An experimental study of low-level laser therapy in rat Achilles tendon injury

The aim of this controlled animal study was to investigate the effect of low-level laser therapy (LLLT) administered 30 min after injury to the Achilles tendon. The study animals comprised 16 Sprague Dawley male rats divided in two groups. The right Achilles tendons were injured by blunt trauma using a mini guillotine, and were treated with LLLT or placebo LLLT 30 min later. The injury and LLLT procedures were then repeated 15 hours later on the same tendon. One group received active LLLT (λ = 904 nm, 60 mW mean output power, 0.158 W/cm2 for 50 s, energy 3 J) and the other group received placebo LLLT 23 hours after LLLT. Ultrasonographic images were taken to measure the thickness of the right and left Achilles tendons. Animals were then killed, and all Achilles tendons were tested for ultimate tensile strength (UTS). All analyses were performed by blinded observers. There was a significant increase in tendon thickness in the active LLLT group when compared with the placebo group (p < 0.05) and there were no significant differences between the placebo and uninjured left tendons. There were no significant differences in UTS between laser-treated, placebo-treated and uninjured tendons. Laser irradiation of the Achilles tendon at 0.158 W/cm2 for 50 s (3 J) administered within the first 30 min after blunt trauma, and repeated after 15 h, appears to lead to edema of the tendon measured 23 hours after LLLT. The guillotine blunt trauma model seems suitable for inflicting tendon injury and measuring the effects of treatment on edema by ultrasonography and UTS. More studies are needed to further refine this model

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

COMMENTS AND RESPONSE Overviews and Systematic Reviews on Low Back Pain Annals of Internal Medicine Letters

TO THE EDITOR: In a recent overview of systematic reviews and randomized trials of pharmacotherapy in low back pain, Chou and Huffman (1) concluded that there is good evidence that acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants provide moderate pain relief in acute low back pain. In the clinical practice guideline (2) in the same issue, the recommendations for acetaminophen and NSAIDs are extended to include chronic low back pain and tramadol, opioids, and benzodiazepines are recommended both in acute and chronic low back pain despite lack of &quot;good&quot; or even &quot;fair&quot; evidence. Chou and Huffman&apos;s method of reviewing literature relies too heavily on preexisting systematic reviews, some seriously outdated. As a result, previous work is reiterated without adequate scrutiny. In fact, methodological issues led to inclusion of studies not meeting the stated eligibility criteria and, more important, to erroneous conclusions. Acetaminophen: No direct evidence shows acetaminophen to be more effective than placebo for treating low back pain. A small (n ϭ 30) trial (3) found acetaminophen to be less effective than NSAIDs in treating acute low back pain. One low-quality trial (4) reported no difference between acetaminophen and no treatment, and another (5) showed ambiguous results. In an outdated Cochrane review (6) cited by Chou and Huffman, 2 low-quality trials (7, 8) found no difference between NSAIDs and acetaminophen. One of these trials (7) was not randomized. Comparative studies (9) of acetaminophen and nonpharmacologic treatments in high-quality randomized, controlled trials (RCTs) have shown that acetaminophen was inferior to superficial heat. In an old trial of lower quality (10), acetaminophen allegedly was slightly inferior to manipulation, but poor reporting of treatment allocation and handling of withdrawals obscured these results. As for evidence of the effectiveness of acetaminophen in nonlow back pain scenarios, the authors claim that 3 systematic reviews demonstrate the superiority of NSAIDs over acetaminophen in osteoarthritis, with a standardized mean difference of approximately 0.3. We have previously reported the effectiveness of NSAIDs over placebo in knee osteoarthritis, corresponding to a standardized mean difference of 0.31 (11), whereas acetaminophen had statistically significant but clinically insignificant effects in knee osteoarthritis, with a weighted mean difference for pain of 3.0 mm (95% CI, 1.4 to 4.7 mm) on a visual analogue scale (12). In summary, there is no direct evidence and a paucity of indirect evidence to prove the effectiveness of acetaminophen in low back pain. Chou and Huffman&apos;s claim of &quot;good evidence of a moderate effect&quot; of acetaminophen in this condition is, in our view, unsubstantiated. NSAIDs: The outdated Cochrane review (5, 13) cited by Chou and Huffman has several shortcomings. Most important, the standardized mean difference analysis for pain was statistically insignificant for NSAIDs in acute low back pain (Ϫ0.53 [CI, Ϫ2.74 to 1.69]). Chou and Huffman state that the Cochrane review included 6 trials in which NSAIDs were superior to placebo in acute low back pain, with a relative risk for benefit of 1.24 (CI, 1.10 to 1.41). Of these 6 trials, 4 found statistically insignificant differences, whereas 2 (14, 15) reported statistically significant positive results. In the first of these studies, groups of patients received intramuscular injections of dipyrone (metamizole), diclofenac, or saline (placebo). Dipyrone, the sodium sulfonate of the obsolete antipyretic agent antipyrine, is not licensed in the United States and many other countries because of serious side effects and is hardly a typical NSAID. However, only data for the dipyrone group in this particular study were entered into the Cochrane analysis. In addition, 1 of the trials (16) was not randomized and thus was not eligible for the overview. Removing this trial and substituting dipyrone data with diclofenac data in the other trial rendered global improvement statistically insignificant, with relative risk for benefit of 1.11 (CI, 0.98 to 1.26). The overview claims ibuprofen was superior to placebo in 1 trial of chronic low back pain, but this trial (17) actually states that both groups received ibuprofen, and additional medication was compared with placebo. Thus, on the basis of the cited material, the conclusion that there is good evidence for moderate effect of NSAIDs in low back pain is erroneous. Muscle relaxants, including benzodiazepines: On the basis of 4 RCTs summarized in a Cochrane review (18), the overview states that there is &quot;good&quot; evidence of a &quot;moderate&quot; effect of muscle relaxants in acute low back pain. However, 3 out of 4 RCTs in this relative risk analysis for pain have statistically insignificant results, with CIs less than 1. The positive overall result rests more or less on a single RCT from 1982 in which Merck &amp; Co. personnel performed the statistical analysis. In the review, 79% of the weight in the statistical analysis came from this trial, which has a methodological quality score at the reviewers&apos; cutoff value (6 out of 11). In other words, if this RCT had been rated 5 instead of 6 out of 11 and thereby was excluded from the analysis for poor methodological quality, the overall result of the meta-analysis would have been negative. The reported relative risks stated in the overview (1.25 and 1.72) differ from those reported in the Cochrane review (0.80 and 0.58), and the reason for this discrepancy remains obscure. Chou and Huffman also claim that tizanidine was efficacious in 8 trials, but according to the cited review (18), only 6 of the trials were placebo-controlled and just 3 of these reported statistically significant results. For benzodiazepines, the positive overall result in the overview rests on 2 RCTs. However, the analyses failed to include 51 patients who dropped out in 1 of these studies (19). The relative risk for pain relief by benzodiazepines became statistically insignificant at 1.38 (CI, 0.99 to 1.92) after inclusion of these withdrawals. Low-level laser therapy (LLLT): Chou and Huffman handled LLLT on a trial-by-trial basis because no suitable reviews of LLLT were identified. The overview states that the LLLT material is heterogeneous, although adequate doses of LLLT with wavelengths ranging from 600 to 1100 nm seem to offer an anti-inflammatory class effect We believe that the examples given are sufficient to support our key message: Overviews of systematic reviews are methodologically inferior to systematic reviews. The degree of transparency is low, errors often remain unacknowledged, and sensitive and unreliable data are propagated. With the small body of RCTs that eventually constitute the critical basis for guidelines, systematic review with updated meta-analyses should be mandatory. If the present overview&apos;s definition of &quot;good evidence&quot; is applie

Effect of incoherent LED radiation on third-degree burning wounds in rats

The main physiological characteristics in a burn process are the increase of the capillary permeability and the occurrence of edema and exudation. Light-emitting diode (LED) has been proposed as treatment of burning. This study investigated the effects of LED on the repair process of rat skin submitted to a third-degree burning. the lesions were produced on the dorsal surface of male Wistar rats. Animals were divided into 4 groups (n = 6) as follows: L1 and L2 groups as LED-treated burned rats, and received LED therapy along 7 and 15 days with 48 hours intervals, respectively; C1 and C2 groups as control, non-treated burned rats. A red LED (640 nm, 30 mW) operating with a fluence of 4 J/cm(2) was used. the wound area was measured daily after irradiation. Animals were euthanized at the 8th and 16th days after burning, and the wound fragment was submitted to histology. the inflammatory cells as well as the damaged area at the 8th day after burns were significantly lower for the LED-treated group when compared to control. Furthermore, the LED phototherapy effect on cellular migration was even more pronounced at the 16th day. Our results indicated that the treatment with a LED system was clearly effective in reducing the number of inflammatory cells and improving the healing process in an experimental model of third-degree burnings.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Sci & Technol, Unifesp, BR-12231280 Sao Jose Dos Campos, SP, BrazilChapeco Univ UNOCHAPEC, Hlth Sci Ctr, Chapeco, SC, BrazilCamilo Castelo Branco Univ UNICASTELO, Inst Biomed Engineer, Sao Jose Dos Campos, SP, BrazilNove Julho Univ UNINOVE, Dept Rehabil Sci, São Paulo, BrazilUniv São Paulo, Dept Pharmacol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Sci & Technol, Unifesp, BR-12231280 Sao Jose Dos Campos, SP, BrazilFAPESP: 2007/02596-7Web of Scienc

Photodynamic Therapy in the Extracellular Matrix of Mouse Lungs: Preliminary Results of an Alternative Tissue Sterilization Process

Lung transplantation is one of the most difficult and delicate procedures among organ transplants. For the success of the procedure and survival of the new organ, the sterilization step for acellular lungs prior to recellularization is important to ensure that they are free of any risk of transmitting infections from the donor to the recipient subject. However, there are no available information concerning the lung mechanical parameters after sterilizing photodynamic therapy. The aim of this study was to evaluate the extracellular matrix (ECM) and lung mechanical parameters of decellularized lungs undergoing sterilizing photodynamic therapy (PDT). Besides, we also analyzed the lung after controlled infection with C. albicans in order to evaluate the effectiveness of PDT. The lung mechanical evaluation parameters, resistance (RL) and elastance (EL), exhibited no significant differences between groups. In addition, there were no PDT-induced changes in lung properties, with maintenance of the viscoelastic behavior of the lung scaffold after 1 h exposure to PDT. The ECM components remained virtually unchanged in the acellular lungs of both groups. We also showed that there was a reduction in fungal infection population after 45 minutes of PDT. However, more studies should be performed to establish and verify the effectiveness of PDT as a possible means for sterilizing lung scaffolds. This manuscript was presented as a master thesis of Nadua Apostólico at the postgraduate program in rehabilitation sciences, University Nove de Julho—UNINOVE

Avaliação do ácido láctico intramuscular através da espectroscopia Raman: novas perspectivas em medicina do esporte Evaluacion de ácido láctico intra-muscular a través de espectroscopia Raman: novas perspectivas en medicina del deporte Intramuscular lactic acid assessment through Raman spectrography: new perspectives in sports medicine

O uso da espectroscopia Raman no infravermelho pode vir a constituir uma nova técnica para avaliação física, permitindo medidas da concentração de ácido láctico em sangue e em músculo esquelético, por um método não invasivo. A espectroscopia Raman é uma técnica que oferece grande riqueza de detalhes provida pela vibração de moléculas em diferentes níveis de energia. Em estudos prévios, foram obtidos espectros Raman de ácido láctico em plasma humano e em sangue de rato, onde os picos característicos foram observados claramente na matriz biológica. No presente estudo a espectroscopia Raman foi usada para a identificação de ácido láctico em músculo tibial de rato. Foi usado um laser de Ti:safira sintonizado em 830nm, um espectrômetro Kaiser f/l.8 e um detector de CCD refrigerado. O espectro Raman do ácido láctico apresenta oito picos bem distintos, entre 700 e 1.500cm-1, correspondendo aos diferentes modos de vibração da molécula do ácido láctico. O pico principal em 830cm-1 foi usado para caracterizar a presença do ácido láctico no músculo tibial de rato. Foram analisados espectros Raman de músculos tibiais in vivo e in vitro. Além disso, também foi monitorada a difusão do ácido láctico através do músculo, in vitro. Pode-se concluir, a partir dos resultados obtidos, que a espectroscopia Raman no infravermelho próximo apresenta grande potencial para, no futuro, com o aperfeiçoamento da técnica, ser utilizada em avaliações físicas com o intuito de permitir medições das concentrações de ácido láctico no músculo esquelético, através de metodologia não invasiva.<br>El uso de la espectroscopia Raman de infrarojo puede constituir una nueva técnica para la evaluación física, permitiendo medidas de la concentración de ácido láctico en sangre y en músculo esquelético, por un método no invasivo. La espectroscopia Raman es una técnica que ofrece una gran riqueza de detalles provista por la vibración de las moléculas en diferentes niveles de energia. En estudios previos, se obtuvieron espectros Raman de ácido láctico en plasma humano e en sangre de ratón, donde los picos característicos se observaron claramente en la matriz biológica. En el presente el estudio de la espectroscopia Raman ha sido usado para la identificación de ácido láctico en el músculo tibial del ratón. Se utilizó un laser de Ti:Safiro sintonizado en 830nm, un espectrómetro Kaiser f/l.8 y un detector de CCD refrigerado. El espectro Raman de ácido láctico presenta ocho picos bien distintos, entre 700 e 1.500cm-1, correspondiendo a los diferentes modos de vibración de la molécula de ácido láctico. El pico principal en 830cm-1 ha sido usado para caracterizar la presencia de ácido láctico en el músculo tibial de ratón. Fueron analizados los espectros Raman de músculos tibiales in vivo e in vitro. Además de esto, también fué monitoreada la difusión de ácido láctico a través del músculo, in vitro. Nosotros podemos concluir a partir de los resultados obtenidos, que la espectroscopia Raman de infrarojo próximo presenta un gran potencial para, en el futuro, con el perfeccionamiento de la técnica a ser utilizada en avaluaciones físicas con la intención de permitir mediciones de las concentraciones de ácido láctico en el músculo esquelético, a través de una metodología no invasiva.<br>The infrared Raman spectroscopy is a technique that could be employed in the future in physical evaluations, specifically to non-invasive determinations of the muscle amounts of lactate. Raman spectroscopy supplies a wealth of details provided by the molecule vibrational levels of energy, representing the "fingerprint" of the molecules. In previous studies the Raman spectra of lactic acid in human plasma and rat blood were obtained, where characteristic peaks of this compound in the biological matrix were clearly observed. In this study, Raman spectroscopy was used in order to determinate the skeletal muscle amounts of lactic acid using the experimental model of rat tibial muscle. For this purpose the authors used a system composed by a Ti:saphire laser tuned at 830 nm, a spectrometer Kaiser f/l.8 and a CCD detector refrigerated with liquid nitrogen. Holographic Kaiser filters were employed to reduce back-scattered radiation by the sample. The Raman spectrum of the lactic acid presented several sharp and well-resolved peaks in the frequency range between 700 and 1,500 cm-1. The principal Raman peak at 830 was used to detect the presence of the lactic acid in the rat tibial muscle. Raman spectra of tibial muscles of rats were taken in vivo and in vitro. The diffusion of the lactic acid through the muscle, in vitro, was also monitored. The results suggest that near infrared Raman spectroscopy, in the future, could be an alternative technique for physical evaluation, allowing measurements of the lactic acid concentration in skeletal muscle, through a non-invasive method

The low level laser therapy (LLLT) operating in 660 nm reduce gene expression of inflammatory mediators in the experimental model of collagenase-induced rat tendinitis

International audienceTendinopathy is a common disease with a variety of treatments and therapies. Laser therapy appears as an alternative treatment. Here, we investigate the effects of laser irradiation in an experimental model of tendinitis induced by collagenase injection on rats' Achilles tendon, verifying its action in important inflammatory markers. Male Wistar rats were used and divided into five groups: control saline (C), non-treated tendinitis (NT) and tendinitis treated with sodium diclofenac (D) or laser (1 J) and (3 J). The tendinitis was induced by collagenase (100 μg/tendon) on the Achilles tendon, which was removed for further analyses. The gene expression for COX-2; TNF-α; IL-6; and IL-10 (RT-PCR) was measured. The laser irradiation (660 nm, 100 mW, 3 J) used in the treatment of the tendinitis induced by collagenase in Achilles tendon in rats was effective in the reduction of important pro-inflammatory markers such as IL-6 and TNF-α, becoming a promising tool for the treatment of tendon diseases