Morphometric aspects of the articular cartilage of rats treated with low-level laser therapy and exercise in a rheumatoid arthritis model

INTRODUCTION: Rheumatoid arthritis (RA) is classified as an autoimmune, chronic disease affecting diarthrodial joints and periarticular structures. OBJECTIVE: To evaluate whether low-intensity laser treatment (LLLT) and/or exercise reduce the deleterious effects of tissue in a rheumatoid arthritis model. METHODS: 128 rats were divided into two inflammatory periods: acute (7 days) and chronic (28 days) and subdivided into control, injury and treatment. The protocol with Freund's Complete Adjuvant was used in two inoculations, one intradermal and one intraarticular in the tibiofemoral joint, the control animals received saline solution. For treatment, LLLT 660 nm, 5 J/cm² was used in the sensitized joint and climbing exercise in stairways with an overload of 100 grams. After the experimental period, the animals were euthanized and the joints were prepared for morphometric analysis of the total thickness, superficial, deep, and cellular density of the articular cartilage. Generalized Linear Models with Sidak post-test were chosen. RESULTS: The control group was found to be different from the lesion group with greater joint cartilage thickness, andthe animals treated with exercise alone increased the joint cartilage compared to thecontrol group. CONCLUSION: The animals treated with laser association and exercise showed improvement in the morphometric aspects of the articular cartilage.

Use of Laser Acupuncture in Chronic Tensional Headache: Randomized Clinical Trial / Uso do Laser Acupuntura na Cefaleia Tensional Crônica: Ensaio Clínico Randomizado

Since tension headache, besides being highly prevalent, has a deleterious effect on daily activities, the search for therapeutic resources is interesting. Thus, the objective of this study was to verify the effect of laser acupuncture in individuals with chronic tensional headache. The sample consisted of 14 volunteers with chronic tensional headache, separated into a control group (placebo) and an intervention group (laser acupuncture, 660nm, 10 J/cm²), in both groups the pen was positioned for 20 seconds in each of the six acupuncture points. There were three therapies on alternate days, and at the end there was previous evaluation by both the Visual Analog Pain Scale and the Headache Impact Test questionnaire. In both forms of evaluation there were significant differences in the comparison between evaluations, with reduction of values (p<0.001), but without differences between groups or interaction (p>0.05). It was concluded that the acupuncture laser showed no greater effectiveness than the placebo. (AU)

Visto que a cefaleia tensional, além de apresentar alta prevalência, tem um efeito deletério sobre as atividades diárias, apresenta-se interessante a busca por recursos terapêuticos. Desta forma, o objetivo deste estudo foi verificar o efeito do laser acupuntura em indivíduos com cefaleia tensional crônica. A amostra foi composta por 14 voluntários, com cefaleia tensional crônica, separados em grupo controle (placebo) e grupo intervenção (laser acupuntura, 660nm, 10 J/cm²), em ambos os grupos a caneta foi posicionada por 20 segundos em cada um dos seis pontos de acupuntura. Foram três terapias em dias alternados, sendo que houve avaliação prévia e ao final delas tanto pela Escala Visual Analógica de Dor quanto pelo questionário Headache Impact Test. Em ambas as formas de avaliação houve diferenças significativas na comparação entre avaliações, com redução dos valores (p<0,001), porém sem diferenças entre os grupos ou interação (p>0,05). Conclui-se que o laser acupuntura não mostrou eficácia superior ao placebo. (AU)

Photobiostimulation in patients with shoulder impact syndrome. Randomized clinical trial / Fotobioestimulação em pacientes com síndrome do impacto do ombro. Ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate the effects of cluster therapy (Laser+LED) on shoulder impact syndrome, aiming at modulating pain and functionality. METHODS: Clinical, randomized, non double-blind study. Consisting of 28 individuals of both sexes, aged between 18 and 50 years, who were separated into: control group (CG n=13) and treatment group (TG n=15). The volunteers answered the Shoulder Pain and Disability Index (SPADI) questionnaire and goniometric evaluation of three active movements: flexion, abduction, and external rotation. The treatment group was submitted to Fluence Cluster - HTM, with energy of 12.8J, for 1 min and 30 seconds, 3 times a week, for 4 weeks, totaling 12 therapies, in the insertion of the tendon of the supraspinatus muscle and the passage of the long portion of the biceps brachii. The control group received orientation regarding daily activities. RESULTS: In both groups there was a reduction in pain, but the effect size observed was greater for the treatment group In the total SPADI evaluation, treatment presented a significant reduction in values, again with a greater effect size. In active movements, both flexion and external rotation, again the group that used the cluster had advantages, both inferential and in effect sizes. CONCLUSION: The cluster significantly reduced pain and increased functionality in patients with shoulder impingement syndrome.

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar os efeitos da terapia com cluster Laser+LED na síndrome do impacto do ombro, visando modulação da dor e funcionalidade. MÉTODOS: Estudo clínico, randomizado, não duplo-cego, que incluiu 28 indivíduos de ambos os sexos, com idade entre 18 e 50 anos, separados em grupo controle (GC n=13) e tratamento (GT n=15). Após responderem o questionário Shoulder Pain and Disability Index (SPADI) foi realizada avaliação goniométrica de três movimentos ativos: flexão, abdução e rotação externa. O grupo tratamento foi submetido ao Fluence Cluster - HTM com energia de 12,8J, durante 1 min e 30 segundos, 3 vezes por semana, durante 4 semanas, totalizando 12 terapias, na região de inserção do tendão do músculo supraespinhal e passagem da porção longa do bíceps braquial. O grupo controle recebeu orientações quanto às atividades diárias. RESULTADOS: Em ambos os grupos houve redução do quadro álgico, porém o efeito observado foi maior para o grupo tratamento. Na avaliação total do SPADI o grupo tratamento apresentou redução significativa dos valores com maior tamanho de efeito. Nos movimentos ativos, tanto flexão quanto rotação externa, o grupo tratamento apresentou vantagens, tanto de forma inferencial quanto nos tamanhos de efeito. CONCLUSÃO: A fotobioestimulação reduziu de modo significativo a dor e aumentou a funcionalidade dos pacientes com síndrome do impacto do ombro.

Exercício resistido promove reparo no musculoesquelético em modelo experimental de artrite reumatoide / Resisted exercise promotes repair in musculoskeletal structure in experimental model of rheumatoid arthritis

Distúrbios decorrentes da artrite reumatoide (AR) resultam em incapacitação funcional, com reflexos econômicos e sociais aos sistemas de saúde. Uma alternativa terapêutica que tem sido proposta é a atividade física na modalidade resistida. O presente estudo analisou os efeitos do exercício resistido de subida em escada (ERSE) na histomorfologia do músculo extensor longo dos dedos (EDL) de ratos Wistar, em modelo experimental de AR. Ratos machos (n=20) foram distribuídos aleatoriamente em quatro grupos. A lesão da AR foi induzida por administração intra-articular de Adjuvante Completo de Freund (CFA). Os resultados revelaram que a AR alterou a histomorfometria das fibras do EDL e que o ERSE promoveu reparo muscular, sugerindo sua eficiência na restauração da funcionalidade muscular. Ainda, o ERSE pode ser uma opção de tratamento voltado à melhoria na qualidade de vida dos portadores de AR.

Disorders from rheumatoid arthritis (RA) result in functional disability, with economic and social impacts on health systems. A therapeutic alternative that has been proposed is physical activity in the resisted modality. Current study analyzed the effects of resistance exercise on stairs (ERSE) on the histomorphology of the extensor digitorum longus muscle (EDL) of Wistar rats in an experimental model of RA. Male rats (n=20) were randomly assigned to four groups. RA injury was induced by intra-articular administration of Freund's Complete Adjuvant (CFA). Results revealed that RA altered the histomorphometry of EDL fibers and that ERSE promoted muscle repair, suggesting its efficiency in restoring muscle functionality. Furthermore, ERSE may be a treatment option to improve the life quality of people with RA.

Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

ABSTRACT OBJECTIVE To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents. METHODS The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10-19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating. RESULTS A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence. CONCLUSION The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

Comparação de diferentes comprimentos de onda do laser de baixa potência no sóleo de ratos Wistar após lesão nervosa / Comparación entre diferentes longitudes de onda de láser de baja potencia en el sóleo de ratas Wistar tras lesión nerviosa / Comparison of different low-level laser therapy wavelengths in the soleus of Wistar rats after nerve injury

RESUMO Os músculos esqueléticos podem ser afetados por lesões do sistema nervoso periférico, levando a fraqueza e atrofia muscular. Na tentativa de recuperar a funcionalidade dos músculos, existem vários recursos terapêuticos utilizados, dentre os quais o laser de baixa potência (LBP). Este estudo comparou o efeito do LBP em dois comprimentos de onda (660 nm e 830 nm), em características morfológicas do tecido muscular após axonotmese de nervos isquiáticos de ratos Wistar. Para tanto, foram utilizados 32 ratos Wistar, divididos em quatro grupos, sendo G1 (controle), G2 (lesão), G3 (lesão e tratamento com LBP de 660 nm) e G4 (lesão e tratamento com LBP de 830 nm). Os animais de G2, G3 e G4 foram submetidos à lesão do nervo isquiático e, três dias após a lesão, G3 e G4 realizaram tratamento com LBP de 660 nm e 830 nm, respectivamente. Após o tratamento, todos os animais foram eutanasiados e os músculos sóleos coletados para confecção das lâminas histológicas, visando a realização de análises morfológicas do tecido. Constatou-se que os animais submetidos à lesão sofreram alterações morfológicas na fibra, resultando em sua atrofia. Foi percebido também que o LBP com comprimento de onda de 830 nm apresentou ligeiros sinais de recuperação das características morfométricas analisadas.

RESUMEN Las lesiones en el sistema nervioso periférico pueden afectar los músculos esqueléticos y provocar debilidad y atrofia muscular. Para recuperar la funcionalidad de los músculos, se utilizan varios recursos terapéuticos, entre los cuales el láser de baja potencia (LBP). Este estudio comparó el efecto del LBP en dos longitudes de onda (660 nm y 830 nm) sobre las características morfológicas del tejido muscular después de la axonotmesis de los nervios ciáticos en ratas Wistar. Para ello, se utilizaron 32 ratas Wistar, divididas en cuatro grupos: G1 (control), G2 (lesión), G3 (lesión y tratamiento con LBP de 660 nm) y G4 (lesión y tratamiento con LBP de 830 nm). Los animales de G2, G3 y G4 se sometieron a lesión del nervio ciático y, tres días después de la lesión, el G3 y G4 se sometieron al tratamiento con LBP de 660 nm y 830 nm, respectivamente. Después del tratamiento, todos los animales fueron sacrificados y se recogieron los músculos sóleos para la preparación de placas histológicas, con el fin de realizar análisis morfológicos del tejido. Se encontró que los animales sometidos a lesión sufrieron cambios morfológicos en la fibra, lo que resultó en atrofia. También se observó que el LBP con la longitud de onda de 830 nm presentó leves signos de recuperación de las características morfométricas analizadas.

ABSTRACT Skeletal muscles may be affected by peripheral nervous system injuries, leading to muscle weakness and atrophy. Several therapeutic resources may be used in the attempt to recover the functionality of muscles, such as low-level laser therapy (LLLT). This study compared the effect of LLLT of two wavelengths (660 nm and 830 nm) on morphological characteristics of muscle tissue after axonotmesis of ischiatic nerves of Wistar rats. A total of 32 Wistar rats were divided into four groups: G1 (control), G2 (injury), G3 (injury and treatment with 660 nm LLLT) and G4 (injury and treatment with 830 nm LLLT). G2, G3, and G4 animals were submitted to sciatic nerve damage and, three days after the injury, G3 and G4 were treated with LLLT of 660 nm and 830 nm, respectively. After the treatment, all animals were euthanized, and the soles muscles were collected to perform morphological analyzes of the tissue using histological slides. We verified that animals submitted to the lesion underwent morphological changes in the fiber, resulting in their atrophy. We also noticed that LLLT with a wavelength of 830 nm presented slight signs of recovery of the morphometric characteristics analyzed.

Low-level laser therapy in periarticular morphological aspects of the knee of Wistar rats in rheumatoid arthritis model / Laser de baixa intensidade nos aspectos morfológicos periarticulares do joelho de ratos Wistar em modelo de artrite reumatoide

ABSTRACT BACKGROUND AND OBJECTIVES: The deleterious effects of rheumatoid arthritis on periarticular tissues have not yet been fully elucidated. Therefore, the search for treatments that can modulate the inflammatory profile and tissue remodeling is pertinent. The present study evaluated the effects of low-level laser therapy (LLLT) on the morphology of periarticular tissues and synovial membrane of rats in a rheumatoid arthritis model. METHODS: Sixty-four male rats were divided into acute (7 days) and chronic (28 days) inflammatory periods, with four groups (n=8) each, being: CG (control group), LG (lesion group), CLaG (laser control group) and LLaG (laser lesion group). The animals of the lesion groups received two inoculations of Freund's Complete Adjuvant at a concentration of 50µL, the first at the base of the tail, and the second at the right knee. The animals in the control groups were injected with isotonic sodium chloride solution. The ClaG and LLaG were treated with 660nm LBI, 5J/cm2 in the right knee. After the experimental period, the animals were euthanized, and the knees were processed for light microscopy. RESULTS: The CG and CLaG morphological analysis had normal aspects. The LG showed synovitis, femur, and tibia with changes in the periosteum, with inflammatory cells and bone modifications. In the LLaG, the synovial membrane showed signs of improvement. Bone tissue in the chronic period showed morphological aspects, denoting tissue remodeling. CONCLUSION: The experimental model was efficient in simulating inflammatory tissue events, and the low-level laser therapy showed beneficial effects on the morphology of the periarticular tissues.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os efeitos deletérios da artrite reumatoide nos tecidos periarticulares ainda não estão totalmente elucidados, sendo pertinente a busca por tratamentos que possam modular o perfil inflamatório e a remodelação tecidual. O presente estudo avaliou os efeitos do laser de baixa intensidade (LBI) na morfologia dos tecidos periarticulares e membrana sinovial de ratos submetidos à um modelo de artrite reumatoide. MÉTODOS: Para tanto, 64 ratos machos foram divididos em períodos inflamatórios agudo (7 dias) e crônico (28 dias), com 4 grupos (n=8) cada, sendo: GC (grupo controle), GL (grupo lesão), GCLa (grupo controle laser) e GLLa (grupo lesão laser). Os animais dos grupos lesão foram submetidos a duas inoculações de Adjuvante Completo de Freund na concentração de 50µL, sendo a primeira na base da cauda e a segunda no joelho direito. Os animais do grupo controle foram submetidos a injeções com solução isotônica de cloreto de sódio. Os grupos GCla e GLLa foram tratados com LBI 660nm, pontual no joelho direito, 5J/ cm2. Após o período experimental, os animais foram eutanasiados e os joelhos processados para análises em microscopia de luz. RESULTADOS: Na análise morfológica, GC e GCLa apresentaram aspectos normais. O GL apresentou sinovite, fêmur e tíbia com alterações no periósteo, com células inflamatórias e modificações ósseas. A membrana sinovial mostrou sinais de melhora no GLLa. No período crônico, o tecido ósseo apresentou aspectos morfológicos, denotando remodelação tecidual. CONCLUSÃO: O modelo experimental foi eficiente em simular os eventos inflamatórios teciduais, e o laser de baixa intensidade apresentou efeitos benéficos sobre a morfologia dos tecidos periarticulares.

Efeitos adversos da eletrotermofototerapia em clínicas da cidade de Cascavel - PR / Los efectos adversos del electrotermofototerapia en clínicas de la ciudad de Cascavel - PR / Adverse effects of electrothermal phototherapy in clinics in the city of Cascavel - PR

RESUMO Esta pesquisa teve como objetivo identificar os principais efeitos adversos observados por fisioterapeutas com o uso de aparelhos de eletrotermofototerapia em clínicas da cidade de Cascavel, Paraná. A amostra contou com 35 clínicas e destas, 25 foram alvo de coleta após triagem, cujos dados foram obtidos por questionários em forma de entrevista semiestruturada. Nestes se questionava aos responsáveis pelo serviço de eletrotermofototerapia sobre a ocorrência de efeitos adversos experienciados durante atividades laborais na clínica. Observou-se que a Neuroestimulação Elétrica Transcutânea (TENS) apresentou problemas em 64% dos casos, com 36% devido a irritações cutâneas e 28% a dor. O aparelho de ondas curtas apresentou efeitos adversos em 60%, em que 40% foram queixas de dor e 20% causaram queimaduras leves. Já acerca do ultrassom terapêutico foram relatados efeitos adversos em 52%, sendo 32% de quadros de dor e 20% de casos com náuseas. A laserterapia de baixa potência demonstrou efeito adverso em 36%, com relatos de aumento da sensibilidade local. Por fim, os aparelhos de média frequência apresentaram efeitos adversos em apenas 20% dos casos, de queixas de náuseas. A quantidade de tais efeitos encontrados foi importante, porém sua gravidade não causou grande preocupação.

RESUMEN Este estudio propone identificar los principales efectos adversos observados por fisioterapeutas con el uso de aparatos de electrotermofototerapia en clínicas de la ciudad de Cascavel, Paraná (Brasil). De la muestra han participado 35 clínicas, de las cuales restaron 25 después del triaje, cuyos datos fueron obtenidos por cuestionarios en forma de entrevista semiestructurada. Estos contenían preguntas al responsable del servicio de electrotermofototerapia sobre la ocurrencia de los efectos adversos ocurridos durante el trabajo en la clínica. Se observó que el Electroestimulación Transcutánea (TENS, en inglés) presentó problemas en un 64 % de los casos, con un 36 % debido a irritaciones de la piel y un 28 % al dolor. En el aparato de ondas cortas se verificó efectos adversos en un 60 %, de las cuales un 40 % fueron de quejas de dolor y un 20 % de quemaduras leves. Sobre el ultrasonido terapéutico, se han divulgado los efectos adversos en un 52 %, de los cuales un 32 % fueron síntomas de dolor y un 20 % casos con náuseas. La terapia con láser de baja intensidad resultó en efectos adversos en el 36 %, con informes de aumento de la sensibilidad local. Por último, los dispositivos de frecuencia media revelaron efectos adversos en sólo el 20 % de los casos de las quejas de náuseas. La cantidad de estos efectos encontrados es importante, pero su gravedad no demostró gran preocupación.

ABSTRACT This study aimed to identify the main adverse effects observed by physical therapists using electrothermal phototherapy devices in clinics in the city of Cascavel, Paraná. The sample comprised 35 clinics, of which 25 were submitted to data collection after sorting. Data were collected through questionnaires in the form of semi-structured interview. In these questionnaires, the responsible for providing the electrothermal phototherapy service were asked about the occurrence of adverse effects experienced during labor activities at the clinic. Transcutaneous electrical nerve stimulation (TENS) showed problems in 64% of cases, being 36% due to skin irritations and 28% due to pain. The shortwave apparatus showed adverse effects in 60% of cases, of which 40% consisted of complaints of pain and 20% caused minor burns. Regarding therapeutic ultrasound, adverse effects were reported in 52% of cases, of which 32% were episodes of pain and 20% of nausea. The low-power laser therapy showed adverse effect on 36% of cases, with reports of increased local sensitivity. Finally, the medium frequency devices had adverse effect in only 20% of cases, being complaints of nausea. The amount of such effects found was important, but their gravity did not cause major concern.

Proprioceptive evaluation in healthy women undergoing Infrared Low Level Laser Therapy

Abstract Aim To evaluate if the application of infrared low-level laser therapy (LLLT) alters proprioception in young women. Methods 26 female volunteers were evaluated statically and dynamically by means of electronic baropodometry in the variables: distance from the foot center, maximum and medium pressure, and surface. Proprioception was also functionally assessed by the Star Excursion Balance Test (SEBT). The intervention occurred in two distinct periods, separated by one week apart, as this was a crossover study, so volunteers were submitted to placebo or LLLT (830 nm, 8 J/cm2), on the muscles: gastrocnemius, soleus, tibialis previous and long and short fibular. Results the analysis of baropodometry for both dynamic and static found no significant differences for the intervention group and the control group. Similar results were observed for SEBT. Conclusion The application of the LLLT, in the proposed parameters, did not influence the proprioception in young women.(AU)