Customized Photobiomodulation Modulates Pain and Alters Thermography Pattern in Patients with Knee Osteoarthritis: A Randomized Double-Blind Pilot Study.

Background: Photobiomodulation therapy (PBMT) modulates a wide variety of biological processes, leading to anti-inflammatory and analgesic effects. Understanding the mechanisms underlying therapeutic effects of PBMT remains challenging due to varying outcomes observed between wavelengths, dosage, and site of application. Our research group has dedicated close attention to customization and individualization of dosimetry for PBMT protocols. Preliminary data showed that using an individualized treatment could solve contradictory results reported by previous studies. Based on literature and our preliminary data on light absorption, the goal of the present pilot is to determine whether our individualized dosimetry is a feasible method to assist osteoarthritis (OA) pain control. Methods: This parallel two-arm controlled-pilot study aimed to assess whether personalized PBMT can be effective in the treatment of painful chronic knee OA. Thirty-one patients were randomly allocated into treatment and placebo group (sham irradiation), and the treatment procedure was performed twice a week, for 5 weeks. The PBMT was applied using 850 nm with continuous wave and a total of 526-1402 J each session. Individualized dosimetry was chosen based on each patient's body mass index and skin color. Quality-of-life (QOL) questionnaires and serum/urine analyses were performed before and after treatment was over. Both examiners and participants were blinded to group allocation. Results: Pain scores were reduced significantly in the 4th, 5th, and 10th sessions and remained lower 6 weeks posttherapy in the treatment group when compared to the placebo group. Moreover, the treatment group's results were improved in QOL questionnaires score, dopamine level, and in microcirculation. Conclusions: The present results provide initial evidence that customized photobiomodulation (PBM) reduce pain levels in short- and medium-term in patients with symptomatic knee OA when compared to placebo group. Furthermore, we have provided evidence that customized PBM is able to improve the QOL of those patients.

Analysis of the Potential of Blood Transvascular Sublingual with Light-Emitting Diode Irradiation in COVID-19 Patients: A Pilot Clinical Study.

Background: Due to the high morbidity and mortality rates of this century, the COVID-19 pandemic has had a devastating impact on the health of the global population. Objective: The aim was to evaluate the disturbing impact of in-hospital stay length and the appeal of severe problems for supplemental oxygen for our patients with COVID-19 in moderate stage who were undergoing transvascular blood irradiation onto sublingual vessels. The demand for supplemental oxygen and the serum oxygen levels were measured, and the impact on the length of hospital stay was assessed. Methods: This randomized, prospective, clinical pilot study evaluated the diagnosis of COVID-19 patients admitted to the ventilatory care unit and undergoing treatment protocol usage of light-emitting diode (LED) irradiation by transvascular application onto the sublingual vessels daily. Patients were selected and enrolled into two groups: the Placebo group (n = 7) that received conventional treatment by the device off (LED-off), and the photobiomodulation therapy (PBMT) group (n = 7) that also received the same therapy plus LED irradiation. Results: There was a statistically significant clinical improvement, such as a reduction in serum creatinine, and oxygen usage per few days less in the PBMT group compared with the Placebo group. All patients in the PBMT group had normalized SatO2, while a quarter of patients in the Placebo group required longer O2 supplementation until hospital discharge. Conclusions: The surveillance of clinical improvement in moderate stage indicated that the daily PBMT was able to diminish oxygen supplementation within a short time, besides reducing the hospital stay length in the PBMT group, particularly, when compared with the Placebo group. Clinical Trial Registration number: The study was reviewed by the Ethics Committee in UNINOVE research under number 42325020.6.0000.5511 and approved through number 5,090,119.

Pilot study of the effect of therapeutic photobiomodulation on postoperative pain in knee arthroplasty.

Nine participants undergoing primary TKA submitted to spinal anesthesia, sedation, ultrasound-guided obturator and Femoral nerve Block analgesia, and photobiomodulation Therapy (FBMT) were evaluated regarding postoperative pain and morphine consumption. FBMT sessions were performed in the Immediate Postoperative period (IPO) and after 24 hours. Participants received 16.7±15 mg of morphine up to the third postoperative day. At IPO, mean pain score was 4.8±3.2 and 5.6±3.5, at rest and on movement, respectively. Photo biomodulation therapy can be considered an option for mitigating pain for patients undergoing TKA.

Descriptive Analysis of In Vitro Cutting of Swine Mitral Cusps: Comparison of High-Power Laser and Scalpel Blade Cutting Techniques.

BACKGROUND AND OBJECTIVES: The most common injury to the heart valve with rheumatic involvement is mitral stenosis, which is the reason for a big number of cardiac operations in Brazil. Commissurotomy is the traditional technique that is still widely used for this condition, although late postoperative restenosis is concerning. This study's purpose was to compare the histological findings of porcine cusp mitral valves treated in vitro with commissurotomy with a scalpel blade to those treated with high-power laser (HPL) cutting, using appropriate staining techniques. MATERIALS AND METHODS: Five mitral valves from healthy swine were randomly divided into two groups: Cusp group (G1), cut with a scalpel blade (n = 5), and Cusp group (G2), cut with a laser (n = 5). G2 cusps were treated using a diode laser (λ = 980 nm, power = 9.0 W, time = 12 sec, irradiance = 5625 W/cm2, and energy = 108 J). RESULTS: In G1, no histological change was observed in tissue. A hyaline basophilic aspect was focally observed in G2, along with a dark red color on the edges and areas of lower birefringence, when stained with hematoxylin-eosin, Masson's trichrome, and Sirius red. Further, the mean distances from the cutting edge in cusps submitted to laser application and stained with Masson's trichrome and Sirius red were 416.7 and 778.6 µm, respectively, never overcoming 1 mm in length. CONCLUSIONS: Thermal changes were unique in the group submitted to HPL and not observed in the cusp group cut with a scalpel blade. The mean distance of the cusps' collagen injury from the cutting edge was less than 1 mm with laser treatment. Additional studies are needed to establish the histological evolution of the laser cutting and to answer whether laser cutting may avoid valvular restenosis better than blade cutting.

The use of a high-power laser on swine mitral valve chordae tendineae.

Worldwide, rheumatic fever remains a significant cause of mitral valve insufficiency. It is responsible for approximately 90 % of early childhood valvular surgeries in Brazil. Elongated or flail chordae are frequently responsible and require surgical correction. The purpose of this study was to analyze and compare the histological tissues of the mitral valve chordae and the mechanical resistance generated by the chordae, both with and without the application of a high-power laser. Twenty normal porcine mitral valve chordae were measured and divided randomly into the following two groups: control group (not subjected to a high-power laser) and laser group (subjected to photonic irradiation). Laser surgery was performed under controlled conditions, using following parameters: λ = 980-nm wavelength, power = 3 W, and energy = 60 J. A mechanical test machine was used in combination with a subsequent histological study to measure chordae tensile properties. A histological analysis demonstrated a typical collagen bundle arrangement in the control group; however, under a particular reached temperature range (48), the collagen bundles assumed different arrangements in the laser group. Significant reductions in the chordae tendineae lengths and changes in their resistance in the laser group were observed, as these chordae exhibited less rigid fibers. The chordae tendineae of normal porcine valves subjected to a high-power laser exhibited its length reduction and less stiffness compared to the control group. A histological analysis of the laser treatment specimens demonstrated differences in collagen bundle spatial organization, following slight changes into tissue temperature.

Low-level laser therapy prevents prodromal signal complications on saphenectomy post myocardial revascularization.

BACKGROUND AND OBJECTIVE: One of the most frequent treatments for ischemic heart disease is myocardial revascularization, often applying the saphenous vein as a coronary graft. However, postoperative complications may occur, such as saphenous dehiscence. According to the literature, low-level laser therapy (LLLT) has been used in the treatment of several inflammatory processes in patients. Recently, its uses have expanded to include LLLT preventive therapy and postoperative treatment. Despite our department's successful application of LLLT in the treatment of saphenectomy incisions, many colleagues are still uncertain as to laser therapy's benefits. Therefore, the study's purpose was to evaluate tissue repair of prodromal surgical incisions after the administration of LLLT. MATERIALS AND METHODS: The pilot study included 14 patients, divided into two groups. Both groups of patients received the traditional treatment; additionally, the Laser Group (n = 7) received diode laser treatment (λ = 780 nm, fluence = 19 J/cm(2), pulse = 25 mW, time = 30 sec, energy = 0.75 J, irradiance = 625 mW/cm(2), beam spot size 0.04 cm(2)), which was applied on the edges of the saphenectomy incision. The Control Group (n = 7) received conventional treatment exclusively. RESULTS: In the Laser Group: all seven patients showed significant improvement, whereas the Control Group had twice as many complications, including critical rates of incisional dehiscence. CONCLUSIONS: LLLT was valuable in preventing prodromal complications in saphenectomy post myocardial revascularization.

Análise do efeito do laser de alta potência em valvas mitrais cardíacas de suínos: estudo experimental / Analysis of high power laser effect in swine cardiac mitral valves: experimental study

Introdução e Objetivo: No Brasil, procedimentos valvares representam no mínimo 30% das cirurgias cardíacas realizadas no país. Em nosso meio ainda predominam as lesões valvares decorrentes da febre reumática e doenças degenerativas. Nos pacientes reumáticos, a valva mitral é a mais acometida, predominando a estenose devido à fusão comissural e lesões no plano subvalvar; porém espessamento e retração de cúspides também são comuns, determinando dupla lesão ou insuficiência desta valva. Em processos degenerativos, as cordas tendíneas podem se apresentar alongadas. Na tentativa de utilização futura do laser como método auxiliar na correção cirúrgica dessas valvopatias, iniciamos estudo experimental com o objetivo de comparar histologicamente o tecido valvar mitral de suínos (cordas tendíneas e cúspides) submetido com e sem o laser de alta potência (LAP). Métodos: Foram estudadas cordas tendíneas e cúspides mitrais de suínos jovens e saudáveis, divididos em 6 grupos: G1-Aplicação do laser em cordas tendíneas com o tempo de 15 s; G2- Aplicação do laser em cordas tendíneas com o tempo de 20 s; G3- Aplicação do laser em cordas tendíneas com o tempo de 30 s; G4- Grupo controle relacionado a G1, G2 e G3; G5- Grupo cúspide submetido a corte com lâmina de bisturi; G6- Grupo cúspide submetido a corte com laser. As cordas tendíneas dos grupos G1, G2 e G3 receberam tratamento com laser de diodo (=980 nm, P=3,0 W) e o grupo G6 com laser de diodo em outros parâmetros (=980 nm, P=9,0 W, T=12s). Termografia e tomografia por coerência óptica foram utilizadas durante o experimento. Parte da amostra foi preservada em formaldeído e glutaraldeído para análise microscópica e a outra parte foi preservada em solução fisiológica 0,9% para análise mecânica. Resultados: Houve um decréscimo significante no comprimento das cordas tendíneas após aplicação do laser quando comparado ao comprimento inicial (p=0,005 em G1 e G2 e p=0,004 em G3). À microscopia óptica, G1, G2 e G3 apresentaram...

Introduction and Objective: In Brazil, valvar procedures represent at least 30% of cardiac surgeries performed in the country. It still predominate valvar lesions resulting from rheumatic fever and degenerative diseases. In rheumatic patients, the mitral valve is the most affected, predominantly stenosis due to commissural fusion and lesions in the subvalvar plane, however, thickening and retraction of the leaflets are also common, causing double lesion or mitral insufficiency. In degenerative process, the chordae tendineae may present elongated. In an attempt to further use of the laser as an auxiliary method in the surgical correction of valvar heart disease, we started experimental study with the purpose of comparing the histological swine tissue mitral valve (chordae tendineae and cusps) with and without high-power laser (HPL) application. Methods: Normal porcine mitral valve chordae and cups were studied and divided randomly into the following 6 groups: G1- Laser in the chordae tendineae with time of 15s; G2- Laser in the chordae tendineae with time of 20s; G3- Laser in the chordae tendineae with time of 30s; G4- Control Group; G5- Cusp group cut with a scalpel blade; G6- Cusp group cut with laser. Chordae tendineae from G1, G2 e G3 received diode laser (=980 nm, P=3,0 W) and G6 diode laser with other parameters (=980 nm, P=9,0 W, T=12s). Termography and optical coherence tomography were included during the procedure. Part of the sample was preserved in formaldehyde and glutaraldehyde for microscopic analysis and another part was stored in 0.9% saline for mechanical analysis. Results: There was a significant decrease in chordae length after laser application when compared to the initial length (p=0,005 to G1 and G2; p=0,004 to G3). In laser groups, histological analysis revealed a typical hyaline areas occupying almost the entire thickness of the chordae, when stained with Hematoxylin-Eosin (HE); dark red central areas when stained with Masson ...

Pilot study in neonates using low-level laser therapy in the immediate postoperative period of myelomeningocele / Estudo piloto em neonatos utilizando o laser de baixa intensidade no pós-operatório imediato de mielomeningocele

Objective: To analyze the tissue repair behavior after corrective surgical incision in neonates submitted to low-level laser therapy, in an attempt to diminish the incidence of postoperative dehiscence following the surgery for myelomeningocele performed immediately after birth. Methods: It is a prospective pilot study with 13 myelomeningocele patients submitted to surgery at birth who received adjuvant treatment with low-level laser therapy (Group A). Diode laser C.W., lambda = 685t nm, p = 21 mW, E = 0.19 J was punctually applied along the surgical incision, summing up 4 to 10 J energy delivered per patient, according to the surgical wound area and, then, compared with the previous results, which were obtained from 23 patients undergoing surgery without laser therapy (Group B). Results: This pilot study showed a significant decline in dehiscence of surgical wounds in neonates submitted to low-level laser therapy as compared to controls (7.69 versus 17.39%, respectively), demonstrating this is an effective, safe and noninvasive treatment method. Conclusion: This new adjuvant therapeutic proposal with low-level laser therapy aided healing of surgical wounds, preventing morbidities, as well as decreasing hospital stay, which implies cost of reduction for patients and for the institution.

Objetivo: Analisar o comportamento da reparação tecidual de incisão cirúrgica corretiva em neonatos submetidos ao laser de baixa intensidade, auxiliando a redução de incidência de deiscência pós-operatória de correção cirúrgica de mielomeningocele realizada imediatamente após o nascimento. Métodos: Estudo piloto, prospectivo, com 13 pacientes operados ao nascimento de mielomeningocele e submetidos ao laser de baixa intensidade como adjuvante. Foi aplicado, ao longo da incisão cirúrgica, o laser de diodo C.W., lambda = 685 nm, p = 21 mW, com E = 0,19 J por ponto, totalizando valores de energia entregue por paciente entre 4 e 10 J, de acordo com a área da cicatriz cirúrgica, e comparando com os resultados obtidos previamente de 23 pacientes operados sem a terapia com o laser (Grupo B). Resultados: Este estudo revelou significativa redução de deiscências no pós-operatório de neonatos, quando submetidos ao laser de baixa intensidade comparados ao controle (7,69 versus 17,39%, respectivamente), evidenciando ser um método de tratamento eficaz, seguro e não-invasivo. Conclusão: Esta nova proposta terapêutica adjuvante com o laser de baixa intensidade auxiliou na reparação tecidual da ferida operatória, evitando morbidades, além de diminuir o tempo de internação, sinalizando possível redução de custos tanto para os pacientes quanto para a instituição.

Pilot study in neonates using low-level laser therapy in the immediate postoperative period of myelomeningocele.

OBJECTIVE: To analyze the tissue repair behavior after corrective surgical incision in neonates submitted to low-level laser therapy, in an attempt to diminish the incidence of postoperative dehiscence following the surgery for myelomeningocele performed immediately after birth. METHODS: It is a prospective pilot study with 13 myelomeningocele patients submitted to surgery at birth who received adjuvant treatment with low-level laser therapy (Group A). Diode laser C.W., λ = 685t nm, p = 21 mW, E = 0.19 J was punctually applied along the surgical incision, summing up 4 to 10 J energy delivered per patient, according to the surgical wound area and, then, compared with the previous results, which were obtained from 23 patients undergoing surgery without laser therapy (Group B). RESULTS: This pilot study showed a significant decline in dehiscence of surgical wounds in neonates submitted to low-level laser therapy as compared to controls (7.69 versus 17.39%, respectively), demonstrating this is an effective, safe and noninvasive treatment method. CONCLUSION: This new adjuvant therapeutic proposal with low-level laser therapy aided healing of surgical wounds, preventing morbidities, as well as decreasing hospital stay, which implies cost of reduction for patients and for the institution.

Low level laser therapy in acute dehiscence saphenectomy: therapeutic proposal.

Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy.

Laser de baixa intensidade em deiscência aguda de safenectomia: proposta terapêutica / Low level laser therapy in acute dehiscence saphenectomy: therapeutic proposal

Deiscência é uma complicação temida em cirurgias de grande porte. Paciente submetida a revascularização miocárdica evoluiu com deiscência de safenectomia em membro inferior, edema e dor no 15º dia pós-operatório (PO), tendo sido realizado inicialmente o tratamento convencional no ambulatório sem melhora clínica. No 30º PO, aplicou-se somente Laser de Baixa Intensidade (LBI) ao redor da borda da ferida, pontualmente. A lesão respondeu com tecido de granulação, diminuição do processo inflamatório e analgesia desde a primeira aplicação. Neste estudo piloto, a laserterapia mostrou ter um papel importante como agente facilitador de cicatrização, por meio de uma terapia nãoinvasiva, eficaz e segura.

Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy.