognitive and behavioural influences - a model emerges suggesting, amongst other results, a multidisciplinary-approach to the intervention of somatic dysfunction. Finally, it is proposed that a sixth osteopathic 'meta-model' - the connective tissue-fascial model - be added to the existing five models in osteopathic philosophy as the main interface between all body systems, thus providing a structural and functional framework for the body's homoeostatic potential and its inherent abilities to heal.

A unifying neuro-fasciagenic model of somatic dysfunction - underlying mechanisms and treatment - Part I.

This paper offers an extensive review of the main fascia-mediated mechanisms underlying various dysfunctional and pathophysiological processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the diverse fascial influences that may come into play in its genesis and maintenance. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of dysfunctional process as being partially, if not entirely, mediated by the fascia.

Wound management and nutrition for optimal wound healing.

The process of wound healing is complicated and requires optimization of wound bed conditions locally through wound management and systemically through proper nutritional care. Although there are a variety of local and systemic factors that can adversely influence healing, the wound environment can be treated through proper dressings to decrease necrotic debris, bacterial load, and foreign bodies. In addition, maintaining or improving patient nutritional status will help the body to supply the necessary building blocks and cellular response for healing to take place.

Mathematical model of fiber orientation in anisotropic fascia layers at large displacements.

A mathematical model is developed to determine the relationship between stretch and the orientation of fibers in the fascia. The transversely isotropic stress- strain relation for large displacements valid for the human fascia reinforced by the collagen fibers is employed. The relation between the orientation of fibers in the un-deformed and deformed state depending upon the stretch is plotted. It is observed that for greater fiber angle orientation, the fibers are more resistant to reorientation as the fascia is stretched longitudinally. It is also concluded that the reinforced fascia will always be in tension as the stretch is applied. However, we suggest future research to resolve the tension and compression issues in fascia.

Fluorofenidone attenuates diabetic nephropathy and kidney fibrosis in db/db mice.

BACKGROUND/AIMS: Fluorofenidone [1-(3-fluorophenyl)-5-methyl-2-(1H)-pyridone, AKF-PD], a novel pyridone agent, showed potent antifibrotic properties. The aim of the present study was to investigate the effects of AKF-PD on diabetic nephropathy and kidney fibrosis, and to obtain an insight into its mechanisms of action. METHODS: We administered AKF-PD to diabetic db/db mice for 12 weeks. Moreover, we performed in vitro cultures using murine mesangial cells exposed to high ambient glucose concentrations. RESULTS: AKF-PD reduced renal hypertrophy, mesangial matrix expansion and albuminuria in the db/db mice. The upregulated expression of α1(I)- and α1(IV)-collagen and fibronectin mRNAs, transforming growth factor-ß1 (TGF-ß1), α-smooth muscle actin (α-SMA), and tissue inhibitors of metalloproteinase 1 (TIMP-1) mRNAs and proteins was inhibited by AKF-PD treatment in the renal cortex of db/db mice. The maximal effective dose of AKF-PD was about 500 mg/kg body weight. AKF-PD inhibited the upregulated expression of α1(I)- and α1(IV)-collagens, TGF-ß1, TIMP-1 and α-SMA induced by high glucose concentrations in cultured mesangial cells. CONCLUSIONS: Our data indicate that AKF-PD diminishes the abnormal accumulation of mesangial matrix through the inhibition of upregulated expression of TGF-ß target genes in kidneys of db/db mice, resulting in attenuation of renal fibrosis and amelioration of renal dysfunction despite persistent hyperglycemia. Therefore, AKF-PD, a potent antifibrotic agent, holds great promise in the treatment of diabetic nephropathy.

Effects of two low-intensity laser therapy protocols on experimental tooth movement.

OBJECTIVE: The purpose of this in vivo study was to determine the effect of two low-intensity laser therapy (LILT) protocols on macroscopic and microscopic parameters of experimental tooth movement. MATERIALS AND METHODS: To induce experimental tooth movement in rats, 40 cN of orthodontic force was applied to the left first molars. Next, a gallium-aluminum-arsenide (Ga-Al-As) diode laser with a wavelength of 830 nm and power output of 100 mW was applied with fluence of 6000 J/cm(2) on the area around the moved tooth. Two different application protocols were used in the experimental groups: one with daily irradiation and another with irradiation during early stages. Macroscopic and microscopic analyses were performed at days 2 and 7 of tooth movement. The amount of tooth movement was measured with a caliper, and tartrate-resistant acid phosphatase and picrosirius staining were used to enable identification of osteoclasts and immature collagen, respectively. RESULTS: The amount of tooth movement did not differ between the irradiated and nonirradiated groups on days 2 and 7 of the experiment. On day 2, no difference was observed in the number of osteoclasts or the percentage of immature collagen. On day 7, there was an increase in the number of osteoclasts after daily applications of LILT, while two applications produced no significant difference from control. The amount of immature collagen on the tension side significantly increased in the nonirradiated group and when LILT was applied for only 2 d, whereas it was shown to be inhibited by daily LILT applications (p < 0.05). CONCLUSION: The tested LILT protocols were unable to accelerate tooth movement. Even though the number of osteoclasts increased when LILT was applied daily, the repair at the tension zone was inhibited.

New clinical outcomes utilizing a 1064-nm Nd:YAG laser for lipolysis of the torso oblique region.

OBJECTIVES: The safety and efficacy of a 1064-nm Nd:YAG laser (Cynosure, Westford, USA) utilizing a 300-microm optical fiber and a 1-mm diameter micro-cannula were evaluated as a treatment for reduction in the appearance or elimination of unwanted fat in the lower back/flanks ('love handles'). In addition, the use of the laser for tightening the skin and collagen regeneration in the area of lipolysis was assessed through biopsies. METHODS: Ten subjects with unwanted flaccidity and fat deposits in the oblique region of the torso were enrolled in the study. Subjects underwent a single laser lipolysis treatment followed by aspiration of the treatment area. The total tumescence used, laser energy delivered, and tissue removed was recorded for each subject. All subjects had baseline photographs taken and their weight recorded prior to treatment. Pregnancy tests (if applicable) were performed prior to treatment as well. Three subjects had 4-mm biopsies taken at baseline and 6 months to evaluate collagen regeneration. Collagen and elastic tissue fibers were evaluated using special routine stains and histochemical stains designed to highlight these dermal components. Follow-up visits were conducted at 1 week, 1 month, 3 months and 6 months following treatment to evaluate side effects, weight loss and laxity. Additionally, patients kept an evaluation log for each of the first 7 days following treatment. At the 6-month conclusion, patient satisfaction was recorded. RESULTS: Laser lipolysis procedures with subsequent aspiration were performed bilaterally on the flanks of 10 subjects. At 1-week post-treatment, 80% of the subjects demonstrated reduction in laxity. Similarly, 100% of patients showed visible skin improvement at 1 month, with 70% recording a score of 2 (good improvement). Three-month evaluations yielded one patient (10%) with a score of 3 (excellent improvement) and seven patients (70%) with a score of 2. Histology reports confirmed the visual clinical outcomes, describing thicker collagen bundles at 6 months, as well as coagulation of blood vessels and adipocytes. Side effects were mild and transient in nature, and the majority of discomfort, redness, bruising, swelling, and tingling experienced was resolved within 1 week post-procedure. The treatment was well tolerated and efficacious, with 90% of patients rating their results as good or excellent and 100% of patients reporting that they would recommend the procedure. CONCLUSION: The use of the 1064-nm Nd:YAG laser with a 300-microm fiber demonstrated the ability to treat adipose tissue in the highly vascular flank area with favorable efficacy and safety. Patients exhibited a quick recovery time and excellent tolerance, as well as visually improved skin.

Improvement of hypertrophic scarring by using topical anti-fibrogenic/anti-inflammatory factors in a rabbit ear model.

This study investigates the scar-reducing efficacy of topical application of stratifin and acetylsalicylic acid (ASA) in a rabbit ear model. A total of five New Zealand white rabbits with four wounds per ear were examined. Either recombinant stratifin (0.002%) or ASA (0.5%) incorporated in carboxymethyl cellulose gel was topically applied on each wound at postwounding Day 5. Scars were harvested at postwounding Day 28 for histological analysis. The wounds treated with stratifin and ASA showed 82 and 73% reduction in scar volume, respectively, compared with that of untreated controls. A reduction of 57 and 41% in total tissue cellularity along with 79 and 91% reduction in infiltrated CD3+ T cells were observed in response to treatment with stratifin and ASA, respectively, compared with those of untreated controls. Wounds treated with stratifin showed a 2.8-fold increase in matrix metalloproteinase-1 expression, which resulted in a 48% decrease in collagen density compared with those of untreated controls. Qualitative wound assessment showed a reduced hypertrophic scarring in stratifin and ASA-treated wounds when compared with the controls. This study showed that topical application of either stratifin or ASA-impregnated carboxymethyl cellulose gel reduced hypertrophic scar formation following dermal injuries in a rabbit ear fibrotic model.

Intense pulsed light: what works, what's new, what's next.

Intense pulsed light technology has revolutionized the noninvasive treatment of a whole variety of cutaneous cosmetic problems. Today's machines are safer, more diverse, less painful, and readily available. Intense pulsed lights can be used to treat vascular and pigmented lesions and are used for facial rejuvenation and the removal of unwanted hair. Newer, less powerful home-device intense pulsed light sources will not replace those used in a physician's office but will augment the use of today's more powerful medical office systems.