Light emitting diode (LED) therapy reduces local pathological changes induced by Bothrops asper snake venom.

The therapeutic effect of the Light Emitting Diode (LED) treatment in two wavelengths (635 or 945 nm) was evaluated in the local pathological alterations induced by Bothrops asper snake venom. Mice received irradiation of infrared LED (120 mW, 945 nm) or red LED (110 mW, 635 nm) applied immediately, 1 and 2 h after venom injection. LED treatment reduced edema formation in the plantar region and gastrocnemius muscle and significantly reduced neutrophil migration and hyperalgesia after the venom injection. Also, both infrared LED and red LED treatment significantly reduced myonecrosis, as revealed by muscle CK and plasma CK levels. Histological analysis corroborated the reduction in the extent of venom-induced myonecrosis. In conclusion, our data demonstrates that PBM with LED light in both red and infrared wavelengths, when applied after envenomation in mice, reduces the extent of myotoxicity, edema, inflammatory infiltrate and hyperalgesia, suggesting that photobiomodulation is a potential therapeutic approach that should be further investigated for the treatment of local effects of Bothrops snakebite.

Histomorphologic and ultrastructural recovery of myopathy in rats treated with low-level laser therapy.

The purpose of the present work was to study the effect of low-level laser therapy (LLLT): helium-neon (He-Ne) and gallium arsenide (Ga-As) laser on the histomorphology of muscle and mitochondria in experimental myopathy in rats. Thirty Suquía strain female rats were distributed in groups: (A) control (intact), (B) injured, (C) injured and treated with He-Ne laser, (D) injured and treated with Ga-As laser, (E) irradiated with He-Ne laser on the non-injured muscle, and (F) irradiated with Ga-As laser on the non-injured muscle. Myopathy was induced by injecting 0.05 mg/rat/day of adrenaline in the left gastrocnemius muscle at the same point on five consecutive days, in groups B, C, and D. LLLT was applied with 9.5 J cm-2 daily for seven consecutive days in groups C, D, E, and F. The muscles were examined with optic and electronic microscopy. The inflammation was classified as absent, mild, and intense and the degree of mitochondrial alteration was graded I, II, III, and IV. Categorical data were statistically analyzed by Chi-square and the Fisher-Irwin Bilateral test, setting significant difference at p < 0.05. The damage found in muscle and mitochondria histomorphology in animals with induced myopathy (B) was intense or severe inflammation with grade III or IV of mitochondrial alteration. They underwent significant regression (p < 0.001) compared with the groups treated with He-Ne (C) and Ga-As (D) laser, in which mild or moderate inflammation was seen and mitochondrial alteration grades I and II, recovering normal myofibrillar architecture. No differences were found between the effects caused by the two lasers, or between groups A, E, and F. Group A was found to be different from B, C, and D (p < 0.001). LLLT in experimental myopathy caused significant muscular and mitochondrial morphologic recovery.

[Radiotherapy indications for non-malignant diseases in 2014]. / Indications non oncologiques de la radiothérapie : quelles indications en 2014 ?

This review updates the radiotherapy indications for non-malignant diseases, except those treated by radiosurgery. Since the last 2005 review, there have been no major changes in the indications: the prevention of heteropic bone formation and keloids remain classical indications, while the treatment of macular degeneration or the prevention of coronary restenosis are now past history. Nevertheless, the radiation treatment for benign diseases should have the same criteria as for malignant diseases: information of the patient on risks, benefits and treatment quality.

Effects of low-level laser therapy on skeletal muscle repair: a systematic review.

A review of the literature was performed to demonstrate the most current applicability of low-level laser therapy (LLLT) for the treatment of skeletal muscle injuries, addressing different lasers, irradiation parameters, and treatment results in animal models. Searches were performed in the PubMed/MEDLINE, SCOPUS, and SPIE Digital Library databases for studies published from January 2006 to August 2013 on the use of LLLT for the repair of skeletal muscle in any animal model. All selected articles were critically appraised by two independent raters. Seventeen of the 36 original articles on LLLT and muscle injuries met the inclusion criteria and were critically evaluated. The main effects of LLLT were a reduction in the inflammatory process, the modulation of growth factors and myogenic regulatory factors, and increased angiogenesis. The studies analyzed demonstrate the positive effects of LLLT on the muscle repair process, which are dependent on irradiation and treatment parameters. The findings suggest that LLLT is an excellent therapeutic resource for the treatment of skeletal muscle injuries in the short-term.

Effect of laser therapy on skeletal muscle repair process in diabetic rats.

Skeletal muscle myopathy is a common source of disability in diabetic patients. This study evaluated whether low-level laser therapy (LLLT) influences the healing morphology of injured skeletal muscle. Sixty-five male Wistar rats were divided as follows: (1) sham; (2) control; (3) diabetic; (4) diabetic sham; (5) nondiabetic cryoinjured submitted to LLLT (LLLT); (6) diabetic cryoinjured submitted to LLLT (D-LLLT); and (7) diabetic cryoinjured non-treated (D). Diabetes was induced with streptozotocin. Anterior tibialis muscle was cryoinjured and received LLLT daily (780 nm, 5 J/cm(2), 10 s per point; 0.2 J; total treatment, 1.6 J). Euthanasia occurred on day 1 in groups 1, 2, 3, and 4 and on days 1, 7, and 14 in groups 5, 6, and 7. Muscle samples were processed for H&E and Picrosirius Red and photographed. Leukocytes, myonecrosis, fibrosis, and immature fibers were manually quantified using the ImageJ software. On day 1, all cryoinjured groups were in the inflammatory phase. The D group exhibited more myonecrosis than LLLT group (p < 0.05). On day 14, the LLLT group was in the remodeling phase; the D group was still in the proliferative phase, with fibrosis, chronic inflammation, and granulation tissue; and the D-LLLT group was in an intermediary state in relation to the two previous groups. Under polarized light, on day 14, the LLLT and D-LLLT groups had organized collagen bundles in the perimysium, whereas the diabetic groups exhibited fibrosis. LLLT can have a positive effect on the morphology of skeletal muscle during the tissue repair process by enhancing the reorganization of myofibers and the perimysium, reducing fibrosis.

Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature.

The authors performed a review of the literature to evaluate the efficacy of low level laser therapy (LLLT) for the treatment of temporomandibular disorders (TMD). Selection criteria included: 1) human subjects, 2) articles written in English, and 3) randomized placebo-controlled trials. Evaluation was performed according to the CONSORT 2010 criteria. A total of 14 articles were included in the review. Studies varied considerably in terms of methodological design, particularly regarding the site of application of the laser beam, the number of applications performed, their duration, the laser beam features (wavelength, frequency, output, dosage), and outcome measures. The outcome of the trials was controversial and not particularly related to any features of the laser beam, to the number of laser applications, and their duration. Based on the results of this review no definitive conclusions can be drawn on the efficacy of LLLT for the treatment of TMD. Many methodological differences among the studies, especially regarding the number and duration of laser applications and characteristics of the laser beam (wavelength, frequency, output), do not allow for standardized guidelines for effective treatment with LLLT. The only indication seems to be that LLLT is probably more effective for the treatment of TMJ disorders, and less effective for the treatment of masticatory muscle disorders.

Effect of low-level laser therapy in the myonecrosis induced by Bothrops jararacussu snake venom.

OBJECTIVE: The aim of this work was to investigate the capacity of low-level laser therapy (LLLT) alone or in combination with antivenom (AV) to reduce myonecrosis induced by Bothrops jararacussu snake venom. BACKGROUND DATA: Myonecrosis is the most pronounced local effect caused by B. jararacussu venom. AV therapy and other first-aid treatments do not reverse these local effects. MATERIAL AND METHODS: Male Swiss mice were used. Myonecrosis was induced by injection of 0.6 mg/kg of B. jararacussu venom in the right gastrocnemius muscle and was evaluated at 3 or 24 h after venom injection. The site of venom administration was irradiated for 29 s with a low power semiconductor laser (685 nm) at a dose of 4.2 J/cm(2). Intravenous AV therapy (0.5 mL dose) was administered at different times: 30 min before venom injection or 0, 1, or 3 h afterward. Both AV therapy and LLLT treatments were duplicated in mice groups killed at 3 or 24 h. RESULTS: B. jararacussu venom caused a significant myonecrotic effect 3 and 24 h after venom injection. LLLT significantly reduced myonecrosis by 83.5% at 24 h (p < 0.05) but not at 3 h, and AV therapy alone was ineffective for reducing myonecrosis at 3 and 24 h. CONCLUSION: Only LLLT significantly reduced myonecrosis of the envenomed muscle, suggesting that LLLT is a potentially therapeutic approach for treating the local effects of B. jararacussu venom.

The ability of low level laser therapy to prevent muscle tissue damage induced by snake venom.

Antivenom therapy has been ineffective in neutralizing the severe local fast developing tissue damage following snakebite envenoming. Herein, some effects of in situ helium neon (HeNe) laser irradiation on rat nerve-muscle preparation injected with Bothrops jararacussu venom are described. The tibialis anterior muscle was injected with venom diluted in 0.9% saline solution (60 microg/0.02 mL) or saline solution alone. Sixty minutes after venom injection, laser (HeNe) treatment was administered at three incident energy densities: dose 1, a single exposure of 3.5 J cm(-2); dose 2, three exposures of 3.5 J cm(-2); dose 3, a single exposure of 10.5 J cm(-2). Muscle function was assessed through twitch tension recordings whereas muscle damage was evaluated through histopathologic analysis, morphometry of area of tissue affected and creatine kinase (CK) serum levels, and compared to unirradiated muscles. Laser application at the dose of 3.5 J cm(-2) reduced the area of injury by 64% (15.9 +/- 1.5%vs 44.2 +/- 5.7%), decreased the neuromuscular blockade (NMB) by 62% (11.5 +/- 2.5%vs 30.4 +/- 5.2%) and reduced CK levels by 58% (from 455 +/- 4.5% to 190.3 +/- 23.4%) when compared with unirradiated controls. Dose 2 showed a poorer benefit than dose 1, and dose 3 was ineffective in preventing the venom effects. Measurements of the absorbance of unirradiated and irradiated venom solution showed no difference in absorption spectra. In addition, no difference in the intensity of partial NMB in nerve-muscle preparation was shown by unirradiated and irradiated venom. The results indicate that the laser light did not alter venom toxicity. We conclude that HeNe laser irradiation at a dosage of 3.5 J cm(-2) effectively reduces myonecrosis and the neuromuscular transmission blocking effect caused by B. jararacussu snake venom. Thus, low level laser therapy may be a promising tool to minimize the severity of some of the local effects of snake envenoming.

Effects of the Ga-As laser irradiation on myonecrosis caused by Bothrops Moojeni snake venom.

BACKGROUND AND OBJECTIVES: Viper snake envenoming induces in the victims systemic coagulopathy, and severe local tissue damage such as edema, hemorrhage, intense pain, and myonecrosis. Serumtherapy and other first-aid managements are ineffective in neutralizing these local effects. The effects of the gallium-arsenide (Ga-As) laser irradiation on mice gastrocnemius injected intramuscularly (i.m.) with Bothrops moojeni snake venom were investigated. STUDY DESIGN/MATERIALS AND METHODS: Macroscopical, histopatological, and myonecrosis quantification through serum creatine kinase (CK) evaluation was done at 3, 12, and 24 hours (two, five, and eight irradiation sessions, 4 J/cm(2), 1 minute 32 seconds per period, respectively), were done after the venom or saline injection, and in venom-unirradiated mice. RESULTS: In unirradiated gastrocnemius, the venom induced massive hemorrhage, vascular congestion, time-progressing myonecrosis, edema, abundant inflammatory infiltrate, and high CK serum levels. Ga-As irradiation significantly decreased the amount of myonecrosis in all the periods tested (P < 0.05). CONCLUSIONS: The laser treatment significantly inhibited the ability of B. moojeni venom to rapidly disrupt the integrity of the plasma membrane.

Low-energy laser irradiation promotes the survival and cell cycle entry of skeletal muscle satellite cells.

Low energy laser irradiation (LELI) has been shown to promote skeletal muscle cell activation and proliferation in primary cultures of satellite cells as well as in myogenic cell lines. Here, we have extended these studies to isolated myofibers. These constitute the minimum viable functional unit of the skeletal muscle, thus providing a close model of in vivo regeneration of muscle tissue. We show that LELI stimulates cell cycle entry and the accumulation of satellite cells around isolated single fibers grown under serum-free conditions and that these effects act synergistically with the addition of serum. Moreover, for the first time we show that LELI promotes the survival of fibers and their adjacent cells, as well as cultured myogenic cells, under serum-free conditions that normally lead to apoptosis. In both systems, expression of the anti-apoptotic protein Bcl-2 was markedly increased, whereas expression of the pro-apoptotic protein BAX was reduced. In culture, these changes were accompanied by a reduction in the expression of p53 and the cyclin-dependent kinase inhibitor p21, reflecting the small decrease in viable cells 24 hours after irradiation. These findings implicate regulation of these factors as part of the protective role of LELI against apoptosis. Taken together, our findings are of critical importance in attempts to improve muscle regeneration following injury.

Low intensity monochromatic infrared therapy: a preliminary study of the effects of a novel treatment unit upon experimental muscle soreness.

BACKGROUND AND OBJECTIVE: The current study (for which ethical approval was obtained) sought to assess the effect of low intensity monochromatic infrared therapy (LIMIRT) on experimentally induced delayed onset muscle soreness (DOMS). STUDY DESIGN/MATERIALS AND METHODS: Healthy volunteers were recruited (n = 24, 12M:12F) and randomly allocated under strict double blind conditions to one of three experimental groups (n = 8, 4M:4F): Control, Placebo, or Treatment (840 nm; 3.0 J cm(-2), pulse frequency 1 kHz). DOMS was induced in a standardised manner in the biceps brachii of the nondominant arm. Subjects attended on 5 consecutive days during which the degree of pain and functional impairment was assessed. RESULTS: Analysis of results by using nonparametric Freidman and Kruskal-Wallis H tests (with relevant post hoc tests) revealed significant differences (P < 0.05) between Control and LIMIRT treatment groups for pain and tenderness scores. Despite trends in favour of the Treatment group, analysis failed to show any significant differences between the LIMIRT treatment and Placebo groups for all variables except mechanical pain threshold points 3-6 on day 2. CONCLUSION: The results of the current study suggest that LIMIRT is ineffective in the management of DOMS at the parameters investigated.

Delayed-onset muscle soreness: lack of effect of combined phototherapy/low-intensity laser therapy at low pulse repetition rates.

A double-blind, placebo-controlled study using male subjects (n = 60), was conducted to investigate the efficacy of three different frequencies of combined phototherapy/low-intensity laser therapy (CLILT) in alleviating the signs and symptoms of delayed-onset muscle soreness (DOMS). The study was approved by the University's ethical committee. After screening for relevant pathologies, recent analgesic or steroid drug usage, current pain, diabetes, or current involvement in regular weight-training activities, subjects were randomly allocated to one of five experimental groups: Control, Placebo, or 2.5-Hz, 5-Hz, or 20-Hz CLILT groups (660-950 nm; 31.7 J/cm2; pulsed at the given frequencies for a duration of 12 min; n = 12 all groups). Once baseline measurements were obtained, DOMS was induced in the nondominant arm, which was exercised in a standardized fashion until exhaustion, using repeated eccentric contractions of the elbow flexors. The procedure was repeated twice more to ensure exhaustion was achieved, after which subjects were treated according to group allocation. In the CLILT/placebo groups, the treatment head was applied directly to the affected arm at the level of the musculotendinous junction. Subjects returned on two consecutive days for further treatment and assessment. The range of variables used to assess DOMS included range of movement (universal goniometer), mechanical pain threshold/tenderness (algometer) and pain (visual analogue scale and McGill Pain Questionnaire). Measurements were taken before and after treatment on each day, except for the McGill Pain questionnaire, which was completed at the end of the study. Analysis of results using repeated measures and one-factor analysis of variance with relevant post hoc tests showed significant changes in ranges of movement accompanied by increases in subjective pain and tenderness for all groups over time (p = 0.0001); however, such analysis failed to show any significant differences between groups on any of the days. These results thus provide no convincing evidence for any putative hypoalgesic effect of CLILT upon DOMS at the parameters used here.

Graves ophthalmopathy: MR evaluation of 10-Gy versus 24-Gy irradiation combined with systemic corticosteroids.

PURPOSE: To establish the most effective radiation dose for treatment of Graves ophthalmopathy (GO). MATERIALS AND METHODS: A combination of 10 Gy (n = 15) or 24 Gy (n = 16) of radiation and corticosteroids was used to treat 31 patients with GO. Magnetic resonance (MR) images obtained before treatment showed swollen extraocular muscles with prolonged T2 relaxation times in all patients. RESULTS: Before therapy, T2 relaxation time of extraocular muscle was 79.6 msec (95% confidence interval, 76.3, 82.9) in the 24-Gy group and 77.4 msec (95% confidence interval, 74.6, 80.1) in the 10-Gy group (P = .32). After therapy, T2 relaxation time was 62.8 msec (95% confidence interval, 61.2, 64.4) in the 24-Gy group and 68.9 msec (95% confidence interval, 66.8, 71.1) in the 10-Gy group. In the 24-Gy group, there was a significant decrease in T2 relaxation times (P = .001) and clinical response to initial treatment was better. At 1- and 3-month follow-up, the resistance rate was lower in the 24-Gy group. CONCLUSION: In treatment of GO, 24 Gy of radiation is a more effective dose than 10 Gy when combined with systemic corticosteroids.

A cohort study with regard to the risk of haematological malignancies in patients treated with x-rays for benign lesions in the locomotor system. I. Epidemiological analyses.

Roentgen treatment for painful benign conditions in the locomotor system as arthrosis and spondylosis was in Sweden very common up to the beginning of the 1960s. The mode of treatment differed from the British ankylosing spondylitis series as smaller parts of the red bone marrow were exposed and smaller doses were applied. A cohort of 20,024 such patients treated 1950-1964 at two hospitals in northern Sweden was analysed with regard to the risk of haematological malignancies. Average factors for conversion of prescribed skin doses to mean absorbed red bone marrow doses were estimated on random samples of the different treatment sites and then applied on the cohort in its whole. The standard incidence ratio (SIR) for leukaemia was 1.18 (95% CI: 0.98-1.42) and the standard mortality ratio (SMR) 1.25 (0.99-1.45). In the highest dose group (mean absorbed red bone marrow dose > 0.5 Gy) the corresponding values were 1.40 (1.00-1.92) and 1.50 (1.08-2.04). In the mortality analysis also a slightly increased myeloma risk was noted with SMR = 1.20 (0.99-1.56). Extension of the cohort and nested case-control studies are under progress.

A cohort study with regard to the risk of haematological malignancies in patients treated with x-rays for benign lesions in the locomotor system. II. Estimation of absorbed dose in the red bone marrow.

A cohort study with regard to the risk of haematological malignancies was performed on about 20,000 patients who in 1950-1964 received roentgen treatment for benign conditions in the locomotor system. In order to estimate the mean absorbed red bone marrow dose the treatments were classified as concerning 10 sites (cervical spine, thoracic spine, lumbar spine, sacral region, shoulder, hip, elbow, wrist, knee and ankle). The four last-mentioned sites do not normally contain red bone marrow in adults and their contribution to the mean absorbed dose was regarded as zero. For the other 6 sites random samples consisting of 30 patients for each site were drawn from the cohort. By use of the treatment records and data from the literature on some physical parameters and red bone marrow distribution in normal adult persons, average conversion factors were calculated by which the subscribed surface dose could be converted into mean absorbed dose in red bone marrow. These conversion factors were then applied on the whole cohort and used for stratification of it according to different levels of exposure.

Paraspinal soft-tissue sarcoma. Classification of 14 cases.

Fourteen patients were treated surgically for soft-tissue sarcoma arising in the paraspinal muscles. Eleven patients received adjuvant irradiation administered before or after resection. In describing the treatment and outcomes of these patients, a new classification of paraspinal soft-tissue sarcoma is introduced that is based on the anatomic relationship of the tumor to the spinal lamina and the epidural space. This classification can be used in planning combined modality treatment for paravertebral sarcomas. Lesions that extend through the lamina into the epidural space present an unanswered problem for local control.

[The role of radiotherapy in the treatment of desmoid tumors]. / Die Rolle der Radiotherapie bei der Behandlung von Desmoidtumoren.

Aggressive fibromatoses are benign tumors which derive from connective tissues in muscles, tendons, joints and scars. They are characterized by a low mitotic index and present without major cellular changes. The incidence is low and reaches 0.4 per 100,000. The classification in extra-abdominal, intra-abdominal and abdominal wall tumors has prognostic significance for the therapeutic decision. Extra-abdominal tumors have the highest relapse rate with about two-thirds recurring even after R0 surgical resection. In this meta-analysis, 698 published cases are reviewed and analyzed with respect to the previous surgery and the therapeutic impact of postoperative radiotherapy. After an R1 surgical resection radiotherapy significantly decreases the risk for loco-regional relapse in about 40%. Radiotherapy is also recommended after an R0 surgical resection with safety margins less than 2 cm. A total radiotherapy dose of 50 Gy seems to be sufficient, whereas radiotherapy doses beyond 60 Gy provide no additional control. Following an R2 resection up to 28% of these tumors may not progress or even show a complete remission. A wait-and-see policy is justified for R1-2 resected lesions in the abdominal wall, especially if severe treatment sequelae have to be expected. The role of chemotherapy still remains questionable.

Inadvertent tumor violation during musculoskeletal sarcoma surgery and risk of recurrence.

During the limb preserving procedure for musculoskeletal sarcoma, the course of action that should be taken when a tumor or tumor-cell-contaminated adjacent tissue is violated remains controversial. From January, 1973, to July, 1989, 120 patients with musculoskeletal sarcoma were treated by limb salvage surgery and, in 40 of them, such violations inadvertently occurred during surgery. Follow-up studies on the patients have been conducted for at least one year after the violation. Soft tissue sarcoma was noted in 24 cases (low grade, 4; high grade, 20) and bone sarcoma in 16 (low grade, 6; high grade, 10). To treat the violation, re-excision with a clean margin and copious lavage was generally conducted after careful closure of the violated site. Sixteen cases in the soft tissue sarcoma group and eight in the bone sarcoma group were treated in this way. Local recurrences were found in 13 of the 40 cases (33%), but the percentage was reduced to 13 in cases treated by re-excision with a clean margin. In the present study, there was no significant effect of adjuvant therapy after violation. The survival rate in cases of local recurrence was very low, and not at all improved by adjuvant therapy.

[Laser therapy of inflammatory lesions of the soft parts of the locomotor system]. / Tratamento com laser das lesões inflamatórias das partes moles do aparelho locomotor.

Soft Laser has been suggested as a useful tool in the management of a large number of pathologies. The aim of this study has been to test the utility of this radiation in the treatment of some Locomotor Apparatus Soft Tissues Inflammatory Conditions. One hundred and fourteen patients with clinical data suggesting tendinitis, bursitis or enthesitis entered this study; 97 patients (Group I) were treated with Infra-Red or/and Helion-Neon Laser using a pontual and/or a scanning technique. The remaining 17 patients were considered as a comparison group (Group II). For evaluation purposes, a semi-quantitative data file was used and the pain, mobility, edema and muscular status were observed. The observation of these items was done prior, two weeks and one month after the Laser treatment. Results were classified as positive when complete or significant remission of symptoms and signs were observed, and negative when there was no improvement or a very slight regression of the complaints observed. A significant difference (p. 001) between Group I and II was found; the acute cases registered better results than the chronic ones (86.8% positive results versus 69.4%). The shoulder patients showed the worst results with only 62% positive cases. Significant differences among the different kinds of Laser applications weren't found. This study seems to confirm the Soft Laser utility in the treatment of the Locomotor Apparatus Soft Tissues Inflammatory lesions.