The biological effect of low-intensity laser radiation (helium-neon and infrared light) provides a wide range of photochemical and photophysical changes that cause the intensification of structural and metabolic processes that are not associated with a violation of the integrity of the irradiation zones3.

The impact of coherent radiation with a wavelength of 0.63 μm on biological tissue causes various reactions of the body, namely:

1) an increase in the concentration of alkaline phosphatase in the blood serum;

2) an increase in the content of immunoglobulins O, T-lymphocytes, as well as the phagocytic activity of leu-

3) a decrease in the factor that inhibits the migration of macrophages;

4) strengthening of microcirculation and fibrinolytic activity of blood;

5) an increase in the mitotic index and action potential of the nerve;

6) normalization of increased vascular resistance.

The main points in the complex mechanism of the action of laser radiation on biological structures are the perception of light rays by photoreceptors, the transformation of their molecular composition and a change in their physicochemical state. Subsequently, biochemical reactions are activated with the initiation of active and allosteric centers in enzymes and an increase in their number. This is confirmed by a large number of publications on the growth of enzymatic activity after laser therapy4.

The action of coherent light on biological tissue is carried out through specific enzymes - photoreceptors. Schematically, the primary response of biological systems to laser action is as follows: the light-excited chromophore group of photoreceptors transfers the energy of electronic excitation to a protein bound to it, and if the latter is attached to the membrane, then to the membrane as a whole. As a result of these processes, the heat generated during nonradiative transitions can cause local heating of the photoreceptors, which promotes its reorientation. In this case, the photoreceptor passes through a number of intermediate relaxation states that provide both dynamic and static conformational transformations of the protein and, accordingly, the membrane from which

the swarm of photoreceptor is connected, which, in turn, leads to a change in the membrane potential and membrane sensitivity to the action of biologically active substances.

A wide range of biochemical and physiological reactions observed in the body in response to exposure to a low-intensity laser (Fig. 9.1) indicates the promise of its use in various fields of medicine. Analysis of the results of our own observations showed that the use of infrared coherent light in the early postoperative period in patients with genital endometriosis (endometriosis of the ovaries and the body of the uterus [myometectomy], retrocervical endometriosis) helps to reduce pain, improves blood circulation in the arteries feeding the uterus and ovaries (according to data of transvaginal ultrasound Doppler) and, most importantly, prevents the formation of adhesions in the small pelvis.

During repeated laparoscopy, carried out in order to clarify the clinical situation in some patients with ovarian endometriosis, who had undergone salpingo-ovariolysis during the previous operation, and in the postoperative period, intravaginal low-intensity laser exposure was not detected in all cases. signs of adhesions.

We adhere to the point of view that a low-intensity laser is the method of choice when carrying out rehabilitation measures at the second (main) stage of physical treatment of patients with genital endometriosis. At the same time, one should not underestimate the advantages of other highly effective techniques - pulsed electrostatic field of low frequency, currents of supratonal frequency (ultratonotherapy), alternating and constant magnetic fields.

Research V.M. Strugatsky et al.10 found that the use of a low-frequency pulsed electrostatic field in gynecological patients leads to a decrease in local pain in the small pelvis along the vessels and nerve trunks, as well as to the correction of hormone-dependent disorders. Despite the fact that the main clinical effects of a pulsed electrostatic field - defibrosing and analgesic - are somewhat less pronounced than in the treatment with traditional physical factors with a similar action in direction, this method has a significant advantage, namely, the ability to regulate the estrogen-progesterone ratio. Due to this ability, a pulsed electrostatic field of low frequency can be used for the treatment of patients with hyperestrogenism and / or concomitant hormone-dependent formations of the internal genital organs, ie, when the use of these-forming or heat-transferring factors is excluded or limited.

Ultratonotherapy is a method of electrotherapy in which the patient's body is exposed to an alternating current of a supratonal frequency (22 kHz) of high voltage (3-5 kV). Ultra-tonal frequency currents have a soft effect on biological tissue without causing discomfort. Under the influence of ultratonotherapy, there is an improvement in local blood and lymph circulation, activation of metabolic processes, relief of pain. This method represents one of

highly effective means of preventing reocclusion of the fallopian tubes.

The mechanism of action of the magnetic field on biological tissue is associated with the stimulation of physicochemical processes in biological fluids, biocolloids, blood elements. It is assumed that anisotropic macromolecules, under the influence of a magnetic field, change their orientation and, thereby, acquire the ability to penetrate through membranes, thus affecting biological processes. Such biological processes as free radical reactions of lipid oxidation, reactions with electron transfer in the cytochrome system, oxidation of non-heme iron, as well as reactions involving transition metal ions are sensitive to the action of a magnetic field. The magnetic field accelerates blood flow, reduces the need for tissues and cells in oxygen, has a vasodilating and hypotensive effect, and affects the function of the blood coagulation system. Along with the influence of magnetic fields on physicochemical processes, the mechanism of their therapeutic action is based on the induction of eddy currents in the tissues, emitting very weak heat; the latter, in turn, activates blood circulation, metabolic processes and enhances regeneration, and also provides sedative and analgesic effects5,11.

It should be noted that in the complex of rehabilitation therapy for patients with endometriosis, it is recommended to use radon water in the form of general baths, vaginal irrigation, microclysters. Radon therapy has a beneficial effect on the body of patients with various allergic reactions, chronic

colitis and neuralgia of the pelvic nerves.

BIBLIOGRAPHY

1. Arslanyan KN., Strugatsky VM, Adamyan LV, Volobuev AI. Early restorative physiotherapy after microsurgical operations on the fallopian tubes. Obstetrics and Gynecology, 1993, 2, 45-48

2. Zheleznoe B.I., Strizhakov A.N. Genital endometriosis. "Medicine", Moscow, 1985

3. Illarionov V.E. Basics of laser therapy. "Respect", Moscow, 1992

4. Kozlov V.I., Builin V.A., Samoilov N.1., Markov I.I. Fundamentals of laser physiotherapy and reflexology. "I am healthy", Kiev-Samara, 1993

5. Orzheshkovsky V.V., Volkov E.S., Tavrikov NA. and other Clinical physiotherapy. "I am healthy", Kiev, 1984

6. Savelyeva G.M., Babinskaya L.N., Breusenko V. 1. and other Prevention of adhesions after surgery in gynecological patients in the reproductive period. Obstetrics and Gynecology, 1995, 2, 36-39

Low-intensity laser radiation (LLLT) in dermatology and cosmetology has been used for a long time and successfully. More than forty years ...

Low-intensity laser radiation (LLLT) in dermatology and cosmetology has been used for a long time and successfully. For more than forty years, it has been available to anyone dealing with various skin diseases or cosmetic problems. During this time, both deep scientific research and practical work proved the healing power of laser therapy and the extremely beneficial effect of LILI not only on the skin, but also on the body as a whole [Moskvin SV, 2000].

Previously, most specialists used laser radiation as a therapeutic factor, using only those lasers that were at their disposal, while not realizing the truly unique therapeutic possibilities of laser therapy in full. On the other hand, the peculiarities of cosmetology as a direction of not only a therapeutic, but also a preventive plan urgently required the development of new, most effective equipment based on the latest methodological approaches. Several years of joint work of scientists, engineers and cosmetologists have made it possible not only to create such a specialized technical base for these tasks, but also to develop truly effective, "working" methods.

The most convenient (and effective) for cosmetology are devices that can be used to influence several modes of radiation, to conduct laser therapy sessions using sequentially emitting heads with different wavelengths, powers and other parameters. All these requirements are fully met by the laser therapeutic devices "Matrix" and "LASMIK®", which were chosen as the basis for the laser physiotherapeutic complex "Matrix-Cosmetologist". The material presented in the book is focused on the use of this particular complex with an optimal set of emitting heads and attachments (taking into account its unique capabilities), but a number of the proposed techniques involve the use of other lasers. This is especially true for the treatment of various dermatological diseases. In any case, the choice of a specific technique always remains with the specialist.

When laser radiation interacts with the integuments of the human body, part of the optical energy is reflected and scattered in space. And the other part is absorbed by biological tissues. The nature of this interaction, in particular the depth of penetration of radiation, depends on many factors (wavelength, properties of the skin and underlying tissues, methods of exposure, etc.) and determines the effectiveness of laser therapy in general.

Skin, blood vessels, subcutaneous adipose tissue, tissue, and skeletal muscles do not equally absorb optical radiation of different wavelengths. The penetration depth of optical radiation gradually increases with the transition from the ultraviolet part of the radiation spectrum to the infrared region. Low-intensity laser radiation used in physiotherapy can belong to different spectral ranges, but the most commonly used laser radiation of the red and infrared spectra, which has the greatest penetrating power and mild biological and therapeutic effects. As a result, the greatest therapeutic breadth, a distinct and long-lasting therapeutic effect and a cosmetic effect. It is these qualities that led to the interest in LLLT with such spectral parameters.

In almost all diseases, regardless of etiology and pathogenesis, as well as with aging, there is a violation of microhemo- and lymphocirculation. As a result, the normal relationship between the cellular, interstitial, blood and lymphatic spaces of the internal environment of the body is disrupted. Breakdown of the microcapillary mechanism (spasm of capillaries, a decrease in their number and density, shunting of blood and lymph in the precapillary area, deterioration of the rheology of the transported medium) leads to edema, tissue hypoxia, under-oxidation of metabolic products and their accumulation, dysfunction of the collagen pool, accumulation in tissues hydrolytic products, depletion of antioxidant and immunocompetent systems, etc.

The effect of low-intensity laser radiation on biological tissues depends on the activation of biochemical reactions induced by laser light, as well as on the physical parameters of the radiation. Under the influence of LILI, atoms and molecules of biological tissues pass into an excited state, more actively participate in physical and physicochemical interactions. Various complex organic molecules can act as a photoacceptor: proteins, enzymes, nucleic acids, phospholipids, etc., as well as simple inorganic molecules (oxygen, carbon dioxide, water). Selective or preferential excitation of certain atoms or molecules is due to the wavelength and frequency of LILI. For the visible range, photoacceptors are chromatoform (light-absorbing) groups of protein molecules. LLLT of the infrared range is predominantly absorbed by molecules of protein, water, oxygen and carbon dioxide.

Energy absorption leads to a sharp increase in the intracellular concentration of Ca 2+ and stimulation of calcium-dependent processes: acceleration of the course of intracellular biochemical reactions of free radical type, an increase in the content of free forms of biologically active molecules not associated with proteins and crystallization water, activation of the accumulation and release of ATP, restoration of cell membranes, activation of proliferation, etc. Thus, there is a nonspecific stimulation of the biochemical activity of tissues exposed to laser irradiation. Many molecular acceptors of LLLT are associated with cell membranes and, passing into an electronically excited state, increase the bioenergetic activity of cell membrane complexes and enzymatic systems fixed on the membranes that support vital activity and synthetic processes in the cell (Fig. 73).

Analysis of changes in intracellular biochemical processes that occur under the influence of LILI shows that there is an increase in the oxidative phosphorylation of glucose (Krebs cycle) and an increase in the production of ATP. This is due to the activation of the chain of respiratory enzymes of the mitochondria (cytochromes) and the acceleration of the movement of electrons along this chain, as a result of which the energy potential of the cell increases. Stimulation of various intracellular enzymatic processes, life support systems leads to an increase in oxygen metabolism. Under the influence of LLLT, oxygen tension in tissues and its utilization by cells increases. There is a pronounced increase in local blood circulation, blood flow velocity, an increase in the number of collaterals and functioning capillaries. As a result, the supply of tissues with oxygen increases to the required level and the excess "metabolic demand" stimulated by LILI is satisfied. An increase in the activity of oxygen metabolism enhances the energy and plastic processes in the cell.

It is known that adenosine triphosphoric acid (ATP) acts as a universal photobiological energy accumulator. The various vital functions associated with ATP energy consumption are based on:

1) energy supply of chemical bonds of biological compounds (the basis for the synthesis of various chemical compounds);

2) mechanical work (cell division, muscle movement);

3) bioelectric processes (ensuring the functions of cell membranes).

Biological cell membranes play a vital role as a kind of structural barrier between the body and the environment. Disruption of the membrane can lead to malfunction of cells and even their death. Laser radiation prevents this process by affecting the antioxidant defense mechanism.

Cell proliferation (division) is a process that occurs constantly. The proliferation rate depends on the cell type. It is important that laser radiation not only enhances proliferation, which allows you to remove "old" cells from the body and replace them with young ones, but, most importantly, restores the biorhythm of division of various groups of cells in tissues and their interaction.

The laser effect, of course, manifests itself as a multilevel effect on the body: from the appearance of excited states and conformational rearrangement of molecules, changes in the oxygen balance and the activity of redox processes, changes in the membrane potential of the cell, changes in the pH of the intercellular fluid, microcirculation, etc. the level of the organism of response complex adaptive neuroreflex and neurohumoral reactions with activation of the immune system.

When exposed to low-intensity laser radiation on human surface biological tissues (skin, subcutaneous fatty tissue, fatty accumulations and muscles), the following positive changes occur:

Elimination of concomitant or parallel inflammatory processes;

Strengthening local and general immunity, and as a consequence, antibacterial action;

Slowing down the aging of cells and extracellular connective tissue;

Improving elasticity and reducing the density of the epidermis and dermis;

Increase in the thickness of the epidermal layer and dermoepidermal junction due to an increase in the number of mitoses and a decrease in desquamation;

Reconstruction of the dermis due to the ordering of the structure of elastic collagen fibers with the restoration of the water sector and a decrease in the amount of colloidal masses;

An increase in the number of sweat and sebaceous glands with the normalization of their activity while maintaining homogeneity, restoration of the mass of adipose tissue in parallel with the normalization of metabolic processes in it;

Fixation of accumulations of adipose tissue in their natural place, an increase in muscle mass with an improvement in metabolic processes and, as a result of the above changes, a decrease in the degree of sagging (ptosis);

Stimulates hair growth by enhancing microcirculation and improving tissue nutrition.

The listed effects of laser therapy can be achieved only with its systematic and long-term use!

The first results can sometimes be obtained as early as the 2-3rd procedure, but in most cases only after 10-30 sessions. To consolidate the result obtained in cosmetology, it is necessary to carry out preventive courses 3-4 times a year, each of which consists of at least 10 sessions. In the treatment of various dermatological diseases, methodological approaches differ significantly, they are presented in the relevant sections.

Thus, laser therapy and laser prophylaxis is a dynamic process under the supervision of specialists: a cosmetologist or dermatologist who have specialized in laser therapy.

In our Center of Medicine and Aesthetics "TRISH Clinic" Low-intensity laser radiation (LLLT) performed only by trained physicians. In each case, the doctor determines the appropriateness of the procedure.

LOW INTENSITY LASER THERAPY

Today the situation in laser medicine can be characterized as enriched by new trends. If you go to the INTERNET, more than 27,000 references will pop up on laser medicine, and if you add here the work done earlier in the USSR and Russia-CIS for 30 years, then the number of publications will surely surpass 30,000. laser surgery. Today, more than half of all publications are related to the problems of laser therapy. What has changed? First of all, the level of understanding of the mechanisms of the effect of low-intensity optical radiation (LEI) on living organisms has increased.

Recall: we subdivide the therapeutic effect of laser radiation into surgical and therapeutic. Therapeutic, as opposed to surgical, is governing, but not destructive, impact. This means that after exposure, the biological object remains alive. Moreover, if the task of controlling objects in a living organism, set as the main one in laser therapy, is solved correctly, then the biological object becomes, as it were, "better than it was" after exposure - pathological processes are suppressed in it and natural processes that support homeostasis are stimulated. Note that there is a natural "reference point" for the NOI - the spectrum of sunlight (see Fig. 21.1).

Fig. 21.1.

Dependences of the spectral density of sunlight on the wavelength:

1 - outside the atmosphere; 2 - radiation of an absolutely black body with a temperature of 5900 0 K; 3 - on the surface of the Earth at mid-latitudes (height 30 0 above the horizon).

This "benchmark" has already been considered above (A1). The spectrum-integrated intensity of solar radiation in free space at a distance equal to the average distance between the Earth and the sun is 1353 W / m 2. On the way to the Earth's surface, radiation is actively filtered by the Earth's atmosphere. Absorption in the atmosphere is mainly due to molecules of water vapor (H 2 O), carbon dioxide (CO 2), ozone (O 3), nitric oxide (N 2 O), carbon monoxide (CO), methane (CH 4) and oxygen ( About 2).

Living organisms in the process of evolution have repeatedly adapted to the changing "electromagnetic environment". About one and a half million species of living organisms live on the surface of the Earth, and all of them exist thanks to sunlight.

In the twentieth century, the situation with the "electromagnetic environment" on Earth turned out to be very different from the one that organisms faced during many millions of years of evolution. A lot of anthropogenic radiation has appeared. In the optical (UFIKOP) range, laser devices are located above all in terms of spectral radiation density. The dependence of the spectral density of radiation of medical lasers on the wavelength in comparison with a similar dependence for radiation from the Sun and some other light sources is shown in Fig. 21.2.

Fig. 21.2.

The emission spectrum of various light sources:

1 - sunlight on the Earth's surface at mid-latitudes; 2 - the maximum estimated level of the natural background; 3 - continuous mode neon-helium laser, power 15 mW, wavelength 633 nm, spot area 1 cm 2; 4 - superluminescent light-emitting diode, integrated power 5 mW, maximum intensity 660 nm; 5 - semiconductor laser of quasi-continuous mode, 5 mW, 780 nm; 6 - semiconductor laser of pulse-periodic mode, pulse power 4 W, 890 nm; 7 - 60 W household incandescent lamp, 60 cm distance.

The solid line, covering the entire spectral range from UV to IR regions, demonstrates the "smoothed" level of sunlight at mid-latitudes on a clear summer day. In relation to the natural level of sunlight, the spectral densities of laser and LED devices used in medicine are very different. For example, the spectral maximum of the LED feed (curve 4, see below) in the corresponding spectral interval is at the level of solar radiation, and the analogous curve of an IR laser device based on a semiconductor laser of a quasi-continuous mode (curve 5) reaches the maximum estimated level of the natural background (curve 2) ... At the same time, the maxima of the curves for a pulsed semiconductor laser (curve 6) and especially for a neon-helium laser (curve 3) overlap these values ​​by several orders of magnitude. In this case, the maximums of the spectral density of the sources reflect not so much the energy characteristics of light as the degree of its monochromaticity. Thus, the output power of a neon-helium laser exceeds the power of a red LED by only 3 times, and at the maximum spectral density this excess is more than 10 5 (!).

The increased level of "artificial" EMP in comparison with the natural background corresponds to the appearance on the Earth's surface of additional electromagnetic energy, the value of which is continuously increasing. This energy, in principle, can (yes, perhaps, it should) "interest" biological systems either in terms of developing a general adaptation syndrome (such as a stress response), or adapt to the impact like photosynthesis. The past century, obviously, represents too little time for the implementation of such a large-scale program, but it is necessary to think about the problem now.

Low-intensity optical radiation, primarily laser radiation, has found wide application in medicine. “It is difficult to name a disease in the treatment of which laser exposure has not been tested. A simple enumeration of the forms and variants of pathology, in the treatment of which the effectiveness of the laser beam is shown, will take up a lot of space, and the list of diseases in which the therapeutic effect of NOI is beyond doubt will be quite representative ”.

There are many works on the study of the mechanisms of action of NOI on biological objects of different levels of organization. - from molecular to organismic and supraorganic. However, there is still no generally accepted concept of the mechanism of action of NOI on living organisms. There are several alternative points of view explaining particular phenomena or experiments.

Why do we say not LILI (low-intensity laser radiation) and NOI (low-intensity optical radiation)? Because of the main characteristics of laser radiation, the wavelength and spectral density are of primary importance. The coherence and polarization of laser radiation do not have such a strong effect on the biostimulation effect, although there is no sufficient reason to assert that they do not matter at all.

Among the problems of phototherapy, which are in the focus of attention of both physicians and biologists, and developers of equipment, the main - elucidation of the mechanisms of action of NOI on biological objects. This problem has been central to the development of LLLT for nearly 50 years. It is still far from being resolved, although the very fact of a sharp increase in interest in LILT in the last 10 years speaks of positive shifts in its study. Among physicians and biologists, the idea of ​​the specificity and nonspecificity of the interaction of NOI with living organisms has been formed. Exactly, specific is called the interaction of light and BO associated with intense molecular absorption of light, i.e. one for which "specific" photoacceptors have been established, which carry out the primary absorption of light and then trigger a number of "specific" photochemical reactions. A typical example of this interaction - photosynthesis. Respectively, non-specific the interaction is considered when the biological response is large, and the absorption of light is so small that it is not possible to unambiguously establish the primary acceptor. It is this aspect - establishment of primary acceptors in the absence of strong absorption - and causes the most fierce discussions, since the transformation of a nonspecific interaction into a specific one opens the way to the practical application of LLLT not on an empirical, but on a strictly scientific basis.

The phenomenon of NOI action is investigated at various levels. This refers to the hierarchical levels of building a living system: molecular, organoid, cellular, tissue, organismic, supraorganism. Each of these levels has its own problems, but the greatest difficulties are associated with transitions from one level to another.

If, first of all, the spectral density and wavelength should be taken into account, then this means that a similar biological effect can be provided by both laser and incoherent sources (primarily LEDs), provided that these characteristics coincide.

The spectral range in which laser therapeutic devices operate corresponds to the "transparency window" of biological tissues (600-1200 nm) and is far from the characteristic electronic absorption bands of all known chromophores of the body (exception - eye pigments absorbing at 633 and 660 nm). Therefore, no significant absorbed energy is out of the question.

Nevertheless, a number of clinical effects are observed under the influence of NIE, which have served as the basis for LLLT for a long time. If we try to generalize all these effects, then we can formulate nonspecific integral action at the cellular level: laser radiation affects the functional activity of cells. At the same time, it does not change the function itself, but can enhance its intensity. That is, the erythrocyte, as it crawled through the capillaries, giving oxygen through its membrane and walls of the capillaries, continues to do this, but it can do better after irradiation. The phagocyte, as it caught and destroyed sick guests, continues to do so, but already with different speed... In other words, under the influence of NOI the rate of processes of cellular metabolism changes. In physicochemical parlance, this means that potential barriers to key biological reactions change their height and width. In particular, NOI can strongly affect the membrane potential. With an increase in the membrane field strength, the activation barriers of enzymatic reactions tied to membrane transport decrease, thereby providing exponential growth of the rate of enzymatic reactions.

The key concept when considering the action of the NIE is spectrum of biological action (WBS) ... The definition of the WBS has already been given in the course of the WFPBO. In view of its importance, let us remember it again.

If, as a result of absorption of light, a new product appears, then the time dependence of the concentration of this product c (t) obeys the equation:

(21.1)

Where η - quantum efficiency, σ - light absorption cross section per unit quantum, Ι (t) - the intensity of the incident light, ħω - the energy of the absorbed photon.

Obviously means the number of absorbed photons. If we introduce into consideration a function that makes sense of the rate of production of biomolecules of a given type in terms of one photon with a wavelength λ, then it is a quantitative expression of the SDB. Qualitatively, the SDS is defined as dependence of the relative efficiency of the studied photobiological effect on the wavelength. Thus, SDB is that part of the absorption spectrum that is responsible for a certain photobiological effect. At the molecular level, SDB can be considered in terms of a unit quantum. But the SDB is interesting because it can be considered at any system level. Indeed, all radiation absorbed by a biological object forms its absorption spectrum (AB). But the spectrum of biological action is being formed only those molecules that initiate this effect. Therefore, it is natural to call the molecules responsible for the WBD, differential molecules (as opposed to background molecules responsible for the entire joint venture). SDS is often considered as an additive part of the joint venture. But such a consideration can be recognized as correct only if there is a recipe for separating the SDU from the SP (similar to how the signal is extracted from the noise in case of strong noise due to the difference in correlation functions). If the noise is modulation in nature, i.e. not present as added to the signal magnitude, and how factor, so that the amplitude of the noise grows with the growth of the signal, then the extraction of useful information is sharply complicated. The additivity of the SDU in relation to the SP can be considered only in the case of linearity interaction of laser radiation with a biological medium, or with a deliberately negligible interaction of differential molecules with each other. In very many cases, this does not seem obvious, since, as a rule, any photobiological effect is of a threshold nature, i.e. exhibits non-linearity. Therefore, a methodological compromise is required to register an SDS, including transition from one system level to another. Exactly,

1) selection of a standard and, if possible, well-studied biological object with stable and reproducible characteristics;

2) the choice of the parameter P, which characterizes the biological object at a higher (in this case, the cellular) level, so that P is linearly associated with the probability of a microevent (the primary act of excitation of a biomolecule), i.e. its measurement would not disturb the cell and would allow the implementation of acceptable accuracy;

3) the presence of a radiation source tunable in a given range of the spectrum with sufficient monochromaticity and a given intensity to ensure the achievement of the required effect.

The simultaneous provision of these conditions presents great practical difficulties. Therefore, the information in the literature on measuring SDS is almost all inconsistent from a methodological point of view. An exception is the work carried out at FIAN (S.D. Zakharov et al.) In conjunction with the Oncological Center of the Russian Academy of Medical Sciences named after V.I. N.N. Blokhin (A.V. Ivanov et al.).

Study of biological action spectra - it is a path from a non-specific action of light to a specific one. The main "stumbling block" in the search for the primary photoacceptor ("the problem of the primary photoacceptor") - this is the absence of noticeable absorption by NOI for all wavelengths used in phototherapy. Therefore, within the framework of traditional photobiology, laser biostimulation effects do not find a satisfactory explanation. As for the "non-traditional" photobiology, here water (intracellular, interstitial, etc.) comes to the fore as a universal nonspecific photoacceptor, suggesting the presence of primary photophysical processes. This concept assumes that primary the photoacceptor (at the molecular level) is dissolved molecular oxygen, which, upon absorption of a quantum of light, passes into a singlet state. Thus, specificity at the molecular level is combined with non-specificity at subsequent levels of the systemic hierarchy. The 3 О 2 → 1 О 2 transition occurs at wavelengths of 1270, 1060, 760, 633, 570, 480 nm, and this transition is forbidden for an isolated О 2 molecule. However, in the aquatic environment, the formation of singlet oxygen is possible, and this is primarily manifested in the excitation spectrum of the cellular reaction of erythrocytes (as a change in the elasticity of the membrane). The maximum of this effect corresponds to 1270-1260 nm (absorption band of molecular oxygen), and the shape of the spectrum coincides in detail with the line of transition from the ground state to the first excited state of molecular oxygen (3 Σ g → 1 Δ g).

Singlet oxygen plays a key role in almost all processes of cellular metabolism, and a very small change in the concentration of 1 O 2 (within an order of magnitude) is required to change the nature of enzymatic reactions. Experiments of recent years (in particular, G. Klim) have shown that the rate of cell growth for the most important cell cultures (leukocytes, lymphocytes, fibroblasts, malignant cells, etc.) changes significantly depending on the energy density (in the range from 10 to 500 J / cm 2), mode and wavelength of incident radiation. The transition from the molecular level to the cellular level is carried out through a change in the structure of the water matrix. Singlet oxygen can be quenched, as is known, either chemically or physically. In the absence of sensitizers (see below, Ch. 24), we can assume that physical quenching predominates (the cells have a well-developed defense against chemical quenching). During the physical deactivation of 1 O 2 molecules, an energy of about 1 eV is transferred to the vibrational sublevels of the surrounding molecules. This energy is sufficient to break hydrogen bonds, create ionic or orientational effects. The average vibrational energy per degree of freedom at physiological temperature (~ 310 K) is ~ 0.01 eV, therefore the local release of 1 eV energy leads to a strong perturbation of the structure of the nearest environment of the dissolved 1 O 2 molecule. obeys the laws of heat conduction (which, generally speaking, is not true!), then as a result of solving the equation for the spherically symmetric case, we obtain:

Where Q- energy instantly released at the initial moment, D- coefficient of thermal conductivity, H- heat capacity, ρ - density of matter. If you substitute data for water here and accept Q = 1 eV, then for a time of the order of 10 -11 s, the release of such energy will lead to heating up to 100 0 С of a region with a diameter of ~ 10 Å (10 -7 cm). This estimate, obviously inappropriate at small distances, can be considered as the lower limit of the space-time scale for a kind of microhydraulic shock. In a thermodynamically stable state, a single perturbation at a distance of ~ 10 -7 cm cannot play an appreciable role and must be destroyed with a guarantee by thermal fluctuations. However, biofluids cannot, generally speaking, be regarded as thermodynamically equilibrium structures. To simulate processes in biofluids, one should use the metastable state of solutions of biomolecules, which occurs in initial phases dissolution process. The peculiarity of such metastable states - high sensitivity to local disturbances.

Let us estimate the volume of the sphere of perturbation without resorting to the heat conduction equation. Assuming that the average vibrational energy per one molecule of the water matrix is ​​0.01 eV, we find that the deactivation energy of 1 O 2 in 1 eV is evenly distributed among 100 water molecules. Intracellular or interstitial water are structures close to a liquid crystal (one-dimensional long-range order), with a distance between molecules of ~ 2.7 Å. When such particles are "rolled up" into a spherical layer, 100 molecules are just placed inside a sphere with a radius of ~ 10 Å, which qualitatively coincides with the "anti-estimate" in terms of thermal conductivity.

The change in the structure of the water matrix should be reflected in the change in the refractive index of the bioliquid solution, which was observed experimentally when the bioliquid solutions were irradiated with He-Ne laser radiation (λ = 632.8 nm).

Note that dynamic excitations of liquid crystal water can, under certain conditions, lead to the emergence of collective dynamic states (similar to the excess of the lasing threshold in a laser, where an avalanche-like increase in the dominance of the induced radiation is indicated). In other words, the dynamics of water becomes coherent, so that the structure of the liquid in the volume of a certain cluster becomes dominant in the entire volume of the solution. According to the estimates, in 1 cm 3 of water there are on average 10 16 -10 17 clusters, of which only 10 10 -10 11 molecules of photoexcited singlet oxygen appear (~ 10 -6 of the total number). Upon relaxation of these clusters, nuclei of a new structural phase are formed. Synergetics during the growth of embryos gives a change Δn 0, 10 6 times more than would correspond to the reorientation of an individual cluster. This was just observed experimentally (SD Zakharov et al., 1989): the absorption of light from a laser in the range of 10 -2 -10 -9 J caused such a change in the refractive index of the blood plasma, which would correspond to the "cooling" of the entire volume of the medium by ~ 6 J (!). After Zakharov, dependences similar in nature were observed in solutions of proteins, lipids, glycoproteins, etc. The common ingredient for all these substances is water, and this indirectly confirms the conclusion that water is universal non-specific acceptor for all types of electromagnetic radiation, the "specific" acceptor for which is the dissolved gas from the air (О 2, N 2, CO 2, NO, etc.). Thus, primary processes involving air gases ("respiratory chain") lead to secondary processes associated with the reorientation of the water matrix.

Secondary processes are otherwise called dark, meaning that many reactions at the cellular level, caused by irradiation, occur long enough after the cessation of irradiation. For example, DNA and RNA synthesis after 10 seconds of irradiation is observed after 1.5 hours. The abundance of possible secondary mechanisms today does not allow building a more or less convincing "bridge" between the cellular and tissue levels, similar to the "coherence" of the orientation of the water matrix. Nevertheless, the accumulation of data speaks in favor of the predominance of redox processes.

When analyzing processes at the tissue level, the characteristics of the incident radiation come to the fore (not only the wavelength and dose, but coherence, polarization, spatial distribution of power). The role of coherence is particularly controversial.

The need to take into account coherence is supported by the fact that when laser radiation is scattered from a biological object, a speckle structure is always observed, which carries information about the object (for more details, see below, Chapter 27) and allows achieving a therapeutic effect under certain conditions. The speckle structure is observed only at a sufficiently high degree of coherence of the incident radiation. This means that coherence cannot be neglected, especially since the degree of coherence can differ quite strongly for different types of laser sources (see Fig.21.2, where the spectral density for a neon-helium laser is many times higher than that for a semiconductor laser due to its higher monochromaticity; but monochromaticity - a direct consequence of temporal coherence).

Opponents of taking coherence into account cite the fact that coherence is almost immediately destroyed when laser radiation interacts with optically anisotropic biological tissues. Numerous experiments at the cellular and subcellular levels show that similar effects are observed both when using a laser and incoherent sources (an incandescent lamp equipped with a light filter).

Apparently, the truth, as is usually the case, is hidden somewhere between the polar points of view. In the process of re-radiation inside the tissue, coherence is, in fact, destroyed. But at the same time, zones with a high degree of spatial inhomogeneity of radiation are formed. The degree of the arising spatial inhomogeneity is directly related to the degree of coherence of the incident radiation. High power density causes local nonlinear effects at the primary process level. At the cellular level, this nonlinearity will inevitably cause a corresponding nonspecific response. Thereby:

1) biological tissue affects radiation, destroying coherence;

2) radiation affects biological tissue, changing its characteristics in accordance with the degree of coherence of the incident radiation.

So, coherence does not disappear in tissues without leaving a trace, but gives rise to a cascade of processes on which the effect at the tissue level depends. A detailed study of the spatial and temporal characteristics of these processes will make it possible to unambiguously establish the role of coherence in specific cases (see the literature to L. 27).

The dose dependence of the effect at the tissue level can also take on a specific character. There are three dose thresholds:

1) the minimum dose that causes changes at the cellular level;

2) the optimal dose causing a) an increase in morpho-forming processes, b) an acceleration of proliferation, c) cell differentiation;

3) the limiting dose at which stimulation is replaced by inhibition of proliferative activity.

The quantitative expression of dose thresholds depends on many parameters (characteristics of the laser, the functional state of the tissue, the general state of the organism). On the whole, it is easy to establish a systemic connection between the complexity of elucidating the mechanisms and the level of organization at which we wish to establish any regularities: the higher we climb the hierarchy, the more noticeable is the role of empiricism. Isolation of the primary photoacceptor at the molecular level makes it possible to construct, albeit with considerable difficulties, a picture of secondary effects at the subcellular and cellular levels. The transition from the cellular to the tissue level is already much more difficult, therefore, recommendations for choosing a dose are no longer at the level of recording solutions of certain equations, but at the level of a verbal description of possible processes. The transition from the tissue to the organismic level, and in general, sins with a significant amount of shamanism: do as I say, otherwise it will be bad. But, on the one hand, not to become like primitive clergy, and on the other - not to be a thoughtful theorist who has been calculating not what is needed for practice, but what he himself likes, we will try to generalize the problem to supraorganic level.

All living systems are open non-equilibrium systems operating on the balance of matter and energy in exchange with the environment. The living system is constantly self-organizing, i.e. reduces its entropy. The intensity of the decrease in entropy is directly related to the amount of information entering the system. From this point of view, low-intensity optical radiation acts as an external signal (information), which abruptly transfers a trigger (energy-informational state of a pathological focus with a predominance of entropy) from one stationary state to another. The transfer of an organism as a system from one state to another is inextricably linked with biorhythms. The range of biorhythms extends from 10 - 15 s (the time of one period of a light wave, which is of the same order as the time of molecular electronic transitions) to ~ 7 10 10 s (average life span), thus making up about 10 25 Hz in frequency scale. The task of optimizing the impact at the organismal level - bring the impact in line with biorhythms.

With regard to low-frequency biorhythms, measured in days, weeks, months, years, optimization of exposure means conducting radiation sessions at those times when it contributes to streamlining natural processes and failure pathological, which is an increase in the entropy of the organism as a system. For example, the treatment of chronic diseases that aggravate in accordance with the seasons (spring, autumn) prescribes LLLT courses at the beginning of the corresponding season, even before the next exacerbation of the disease begins. Practice shows that the effectiveness of treatment increases, and this applies not only to phototherapy itself, but also to concomitant medication and other methods of treatment. Prevention of long-term consequences of radical treatment also recommends periodic repetition of LLLT courses in accordance with the temporal characteristics of pathological processes (for more details see L.23). Sometimes this approach to LLLT at the organismal and supraorganic level is called chronobiological.

With regard to high-frequency biorhythms (within one session radiation), the following features of laser therapy can be noted.

The high natural frequency of the acting electromagnetic radiation, corresponding to periodic processes in biomolecules at the level of electronic transitions, provides the richest opportunities for modulation impact. In addition, it is possible to form information block impacts with an extremely high capacity. Within such a block, it is possible to create multifrequency impact with a given spectrum of modulation frequencies. Finally, which is especially important from a systemic point of view, it is possible to introduce biosynchronization into the impact itself due to feedback through the biological object.

The body as a whole has lower biorhythm frequencies (fractions of hertz), its systems and organs - higher (units and tens of hertz). The spectrum of biorhythms has an individual character and can be considered as a vibrational "portrait" of a specific personality. Multifrequency biosynchronized laser exposure can extremely effectively control all reactions of the body, including defense reactions to external adverse effects of a very different nature.

Literature for lecture 21.

1. The effect of electromagnetic radiation on biological objects and laser medicine. Sat. under the editorship of Acad. IN AND. Ilyichev. - Vladivostok: FEB USSR Academy of Sciences, 1989, 236 p.

2. V.M. Chudnovsky, G.N. Leonova, S.A. Skopinov et al. Biological models and physical mechanisms of laser therapy. - Vladivostok: Dalnauka, 2002, 157 p.

Laser radiation in medicine is a stimulated or stimulated wave of the optical range with a length of 10 nm to 1000 μm (1 μm = 1000 nm).

Laser radiation has:
- coherence - the coordinated course of several wave processes of the same frequency in time;
- monochromaticity - one wavelength;
- polarization - the orderly orientation of the vector of the intensity of the electromagnetic field of the wave in the plane perpendicular to its propagation.

Physical and physiological effects of laser radiation

Laser radiation (LR) has photobiological activity. Biophysical and biochemical reactions of tissues to LR are different and depend on the range, wavelength and energy of the radiation photon:

IR radiation (1000 microns - 760 nm, photon energy 1-1.5 EV) penetrates to a depth of 40-70 mm, causes oscillatory processes - thermal effect;
- visible radiation (760-400 nm, photon energy 2.0-3.1 EV) penetrates to a depth of 0.5-25 mm, causes dissociation of molecules and activation of photochemical reactions;
- UV radiation (300-100 nm, photon energy 3.2-12.4 EV) penetrates to a depth of 0.1-0.2 mm, causes dissociation and ionization of molecules - photochemical action.

The physiological effect of low-intensity laser radiation (LLLT) is realized by the nervous and humoral pathways:

Changes in biophysical and chemical processes in tissues;
- changes in metabolic processes;
- metabolic changes (bioactivation);
- morphological and functional changes in the nervous tissue;
- stimulation of the cardiovascular system;
- stimulation of microcirculation;
- increasing the biological activity of cellular and tissue elements of the skin, activates intracellular processes in muscles, redox processes, the formation of myofibrils;
- increases the body's resistance.

High-intensity laser radiation (10.6 and 9.6 μm) causes:

Thermal tissue burn;
- coagulation of biological tissues;
- charring, combustion, evaporation.

Therapeutic effect of a low-intensity laser (LLLT)

Anti-inflammatory, reducing tissue swelling;
- analgesic;
- stimulation of reparative processes;
- reflexogenic effect - stimulation of physiological functions;
- generalized effect - stimulation of the immune response.

The therapeutic effect of high-intensity laser radiation

Antiseptic action, formation of a coagulation film, protective barrier against toxic agents;
- tissue cutting (laser scalpel);
- welding of metal prostheses, orthodontic appliances.

LLLT readings

Acute and chronic inflammatory processes;
- soft tissue injury;
- burns and frostbite;
- skin diseases;
- diseases of the peripheral nervous system;
- diseases of the musculoskeletal system;
- cardiovascular diseases;
- diseases of the respiratory system;
- diseases of the gastrointestinal tract;
- diseases of the genitourinary system;
- diseases of the ear, throat, nose;
- violations of the immune status.

Indications for laser radiation in dentistry

Diseases of the oral mucosa;
- periodontal disease;
- non-carious lesions of dental hard tissues and caries;
- pulpitis, periodontitis;
- inflammation and trauma of the maxillofacial region;
- TMJ diseases;
- facial pain.

Contraindications

Tumors are benign and malignant;
- pregnancy up to 3 months;
- thyrotoxicosis, type 1 diabetes, blood diseases, insufficiency of the function of respiration, kidneys, liver, blood circulation;
- feverish conditions;
- mental illness;
- the presence of an implanted pacemaker;
- convulsive states;
- individual factor intolerance.

Equipment

Lasers are technical devices that emit radiation in a narrow optical range. Modern lasers are classified:

For the active substance (source of induced radiation) -solid-state, liquid, gas and semiconductor;
- by wavelength and radiation - infrared, visible and ultraviolet;
- in terms of radiation intensity - low-intensity and high-intensity;
- by the mode of radiation generation - pulsed and continuous.

The devices are equipped with emitting heads and specialized nozzles - dental, mirror, acupuncture, magnetic, etc., ensuring the effectiveness of the treatment. The combined use of laser radiation and a constant magnetic field enhances the healing effect. Mainly three types of laser therapy equipment are mass-produced:

1) based on helium-neon lasers operating in a continuous mode of generation of radiation with a wavelength of 0.63 μm and an output power of 1-200 mW:

ULF-01, "Yagoda"
- AFL-1, AFL-2
- SHUTTLE-1
- ALTM-01
- FALM-1
- "Platan-M1"
- "Atoll"
- ALOK-1 - device for laser blood irradiation

2) based on semiconductor lasers operating in a continuous mode of generation of radiation with a wavelength of 0.67-1.3 μm and an output power of 1-50 mW:

ALTP-1, ALTP-2
- "Isel"
- "Mazik"
- "Vita"
- "Bell"

3) based on semiconductor lasers operating in a pulsed mode of generation of radiation with a wavelength of 0.8-0.9 μm, a pulse power of 2-15 W:

- "Pattern", "Pattern-2K"
- "Lazurit-ZM"
- "Luzar-MP"
- "Nega"
- "Azor-2K"
- "Effect"

Magnetic laser therapy devices:

- "Mlada"
- AMLT-01
- "Svetoch-1"
- "Azure"
- "Erga"
- MILTA - magneto-infrared

Technique and technique of laser radiation

The impact of LI is carried out on the lesion focus or organ, segmental-metameric zone (cutaneous), biologically active point. In the treatment of deep caries and pulpitis by the biological method, irradiation is carried out in the area of ​​the bottom of the carious cavity and the neck of the tooth; periodontitis - the light guide is inserted into the root canal, previously mechanically and medically treated, and advanced to the apex of the tooth root.

The technique of laser irradiation is stable, stable-scanning or scanning, contact or remote.

Dosage

Responses to LI depend on dosing parameters:

Wavelength;
- methodology;
- operating mode - continuous or impulse;
- intensity, power density (PM): low-intensity LI - soft (1-2 mW) is used to influence reflexogenic zones; medium (2-30 mW) and hard (30-500 mW) - on the area of ​​the pathological focus;
- exposure time to one field - 1-5 minutes, total time no more than 15 minutes. daily or every other day;
- The course of treatment is 3-10 procedures, repeated in 1-2 months.

Safety engineering

The eyes of the doctor and the patient are protected with glasses SZS-22, SZO-33;
- do not look at the source of radiation;
- the walls of the office must be matte;
- press the "start" button after installing the emitter on the pathological focus.

Durnov L.A. *, Grabovshchiner A.Ya. **, Gusev L.I. *, Balakirev S.A. *
* Russian Cancer Research Center named after V.I. N.N. Blokhin, Russian Academy of Medical Sciences;
** Association "Quantum Medicine", Moscow

Often in the literature on low-intensity laser therapy for various diseases, oncology is in the first place in the list of contraindications. This approach to cancer is due to the fact that the effect of low-intensity laser radiation (LLLT) on malignant neoplasms is still unclear. Researchers have been studying this factor since the late 70s.

Studies carried out by various scientists have shown the following negative results of such an impact.

• Stimulation of the growth of Ehrlich ascites carcinoma cells in in vitro experiments was observed when exposed to a He-Ne laser (Moskalik K. et al. 1980).
• A stimulating effect on a tumor of various types of LILI was found in tumor-bearing animals (Moskalik K. et al. 1981).
• Stimulation of the growth of Harding-Nassi melanoma, adenocarcinoma 765 and sarcoma 37 was observed when exposed to He-Ne (633 nm) and pulsed nitrogen lasers (340 nm) (Ilyin A 1980, 1981, 1983; Pletnev S. 1980, 1985, 1987).
• Stimulation of the growth of benign mammary gland tumors in experimental rats was obtained by exposure to a He-Ne laser (Panina N. et al., 1992).
• Stimulation of growth and an increase in the frequency of metastasis of such tumors as: Pliss lymphosarcoma, B-16 melanoma, Ehrlich's ascites carcinoma, Lewis lung adenocarcinoma, were observed when exposed to a He-Ne laser (Zyryanov B. 1998).
• Stimulation of growth in some cases and inhibition in others were noted during experiments on the effect of LILI (480 nm and 640 nm) on cultured cells of human malignant tumors (melanoma, breast and colon tumors) (Dasdia T. et al. 1988).

Similar results were obtained when LLLT was exposed to colonies of various malignant cells with an argon laser or a dye laser pumped by an argon laser with a power density of 8.5-5.0 mW / cm KB (Fu-Shou Yang et.al., 1986).

On the other hand, the studies carried out have proven the positive results of such an impact.

• Inhibition of transplanted tumors under irradiation with a cadmium-helium laser (440 nm) at a diabetes mellitus of 30 J (Ilyina AI., 1982).
• The inhibitory effect of the helium-neon laser on living cells of Lewis carcinoma is higher with an earlier onset and longer duration of the course of irradiation (Ivanov AV, 1984; Zakharov SD, 1990).
• When exposed to a semiconductor laser (890 nm) on transplantable Walker's sarcoma in rats and breast cancer in mice, a 37.5% slowdown in tumor growth was noted with a DM of 0.46 J / cm2, whereas with a DM of 1.5 J / cm2, the effect was not discovered (Mikhailov V.A., 1991).
• In the case of non-radically removed soft tissue sarcoma in operated animals followed by irradiation with a helium-neon laser, inhibition of the tumor process was noted. An increase in the life span of animals was recorded twice compared with the control group (Dimant IN, 1993).
• Pronounced changes in the structure of the primary tumor, up to the death of the cellular elements of the tumor, were recorded during laser irradiation of blood. Metastases in these animals were significantly less than in the control group (Gamaleya N.F., 1988).

We cited the results of experimental studies in order to make it clear why it is impossible to influence LLLT on neoplasms in the clinic, since the results are unpredictable.

As a result of scientists' research, the biological effects of low-intensity laser radiation (LILI) are described, which are of great importance in practical medicine, since, unlike high-power laser radiation, LILI does not damage the tissues of the body. On the contrary, low-intensity laser radiation has an anti-inflammatory, immunocorrective, analgesic effect, promotes wound healing, and restores balance between the components of the nervous system. The source of the variety of these effects is the mechanisms of the body's response to laser radiation.

Laser radiation is perceived by photo-acceptors, or, more simply, special sensitive molecules involved in maintaining balance inside the cell, every human cell. After the interaction of laser radiation and a sensitive molecule in the cell, the metabolism and energy is activated, which makes it possible for it to fully perform its functions, and at a certain stage of development - to divide, forming healthy offspring.

The method of exposure to low-intensity laser radiation on the body depends on the type and location of the pathological process. There are the following methods of laser therapy: 1) laser blood irradiation, 2) external (percutaneous) exposure, 3) laser reflexotherapy (LILI effect on acupuncture points, 4) intracavitary exposure.

Laser irradiation of blood.

This technique was developed in the 80s at the Novosibirsk Research Institute of Circulatory Pathology under the leadership of Academician E.N. Meshalkin and was originally used as intravascular laser blood irradiation (ILBI) (Meshalkin E.N. et al. 1981, Korochkin I.M. et al. 1984). The mechanism of the therapeutic action of laser blood irradiation is common in various pathologies (Gafarova GA et al. 1979). The pronounced effect of laser irradiation of blood is associated with the influence of LILI on metabolism. At the same time, the oxidation of energy materials - glucose, pyruvate, lactate, increases, which leads to an improvement in microcirculation and oxygen utilization in tissues. Changes in the microcirculation system are associated with vasodilation and a change in the rheological properties of blood due to a decrease in its viscosity and a decrease in the aggregate activity of erythrocytes. It is noted that when the fibrinogen level is exceeded by 25-30%, after laser exposure, it decreases by 38-51%, and at its low rates before treatment, it increases by 100% (Korochkin I.M. et al. 1984 , Moskvin S.V. et al. 2000).

Laser irradiation of blood has a stimulating effect on hematopoiesis in the form of an increase in the amount of hemoglobin, erythrocytes and leukocytes (Gamaleya NF 1981, Gamaleya NF et al. 1988). There is a stimulation of the nonspecific defense system - the functional and phagocytic activity of lymphocytes increases. It is interesting that the stimulation of T-cells is more pronounced during irradiation of blood lymphocytes of cancer patients than when they are irradiated in healthy people (Gamaleya NF et al. 1986, Pagava KI 1991).

When exposed to LLLT on the blood, the T-system of the immune system is stimulated. The helper activity increases and the suppressor activity of T-lymphocytes decreases, the content of B-lymphocytes normalizes, the CEC level decreases, the imbalance of immunoglobulins is eliminated (Meshalkin EN 1983, Zyryanov BN et al. 1998). The immunocorrective effect of laser irradiation of blood is explained by an increase in the production by blood cells of the endogenous immune mediator interleukin-1 (IL-1) (Zhiburt EB et al. 1998). Research carried out at the Russian Cancer Research Center of the Russian Academy of Medical Sciences confirms these data. Mononuclear cells (MNCs) were exposed to LILI for 20 and 40 min. As a result, when studying the cytotoxicity of MNCs, it was found that exposure to laser radiation for 20 min. does not lead to a significant increase in the killer properties of MNC donors. An increase in the ability of donor MNCs to lyse tumor cells of the K-562 line was noted with an increase in radiation exposure up to 40 min. Under these conditions, the cytolytic potential of MNCs increased on average from 31 ± 8% to 57 ± 5% (p

Exposure to laser radiation increases the ability of MNCs to release IL-1 and TNF. In particular, with an exposure of 20 min. there is a tendency to an increase in the concentration of the studied cytokines in the supernatant of MNCs compared with the initial level, and an increase in the exposure time leads to a more pronounced ability of MNCs of donors to release IL-1 and TNF.

Thus, LLLT leads to the activation of MNCs in the blood of donors, i.e. increases their cytotoxic activity and induces the ability of MNCs to release cytokines (IL-1 and TNF), which play an important role in the development of the body's immune response (Durnov LA et al. 1999).

Table 1
Effect of laser radiation on cytotoxic activity (%) of mononuclear cells and induction of cytokine release (pg / ml)

The present study was carried out using the MILTA apparatus in the mode: frequency 5000 Hz, exposure duration of the session 5 min. The research will be continued. it seems interesting to investigate the 50 and 1000 Hz modes and the exposure time interval of 2 minutes.

With the development of laser technology, intravascular laser irradiation of blood has been replaced by a supravascular (percutaneous) effect on the blood. For intravascular blood irradiation, low-power helium-neon (He-Ne) lasers were usually used, requiring replaceable disposable quartz-polymer fibers. This is due to the fact that a certain technical difficulty was represented by the impact on relatively deeply located structures (in particular, vessels), since the penetration depth of laser radiation is small. It depends on the wavelength (from 20 microns in the violet part of the spectrum to 70 mm in the near infrared), and the need to "reach" the deeper tissues requires an increase in the power of exposure. This problem is successfully solved in laser devices operating in a pulsed mode. The most proven in this respect are gallium arsenide (Ga-As) lasers operating in high-frequency pulsed mode.

The duration of the flash of a pulsed laser is milliseconds, which makes it possible to influence the tissue with the power required to irradiate deep structures without the risk of damaging the surface structures.

Modern laser devices are equipped with special magnetic attachments with an optimal form of constant magnetic field (PMF). In addition to the therapeutic effect of magnetotherapy, PMF gives a certain orientation to molecular dipoles, aligning them along their lines of force directed deep into the irradiated tissues. This leads to the fact that the bulk of the dipoles are located along the light flux, contributing to an increase in the depth of its penetration (Illarionov V.E., 1989). Mostovnikov V.A. et al (1981) explain the effect of high biological activity of two physical factors by the fact that their effect on membranes and cell components involved in the regulation of metabolic processes leads to a rearrangement of the spatial structure of the membrane and, as a consequence, its regulatory functions.
The therapeutic effect of the CLOK is explained by the following factors:

• Improvement of microcirculation: aggregation of platelets is inhibited, their flexibility increases, the concentration of fibrinogen in plasma decreases and fibrinolytic activity increases, blood viscosity decreases, rheological properties of blood improve, and tissue oxygen supply increases.
• Reduction or disappearance of ischemia in organ tissues. Cardiac output increases, total peripheral resistance decreases, and coronary vessels dilate.
• Normalization of energy metabolism of cells subjected to hypoxia or ischemia, preservation of cellular hemostasis.
• Anti-inflammatory effect due to inhibition of the release of histamine and other mediators of inflammation from mast cells, normalization of capillary permeability, reduction of edema and pain syndromes.
• Correction of immunity: an increase in the total level of T-lymphocytes, lymphocytes with suppressor activity, an increase in the content of T-helpers in the absence of a decrease in the level of leukocytes in the peripheral blood.
• Influence on the processes of lipid peroxidation in blood serum: a decrease in the content of malondialdehyde, diene conjugates, cipher bases and an increase in tocopherol in the blood.
• Normalization of lipid metabolism: an increase in lipoprotein lipase, a decrease in the level of atherogenic lipoproteins.

Experimental and clinical studies have shown that the effectiveness of percutaneous laser blood irradiation (PLC) and ILBI is approximately the same (Koshelev V.N. et al. 1995). However, the simplicity of the PLC technique, non-invasiveness, the availability of conduction in any conditions, high therapeutic efficacy - all these factors have made it possible to widely introduce PLC into medical practice.

Percutaneous laser blood irradiation is used as an analgesic, antioxidant, desensitizing, biostimulating, immunostimulating, immunocorrecting, detoxifying, vasodilating, antiarrhythmic, antibacterial, antihypoxic, decongestant and anti-inflammatory agent (Moskvin. 2000).

Scientists from the Tomsk Research Institute of Oncology were among the first researchers to study the effectiveness of laser blood irradiation in cancer patients. When working out the regime of laser exposure, an exposure of 30 min was used. and 60 min. once within 5 days. There were no significant differences in these groups. No complications and side effects were recorded. An acceleration of the healing of postoperative wounds was noted, and the analysis of long-term results showed that the frequency and timing of recurrence in the group of patients who underwent laser blood irradiation were significantly lower than in the control group.

At the Research Institute of Pediatric Oncology and Hematology of the Russian Cancer Research Center of the Russian Academy of Medical Sciences, the effectiveness of PLCC was studied by studying the dynamics of cellular immunity in children who received chemotherapy for various malignant neoplasms. LLLT was applied to large vessels in the cubital and popliteal areas. The LLLT frequency is 50 Hz, the time interval for older children was 15 ... 20 minutes. (blood irradiation was carried out by two terminals simultaneously). A total of 2 to 4 sessions were carried out. In patients who received more than 2 sessions, an increase in the number of mature T-lymphocytes, T-suppressors and lymphocytes was noted. There is a clear tendency towards positive dynamics. Complications and side effects were not observed in any patient. For young children, the LLLT dose is calculated individually.

The frequency of 50 Hz for laser irradiation of blood was not chosen by chance. Researchers Zemtsev I.Z. and V.P. Lapshin (1996), studying the mechanisms of cleaning the surface of biomembranes from toxic substances, found that depolarization of membrane activity (as a result of laser irradiation of blood), accompanied by their "washing", occurs at a LLLT pulse frequency below 100 Hz.

External (local) impact.

When the pathological focus is localized on the skin or visible mucous membranes, the LILI effect is carried out directly on it. At the Research Institute of Pediatric Oncology and Hematology, low-intensity laser therapy is widely used in the treatment of stomatitis, inflammation of the nasopharynx, phlebitis, long-term non-healing postoperative wounds, and bedsores. More than 280 patients have been treated. Damage to the oral mucosa and gastrointestinal tract is a serious problem for children receiving chemotherapy treatment. The mucous membrane of the oral cavity with stomatitis is painful, defects of different sizes and depths are formed on it, which limits or makes it completely impossible to eat. In severe cases, this leads to a long interruption in anticancer therapy. In the treatment of stomatitis, rinses from decoctions of herbs, solutions of drugs have been and are used, but these funds require a long investment of time. As a rule, the effect of this type of treatment is noted on the 7-10th day. When treating LILI, the effect is achieved on the 3-5th day.

In the treatment of post-radiation skin reactions, a positive effect has been achieved in all cases. Comparison of the time of complete disappearance of local manifestations in children who underwent polyfactorial quantum (magneto-infrared laser) therapy with historical control showed that under the influence of LILI, the recovery time was reduced by 28%.

The main contraindications for percutaneous laser blood irradiation are blood diseases with bleeding syndrome, thrombocytopenia below 60,000, acute fevers, coma, active tuberculosis, hypotension, decompensated states of the cardiovascular, excretory, respiratory and endocrine systems.

With the local treatment of such complications of chemotherapy and radiation therapy as stomatitis, gingivitis, radioepitheliitis, as well as bedsores, sluggish current wound processes, the above diseases and conditions are not an absolute contraindication.

Zones of localization of the malignant process are an absolute contraindication for the local use of LILI.