Alleviation of Dyspnea Sensation by Phototherapy in Healthy Adults.

BACKGROUND: Because both dyspnea and pain have common features from a clinical and physiologic point of view, we hypothesized that stellate ganglion irradiation by using a linear polarized near-infrared ray device, which is often used for pain management, might be applicable for dyspnea relief. To evaluate the use of stellate ganglion irradiation as a novel noninvasive treatment for dyspnea, we investigated the influence of stellate ganglion irradiation on dyspnea. METHODS: Perceptions of dyspnea were examined with or without stellate ganglion irradiation in 28 healthy adults. The sensation of breathing difficulty was induced by a two-way non-rebreathing valves with linear inspiratory resistance (R) of 0, 10, 20, and 30 cm H2O/L/s. Dyspnea was evaluated with the modified Borg scale to determine subjects' discomfort level. Stellate ganglion irradiation was performed by intermittent irradiation near the bilateral stellate ganglion by using a linear polarized near-infrared ray device. RESULTS: There were significant changes from baseline at R = 10 cm H2O/L/s (P = .007), R = 20 cm H2O/L/s (P = .005), and R = 30 cm H2O/L/s (P = .009). For each resistive load, the mean dyspnea sensation score was lower with stellate ganglion irradiation compared with sham irradiation, with significant differences (P = .003 at R = 0 cm H2O/L/s; P < .001 at R = 10, 20, 30 cm H2O/L/s). There was a significantly lower slope of the dyspnea response for the linear regression of the loads and Borg scores in the stellate ganglion irradiation versus sham treatment (P = .003). CONCLUSIONS: Stellate ganglion irradiation significantly alleviated dyspnea induced by an external inspiratory load in healthy adults. Stellate ganglion irradiation might be an option to treat dyspnea in some cases. Further studies in individuals with diverse types of dyspnea and clinical settings are warranted.

The effect of low level laser therapy for pain in major muscles controlling two joints.

BACKGROUND AND AIMS: Chronic pain is a significant health care problem which is often encountered in medical institute out-patient clinics . In previous studies we have reported on the benefits of low level laser therapy (LLLT) for chronic musculoskeletal pain patients. The present study is a report on the effects of LLLT in patients with pain in major muscles which govern the motion of two joints (2-joint muscles). MATERIALS AND METHODS: Over the past 5 years, 19 subjects visited our out-patient clinic with complaints of pain in 2-joint muscles (biceps brachii muscle or gastrocnemius muscle). They were treated with LLLT using a 1000 mW semi-conductor laser device delivering 20.1 J/cm2 per point at 830 nm in continuous wave. Four shots were given per session (1 treatment) twice a week for 2 months (total of 16 treatments). RESULTS: A treatment approach modified from the methods of Shiroto and Ohshiro, was used, and the efficacy of LLLT for pain attenuation in the affected muscle was determined. After the end of the treatment regimen, excellent and good improvement was observed in 16 patients out of 19. Discussions with the patients revealed that it was important for them to learn how to modify their everyday life to avoid posture and activities of daily life that could cause them pain in the 2-joint muscles, in order to enjoy continuous benefits from the treatment. CONCLUSION: The present study demonstrated that LLLT was an effective form of treatment for pain in the biceps brachii and gastrocnemius muscles. To maximize and prolong treatment efficacy, advice should be given to patients to avoid adopting any posture and activities of daily living which would cause pain in these specific muscles.

Low Level Laser Therapy for Radial Nerve Palsy Patients : Our Experience.

BACKGROUND AND AIMS: Peripheral nerve injury is one of the frequent complaints which is seen in the outpatient clinic of our medical institute. In previous studies we have reported on the benefits of low level laser therapy (LLLT) for central nerve system disorders, namely cerebrovascular accidents and cerebral palsy. The present study is a report on our experience of the effects of LLLT for peripheral nerve palsy. MATERIALS AND METHODS: Over the past 5 years, 13 subjects visited the out-patient clinic with the chief complaint of radial nerve palsy caused by compression of the nerve through with abnormal positioning, and sleeping posture at night. The patients were treated with LLLT. A 1000 mW semi-conductor laser device was used, delivering 830 nm in continuous wave at a dose of 20.1 J/cm2 /point, and five points were treated per session (i.e., 1 treatment) twice a week for 3 months (total 24 treatments). In 6 patients LLLT was combined with brace therapy. RESULTS: Modified Daniels' manual muscle testing was used to determine the effects of LLLT for the muscle power of the extensor carpi radialis, and on completing the treatment regimen excellent improvement was observed in 9 cases out of 13. Combination treatment (laser therapy with bracing) resulted in 4 excellent cases out of 6 cases. Discussions with the patients clarified that it was important for them to learn how to avoid the particular posture that could cause them radial nerve palsy in daily life in order to have continuous benefits from the treatment. CONCLUSION: The present study demonstrated that LLLT was an effective form of treatment for radial nerve palsy. In addition, patients were advised to avoid any incorrect posture which might induce radial nerve palsy.

Low Level Laser Therapy in patients with chronic foot and ankle joint pain.

BACKGROUND AND AIMS: Chronic foot and ankle joint pain is one of the most frequent complaints which is regularly seen in the out-patient clinic of our medical institute. In previous studies we have reported on the benefits of low level laser therapy (LLLT) for chronic pain in the elbow, hand, finger and the lower back. The present study examined the effects of LLLT on chronic foot and ankle joint pain. MATERIALS AND METHODS: Over the past 5 years, 17 subjects visited the out-patient clinic with complaints of chronic foot and ankle joint pain of a variety of aetiologies. The patients received LLLT using a 1000 mW semi-conductor laser device, delivering 20.1 J/cm2 per point at 830 nm in continuous wave. Each patient was given four shots per session per foot twice a week for 4 weeks. RESULTS: A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p < 0.01). All but 2 of the patients showed improvement: excellent (2) and good (13). After treatment, no significant differences were observed in the ankle joint range of motion, however. Discussions with the patients revealed that it was important for them to learn how to avoid overuse of the ankle when walking, poor walking posture and a poor pacing technique that would caused them foot and ankle pain in everyday life. Following these postural guidelines could ensure continuous benefits from the treatment. CONCLUSION: The present study demonstrated that LLLT was an effective form of treatment for chronic foot and ankle joint pain, in conjunction with postural education during all activities of daily living.

Chemical Senses Affecting Cough and Swallowing.

BACKGROUND: Dysfunction of swallowing and coughing leads to life-threatening aspiration pneumonia, especially in the elderly. In order to induce the cough and swallowing reflexes efficiently, sensory inputs to trigger the reflexes are essential. METHODS: Both the cough and swallowing reflexes respond to mechanical and chemical stimuli. However, the mechanisms of action of the two reflexes are not homogeneous. Some substances stimulate both reflexes, but others stimulate one of the reflexes and inhibit the other one. RESULTS: Capsaicin, a TRPV1 agonist, stimulates both the cough and swallowing reflexes. Menthol, a TRPM8 agonist, stimulates the swallowing reflex, but it inhibits the cough reflex, especially if applied to the nose. Acid stimulates the cough reflex but its effect on the swallowing reflex is complicated. Theophylline inhibits the cough reflex by decreasing the excitability of sensory nerves, whereas it stimulates the swallowing reflex by antagonizing adenosine receptors. In smoking, cigarette smoke and nicotine have different effects. Cigarette smoke stimulates the cough reflex, while it inhibits the swallowing reflex. Nicotine inhibits the cough reflex but does not affect the swallowing reflex. CONCLUSION: Whenever you prescribe for an abnormality of one of the reflexes, you should think about the effect of the prescription on the other reflex.

Effect of Notch expression in glioma stem cells on therapeutic response to chemo-radiotherapy in recurrent glioblastoma.

Glioma stem cells (GSCs) have the capacity to repopulate tumors and mediate resistance to radiotherapy and chemotherapy. The Notch signaling pathway is important in proliferation, stem cell maintenance, cell differentiation, and tumorigenesis in GSCs. In this study, we compared CD133, Notch, and VEGF expressions in histological sections of primary and recurrent glioblastomas after radiotherapy and chemotherapy. In vitro study, the γ-secretase inhibitor inhibited NICD, Hes1 and pVEGFR2 expressions in GSCs. GSCs cultured under endothelial conditions undergo endothelial differentiation. Tumor samples were collected from 27 patients at the time of tumor recurrence. We used immunohistochemical techniques to compare expression of CD133, Notch-1 and VEGF. Expressions of CD133-, Notch-1-, and VEGF-positive glioma cells were higher in recurrent glioblastoma after radiotherapy and chemotherapy. To determine the clinical importance of Notch-1 expression in glioblastoma, we analyzed 15 patients who had received bevacizumab therapy followed by a second surgery at recurrence. OS was significantly longer in cases with Notch-1 negativity (8.8 months) than in those with I Notch-1 positivity (6.8 months). We noted that GSCs have the potential for endothelial differentiation with Notch activity. We believe that Notch-1 is a potential target and/or biomarker for antiangiogenic treatments.

Low Level Laser Therapy for chronic knee joint pain patients.

BACKGROUND AND AIMS: Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain. MATERIALS AND METHODS: Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm(2) per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks. RESULTS: A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). After treatment, no significant differences were observed in the knee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment. CONCLUSION: The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee.

Treatment of moyamoya syndrome associated with systemic lupus erythematosus and hypothyroidism in an adult by encephaloduroarteriosynangiosis: a case report.

A 54-year-old woman presented to our hospital with progressive motor weakness of the right arm. She had a medical history of systemic lupus erythematosus (SLE) and hypothyroidism. Magnetic resonance imaging indicated a watershed infarction of the left hemisphere. Cervical echogram indicated severe stenosis of the internal carotid artery (ICA) without wall thickening. Cerebral angiography indicated left ICA occlusion, development of unilateral moyamoya vessels, and leptomeningeal anastomosis. Encephaloduroarteriosynangiosis (EDAS) was performed after cerebral (99) (m)Technetium-ethyl-cysteinate-dimer single-photon emission computed tomography indicated a decreased cerebral blood flow, diminished cerebrovascular perfusion reserve. Motor weakness finally disappeared 6 months after surgery. Moyamoya syndrome is a rare complication of both SLE and hypothyroidism, and the surgical indication remains controversial. By evaluating the decreased cerebral perfusion reserve capacity and the existence of leptomeningeal anastomosis, EDAS could be an efficient method for the treatment of moyamoya syndrome associated with SLE and hypothyroidism.

Posttraumatic cranial cystic fibrous dysplasia.

A 14-year-old was girl admitted to our hospital with a subcutaneous mass of the occipital head. The mass had grown for 6 years, after she had sustained a head injury at the age of 6, and was located directly under a previous wound. Skull X-ray Photograph (xp), computed tomography (CT), and magnetic resonance imaging (MRI) showed a bony defect and cystic changes in the skull corresponding to a subcutaneous mass. Bone scintigraphy revealed partial accumulation. The patient underwent total removal of the skull mass, and the diagnosis from the pathological findings of the cyst wall was fibrous dysplasia (FD). The radiographic findings for cystic cranial FD can be various. Progressive skull disease has been reported to be associated with head trauma, but the relationship between cranial FD and head trauma has not been previously reported. Previous studies have suggested that c-fos gene expression is a key mechanism in injury-induced FD.