Low-level laser therapy stimulates tissue repair and reduces the extracellular matrix degradation in rats with induced arthritis in the temporomandibular joint

The objective of this study was to characterize morphological and biochemistry action of low-level laser therapy (LLLT) on induced arthritis in the temporomandibular joint (TMJ) of rats. Twenty-four male Wistar rats were randomly divided into groups with 12 animals each: (AG) group with arthritis induced in the left TMJ and (LG) group with arthritis induced in the left TMJ and treated with LLLT (830 nm, 30 mW, 3 J/cm²). Right TMJs in the AG group were used as noninjected control group (CG). Arthritis was induced by intra-articular injection of 50 μl Complete Freund’s Adjuvant (CFA) and LLLT began 1 week after arthritis induction. Histopathological analysis was performed using sections stained with hematoxylin-eosin, Toluidine Blue, and picrosirius. Biochemical analysis was determined by the total concentration of sulfated glycosaminoglycans (GAGs) and evaluation of matrix metalloproteinases (MMP-2 and MMP-9). Statistical analysis was performed using paired and unpaired t tests, with p?<?0.05. Compared to AG, LG had minor histopathological changes in the TMJ, smaller thickness of the articular disc in the anterior (p?<?0.0001), middle (p?<?0.0001) and posterior regions (p?<?0.0001), high birefringence of collagen fibers in the anterior (p?<?0.0001), middle (p?<?0.0001) and posterior regions (p?<?0.0001) on the articular disc, and statistically lower activity of MMP-2 latent (p?<?0.0001), MMP-2 active (P?=?0.02), MMP-9 latent (p?<?0.0001), and MMP-9 active (p?<?0.0001). These results suggest that LLLT can increase the remodeling and enhancing tissue repair in TMJ with induced arthritis.     

Bacterial adhesion to braided surgical sutures: an in vitro study

Background

Surgical suture materials are accepted to be associated with a substantial proportion of surgical site infections. These infections are related with biofilm formation similar to that of other synthetic and implantable medical devices.

Methods

We conducted an in vitro study to investigate the bacterial adherence to different types of braided surgical sutures. The included sutures were polyglactin (Vicryl®) group (VG), rapidly absorbable polyglactin (Rapide-Vicryl®) group (RVG), nitrofurazone-coated polyglactin (Vicryl®) group (FVG), polyethylene terephthalate (Etibond®) group (EG), and natural silk (Silk®) group (SG). All sutures were cut in 1 cm length, embedded into tryptic soy broth, and then 10⁶-CFU/ml Escherichia coli and Staphylococcus aureus were added. After the 24th and 96th hour of incubation, bacterial colonies were counted, and results were expressed as CFU/cm.

Results

E.coli adhesion was significantly lower in VG and significantly higher in SG compared to FVG, RVG, and EG at the 24th and 96th hour of cultivation (p?<?0.05). The S.aureus adhesion results at 24th hour showed that VG had the least bacterial adhesion, and FVG had the most bacterial adhesion compared to other sutures (p?<?0.05). The S.aureus adhesion results at the 96th hour of cultivation showed that bacterial adhesion on sutures was not significantly different between groups (p?>?0.05).

Conclusion

Of all braided surgical sutures, bacterial adhesion is significantly lower in polyglactin and significantly higher in silk sutures. Nitrofurazone coverage of suture worsens S.aureus contamination of the suture.Level of Evidence: Not ratable

     

Comparison of the effect of root surface modification with citric acid,EDTA, and aPDT on adhesion and proliferation of human gingival fibroblasts and osteoblasts: an in vitro study

Root demineralization is used in Periodontics as an adjuvant for mechanical treatment. The aim of this study was to evaluate the effects of root surface modification with mechanic, chemical, and photodynamic treatments on adhesion and proliferation of human gingival fibroblasts and osteoblasts. Root fragments were treated by scaling and root planing (C—control group), EDTA (pH 7), citric acid plus tetracycline (CA—pH 1), and antimicrobial photodynamic therapy (aPDT) with toluidine blue O and red laser (pH 4). Cells were seeded (104 cells/well, 6th passage) on root fragments of each experimental group and cultured for 24, 48, and 72 h. Cells were counted in scanning electron microscopy images by a calibrated examiner. For fibroblasts, the highest number of cells were present at 72-h period (p?<?0.05). EDTA group showed a very low number of cells in relation to CA group (p?<?0.05). CA and aPDT group presented higher number of cells in all periods, but without differences between other treatment groups (p?>?0.05). For osteoblasts, there was a significant increase in cell numbers for aPDT group at 72 h (p?<?0.05). In conclusion, aPDT treatment provided a positive stimulus to osteoblast growth, while for fibroblasts, aPDT and CA had a tendency for higher cell growth.     

The effect of a chitosan coating on the adhesive potential and tensile strength of polypropylene meshes

Purpose

The polypropylene mesh used for the repair of abdominal wall hernia can cause intraabdominal adhesions. In this study, the effect of chitosan coating of the polypropylene meshes on the adhesion and tensile strength of the meshes was investigated.

Method

After coating polypropylene meshes with 2?% chitosan, 5?×?3 cm patches were prepared. Under general anesthesia, sterile laparotomy was performed in 96 Wistar albino female rats that were equally allocated to 6 groups. In the first group, only laparotomy was performed. In the second group, chitosan was applied to the peritoneal cavity, and the laparotomy was closed. In the third group, polypropylene (prolene) patches were used to close the abdomen; in the fourth group, polypropylene polyglecaprone 25 (ultrapro) mesh patches were used to close the abdomen. In the fifth and sixth groups, chitosan-coated versions of the meshes used in the third and fourth groups, respectively, were applied. All skin incisions were closed in all groups. On the 7th and 21st?days, eight randomly selected rats from each group were killed. The abdomen was opened, and the adhesions were evaluated using the diamond score. The tensile strength of the meshes was measured by an Instron 4301 device. The histopathological evaluation of the inflammatory response was performed according to the Ehrlich and Hunt classification.

Results

The adhesion score was comparable among mesh groups but higher when mesh groups were compared with the control and chitosan groups (p<0.001). The tensile strength of meshes did not differ among mesh groups. Histopathologically, meshes with or without chitosan were similar in terms of inflammatory findings.

Conclusions

The chitosan coating did not affect the adhesion potential, the tensile strength, or the inflammatory response of the polypropylene meshes.     

In vitro comparison of an Er:YAG laser-activated bleaching system with different light-activated bleaching systems for color change,surface roughness,and enamel bond strength

To compare an Er:YAG laser-activated bleaching system with different light-activated in-office bleaching systems for color change, surface roughness, and post-bleaching enamel bond strength. 51 enamel slabs were prepared from the sound buccal enamel of extracted bovine teeth. The teeth were randomly divided into three groups according to different light-activated office bleaching systems (n?=?17): diode laser (Epic, Biolase) (940 nm, 7 W, continuous mode), Er:YAG laser (LightWalker, Fotona) (2940 nm, 50 mJ, 10 Hz, 1000 μs), and LED (Radii Plus) (440–480 nm, 1500 mW/cm²). All systems were used with their compatible bleaching agents according to manufacturers’ recommendations. The tooth color and surface roughness (Ra) were assessed at baseline and after bleaching using a spectrophotometer and a surface profilometer, respectively. The color change was determined by the CIE L*a*b* system (ΔE, ΔL*, Δa*, Δb*). Kruskal-Wallis test was used for color change whereas Kruskal-Wallis and Wilcoxon tests were used to analyze the roughness data. For shear bond strength test (SBS), composite cylinders were bonded on bleached enamel samples 14 days after bleaching procedures and stored in water (37 °C). Specimens were then debonded with a universal testing machine at 1 mm/min and data were analyzed by using Kruskal-Wallis test. All the tested bleaching systems were effective on color change (ΔE?>?3.3) and produced similar color change (p?>?0.05). There were no significant differences among the Ra values of the groups neither at baseline nor after bleaching (p?>?0.05). However, comparing the baseline and after bleaching Ra values, a significant increase was observed for all tested groups (p?<?0.05). Significant differences were also found among all systems for SBS (p?<?0.05). The highest values were obtained in Er:YAG group, whereas the LED group revealed the lowest values (p?<?0.05). All tested bleaching systems were effective on tooth whitening, whereas they all led to an increase on surface roughness. Although the current Er:YAG laser-activated bleaching system did not differ from other tested bleaching systems according to color change and surface roughness, it appears to provide better results in terms of SBS.     

Influence of omentectomy on peritoneal defense mechanisms in an experimental model of intra-abdominal infection

BACKGROUND/AIM: The omentum has an important role as part of peritoneal defense mechanisms. The aim of this study is to show the bactericidal activity of peritoneal fluid and the role of the omentum as a peritoneal defense mechanism in experimental animals with intra-abdominal infections. METHODS: 40 male Spraque-Dawley rats weighing between 250 and 300 g were used in this study. The rats were randomly divided into four groups consisting of 10 animals. The operative procedures were done under sterile conditions. In group I sham laparotomy was done. In group II, the distal part of the cecum was ligated, and cecum perforation was performed. In group III, total omentectomy was performed after cecal ligation and perforation. In group IV only omentectomy was performed. Baseline and 2- and 4-hour peritoneal fluid samples were taken using a Pasteur pipette during laparotomy under anesthesia. Total peritoneal cells counts, bactericidal activity of peritoneal fluid, and types of phagocytic cells in the peritoneal fluid were assessed. RESULTS: As compared with baseline values, the total peritoneal cell counts were increased at the 2nd and 4th h in all groups (p < 0.05). A significant increase was observed after 4 h as compared with 2 h in sham laparotomy, cecal ligation+perforation+omentectomy, and omentectomy groups (p < 0.05). A significant increase in the cell counts after 2 h was found in the other groups when compared to the sham laparotomy group (p = 0.0001). After 4 h, there was a significant difference between the groups, but especially prominent in the cecum ligation+perforation+omentectomy group (p = 0.0001). Proliferating colony counts of Escherichia coli and Pseudomonas Aeruginosa decreased after 2 h, and there was no proliferation in the subsequent cultures. It was observed that the macrophage counts significantly increased after 2 and 4 h as compared with baseline in intragroup assessments (p = 0.0001). In the intergroup assessment, an increase was observed in the macrophage counts at baseline and after 2 and 4 h, and this was significant in the cecal ligation+perforation+omentectomy group (p = 0.0001). In the omentectomy group, a significant decrease was observed in the macrophage counts between the 2nd and 4th h (p = 0.0001). CONCLUSION: Removal of the omentum in the presence of intra-abdominal infections causes the peripherally derived macrophages to take over the defensive role of macrophages of peritoneal origin as a compensatory mechanism, thus the peritoneal bactericidal activity against E. COLI, the major pathogen in intra-abdominal infections, does not change after omentectomy.     

Liquid Paraffin vs Hyaluronic Acid in Preventing Intraperitoneal Adhesions

Adhesion formation after abdominal and pelvic operations remains a challenging problem. Role of adjuvant barriers have been studied but there is no comparative study between liquid paraffin and hyaluronic acid as a barrier method. Hence, we planned to compare the effectiveness of 0.4 % hyaluronic acid and liquid paraffin in the prevention of postoperative intraperitoneal adhesions in rats. This prospective, randomized and controlled study was conducted in 60 adult Wistar albino rats. Surgical trauma by caecal abrasion and 1 g talcum powder was used in the rat model to induce adhesion formation. After trauma, 3 ml normal saline was instilled in the peritoneal cavity in control group (n?=?20), 3 ml liquid paraffin was instilled in experimental group A (n?=?20) and 3 ml 0.4 % hyaluronic acid was instilled in experimental group B (n?=?20). Two weeks after laparotomy, repeat laparotomy was performed and the adhesions were scored according to Zuhlke classification. Liquid paraffin and hyaluronic acid both reduce the extent and grade of adhesions both macroscopically (p?=?0.018, p?=?0.017) and microscopically (p?=?0.019, p?=?0.019) respectively. Although there was significant reduction in adhesions by hyaluronic acid at certain specific sites as compared with liquid paraffin, its overall effectiveness in preventing postoperative intraperitoneal adhesions is not significantly different from liquid paraffin (p?=?0.092, p?=?0.193) respectively. The presence of liquid paraffin and hyaluronic acid in the peritoneal cavity reduce postoperative intraperitoneal adhesions significantly in rats. However, there is no overall significant difference in the effectiveness of two groups. Dosage and safety of these chemicals in human beings remains to be established.     

The efficacy of bipolar sealer on blood loss in spine surgery: a meta-analysis

Objective

The purpose of this meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to gather data to evaluate the efficacy and safety of bipolar sealer versus standard electrocautery in the management of spinal disease.

Methods

The electronic databases including Embase, PubMed and Cochrane library were searched to identify relevant studies published from the time of the establishment of these databases up to January 2017. The primary outcomes were total blood loss, requirement of transfusion (rate and amount), and operation time. The secondary outcomes were length of hospital stay and postoperative wound infection. Data analysis was conducted with RevMan 5.3 software.

Results

A total of five studies involving 500 patients (261 patients in the BS group and 239 in the control group) were included in the meta-analysis. The pooled results revealed that application of bipolar sealer could decrease the total blood loss in spine surgery [WMD = ?467.49, 95% CI (685.47 to ?249.51); p < 0.05; I ² = 91%]. Compared with standard electrocautery, bipolar sealer was associated with lower rates of need for transfusion [OR = 0.30, 95% CI (0.16–0.55), p < 0.05; I ² = 0%]. In addition, patients in the BS group were likely to receive less amount of blood transfusion compared with patients in the control group[WMD = ?0.73, 95% CI (?1.37 to ?0.09), p < 0.05; I ² = 76%]. The mean operative time was shorter in the BS groups compared with the control group [SMD = ?0.36, 95% CI (?0.60 to ?0.13), p < 0.05; I ² = 0%]. There was no significant difference in terms of length of hospital stay [WMD = ?0.73, 95% CI (?1.96 to 0.51), p = 0.25; I ² = 67%] and postoperative wound infection [OR = 0.88, 95% CI (0.31–2.48), p = 0.81; I ² = 0.0%] between both groups.

Conclusions

The available evidence suggests that bipolar sealer is superior to standard electrocautery with less blood loss, shorter operation time and less transfusion requirement. There is no significant difference between both groups regarding length of hospitalization and wound infection. Hence, bipolar sealer is recommended in spine surgery. Because of the limitation of our study, more well-designed RCTs with large sample are required to provide further evidence of safety and efficacy between bipolar sealer and standard electrocautery in the treatment of spinal disease.

     

Short-term effects of high-intensity laser therapy,manual therapy,and Kinesio taping in patients with subacromial impingement syndrome

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n?=?15), KT?+?EX (n?=?20), MT?+?KT?+?EX (n?=?16), and MT?+?KT?+?HILT?+?EX (n?=?19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT?+?KT?+?EX and HILT?+?MT?+?KT?+?EX groups (p?<?0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups (p?<?0.05). These differences were significant especially between the groups MT?+?KT?+?EX and KT?+?EX (p?<?0.05) and HILT?+?MT?+?KT?+?EX and KT?+?EX (p?<?0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.     

Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients

Nowadays laparoscopic approach is accepted as a valid alternative to open surgery for the treatment of colorectal cancer. Several studies consider this approach to be safe and feasible also in obese patients, even if dissection in these patients may require a longer operative time and involve higher blood loss. To facilitate laparoscopic approach, more difficult in these patients, several energy sources for laparoscopic dissection and sealing, has been adopted recently. The aim of this study is to investigate the possible intraoperative advantages of radiofrequency energy in terms of blood loss and operative time in obese patients undergoing laparoscopic resection for cancer. All patients who underwent laparoscopic surgery for colorectal cancer from January 2010 to December 2015 were registered in a prospective database. Patients with a body mass index BMI (kg/m²) ≥30 were defined as obese, and patients with a BMI (kg/m²) <30 were defined as non-obese. All 136 obese patients observed were divided retrospectively into 2 groups according to the devices used for dissection: 83 patients (Historical group: B) on whom dissection and coagulation were performed using other energy sources (monopolar electrocautery scissors, bipolar electrical energy, ultrasonic coagulating shears) and 53 patients who were treated with electrothermal bipolar vessel sealing (Caiman group: A). In group A, the Laparoscopic Caiman 5 (Aesculap AG, Tuttlingen, Germany) was the only instrument employed in the whole procedure. The study examined only three types of operation: right colectomy (RC), left colectomy (LC), and anterior resection (AR). Preoperative data were similar for RC, LC, and AR in both groups (A and B). The mean operative time was statistically shorter in the Caiman group than in the Historical group [104 vs 124 min (p 0.004), 116 vs 140 min (p 0.004), and 125 vs 151 min (p 0.003) for RC, LC, and AR between group A and B, respectively]. Also intraoperative blood loss results significantly lower in the Caiman group than in the historical one [52 ml vs 93 for RC (p 0.003); 65 vs 120 ml for LC (p 0.001); 93 vs 145 ml for AR (p 0.002) between group A and B, respectively]. No intraoperative complications were recorded in either group. The mean conversion rate was 4.4% (6 patients). There were no statistical differences in intensive care unit (ICU) stay, functional outcomes, mean hospital stay and overall morbidity rate between the two groups. There was no mortality in either group. The use of the Caiman EBVS instrument shows significant advantages with respect to a small number of intraoperative parameters. We can conclude that use of this radiofrequency device, in the laparoscopic approach, offers advantages in terms of lower intraoperative blood loss and shorter operative time in obese patients with colorectal cancer.     

Self-fixing parietex progrip versus the standard sutured prolene mesh in tension-free repair of inguinal hernia: effect on testicular volume and testicular blood flow

Our study was conducted to compare self-fixing lightweight polyester mesh (group I) to the standard heavy weight polypropylene mesh (group II) using tension-free Lichtenstein hernioplasty as regard to the effect of mesh implantation and perimesh fibrosis on testicular blood flow. 80 patients with uncomplicated inguinal hernia were divided in two groups. Doppler ultrasonography measured testicular volume, testicular artery velocity preoperative and 3rd month post operative. Blood flow in the testicles was represented by resistive index (RI). No case of testicular atrophy occurred in either group, however, in both groups a significant postoperative decrease in testicular volume (p?=?0.001 in group I and p?<?0.001 in group II) was accompanied by a significant increase in RI as compared to their pre-operative values (p?<?0.001 in group I and p?=?0.009 in group II). Comparing the two groups, patients in group I showed higher values of decrease in testicular volume accompanied by more increase in RI values postoperatively compared to group II patients, but these values did not reach a significant value (p?=?0.107, p?=?0.136). There was a significant increase in the number of post-operative varicocele and hydrocele in group I compared to group II. Mesh implantation has an effect on testicular size and blood flow by decreasing the testicular size and increasing the RI. This effect was more obvious in the parietex progrip. Although there is an indirect relation between RI and the sperm count, testicular blood flow alone is not enough to judge fertility.     

Radiological and biochemical effects (CTX-II,MMP-3, 8, and 13) of low-level laser therapy (LLLT) in chronic osteoarthritis in Al-Kharj,Saudi Arabia

Inflammation of synovial membrane and degeneration of articular cartilage in osteoarthritis (OA) lead to major changes in joint space width (JSW) and biochemical components such as collagen-II telopeptide (CTX-II) and matrix metallo protineases (MMP-3, 8, and 13). Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as biomodulatory effect on microcirculation and cartilage regeneration in animal studies. The objective of this study was to examine the analgesic and biochemical effect of LLLT in patients with knee osteoarthritis. Subjects (n?=?34) who fulfilled the selection criteria were randomly divided into active group (n?=?17) and placebo group. Subjects in active group were irradiated laser with the frequency of 3 days per week for 4 weeks with the specific parameters on 8 different points on the joint at 1.5 J per point for 60 s for 8 points for a total dose of 12 J in a skin contact method. The placebo group was treated with the same probe with minimum emission of energy. Visual analog scale for pain intensity, joint space width, collagen-II telopeptide, and matrix metallo protinease-3, 8, and 13 was measured before treatment and at 4 and 8 weeks following treatment. Data are analyzed with mean values and standard deviation with p?<?0.05. Baseline values of all outcome measures show insignificant difference (p?>?0.05) in both groups which shows homogeneity. After 4- and 8-week treatment, active laser group shows more significant difference (p?<?0.001) in all the parameters than the placebo laser group (p?>?0.05). Our results show that low-level laser therapy was more efficient in reducing pain and improving cartilage thickness through biochemical changes.     

Low-level laser therapy in the management of plantar fasciitis: a randomized controlled trial

This study aimed at estimating the extent to which a combination therapy of low-level laser therapy (LLLT) with exercise and orthotic support (usual care) affects functional ability in the patient with plantar fasciitis (PF) when compared to usual care alone. Participants with PF were randomly allocated into two groups: LLLT (n?=?27) and control (n?=?22). All the participants received home exercise program with orthotic support. In addition, the LLLT group received a gallium-aluminum-arsenide laser with a 850-nm wavelength for ten sessions, three times a week. Functional outcomes were measured by function subscale of American Orthopedic Foot and Ankle Society Score (AOFAS-F) and 12-min walking test including walking speed, cadence, and activity-related pain using visual analog scale (VAS).The scores were recorded at baseline, third week, and third month after the treatment. Analysis was performed using repeated measures ANOVA and an intention to treat approach using multiple imputations. There was a significant improvement in AOFAS-F total score at 3 weeks in both groups (LLLT, p?<?0.001; control, p?=?0.002), but the improvements were seen only for the LLLT group for AOFAS-F total score (p?=?0.04) and two individual items of AOFAS-F (walking distance (p?<?0.001) and walking surface (p?=?0.01)) at 3 months. The groups were comparable with each other for both walking speed and cadence at all assessment times (p?>?0.05). Both groups showed significant reduction in pain over 3 months (LLLT, p?<?0.001; control, p?=?0.01); however, the LLLT group had lower pain than the control group at 3 months (p?=?0.03). The combination therapy of LLLT with usual care is more effective to improve functional outcomes and activity-related pain when compared to usual care alone.     

The effects of photobiomodulation and low-amplitude high-frequency vibration on bone healing process: a comparative study

This study aimed at investigating the effects of photobiomodulation (PBM) and low-amplitude high-frequency (LAHF) whole body mechanical vibration on bone fracture healing process when metallic plates are implanted in rats’ femurs. Forty male rats weighing between 250 and 350 g, 12 weeks old, were employed in this study. A transverse critical size defect (CSD) was made in their right femurs that were fixed by stainless steel plates. After the surgery, the rats were divided equally into four groups: low-level laser therapy group (GaAlAs laser, 830 nm, 40 mW, 4 J/cm², 0.35 cm beam diameter, LLLT), whole body vibration group (60 Hz, 0.1 mm amplitude, 1.5 g, WBV), a combination of laser and vibration group (LV), and the control group (C). Each group was divided into two subgroups based on sacrifice dates. The rats were sacrificed at intervals of 3 and 6 weeks after the surgery to extract their right femurs for radiography and biomechanical and histological analyses, and the results were analyzed using standard statistical methods. Radiographic analyses showed greater callus formation in the LLLT and WBV groups than in control group at both 3 (P?<?0.05 and P?<?0.001, respectively) and 6 weeks after surgery (P?<?0.05 and P?<?0.05, respectively). Histological evaluations showed a higher amount of new bone formation and better maturity in the LLLT and WBV groups than the control groups at 3 and 6 weeks after surgery. Biomechanical tests showed that the maximum force at fracture in the LLLT (P?<?0.05 in 3 weeks and P?<?0.05 in 6 weeks) and WBV (P?<?0.001 in 3 weeks and P?<?0.05 in 6 weeks) groups was greater than that in the control groups at both time intervals. But a combination of laser and vibration therapy, LV, did not show a positive interaction on bone fracture healing process. The biostimulation effects of PBM or LLLT and of low-amplitude high-frequency WBV both had a positive impact on bone healing process, for critical size defects in the presence of a stainless steel implant. But their combination, i.e., low-level laser therapy and low-amplitude high-frequency whole body vibration (LV), interestingly did not accelerate the fractured bone healing process.     

Effect of photobiomodulation on connective tissue remodeling and regeneration of skeletal muscle in elderly rats

The purpose of this study was to evaluate the effects of low-level laser therapy (LLLT) on morphological aspects, IL-6 and IL-1β expressions, as well as the distribution and organization of collagen in the tibialis anterior (TA) muscle of elderly rats submitted to cryoinjury. Histological photomicrographs were taken of TA muscles stained with HE and picrosirius red. Immunohistochemistry was used for the evaluation of IL-6 and IL-1β. Male Wistar rats, aged 20 months, were distributed into three groups: (1) control animals not injured or treated with LLLT (n?=?5), (2) cryoinjury without LLLT treatment (n?=?15), and (3) cryoinjury treated with infrared LLLT (n?=?15). LLLT was applied to the TA 2 h after of the injury induction and consisted of daily applications until the sacrifice (1, 3, and 7 days). The following parameters were used: λ?=?780 nm, power density 1 W/cm², output power 40 mW, 10 s per point, 8 points, and 3.2 J of total energy. In the histomorphological analysis, the treated group exhibited a significant decrease in inflammatory infiltrate (p?<?0.001) as well as an increase immature fibers and new blood vessels at 7 days compared to the untreated group (p?<?0.05). Furthermore, treatment induced a better collagen distribution and organization at 7 days in comparison to the untreated group (p?<?0.05). In conclusion, LLLT demonstrated a modulatory effect on the muscle repair process in elderly animals with regard to the collagen remodeling and morphological aspects of muscle tissue.     

How much Reliable Is Alvarado Scoring System in Reducing Negative Appendectomy?

There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3 %) patients, and group B contained 210 (74.7 %) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups (p?=?0.002, p?<?0.001, p?<?0.001, and p?=?0.023, respectively). Alvarado scores were significantly different between the groups (p?<?0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.     

Image-guided resection of glioblastoma in eloquent brain areas facilitated by laser surface thermal therapy: clinical outcomes and long-term results

The increased interest in the application of lasers in neuro-oncology prompted us to present our experience of using the laser technologies in the treatment of cerebral gliomas. The aim of the study was to evaluate the clinical efficacy of image-guided laser surface thermal therapy (LSTT) and its influence on survival of patients with glioblastoma (GBM).Data of 91 patients (49 males, 42 females, mean age 51.4 years, range 23–70 years) with supratentorial GBMs located in close vicinity to or within the eloquent brain areas were retrospectively analyzed.All patients were divided into two groups: LSTT group (n?=?28) and control group (n?=?63). There were no significant differences by gender, age, Karnofsky Performance Scale (KPS) score, and tumor location between groups. Total removal in the LSTT group was performed in 67.9%, in the control group—31.7% (p?<?0.01); on the contrary, subtotal removal prevailed in the control group—52.4%; in the LSTT group, it was 32.1%. In postoperative period, there was no significant difference in KPS score between the groups (p?=?0.89). A higher degree of resection provided an increase in survival rates (p?<?0.01). The median overall survival was 15.5?±?10.5 months, in the LSTT group 18.4?±?11.7 and in the control group 14.3?±?9.1 (p?=?0.03). The application of image-guided LSTT in patients with GBMs of eloquent brain areas allowed the high rate of complete resection and improved overall survival without the negative effect on the functional status after surgery.     

Benefits of laparoscopic posterior wall suture repair in treating adolescent indirect inguinal hernias

Purpose

Adolescent inguinal hernias are treated using high ligation or posterior wall suture repair with laparoscopic mesh implantation. This study aimed to evaluate the efficacy of laparoscopic intracorporeal posterior wall suture repair without mesh implantation for treating adolescent indirect inguinal hernias.

Methods

Laparoscopic herniorrhaphy was performed between September 2012 and April 2015 in 244 patients aged 11–18 years who were diagnosed with indirect inguinal hernias at Damsoyu Hospital, Seoul, Korea. The patients were stratified by surgical procedure into the high-ligation (115 patients) and wall suture (129 patients) groups.

Results

Four (3.5%) of the 115 patients in the high-ligation group experienced recurrence, but those in the wall suture group did not. The difference in recurrence rates between these groups was significant (p < 0.001). The wall suture procedures were longer (mean 28.2 min) than the high-ligation procedures (mean 17.4 min) (p < 0.001). The lengths of postoperative hospital stays were similar in both groups. Few complications were observed: one patient developed hematoma and one developed seroma in the high-ligation group; two patients developed inguinal hematomas and one developed seroma in the wall suture group. Visual analog scale scores at 1 week after surgery and the mean times to return to normal activities were similar in both groups. No chronic inguinodynia after the operation in either group was observed.

Conclusions

Laparoscopic intracorporeal posterior wall suture repair without mesh implantation was effective for treating adolescent indirect inguinal hernias and resulted in fewer recurrences than those with high ligation.

     

Comparison of adjustable continence therapy periurethral balloons and artificial urinary sphincter in female patients with stress urinary incontinence due to intrinsic sphincter deficiency

Introduction and hypothesis

The objective was to compare the outcomes of the ACT® device with those of the artificial urinary sphincter (AUS) AMS 800 in the treatment of stress urinary incontinence (SUI) due to sphincter deficiency in women.

Methods

All the women who underwent surgical treatment for SUI due to intrinsic sphincter deficiency from 2007 to 2017 were included in a single-center retrospective study. The primary endpoint was the functional outcome. Perioperative functional parameters of the two groups were compared.

Results

Twenty-five patients underwent an ACT® implantation and 36 an AUS implantation. Patients in the AUS group were younger (62.9 vs 70.4 years; p =?0.03) with less comorbidity (ASA Score?=?3 in 12.1% vs 33.3%; p =?0.005). Operative time and hospital stay were shorter in the ACT® group (45.7 vs 206.1 min; p <?0.001; 1.7 vs 7 days; p <?0.001 respectively). There was a higher rate of intraoperative complications in the AUS group (47% vs 8%; p <?0.001) but the rates of postoperative complications were similar between both groups. The ACT® was associated with an increased risk of urinary retention (20% vs 2.8%; p =?0.04). Results were in favor of AUS for: decrease in USP stress incontinence subscore (?7.6 vs ?3.2; p <?0.001), number of pads per 24 h (? 4.6 vs ?2.3; p =?0.002), PGII scale (PGII?=?1: 61.1% vs 12%; p <?0.001), and cure rate (71.4% vs 21.7%; p <?0.001).

Conclusions

In the present series, keeping in mind the significantly different baseline characteristics, AUS implantation was associated with better functional outcomes than the ACT® in female patients with SUI due to intrinsic sphincter deficiency, but with a higher intraoperative complications rate, longer operative time, and a longer stay.

     

Laparoscopic-assisted transversus abdominis plane block as an effective analgesic in total extraperitoneal inguinal hernia repair: a double-blind,randomized controlled trial

Purpose

Laparoscopic inguinal hernia repair has facilitated early mobilization. Management of post-operative pain is paramount in these day case procedures. The aim of this study was to compare laparoscopic-assisted transversus abdominis plane (TAP) block with periportal local anaesthetic infiltration in managing post-operative pain.

Methods

A double-blind, randomized controlled trial was conducted with patients undergoing elective laparoscopic inguinal hernia repair (January 2016–October 2017). The intervention group received laparoscopic-assisted TAP block with 30 ml 0.25% Bupivacaine. The control group received 15ml of 0.5% Bupivacaine at the periportal sites. Primary outcome measure was assessment of post-operative pain scores using numerical rating on visual analogue scale (VAS) at rest and on coughing at 3 h. Efficacy of TAP block was assessed as reduction in mean pain scores in the order of 2 points using the VAS.

Results

60 (57 males and 3 females) were enrolled; 30 patients were randomized to each group. Patient demographics, anaesthetic and surgical times were similar in both groups. Mean pain scores were significantly reduced in the intervention group at 3 (3.1 vs 1.1 p?<?0.001) and 6 h (4.1 vs 1.7 p?<?0.001) at rest and on coughing at 3 (4.8 vs 2.1 p?<?0.001) and 6 h (5.4 vs 3.0 p?<?0.001). Patient satisfaction was higher (8.0 vs 6.8 p?<?0.001) and rescue analgesic requirements (169.4vs 71.3 p?<?0.001) lower in the intervention group.

Conclusions

This analysis has demonstrated the therapeutic benefit of laparoscopic-assisted TAP block in initial post-operative pain management for patients undergoing elective laparoscopic inguinal hernia repair.