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LLLT Research Abstract Archives

Effect of low-intensity laser therapy on mast cell degranulation in human oral mucosa.

Sawasaki  I, Geraldo-Martins  VR, Ribeiro  MS, Marques  MM

Department of Oral Pathology, School of Dentistry, Londrina State University, Londrina, Parana, Brazil.

Little is known about the physiological mechanisms related to low-intensity laser therapy (LILT), particularly in acute inflammation and subsequent wound healing. The objective of this study was to verify the effect of LILT on mast cell degranulation. Epulis fissuratum tissues from eight patients were used. One part of the lesion was irradiated with an AsGaAl laser (lambda = 670 nm, 8.0 J/cm(2), 5 mW, 4 min). The other part was not irradiated. Then, the specimens were immediately removed, fixed and examined by light microscopy. The number of mast cells was similar in laser-treated samples when compared with non-irradiated specimens. The degranulation indexes of the mast cells observed in the irradiated samples were significantly higher than those of controls (P < 0.05). LILT with the parameters used increased the number of degranulated mast cells in oral mucosa.

Lasers Med Sci 2007 Dec 15 


Enamel matrix derivative and low-level laser therapy in the treatment of intra-bony defects: a randomized placebo-controlled clinical trial.

Ozcelik  O, Cenk Haytac  M, Seydaoglu  G

Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey.

Aim: The aim of this study was to evaluate the immediate post-operative pain, wound healing and clinical results after the application of an enamel matrix protein derivative (EMD) alone or combined with a low-level laser therapy (LLLT) for the treatment of deep intra-bony defects.

Material and Methods: This study was an intra-individual longitudinal test of 12 months' duration conducted using a blinded, split-mouth, placebo-controlled and randomized design. In 22 periodontitis patients, one intra-bony defect was randomly treated with EMD+LLLT, while EMD alone was applied to the contra-lateral defect site. LLLT was used both intra- and post-operatively. Clinical measurements were performed by a blinded periodontist at the time of surgery, in the first week and in the first, second, sixth and 12th month. Visual analogue scale (VAS) scores were recorded for pain assesment.

Results: The results have shown that the treatment of intra-bony defects with EMD alone or EMD+LLLT leads to probing depth reduction and attachment-level gain. In addition, EMD+LLLT had resulted in less gingival recession (p<0.05), less swelling (p<0.001) and less VAS scores (p<0.02) compared with EMD alone.

Conclusion: This study shows that EMD is an effective, safe and predictable biomaterial for periodontal regeneration and LLLT may improve the effects of EMD by reducing post-operative complications.

J Clin Periodontol 2007 Dec 13 


GaAlAs (830 nm) low-level laser enhances peripheral endogenous opioid analgesia in rats.

Hagiwara  S, Iwasaka  H, Okuda  K, Noguchi  T

Department of Brain and Nerve Science, Anesthesiology, Oita University Faculty of Medicine, 1-1 Idaigaoka-Hasamamachi-Yufu City-Oita 879-5593, Japan.

BACKGROUND: Low-level laser therapy (LLLT) has been reported to relieve pain with minimal side effects. Recent studies have demonstrated that opioid-containing immune cells migrate to inflamed sites and release beta-endorphins to inhibit pain as a mode of peripheral endogenous opioid analgesia. The present study investigates whether LLLT may enhance peripheral endogenous opioid analgesia.

METHODS: The effect of LLLT on opioid analgesia and production was evaluated in vivo in a rat model of inflammation as well as in vitro in Jurkat cells, a human T-cell leukemia cell line. mRNA expression of the beta-endorphin precursors proopiomelanocortin and corticotrophin releasing factor was assessed by reverse transcription polymerase chain reaction.

RESULTS: LLLT produced an analgesic effect in inflamed peripheral tissue which was transiently antagonized by naloxone. Beta-endorphin precursor mRNA expression increased with LLLT, both in vivo and in vitro.

CONCLUSION: This study demonstrates that LLLT produces analgesic effects in a rat model of peripheral inflammation. We further revealed an additional mechanism of LLLT-mediated analgesia via enhancement of peripheral endogenous opioids. These findings suggest that LLLT induces analgesia in rats by enhancing peripheral endogenous opioid production in addition to previously reported mechanisms. Lasers Surg. Med. 39:797-802, 2007. (c) 2007 Wiley-Liss, Inc.

Lasers Surg Med 2007 Dec 39(10) 797-802


Effect of low-level laser therapy on bone repair: Histological study in rats.

Pretel  H, Lizarelli  RF, Ramalho  LT

Department of Orthodontics and Pediatric Dentistry, School of Dentistry of Araraquara, Sao Paulo State University (UNESP), Araraquara, SP, Brazil.

BACKGROUND AND OBJECTIVES: Bone remodeling is characterized as a cyclic and lengthy process. It is currently accepted that not only this dynamics is triggered by a biological process, but also biochemical, electrical, and mechanical stimuli are key factors for the maintenance of bone tissue. The hypothesis that low-level laser therapy (LLLT) may favor bone repair has been suggested. The purpose of this study was to evaluate the bone repair in defects created in rat lower jaws after stimulation with infrared LLLT directly on the injured tissue.

STUDY DESIGN/MATERIALS AND METHODS: Bone defects were prepared on the mandibles of 30 Holtzman rats allocated in two groups (n = 15), which were divided in three evaluation period (15, 45, and 60 days), with five animals each. control group-no treatment of the defect; laser group-single laser irradiation with a GaAlAs semiconductor diode laser device (lambda = 780 nm; P = 35 mW; t = 40 s; Theta = 1.0 mm; D = 178 J/cm(2); E = 1.4 J) directly on the defect area. The rats were sacrificed at the pre-established periods and the mandibles were removed and processed for staining with hematoxylin and eosin, Masson's Trichrome and picrosirius techniques.

RESULTS: The histological results showed bone formation in both groups. However, the laser group exhibited an advanced tissue response compared to the control group, abbreviating the initial inflammatory reaction and promoting rapid new bone matrix formation at 15 and 45 days (P<0.05). On the other hand, there were no significant differences between the groups at 60 days.

CONCLUSION: The use of infrared LLLT directly to the injured tissue showed a biostimulating effect on bone remodeling by stimulating the modulation of the initial inflammatory response and anticipating the resolution to normal conditions at the earlier periods. However, there were no differences between the groups at 60 days. Lasers Surg. Med. 39:788-796, 2007. (c) 2007 Wiley-Liss, Inc.

Lasers Surg Med 2007 Dec 39(10) 788-96


Depth of penetration of an 850nm wavelength low level laser in human skin.

Esnouf  A, Wright  PA, Moore  JC, Ahmed  S

School of Health Sciences and Social Care, Brunel University, Uxbridge Campus, UB8 3PH, UK. alan.esnouf@brunel.ac.uk

Low Level Laser Therapy is used for a wide variety of conditions including superficial skin sores, musculoskeletal and joint problems, and dentistry. Knowledge of the penetration depth of laser radiation in human skin is an essential prerequisite to identifying its method of action. Mathematical simulations and estimates from the literature suggest that the depth of penetration of laser radiation using wavelengths from 630nm up to 1100nm may be up to 50mm. The aim of this study is to directly measure the penetration depth of a Low Level Laser in human tissue. Human abdominal skin samples up to 0.784mm thickness were harvested by dermatome following abdominoplasty procedures. These samples were irradiated by a Gallium Aluminium Arsenide Laser (Wavelength 850nm near infra-red invisible light, 100mW, 24kHz, 0.28mm diameter probe) and the transmitted radiation measured with an Ophir Optronics 'Nova' external energy meter. The intensity of laser radiation reduced by 66% after being transmitted through a 0.784mm sample of human abdominal tissue. In this study most laser radiation was absorbed within the first 1mm of skin.

Acupunct Electrother Res 2007 32(1-2) 81-6


308-nm excimer laser for the treatment of alopecia areata.

Al-Mutairi  N

Department of Dermatology, Farwaniya Hospital, Farwaniya, Kuwait. nalmut@usa.net

BACKGROUND: Alopecia areata is loss of hair from localized or diffuse areas of hair-bearing area of the skin. Recently there are reports of efficacy of the 308-nm excimer radiation for this condition.

OBJECTIVE: To study the effect of the 308-nm excimer laser in the treatment of alopecia areata.

MATERIALS AND METHODS: Eighteen patients with 42 recalcitrant patches (including 1 adult with alopecia totalis) were enrolled in this study. The lesions were treated with the 308-nm excimer laser twice a week for a period of 12 weeks; one lesion on each patient was left as a control for comparison.

RESULTS: There were 7 males and 11 females in this study. Regrowth of hair was observed in 17 (41.5%) patches. Thirteen of the 18 lesions in scalp showed a complete regrowth of hair. The extremity regions failed to show a response. Atopic diatheses had an unfavorable effect on the outcome in our patients.

CONCLUSION: The 308-nm excimer laser is an effective therapeutic option for patchy alopecia areata of the scalp and for some cases with patchy alopecia areata of the beard area. It does not work for patchy alopecia areata of the extremities.

Dermatol Surg 2007 Dec 33(12) 1483-7


The minimal erythema dose of broadband ultraviolet B in Taiwanese.

Li  YW, Chu  CY

Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.

The purpose of this study was to determine the cutaneous response to UVB radiation in Taiwanese subjects. The relationships among minimal erythema dose (MED) of broadband UVB, Fitzpatrick's skin phototype, and skin color were examined in 61 healthy Taiwanese volunteers. Thirty-one females and 30 males were enrolled. Overall, the mean MED was 142.3 mJ/cm(2); there was no significant gender difference. The mean MEDs of subjects with Fitzpatrick skin types II, III, IV and V were 122.9 mJ/cm(2), 136.2 mJ/cm(2), 148.3 mJ/cm(2) and 165.0 mJ/cm(2), respectively. Both the mean MEDs and the lower MED limits increased with skin phototypes. To identify patients with abnormal photosensitivity, physicians could use these lower limits as reference values. In addition, different starting doses of broadband UVB phototherapy could be used for different skin phototypes.

J Formos Med Assoc 2007 Nov 106(11) 975-8


The effect of intravenous laser irradiation of blood on the system hemodynamics of patients with chronic obstructive bronchitis exacerbation

Burduli  NM, Aksenova  IZ

The aim of the study was to evaluate the effects of intravenous laser irradiation of blood (ILIB) on system hemodynamics in patients with chronic obstructive bronchitis (COB) exacerbation. Ninety-seven patients with COB exacerbation were divided into two comparable groups. The 47 patients of the control group received conventional medication, while the 50 patients of the main group received the same therapy plus ILIB, which consisted of 10 everyday 20-min procedures. Central hemodynamic variables were measured prior to and after the treatment. The results demonstrated higher effectiveness of COB treatment when ILIB was applied and that ILIB itself had a positive effect on system circulation in COB exacerbation by changing hyperkinetic hemodynamics into normokinetic one. The study shows that it is appropriate to include ILIB into treatment of COB.

Klin Med (Mosk) 2007 85(9) 58-61


An evaluation of laser photobiostimulation as a factor supporting rehabilitation in spinal pain syndromes.

Janiszewski  M, Furmanska-Rozlau  A

Klinika Rehabilitacji, Centrum Medycznego Ksztalcenia Podyplomowego, Otwock.

Spinal pain can afflict both the sick and the healthy, even those with an anatomically correct spine. Such complaints force many people to change profession or even go on disability pension. Both the social and professional aspects are very important, then, in the rehabilitation of these people, since spinal pain syndromes impair the patient's locomotor capacity and his/her ability to work for a living. In view of this, medical rehabilitation takes on particular important, and especially the laser photobiostimulation technique in use for several years now. Biostimulating lasers have analgesis, anti-inflammatory, and antiallergenic effects, and relieve muscle cramps; they also improve metabolism and regenerate cells and tissue. Laser photobiostimulation is an effective, quick, aseptic therapy, with no age limitations or side effects.

Ortop Traumatol Rehabil 2000 Jun 30 2(2) 69-71


Activation of latent TGF-beta1 by low-power laser in vitro correlates with increased TGF-beta1 levels in laser-enhanced oral wound healing.

Arany  PR, Nayak  RS, Hallikerimath  S, Limaye  AM, Kale  AD, Kondaiah  P

Molecular Reproduction Development and Genetics, Indian Institute of Science, Bangalore, Karnataka, India, and Department of Oral and Maxillofacial Pathology, K.L.E.'s Institute of Dental Sciences, Belgaum, Karnataka, India.

The term Laser "Photobiomodulation" was coined to encompass the pleiotropic effects of low-power lasers on biological processes. The purpose of this study was to investigate whether transforming growth factor (TGF)-beta had a role in mediating the biological effects of low-power far-infrared laser irradiation. We assayed for in vitro activation using various biological forms of cell-secreted, recombinant, and serum latent TGF-beta using the p3TP reporter and enzyme-linked immunosorbent assays. We demonstrate here that low-power lasers are capable of activating latent TGF-beta1 and -beta3 in vitro and, further, that it is capable of "priming" these complexes, making them more amenable to physiological activation present in the healing milieu. Using an in vivo oral tooth extraction-healing model, we observed an increased TGF-beta1, but not beta3, expression by immunohistochemistry immediately following laser irradiation while TGF-beta3 expression was increased after 14 days, concomitant with an increased inflammatory infiltrate. All comparisons were performed between laser-irradiated wounds and nonirradiated wounds in each subject essentially using them as their own control (paired T-test p<0.05). Low-power laser irradiation is capable of activating the latent TGF-beta1 complex in vitro and its expression pattern in vivo suggests that TGF-beta play a central role in mediating the accelerated healing response.

Wound Repair Regen 2007 Nov-Dec 15(6) 866-74


Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial.

Gottschling  S, Meyer  S, Gribova  I, Distler  L, Berrang  J, Gortner  L, Graf  N, Shamdeen  MG

University Children's Hospital, Department of Pediatric Hematology and Oncology, Saarland University, Kirrbergerstr., 66421 Homburg, Germany.

To investigate whether laser acupuncture is efficacious in children with headache and if active laser treatment is superior to placebo laser treatment in a prospective, randomized, double-blind, placebo-controlled trial of low level laser acupuncture in 43 children (mean age (SD) 12.3 (+/-2.6) years) with headache (either migraine (22 patients) or tension type headache (21 patients)). Patients were randomized to receive a course of 4 treatments over 4 weeks with either active or placebo laser. The treatment was highly individualised based on criteria of Traditional Chinese medicine (TCM). The primary outcome measure was a difference in numbers of headache days between baseline and the 4 months after randomization. Secondary outcome measures included a change in headache severity using a 10cm Visual Analogue Scale (VAS) for pain and a change in monthly hours with headache. Measurements were taken during 4 weeks before randomization (baseline), at weeks 1-4, 5-8, 9-12 and 13-16 from baseline. The mean number of headaches per month decreased significantly by 6.4 days in the treated group (p<0.001) and by 1.0 days in the placebo group (p=0.22). Secondary outcome measures headache severity and monthly hours with headache decreased as well significantly at all time points compared to baseline (p<0.001) and were as well significantly lower than those of the placebo group at all time points (p<0.001). We conclude that laser acupuncture can provide a significant benefit for children with headache with active laser treatment being clearly more effective than placebo laser treatment.

Pain 2007 Nov 15 


Effects of intranasal phototherapy on nasal mucosa in patients with allergic rhinitis.

Koreck  A, Szechenyi  A, Morocz  M, Cimpean  A, Bella  Z, Garaczi  E, Raica  M, Olariu  TR, Rasko  I, Kemeny  L

Department of Dermatology and Allergology, University of Szeged, P.O. Box 427, H-6701 Szeged, Hungary; Department of Immunology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.

RATIONALE: Rhinophototherapy has been shown to be effective in the treatment of allergic rhinitis. Considering that phototherapy with ultraviolet light (UV) induces DNA damage, it is of outstanding importance to evaluate the damage and repair process in human nasal mucosa.

METHODS: We have investigated eight patients undergoing intranasal phototherapy using a modified Comet assay technique and by staining nasal cytology samples for cyclobutane pyrimidine dimers (CPDs), which are UV specific photoproducts.

RESULTS: Immediately after last treatment Comet assay of nasal cytology samples showed a significant increase in DNA damage compared to baseline. Ten days after the last irradiation a significant decrease in DNA damage was observed compared to data obtained immediately after finishing the treatment protocol. Difference between baseline and 10 days after last treatment was not statistically significant. Two months after ending therapy, DNA damage detected by Comet assay in patients treated with intranasal phototherapy was similar with that of healthy individuals. None of the samples collected before starting intranasal phototherapy stained positive for CPDs. In all samples collected immediately after last treatment strong positive staining for CPDs was detected. The number of positive cells significantly decreased 10 days after last treatment, but residual positive staining was present in all the examined samples. This finding is consistent with data reported in skin samples after UV irradiation. Cytology samples examined two months after ending therapy contained no CPD positive cells.

CONCLUSION: Our results suggest that UV damage induced by intranasal phototherapy is efficiently repaired in nasal mucosa.

J Photochem Photobiol B 2007 Dec 14 89(2-3) 163-9


Treatment of molluscum contagiosum with a pulsed dye laser: Pilot study with 19 children.

Binder  B, Weger  W, Komericki  P, Kopera  D

Department of Dermatology, Medical University, Graz, Austria.

Background: Molluscum contagiosum is a common, self-limiting viral disease of childhood caused by a poxvirus. Often the children themselves and their parents desire treatment for cosmetic reasons or because of pruritus. Laser therapy offers another option to the traditional methods of treatment.

Methods: 19 children aged between 2 and 13 years (median:6) with molluscum contagiosum were treated in a prospective, non-randomized pilot study with the flashlamp pumped pulsed dye laser (wave length:585 nm, pulse duration 0,45 ms, spot size 7 mm, energy density 6-7 J/cm(2)).

Results: All patients tolerated the laser treatment well. In 84.3% one laser treatment led to total remission. In 10.5% a further laser session was necessary and one patient was treated three times to achieve total remission.

Conclusions: Treatment of molluscum contagiosum with the flashlamp pulsed dye laser is a safe and efficient treatment modality.

J Dtsch Dermatol Ges 2007 Nov 9 


UVB phototherapeutic modalities.Comparison of two treatments for chronic plaque psoriasis.

Valkova  S

Department of Dermatology and Venereology, Pleven Medical University, 130 Dojran Str., 5800 Pleven, Bulgaria. soniderm@yahoo.com

BACKGROUND: Combination UVB phototherapeutic regimens were introduced to improve therapeutic results and reduce cumulative UVB doses.

OBJECTIVE: Broadband UVB and UVB + bergamot oil (UVBB) therapies in the treatment of psoriasis were compared with regard to: efficacy, side effects, mean number of procedures, mean UVB dose, and duration of remissions.

PATIENTS/METHODS: One hundred and ninety three (193) patients randomly divided into two groups were treated: Group I with UVB monotherapy and Group II with UVB and bergamot oil (UVBB).

RESULTS: Overall assessment of the efficacy of the two treatment regimens demonstrated no statistically significant differences in either the post-therapy PASI values (t = 0.27, p = 0.786) or the duration of remissions (t = 0.22, p = 0.904). However, significant differences in the number of procedures (t = 2.3, p = 0.04) and the cumulative UVB doses were established (t = 3.4, p = 0.004).

CONCLUSION: UVBB phototherapy significantly reduces the UVB doses and the duration of treatment for psoriatic patients.

Acta Dermatovenerol Alp Panonica Adriat 2007 Mar 16(1) 26-30


WITHDRAWN: Low level laser therapy for nonspecific low-back pain.

Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri S, Mortaz Hejri S, Jonaidi A

BACKGROUND: Low-back pain (LBP) and related disabilities are major public health problems and a major cause of medical expenses, absenteeism and disablement. Low level laser therapy (LLLT) can be used as a therapeutic intervention for musculoskeletal disorders such as back pain.

OBJECTIVES: To assess the effects of LLLT in patients with non-specific low-back pain and to explore the most effective method of administering LLLT for this disorder.

SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE and CINAHL from their start to January 2007 and EMBASE, AMED and PEDro from their start to 2005 with no language restrictions. We screened references in the included studies and in reviews of the literature and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts.

SELECTION CRITERIA: Only randomised controlled clinical trials (RCTs) investigating low level laser therapy as a light source treatment for non-specific low-back pain were included.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Consensus was used to resolve disagreements. Clinically and statistically homogeneous studies were pooled using the fixed-effect model; clinically homogeneous and statistically heterogeneous studies were pooled using the random-effects model.

MAIN RESULTS: Six RCTs with reasonable quality were included in the review. All of them were published in English. Because of clinical heterogeneity in study populations, interventions used and reported outcomes, meta-analysis was not possible to determine an overall effect for pain, disability and range of motion.Three studies (n=168) separately showed a significant pain relief effect of LLLT compared to sham therapy for sub-acute and chronic low-back pain. These effects were only observed at short-term and intermediate-term follow-ups. Long-term follow-ups were not reported. There was insufficient evidence to investigate the difference between LLLT and comparison groups for pain-related disability.There is insufficient evidence to determine the effectiveness of LLLT on anterior-posterior lumbar range of motion compared to control group in short-term follow-up. The relapse rate in the LLLT group was significantly lower than in the control group at six months follow-up period according to the findings of two trials.One study (n=50) reported a significant improvement in pain in LLLT group versus exercise therapy.

AUTHORS' CONCLUSIONS: No side effects were reported. However, we conclude that there are insufficient data to draw firm conclusions.There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, different wavelengths and different dosages. Comparison of different LLLT treatments will be more reasonable if dose calculation methods are harmonized.

Cochrane Database Syst Rev 2007 (4) CD005107


The effect of low reactive-level laser therapy (LLLT) with helium-neon laser on operative wound healing in a rat model.

Yasukawa A, Hrui H, Koyama Y, Nagai M, Takakuda K

Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan. akio@abox6.so-net.ne.jp

The effect of low reactive-level laser therapy (LLLT) with a He-Ne laser on operative wound healing was investigated in a rat model. 10-millimeter surgical wounds were created on the backs of Sprague Dawley rats, and animals were assigned to one of eleven groups (n=5). Ten groups received either 8.5 mW or 17.0 mW irradiation of 15 seconds LLLT a day with one of five different irradiation frequencies, i.e. daily (from the 1st to 6th day following surgery), every other day (the 1st, 3rd, and 5th day), on only the 1st day, on only the 3rd day, and on only the 5th day; the 1st day was the day following the surgery. The control group received no irradiation. A skin specimen was harvested from the dorsal thoracic region on the 7th day to measure the rupture strength. The control group had the lowest rupture strength (5.01 N), and the 17.0 mW every other day irradiation group had the highest rupture strength (13.01 N). Statistical differences were demonstrated in the 8.5 mW irradiation setting between the every other day irradiation group and the control group (p<0.05); and in 17.0 mW irradiation setting between the every day irradiation, the every other day, and the 1st day only groups vs. the control group (p<0.01). Histological examination demonstrated that wound healing in the 17.0 mW every other day irradiation group was promoted most significantly such as the prevention of excessive inflammation, increased formation of collagen fibers, and recovery in continuity of tissues. The control group showed poor wound healing and the other experimental groups showed intermediate healing. Thus LLLT with a He-Ne laser was found to promote the healing of operative wounds in the present rat model, in which the most favorable application of LLLT was the 17.0 mW setting of 15 seconds a day with a frequency of every other day.

J Vet Med Sci 2007 Aug 69(8) 799-806


Psoriasis of the face and flexures.

van de Kerkhof PC, Murphy GM, Austad J, Ljungberg A, Cambazard F, Duvold LB

Department of Dermatology, Radboud University Nijmegen Medical Centre, The Netherlands.

Facial and flexural psoriasis may impair the quality of life of psoriatic patients considerably. For the adequate management of psoriasis it is important to pay attention to lesions at these sensitive sites, which require an approach different to that for lesions on other sites in several respects. An extensive literature search was carried out to collect evidence-based data on facial and flexural psoriasis with respect to epidemiology, clinical aspects, pathogenetic factors and various treatments. Subsequently, a panel of experts, the Copenhagen Psoriasis Working Group (CPWG), discussed these aspects and several recommendations were formulated reconciling the evidence-based data. Facial psoriasis occurs in 17-46% of psoriatics and flexural psoriasis is experienced by 6.8-36% of patients with psoriasis. Therefore, psoriasis at these sites cannot be regarded as a rare manifestation. Facial psoriasis is a prognostic marker indicating a poor prognosis of psoriasis. Facial and flexural psoriasis cannot be regarded as distinct disease entities but rather as site variations. The clinical features of facial psoriasis suggest that there are three subtypes: hairline psoriasis, sebo-psoriasis and true facial psoriasis. Otitis externa and ocular manifestations should not be neglected. Evidence that microbiological factors may be relevant to facial and flexural psoriasis is virtually absent. For facial psoriasis the response to UV radiation is variable. At least 5% of psoriatics have photosensitive psoriasis. In these patients photosensitive diseases such as lupus erythematodes and polymorphic light eruption have to be excluded. Based on the literature assessment and working group discussions the CPWG concluded the following. (1) Low-potency topical corticosteroids, vitamin D3 analogues and calcineurin inhibitors are first choice treatments in facial and flexural psoriasis. Evidence for the efficacy of the first two modalities is at level 3 while it is at level 1 for the third one. An individualized approach is indicated; for example, in case of corticosteroid side effects in the past the other two modalities should be selected and in unstable psoriasis prone to irritation, monotherapy with vitamin D3 analogues should be avoided. (2) Antimicrobial treatments are not indicated for facial and flexural psoriasis. (3) Dithranol and tar treatment are not indicated as first-line treatment but only if the first-line options fail. (4) In case topical therapies are not effective, phototherapy and systemic treatments are indicated. (5) For future drug development the combination of vitamin D(3) analogues with low strength corticosteroids is recommended.

J Dermatolog Treat 2007 Sep 27  1-10


Narrow-band ultraviolet B phototherapy in patients with recalcitrant nodular prurigo.

Tamagawa-Mineoka R, Katoh N, Ueda E, Kishimoto S

Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kamigyo-ku, Kyoto, Japan. risat@koto.kpu-m.ac.jp

Management of nodular prurigo has been less than satisfactory. Conventional therapies such as systemic antihistamines and topical steroids have not been particularly successful. The effects of narrow-band ultraviolet B (NB-UVB) phototherapy in the treatment of various inflammatory dermatoses have been proven, however, no data exist on the efficacy and the duration of remission in NB-UVB monotherapy for nodular prurigo. The aim of this study was to evaluate the effect of NB-UVB phototherapy on recalcitrant nodular prurigo. NB-UVB phototherapy was performed once a week on 10 patients with recalcitrant nodular prurigo. The initial dose was 0.4 J/cm(2), and the dose was increased by 0.1 J/cm(2) for each treatment. The treatment was performed until the eruption was almost clear. In each patient, a mean cumulative dose of 23.88 J/cm(2) was applied over a mean of 24.3 irradiations. The mean maximum daily dose of ultraviolet B was 1.2 +/- 0.4 J/cm(2). NB-UVB phototherapy notably improved the eruption of nodular prurigo in all patients. Follow up at 1 year revealed that only one patient had relapsed. The remaining nine patients continued to derive long-term benefits. NB-UVB phototherapy appears to be an effective treatment for recalcitrant nodular prurigo, offering long-term benefits in the majority of those treated.

J Dermatol 2007 Oct 34(10) 691-5


Do utilization management controls for phototherapy increase the prescription of biologics?

Simpson GL, Yelverton CB, Rittenberg S, Feldman SR

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

The use of phototherapy for psoriasis has declined because of inconvenience, managed care disincentives, and poor reimbursements. However, phototherapy is safer than other options, and the efficacy rates for different methods of phototherapy are among the highest of all available treatment options. Phototherapy is also one of the least costly treatments for moderate-to-severe psoriasis. We hypothesize that utilization management controls on phototherapy shift patients to more expensive and risky systemic treatments. Reducing disincentives on phototherapy will benefit both patients and payors, while increasing physicians' ability to manage this debilitating disease.

J Dermatolog Treat 2006 17(6) 359-61


Laser Phototherapy (780 nm), a New Modality in Treatment of Long-Term Incomplete Peripheral Nerve Injury: A Randomized Double-Blind Placebo-Controlled Study.

Rochkind S, Drory V, Alon M, Nissan M, Ouaknine GE

Division of Peripheral Nerve Reconstruction, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel., Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel.

Objective: The authors conducted this pilot study to prospectively investigate the effectiveness of low-power laser irradiation (780 nm) in the treatment of patients suffering from incomplete peripheral nerve and brachial plexus injuries for 6 months up to several years.

Background Data: Injury of a major nerve trunk frequently results in considerable disability associated with loss of sensory and motor functions. Spontaneous recovery of long-term severe incomplete peripheral nerve injury is often unsatisfactory.

Methods: A randomized, double-blind, placebo-controlled trial was performed on 18 patients who were randomly assigned placebo (non-active light: diffused LED lamp) or low-power laser irradiation (wavelength, 780 nm; power, 250 mW). Twenty-one consecutive daily sessions of laser or placebo irradiation were applied transcutaneously for 3 h to the injured peripheral nerve (energy density, 450 J/mm(2)) and for 2 h to the corresponding segments of the spinal cord (energy density, 300 J/mm(2)). Clinical and electrophysiological assessments were done at baseline, at the end of the 21 days of treatment, and 3 and 6 months thereafter.

Results: The laser-irradiated and placebo groups were in clinically similar conditions at baseline. The analysis of motor function during the 6-month follow-up period compared to baseline showed statistically significant improvement (p = 0.0001) in the laser-treated group compared to the placebo group. No statistically significant difference was found in sensory function. Electrophysiological analysis also showed statistically significant improvement in recruitment of voluntary muscle activity in the laser-irradiated group (p = 0.006), compared to the placebo group.

Conclusion: This pilot study suggests that in patients with long-term peripheral nerve injury noninvasive 780-nm laser phototherapy can progressively improve nerve function, which leads to significant functional recovery.

Photomed Laser Surg 2007 Oct 25(5) 436-42


Effect of low fluence diode laser irradiation on the hydraulic conductivity of perfused trabecular meshwork endothelial cell monolayers.

Roberts CJ, Rivera BK, Grzybowski DM, Mahmoud AM, Weber PA

Department of Ophthalmology, The Ohio State University, Columbus 43210, USA. roberts.8@osu.edu

OBJECTIVE: To determine the effect of low-fluence diode laser irradiation upon the fluid perfusion characteristics of cultured human trabecular meshwork cell monolayers when placed in a specially designed testing apparatus and subjected to fluid flow driven by a hydrostatic pressure gradient.

METHODS: Two experimental series were conducted. In the first series, six low-fluence diode laser irradiation experiments were conducted using cultured human trabecular meshwork cell monolayers grown on filter supports. Upon reaching a steady state perfusion condition at approximately 5.0 mmHg, monolayers were irradiated at fluencies ranging from 0.2619 to 0.8571 J/cm2 using a diode laser (lambda=810 nm). Perfusion and data collection continued for 45 minutes post-irradiation, after which the monolayers were tested to determine post-experimental viability. Hydraulic conductivity values were analyzed for post-irradiation response in 2.5-minute intervals, grouped by viability. In the second series, a total of six irradiated experiments and six simultaneous nonirradiated control experiments were conducted. Fluence values of 0.3571 J/cm2 (n=3) and 0.4286 J/cm2 (n=3) were used. Hydraulic conductivity values were analyzed for post-irradiation response in 2.5-minute intervals, grouped by irradiated vs. nonirradiated control groups.

RESULTS: In the first series, analysis showed that the viable monolayers exhibited a statistically significant increase in hydraulic conductivity (p<0.001) from 10 minutes post-irradiation onward. The non-viable monolayers exhibited a statistically significant decrease in hydraulic conductivity. In the second series, irradiated groups showed a significant difference (p<0.001) from nonirradiated controls from 10 minutes post-irradiation onward.

CONCLUSION: Low-fluence diode laser irradiation increases hydraulic conductivity in viable perfused TM cell monolayers when compared to baseline values or simultaneous nonirradiated controls while decreasing hydraulic conductivity in nonviable monolayers.

Curr Eye Res 2007 Jul-Aug 32(7-8) 625-38


Photoadaptation of vitiliginous skin to targeted ultraviolet B phototherapy.

Rivard J, Hexsel C, Owen M, Strickland FM, Lim HW, Hamzavi I

Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA.

Background: Increasing doses of ultraviolet (UV) radiation are tolerated in patients with vitiligo, due to photoadaptation. In this pilot study, five patients with Fitzpatrick skin phototypes IV-VI with vitiligo received six treatments of targeted UVB phototherapy over a 3-week period.

Methods: To investigate photoadaptation, minimal erythema dose (MED) testing was conducted on treated and untreated vitiliginous and normal skin at baseline and after three and six treatments. One patient had unattainable MED values, and was hence excluded.

Results: Percent change in MED from before to after all treatments in vitiliginous skin ranged from 0% to 128%, with a mean of 48.8%.

Conclusion: The pilot phase of this study suggests possible photoadaptation of vitiliginous skin of some patients to targeted UVB phototherapy.

Photodermatol Photoimmunol Photomed 2007 Dec 23(6) 258-60


UV light and its interaction with cutaneous receptors.

Matz H

Department of Dermatology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. e_h_matz@netvision.net.il

Phototherapy (UV-A and UV-B) has become one of the most commonly used modalities for the treatment of a variety of skin diseases, although the action mechanisms have not been fully understood. Inhibition of DNA synthesis by UV radiation may be one of the therapeutic effects in proliferating skin diseases; however, phototherapy is also used for the treatment of allergic or autoimmune diseases.

Dermatol Clin 2007 Oct 25(4) 633-41


Effect of IR laser photobiomodulation on the repair of bone defects grafted with organic bovine bone.

Marquez Martinez ME, Pinheiro AL, Ramalho LM

School of Dentistry, Pernambuco University, Camaragibe, Pernambuco, Brazil.

A major problem on modern dentistry is the recovery of bone defects of different etiologies. Biomaterials are used to improve the repair of these defects. Previous studies have shown positive effects of Laser Photobiomodulation (LPBM) on the repair of both soft and bone tissues. This study assessed histologically the effect of LPBM on the repair of surgical defects on the femur of rats filled with lyophilized bovine bone. The animals were divided into three groups: group I (control); group II (graft); group III (graft + LPBM). The animals on the irradiated groups received 16 J/cm(2) per session divided into four points around the defect being the first irradiation immediately after surgery and repeated at every 48 h during 2 weeks. Animal death occurred 15, 21, and 30 days after surgery. The specimens were routinely processed and stained with H/E and Sirius red and analyzed by light microscopy. There was histological evidence of improved collagen fiber deposition at early stages of the healing; increased amount of well-organized bone trabeculae at the end of the experimental period on irradiated animals. It is concluded that LPBM has positive biomodulative effect on the healing process bone defects.

Lasers Med Sci 2007 Sep 20 


The effect of the association of NIR laser therapy BMPs, and guided bone regeneration on tibial fractures treated with wire osteosynthesis: Raman spectroscopy study.

Lopes CB, Pacheco MT, Silveira L Jr, Duarte J, Cangussu MC, Pinheiro AL

Laser Center, IP&D, FCS, UNIVAP, S.J. Campos, SP 12244-000, Brazil.

Bone fractures are lesions of different etiology; may be associated or not to bone losses; and have different options for treatment, such as the use of biomaterials, guided bone regeneration, techniques considered effective on improving bone repair. Laser therapy has also been shown to improve bone healing on several models. The association of these three techniques has been well documented by our group using different models. This study aimed to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA approximately 958cm(-1)) on the repair of complete tibial fractures in rabbits treated with wire osteosynthesis (WO); treated or not with laser therapy; and associated or not with the use of BMPs and/or Guided Bone Regeneration. Complete tibial fractures were created in 12 animals that were divided into four groups: WO; WO+BMPs; WO+laser therapy; and WO+BMPs+laser therapy. Irradiation started immediately after surgery; was repeated at every other day during 2 weeks; and was carried out with lambda 790nm laser light (4J/cm(2) per point, 40mW, phi approximately 0.5cm(2), 16J per session). Animal death occurred after 30 days. Raman spectroscopy was performed at both the surface and the depth of the fracture site. Statistical analysis showed significant difference on the concentrations of CHA between surface and depth. The analysis in each of the areas showed at the depth of the fracture significant differences between all treatment groups (p<0.0001). Significant differences were also seen between WO+BMPs+laser therapy and WO (p<0.001) and WO+laser therapy (p<0.001). At the surface, significant difference was seen only between the treatment groups and the non-fractured subjects (p=0.0001). However, no significant difference was seen between the treatment groups (p=0.14). It is concluded that the use of NIR laser therapy associated to BMPs and GBR was effective in improving bone healing on the fractured bones as a result of the increasing deposition of CHA measured by Raman spectroscopy.

J Photochem Photobiol B 2007 Oct 1 


Design of the laser acupuncture therapeutic instrument.

Li C, Zhen H

Sch. of Electr. Eng. & Autom., Harbin Inst. of Technol.

Laser acupuncture is defined as the stimulation of traditional acupuncture points with low-intensity, non-thermal laser irradiation. It has been well applied in clinic since the 1970s; however, some traditional acupuncture manipulating methods still cannot be implemented in the design of this kind of instruments, such as lifting and thrusting manipulating method, and twisting and twirling manipulating method, which are the essential acupuncture method in traditional acupuncture. The objective of this work was to design and build a low cost portable laser acupuncture therapeutic instrument, which can implement the two essential acupuncture manipulating methods. Digital PID control theory is used to control the power of laser diode (LD), and to implement the lifting and thrusting manipulating method. Special optical system is designed to implement twisting and twirling manipulating method. M5P430 microcontroller system is used as the control centre of the instrument. The realization of lifting and thrusting manipulating method and twisting and twirling manipulating method are technological innovations in traditional acupuncture coming true in engineering.

Conf Proc IEEE Eng Med Biol Soc 2006 1 4107-10


Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes? A Double Blind, Sham Controlled Randomized Trial to Evaluate Monochromatic Infrared Photo Energy.

Lavery LA, Murdoch DP, Williams J, Lavery DC

Department of Surgery, Texas A&M University Health and Science, Center College of Medicine, Scott and White Hospital, Temple, TX, USA.

Objective: To determine the efficacy of Anodyne Monochromatic Infrared Photo Energy (MIRE) in-home treatments over a 90-day period to improve peripheral sensation and self-reported quality of life in persons with diabetes mellitus.

Methods: This was a double blinded randomized, sham controlled clinical trail. We randomized 69 persons with diabetes and vibration perception threshold between 20-45 volts into two treatment groups. Patients were randomly assigned to active or sham treatment groups. Sixty patients (120 limbs) completed the study. Anodyne units were used at home every day for 40 minutes for 90 days. We evaluated nerve conduction velocities, vibration perception threshold, Semmes Weinstein Monofilaments (SWM) (4, 10, 26, and 60 gram monofilaments), the Michigan Neuropathy Screening Instrument (MNSI), 10 cm visual analog pain scale, and the Neuropathy Quality of Life Instrument. We used a nested repeated measures MANOVA design. Two sites (great toe and fifth metatarsal) were tested on both the left and right feet of each patient, so, two feet were nested within each patient, and two sites were nested within each foot. To analyze the ordinal SWM scores, we used a nonparametric factorial analysis for longitudinal data.

Results: There were no significant differences in measures for quality of life, Michigan Neuropathy Screening Instrument, VPT, SWM, or NCV's in active or sham treatment groups (p>0.05).

Summary: Anodyne MIRE therapy was no more effective than sham therapy in the treatment of sensory neuropathy in persons with diabetes.

Diabetes Care 2007 Oct 31 


Targeted UVB phototherapy for psoriasis: a preliminary study.

Lapidoth M, Adatto M, David M

Dermatological Laser Clinic, Herzliya Medical Center, Herzeliya, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Excimer laser treatment for psoriasis has been associated with good results at a lower cumulative dose than narrowband ultraviolet (UV)B protocols. To examine the clinical performance of a new targeted UVB lamp (290-320 nm; BCleartrade mark) in the treatment of plaque-type psoriasis, 28 consecutive patients attending a dermatology service were treated twice weekly with the UVB lamp for 6-18 sessions (median 10). UV doses were based on multiples of a predetermined minimal erythema dose (MED). MEDs ranged from 150 to 350 mJ/cm(2); maximal dose was 8 MED. Mean cumulative fluence until remission was 12.63 J/cm(2). The Psoriasis Severity Index (PSI) was measured every 2 weeks for 16 weeks. Mean PSI improvement during treatment peaked at 73% after 6 weeks, and declined to 63% at 16 weeks. At that point, 36% of the patients had a > 75% improvement in PSI, and 21% showed complete clearance. Targeted radiation with the UVB lamp is effective for the treatment of plaque-type psoriasis, requiring as few as six sessions and achieving moderately long remission. As treatment is selectively directed toward lesioned skin, normal surrounding skin is spared unnecessary radiation exposure.

Clin Exp Dermatol 2007 Nov 32(6) 642-5


Therapeutic effects of laser therapy in patients with silent myocardial ischemia

Krysiuk OB, Ponomarenko GN, Obrezan AG

The technique of registration of pain and vibration sensitivity providing early diagnosis of painless ischemic heart disease is described. Basing on evident pathogenetic direction of a therapeutic action of laser therapy to different links of pathogenesis of arterial hypertension and ischemic heart disease, therapeutic effects of laser therapy in patients with painless myocardial ischemia in combination with essential hypertension were studied.

Vopr Kurortol Fizioter Lech Fiz Kult 2007 Jul-Aug (4) 12-5


Effectiveness of narrow-band ultraviolet-B phototherapy for prevention of intimal hyperplasia in a rat carotid balloon injury model.

Kohyama S, Morimoto Y, Nakai K, Kaji T, Tokumaru A, Nawashiro H, Shima K, Satoh Y, Takishima K, Kikuchi M, Matsuo H

Department of Radiology, National Defense Medical College, Saitama, Japan 359-8513.

BACKGROUND AND OBJECTIVE: Narrow-band ultraviolet-B light (NBUVB) (313 nm) is known to have anti-proliferative effects, implying a potential treatment for intimal hyperplasia, but it remains to be ascertained. We assessed the effects of NBUVB irradiation for prevention of intimal hyperplasia.

STUDY DESIGN/MATERIALS AND METHODS: The rat carotid arteries were irradiated with NBUVB after balloon injury (BI), and the degree of intimal hyperplasia was histopathologically assessed. The anti-proliferative effects using cultured human smooth muscle cells were evaluated by flow cytometry and immunoblot analysis.

RESULTS: NBUVB (0.3-4.5 J/cm(2)) irradiation immediately after BI reduced the degree of intimal hyperplasia at 14 and 28 days after BI (P<0.001) without any obvious complications. Neither an increase in the number of medial cells nor upregulation of proliferating cell nuclear antigen was observed in the irradiated arteries. NBUVB irradiation at 2 or 14 days after BI significantly suppressed further intimal hyperplasia (P<0.01). NBUVB-irradiated cultured cells showed inhibited proliferation involved with G(1) and G(2)/M arrests. Increased expression of p53 and inhibition of retinoblastoma protein (pRB) phosphorylation were also seen in the NBUVB-irradiated cells.

CONCLUSIONS: These data suggest that NBUVB irradiation is an effective method for preventing intimal hyperplasia. The anti-proliferative effect is partly due to the cell cycle arrest caused by p53 expression and inhibited pRB phosphorylation.

Lasers Surg Med 2007 Sep 39(8) 659-66


The influence of laser irradiation with different power densities on incisional wound healing in healthy and diabetic rats

Kilik R, Bober J, Gal P, Vidinsky B, Mokry M, Longauer F, Sabo J

1. Chirurgicka klinika, Lekarska fakulta, Univerzity Pavla Jozefa Safarika v Kosiciach, Slovenska republika,

INTRODUCTION: The optimal parameters of low level laser therapy (LLLT) are still under debate. It has been documented that a dose or 5 J/cm2 would be capable to accelerate the wound healing process in patients. However, the optimal delivering form, i.e. power intensity, is unknown. Therefore, the aim of our study was to compare different power densities of LLLT.

MATERIALS AND METHODS: Sixteen male Sprague-Dawley rats were included in this experiment and randomized into two groups, normal healthy group and streptozotocine induced diabetic group. In general anesthesia four full thickness skin incisions were performed under standard aseptic conditions on the back of each rat and immediately closed using intradermal running suture. Three wounds were stimulated with diode laser (wavelength: 635 nm; daily dose 5 J/cm2; power densities: 1 mW/cm2, 5 mW/cm2 and 15 mW/cm2) each with different power density while the fourth wound served as control. Six days after surgery animals were sacrificed and samples removed for histological evaluation.

RESULTS: Our study demonstrated that LLLT positively influences wound healing. The most significant changes were observed in wounds stimulated at the highest power density 15 mW/cm2. Since using the highest power density the shortest time is needed to achieve the optimal daily dose of 5 J/cm2, it can be suggested that 15 mW/cm2 might be optimal parameter for such a therapy in patients.

Rozhl Chir 2007 Jul 86(7) 384-7


Treatment of lateral epicondylitis.

Johnson GW, Cadwallader K, Scheffel SB, Epperly TD

Family Medicine Residency of Idaho, Boise, USA. greg.johnson@fmridaho.org

Lateral epicondylitis is a common overuse syndrome of the extensor tendons of the forearm. It is sometimes called tennis elbow, although it can occur with many activities. The condition affects men and women equally and is more common in persons 40 years or older. Despite the prevalence of lateral epicondylitis and the numerous treatment strategies available, relatively few high-quality clinical trials support many of these treatment options; watchful waiting is a reasonable option. Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. Use of an inelastic, nonarticular, proximal forearm strap (tennis elbow brace) may improve function during daily activities. Progressive resistance exercises may confer modest intermediate-term results. Evidence is mixed on oral nonsteroidal antiinflammatory drugs, mobilization, and acupuncture. Patients with refractory symptoms may benefit from surgical intervention. Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective.

Am Fam Physician 2007 Sep 15 76(6) 843-8


Physical Therapy Interventions for Patients With Osteoarthritis of the Knee: An Overview of Systematic Reviews.

Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, Hagen KB

Norwegian Centre for the Health Services, PO Box 7004, St Olavs Plass, N-0130 Oslo, Norway.

Patients with osteoarthritis of the knee are commonly treated by physical therapists. Practice should be informed by updated evidence from systematic reviews. The purpose of this article is to summarize the evidence from systematic reviews on the effectiveness of physical therapy for patients with knee osteoarthritis. Systematic reviews published between 2000 and 2007 were identified by a comprehensive literature search. We graded the quality of evidence across reviews for each comparison and outcome. Twenty-three systematic reviews on physical therapy interventions for patients with knee osteoarthritis were included. There is high-quality evidence that exercise and weight reduction reduce pain and improve physical function in patients with osteoarthritis of the knee. There is moderate-quality evidence that acupuncture, transcutaneous electrical nerve stimulation, and low-level laser therapy reduce pain and that psychoeducational interventions improve psychological outcomes. For other interventions and outcomes, the quality of evidence is low or there is no evidence from systematic reviews.

Phys Ther 2007 Nov 6 


Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation.

Jaguar GC, Prado JD, Nishimoto IN, Pinheiro MC, de Castro DO Jr, da Cruz Perez DE, Alves FA

Department of Stomatology, Cancer Hospital A.C. Camargo, Sao Paulo, Brazil.

Aim: To evaluate the clinical effects of laser therapy on the prevention and reduction of oral mucositis in patients who underwent hematopoietic stem cell transplantation (HSCT).

Patients and methods: From January 2003 to September 2004, 24 patients received prophylactic laser therapy (L+ group). The applications started from the beginning of the conditioning regimen up to day +2. The oral assessment was performed daily until day +30. This group was compared with historical controls, namely 25 patients, who did not receive laser therapy (L- group).

Results: All patients developed some grade of mucositis. However, the L- group presented initial mucositis by 4.36 days, whereas the L+ group presented it in 6.12 days (P = 0.01). The maximum mucositis occurred between day +2 and day +6 with healing by day +25 in the L- group and between day +2 and day +7 with healing by day +14 for the L+ group (P = 0.84). Laser therapy also reduced the time of oral pain from 5.64 to 2.45 days (P = 0.04), and decreased the consumption of morphine (P = 0.07).

Conclusion: This study suggests that laser therapy can be useful in oral mucositis to HSCT patients and improve the patient's quality of life. However, controlled randomized trials should be performed to confirm the real efficacy of laser therapy.

Oral Dis 2007 Nov 13(6) 538-43


Irradiation with a 632.8 nm helium-neon laser with 5 J/cm2 stimulates proliferation and expression of interleukin-6 in diabetic wounded fibroblast cells.

Houreld N, Abrahamse H

Laser Research Group, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa.

BACKGROUND: The use of lasers has been shown to stimulate wound healing in vivo and in vitro. There is an increase in wound closure, cell viability, proliferation, and cytokine expression. If laser parameters can be optimized and standardized, and the underlying mechanisms better understood, this phototherapy can become an alternative safe treatment to slow-to-heal wounds, such as in patients with diabetes. This study aimed to determine the effect on cellular proliferation, migration, and cytokine [interleukin-6 (IL-6)] expression in diabetic and diabetic wounded fibroblast cells (WS1) post-laser irradiation.

METHODS: Diabetic and diabetic wounded WS1 cells were irradiated at 632.8 nm (23 mW) with 5 J/cm(2) or 16 J/cm(2). IL-6 level, cellular proliferation (neutral red assay), and morphology were then determined.

RESULTS: Diabetic cells irradiated with 5 J/cm(2) showed no significant change, while diabetic wounded cells showed an increase in IL-6 level, proliferation, and migration. On the other hand, diabetic and diabetic wounded cells irradiated with 16 J/cm(2) showed a significant decrease in proliferation and evidence of cellular damage, and wounded cells showed no migration.

CONCLUSION: This study showed that phototherapy at the correct fluence stimulates IL-6 expression, proliferation, and cellular migration in diabetic wounded cells. A fluence of 5 J/cm(2) stimulates diabetic wound healing in vitro, while 16 J/cm(2) is inhibitive.

Diabetes Technol Ther 2007 Oct 9(5) 451-9


Efficiency of a combination of haloaerosols and helium-neon laser in the multimodality treatment of patients with bronchial asthma

Faradzheva NA

A hundred and thirty-eight patients with infection-dependent bronchial asthma, including 73 with moderate persistent asthma and 65 with severe persistent one, were examined. Four modes of a combination of traditional (drug) therapy (DT) and untraditional (halotherapy (HT) and endobronchial helium-neon laser irradiation (ELI) one were used. The efficiency of the treatment performed was evaluated, by determining the time course of clinical symptoms of the disease on the basis of scores of their magnitude and the patients' condition. The findings indicated that in moderate persistent asthma, both HT and ELI in combination with DT exerted an equal therapeutic effect, which provided a good and excellent condition in 83.3% of cases. In severe persistent asthma, such a condition was achieved in 93.75% of cases only when multimodality treatment involving DT, HT, and ELI had been performed.

Probl Tuberk Bolezn Legk 2007 (8) 50-3


Ultraviolet A1 phototherapy for treatment of acrosclerosis in systemic sclerosis: controlled study with half-side comparison analysis.

Durand F, Staumont D, Bonnevalle A, Hachulla E, Hatron PY, Thomas P

Department of Dermatology, University Hospital of Lille, Lille, France.

Background: Treatments currently used in acrosclerosis for patients with systemic sclerosis (SS) are not very efficient and are associated with adverse effects. Several reports concern the efficacy of ultraviolet A1 (UVA1) phototherapy for localized scleroderma. Recent studies appear to indicate the interest of UVA1 in acrosclerosis for patients with SS. However, these studies are uncontrolled.

Objective: To determine whether UVA1 phototherapy is effective for acrosclerosis in SS with a randomized, investigator-blinded, controlled study.

Methods: Nine patients with SS completed the study. The duration of disease ranged from 6 to 21 years. None of them had received glucocorticoids or immunosuppressive agents. Low-dose UVA1 phototherapy (40 J/cm(2)) of the randomized hand was performed three times weekly over a period of 14 weeks. The other hand served as control. The clinical evaluation used a modified semiquantitative skin scoring system, the index flexion and extension, and a visual analog scale (VAS) was performed at baseline and after treatment.

Results: The mean of skin score and VAS improved significantly (P<0.05), but this improvement does not appear to be different between the treated or the untreated hands. There was no modification of the index flexion or extension. Two patients noticeably improved the functions of the treated hand. No side effects were observed.

Conclusions: These results suggest that UVA1 phototherapy does not improve cutaneous thickness in acrosclerosis even if few functional improvements, and some ulcerations healings can be occasionally observed. However, a larger scale trial is necessary to confirm this inefficiency.

Photodermatol Photoimmunol Photomed 2007 Dec 23(6) 215-21


Low-level light stimulates excisional wound healing in mice.

Demidova-Rice TN, Salomatina EV, Yaroslavsky AN, Herman IM, Hamblin MR

Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.

BACKGROUND: Low levels of laser or non-coherent light, termed low-level light therapy (LLLT) have been reported to accelerate some phases of wound healing, but its clinical use remains controversial.

METHODS: A full thickness dorsal excisional wound in mice was treated with a single exposure to light of various wavelengths and fluences 30 minutes after wounding. Wound areas were measured until complete healing and immunofluorescence staining of tissue samples was carried out.

RESULTS: Wound healing was significantly stimulated in BALB/c and SKH1 hairless mice but not in C57BL/6 mice. Illuminated wounds started to contract while control wounds initially expanded for the first 24 hours. We found a biphasic dose-response curve for fluence of 635-nm light with a maximum positive effect at 2 J/cm(2). Eight hundred twenty nanometer was found to be the best wavelength tested compared to 635, 670, and 720 nm. We found no difference between non-coherent 635+/-15-nm light from a lamp and coherent 633-nm light from a He/Ne laser. LLLT increased the number of alpha-smooth muscle actin (SMA)-positive cells at the wound edge.

CONCLUSION: LLLT stimulates wound contraction in susceptible mouse strains but the mechanism remains uncertain. Lesers Surg. Med. 39:706-715, 2007. (c) 2007 Wiley-Liss, Inc.

Lasers Surg Med 2007 Oct 39(9) 706-15


Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial.

Dell'anna ML, Mastrofrancesco A, Sala R, Venturini M, Ottaviani M, Vidolin AP, Leone G, Calzavara PG, Westerhof W, Picardo M

Spedali Civili, Brescia, Italy.

Background. Vitiligo is an acquired depigmenting disease with uncertain aetiopathogenesis, possibly associated with oxidative stress. Narrowband ultraviolet B phototherapy (NB-UVB) is the most widely used and effective treatment. Aim. To evaluate the clinical effectiveness of NB-UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool (AP).

Methods. Patients (n = 35) with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. The area and number of lesions, as well as some parameters of the oxidation-reduction (redox) status of the peripheral blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months, and at the end of the trial.

Results. In total, 28 patients completed the study. After 2 months of AP supplementation, the catalase activity and the production of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05 and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs. 18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P < 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs. placebo) of the basal value was observed in PBMCs. Finally, the AP intake maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 : 3.1; P < 0.05), counteracting phototherapy-induced saturation.

Conclusions. Oral supplementation with AP containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated oxidative stress.

Clin Exp Dermatol 2007 Nov 32(6) 631-6


Effectiveness of Nonpharmacological and Nonsurgical Interventions for Patients With Rheumatoid Arthritis: An Overview of Systematic Reviews.

Christie A, Jamtvedt G, Dahm KT, Moe RH, Haavardsholm EA, Hagen KB

National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vindern, 0319 Oslo, Norway.

CONCLUSIONS: based on systematic reviews of randomized controlled trials are considered to provide the highest level of evidence about the effectiveness of an intervention. This overview summarizes the available evidence from systematic reviews on the effects of nonpharmacological and nonsurgical interventions for rheumatoid arthritis (RA). Systematic reviews of studies of patients with RA (aged >18 years) published between 2000 and 2007 were identified by comprehensive literature searches. Methodological quality was independently assessed by 2 authors, and the quality of evidence was summarized by explicit methods. Pain, function, and patient global assessment were considered primary outcomes of interest. Twenty-eight systematic reviews were included in this overview. High-quality evidence was found for beneficial effects of joint protection and patient education, moderate-quality evidence was found for beneficial effects of herbal therapy (gamma-linolenic acid) and low-level laser therapy, and low-quality evidence was found for the effectiveness of the other interventions. The quality of evidence for the effectiveness of most nonpharmacological and nonsurgical interventions in RA is moderate to low.

Phys Ther 2007 Sep 25 


Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.

Chou R, Huffman LH

Oregon Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu

BACKGROUND: Many nonpharmacologic therapies are available for treatment of low back pain.

PURPOSE: To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain).

DATA SOURCES: English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). These electronic searches were supplemented by hand searching of reference lists and additional citations suggested by experts.

STUDY SELECTION: Systematic reviews and randomized trials of 1 or more of the preceding therapies for acute or chronic low back pain (with or without leg pain) that reported pain outcomes, back-specific function, general health status, work disability, or patient satisfaction.

DATA EXTRACTION: We abstracted information about study design, population characteristics, interventions, outcomes, and adverse events. To grade methodological quality, we used the Oxman criteria for systematic reviews and the Cochrane Back Review Group criteria for individual trials.

DATA SYNTHESIS: We found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain. Benefits over placebo, sham therapy, or no treatment averaged 10 to 20 points on a 100-point visual analogue pain scale, 2 to 4 points on the Roland-Morris Disability Questionnaire, or a standardized mean difference of 0.5 to 0.8. We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain. For acute low back pain (<4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat (good evidence for moderate benefits) and spinal manipulation (fair evidence for small to moderate benefits). Although serious harms seemed to be rare, data on harms were poorly reported. No trials addressed optimal sequencing of therapies, and methods for tailoring therapy to individual patients are still in early stages of development. Evidence is insufficient to evaluate the efficacy of therapies for sciatica.

LIMITATIONS: Our primary source of data was systematic reviews. We included non-English-language trials only if they were included in English-language systematic reviews.

CONCLUSIONS: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.

Ann Intern Med 2007 Oct 2 147(7) 492-504


The dynamics of microcirculation parameters in patients with pneumonia receiving intravenous irradiation of blood as a part of complex treatment

Burduli NM, Pilieva NG

The aim of the study was to evaluate the condition of the microcirculatation under the influence of low-intensity laser irradiation as a part of complex treatment of patients with pneumonia. The subjects were 62 patients with pneumonia divided into two groups. The 30 patients of the control group received only conventional medication therapy, while the 32 patients of the main group received a course of laser irradiation of blood (LIB) in addition to conventional medication. Positive dynamics in microcirculation was more prominent in the main group. In conclusion, LIB may be considered to be an effective method to correct microcirculatory disturbances in patients with pneumonia.

Klin Med (Mosk) 2007 85(7) 48-50


Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrow-band phototherapy.

Brazzelli V, Antoninetti M, Palazzini S, Barbagallo T, De Silvestri A, Borroni G

Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.

Background The treatment of vitiligo is still a challenge, but ultraviolet B narrow-band (UVB-NB) therapy has been recently reported to be an effective and safe therapeutic option in patients with vitiligo.

Objective The purpose of this study is a critical evaluation of the variants (body sites, age, duration of the disease, and duration of the therapy) influencing the clinical response to UVB-NB therapy. Methods Sixty patients (23 male and 37 female), aged 6 to 70 years, with vitiligo, were treated with UVB-NB therapy over a maximum period of 2 years. The evaluation of the percentage of repigmentation was done through photographs.

Results The lesions located on the face obtained a complete repigmentation in 68% of the patients, on the neck in 57.89%, and on the trunk in 50% within the first year of the therapy. In young patients vs. adults patients, the lesions located on the neck obtained a complete repigmentation in 83.33% vs. 46.15%, on the upper limbs in 28.57% vs. 9.52%, and on the lower limbs in 25% vs. 16.67%. In patients with vitiligo of recent onset, the lesions located on the neck obtained a complete repigmentation in 83.33%, on the upper limbs in 33.33%, and on the lower limbs in 28.57%. Hands did not give a positive response in either groups.

Conclusion This study shows that certain body sites respond better than others to the UVB-NB therapy; patients, aged less than 20 years, with recent vitiligo, achieve more repigmentation; the duration of the therapy can influence the response of the lesions over hands and lower limbs, showing only mild repigmentation.

J Eur Acad Dermatol Venereol 2007 Nov 21(10) 1369-74


Increased expression of mitochondrial benzodiazepine receptors following low-level light treatment facilitates enhanced protoporphyrin IX production in glioma-derived cells in vitro.

Bisland SK, Goebel EA, Hassanali NS, Johnson C, Wilson BC

Division of Biophysics and Bioimaging, University of Toronto, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2M9. sbisland@uhnres.utoronto.ca

BACKGROUND AND OBJECTIVES: This study investigates whether low-level light treatment (LLLT) can enhance the expression of peripheral-type mitochondrial benzodiazepine receptors (PBRs) on glioma-derived tumor cells, and by doing so promote the synthesis of protoporphyrin IX (PpIX) and increase the photodynamic therapy (PDT)-induced cell kill using 5-aminolevulinic acid (ALA). The endogenous photosensitizer, PpIX and related metabolites including coproporphyrin III are known to traffic into or out of the mitochondria via the PBRs situated on the outer mitochondrial membrane. Cells of astrocytic derivation within the brain express PBRs, while neurons express the central-type of benzodiazepine receptor.

STUDY DESIGN: Astrocytoma-derived CNS-1 cells were exposed to a range of differing low-level light protocols immediately prior to PDT. LLLT involved using broad-spectrum red light of 600-800 nm or monochromatic laser light specific to 635 or 905 nm wavelength. Cells (5 x 10(5)) were exposed to a range of LLLT doses (0, 1, or 5 J/cm(2)) using a fixed intensity of 10 mW/cm(2) and subsequently harvested for cell viability, immunofluorescence, or Western blot analysis of PBR expression. The amount of PpIX within the cells was determined using chemical extraction techniques.

RESULTS: Results confirm the induction of PBR following LLLT is dependent on the dose and wavelength of light used. Broad-spectrum red light provided the greatest cell kill following PDT, although LLLT with 635 nm or 905 nm also increased cell kill as compared to PDT alone. All LLLT regimens increased PBR expression compared to controls with corresponding increases in PpIX production.

CONCLUSIONS: These data suggest that by selectively increasing PBR expression in tumor cells, LLLT facilitates enhanced tumor cell kill using ALA-PDT. This may further improve the selectivity and efficacy of PDT treatment of brain tumors.

Lasers Surg Med 2007 Sep 39(8) 678-84


The effects of laser irradiation on osteoblast and osteosarcoma cell proliferation and differentiation in vitro.

Renno, AC\McDonnell, PA\Parizotto, NA\Laakso, EL

Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil.

Objective: The aim of this study was to investigate the effects of 670-nm, 780-nm, and 830-nm laser irradiation on cell proliferation of normal primary osteoblast (MC3T3) and malignant osteosarcoma (MG63) cell lines in vitro.

Background: Some studies have shown that laser phototherapy is able to stimulate the osteogenesis of bone tissue, increasing osteoblast proliferation and accelerating fracture consolidation. It has been suggested that laser light may have a biostimulatory effect on tumor cells. However, the mechanism by which the laser acts on cells is not fully understood.

Materials and Methods: Neonatal, murine, calvarial, osteoblastic, and human osteosarcoma cell lines were studied. A single laser irradiation was performed at three different wavelengths, at the energies of 0.5, 1, 5, and 10 J/cm(2). Twenty-four hours after laser irradiation, cell proliferation and alkaline phosphatase assays were assessed.

Results: Osteoblast proliferation increased significantly after 830-nm laser irradiation (at 10 J/cm(2)) but decreased after 780-nm laser irradiation (at 1, 5, and 10 J/cm(2)). Osteosarcoma cell proliferation increased significantly after 670-nm (at 5 J/cm(2)) and 780-nm laser irradiation (at 1, 5, and 10 J/cm(2)), but not after 830-nm laser irradiation. Alkaline phosphatase (ALP) activity in the osteoblast line was increased after 830-nm laser irradiation at 10 J/cm(2), whereas ALP activity in the osteosarcoma line was not altered, regardless of laser wavelength or intensity.

Conclusion: Based on the conditions of this study, we conclude that each cell line responds differently to specific wavelength and dose combinations. Further investigations are required to investigate the physiological mechanisms responsible for the contrasting outcomes obtained when using laser irradiation on cultured normal and malignant bone cells.


Low-Level Laser Therapy (GaAs lambda = 904 nm) Reduces Inflammatory Cell Migration in Mice with Lipopolysaccharide-Induced Peritonitis.

Correa, F\Martins, RA\Correa, JC\Iversen, VV\Joenson, J\Bjordal, JM

University Nove Julho, Sao Paulo, Brazil.

Objective: This study was designed to study the effect of an infrared low-level laser (GaAs lambda = 904 nm, 4 mW) on inflammatory cell migration in lipopolysaccharide (LPS)-induced peritonitis in mice.

Background Data: It has been suggested that red wavelengths of low-level laser therapy (LLLT) can exert anti-inflammatory effects, but little is known about the anti-inflammatory effects of infrared lasers. Peritonitis is a potentially life-threatening inflammatory condition that may be suitable for studying anti-inflammatory effects of infrared lasers.

Methods: Sixty male mice were randomly divided into five groups, and one group was given an intraperitoneal sterile saline injection. In the remaining four groups, peritonitis was induced by an intraperitoneal LPS injection. Animals in three of the LPS groups were irradiated at a single point over the peritoneum with doses of 3 J/cm(2), 7.5 J/cm(2), and 15 J/cm(2), respectively. The fourth group injected with LPS was an LPS-control group.

Results: At 6 hours after injection the groups irradiated with doses of 3 J/cm(2) and 7.5 J/cm(2) had a reduced number of neutrophil cells in the peritoneal cavity compared with the LPS-control group, and there were significant differences between the number of neutrophils in the peritoneal cavity between the LPS-control group and groups irradiated with doses of 3 J/cm(2) (-42%) and 7.5 J/cm(2) (-70%). In the group irradiated with 15 J/cm(2), neutrophil cell counts were lower than, but not significantly different from, LPS controls (-38%; p = 0.07). At 24 hours after injection, both neutrophil and total leukocyte cell counts were lower in all the irradiated groups than in the LPS controls. The 3-J/cm(2) exposure group showed the best results at 24 hours, with reductions of 77% in neutrophil and 49% in leukocyte counts.

Conclusion: Low-level laser therapy (904 nm) can reduce inflammatory cell migration in mice with LPS-induced peritonitis in a dose-dependent manner.


Laser treatment for stroke.

Lampl, Y

Edith Wolfson Medical Center, Department of Neurology, Holon Israel

Low-level laser therapy is an irradiation technique that has the ability to induce biological processes using photon energy. There are studies showing proliferation and angiogenesis after irradiation in skeletal muscle post-myocardial infarction tissue cells. Most evidence of efficacy is based on the increase in energy state and the activation of mitochondrial pathways. In the brain, there is similar evidence of cellular activity with laser irradiation. In vivo studies reinforced the efficacy of this technique for a better neurological and functional outcome post-stroke. The evidence is based on in vivo animal studies of various models and one human clinical study. Although the data is very promising, some fundamental questions remain to be answered, such as the exact mechanism along the cascade of post-stroke interconnective molecular disturbance, the optimal technique and time of treatment, and the long-term safety aspects. The answers to these questions are expected to evolve within the next few years.

Expert Rev Neurother 2007 Aug 7(8) 961-5


Influence of broad-spectrum and infrared light in combination with laser irradiation on the proliferation of wounded skin fibroblasts.

Hawkins, D Abrahamse, H

Laser Research Group, Faculty of Sciences, University of Johannesburg, Doornfontein, Johannesburg, South Africa.

Objective: This study aimed to establish if broad-spectrum or infrared (IR) light in combination with laser therapy can assist phototherapy and accelerate cell proliferation to improve the rate of wound healing.

Background Data: The effect of laser light may be partly or completely reduced by broad-spectrum light. There are few studies that investigate the benefit or detriment of combining laser irradiation with broad-spectrum or IR light.

Methods: Wounded human skin fibroblasts were irradiated with a dose of 5 J/cm(2) using a heliumneon laser, a diode laser, or a Nd:YAG laser in the dark, in the light, or in IR. Changes in cell proliferation were evaluated using optical density at 540 nm, alkaline phosphatase (ALP) enzyme activity, cytokine expression, and basic fibroblast growth factor (bFGF) expression.

Results: The optical density and ALP enzyme activity indicate that 5 J/cm(2) using 1064 nm in the light is more effective in increasing cell proliferation or cell growth than 830 nm in the light, but not as effective as 632.8 nm in the light. bFGF expression shows that the response of wounded cells exposed to 5 J/cm(2) in IR light is far less than the biological response of wounded cells exposed to 5 J/cm(2) in the dark or light. The results indicate that wounded cells exposed to 5 J/cm(2) using 632.8 nm in the dark results in a greater increase in IL-6 when compared to cells exposed to 5 J/cm(2) in the light or in IR.

Conclusion: Results indicate that 5 J/cm(2) (using 632.8 nm in the dark or 830 nm in the light) is the most effective dose to stimulate cell proliferation, which may ultimately accelerate or improve the rate of wound healing.

Photomed Laser Surg 2007 Jun 25(3) 159-69


Antiinfectives and low-level light: a new chapter in photomedicine.

Sommer, AP

Materials Division, University of Ulm, Ulm, Germany.

Objective: The purpose of this study was to identify synergistic effects in the interaction of light with biosystems in the presence of chemical agents. Their systematic analysis promises therapeutic strategies.

Background Data: Light intensities around 1000 Wm(2) potentially induce density variations in nanoscopic water layers adhering to surfaces in air or subaquatically. In permeable nanoscopic compartments in the interior of biosystems, this could result in powerful flow processes and bidirectional flows for repetitive applications of light. Consequently, external stimulation with light will force microorganisms and cells to incorporate a suitable antiinfective. Nanoscale biosystems, which respond to both light stimulation and antibiotics, are nanobacteria. Responses include growth, inhibition, and slime secretion. Slime secretion was provoked in vitro by gentamycin, an agent proposed for in vivo eradication, and blocked by light. Depending on the field of action, co-operative effects between light and an antiinfective can be exploited by considering two properties of the drug: transmission of light and resorption by the tissue. Antiinfectives can be administered in an active form or via drug delivery systems. In the latter case, a double action of the light could be exploited: stimulated release from the carrier and subsequent uptake by the targeted biosystem.

Methods: The attenuation of laser light (670 nm) by antiinfectives was measured in films of different thickness of a vaginal suppository. The effect of 670-nm laser light-not absorbed by water-on nanoscopic water layers was examined by comparing the evaporation time of irradiated drops of water-based nanosuspensions with non-irradiated controls.

Results: The 6-mum-thick suppository films were virtually transparent to the laser light, and the 1-mm-thick films totally attenuated it. Nanosuspension drops irradiated with 670-nm light needed more time to evaporate than controls.

Conclusion: Low-level light (LLL) therapy is compatible with antiinfectives, and even capable of boosting effects of superficially applied and/or absorbed antiinfectives. Temporal coordination between light treatment and drug administration maximizes drug effects and minimizes possible adverse effects. Irradiation should start when the drug concentration has reached its maximum in the desired field of action. Light-induced flow in nanoscale cavities could represent one mechanism of LLL therapy.

Photomed Laser Surg 2007 Jun 25(3) 150-8


Melanin density affects photobiomodulation outcomes in cell culture.

Brondon, P Stadler, I Lanzafame, RJ

Rochester General Hospital Laser Center, Rochester, New York.

Objective: This study investigated the influence of melanin on the outcome of photoradiation at 670 nm in a cell culture model.

Background Data: Melanins are naturally occurring cutaneous pigments. Human skin is classified into six skin types based on melanin content.

Methods: Gelatin photo filters were fabricated with varying melanin contents. Human HEP-2 and murine L929 cell lines were cultured in complete Dulbecco's Modified Eagle's Medium (DMEM) media. Photoradiation at 670 nm delivering 5.0 J/cm(2) per treatment/24 h (50 J/cm(2) total fluence) was carried out with melanin filters placed between the light source and the wells using a light-emitting diode (LED) device. Five groups based on percent melanin were treated: group 1, no filter; group 2, gelatin alone; group 3, 0.0125%; group 4, 0.025%; and group 5, 0.050%. Cell proliferation was measured using CyQuant and 3-(4,5-dimethylthiazol-2-yl)-2,5-disphenyl tetrasodiumbromide (MTT) assays for 240 h post-photoradiation.

Results: The Proliferation Index (PI) as measured by CyQuant assay was not statistically different amongst the groups in either cell line. MTT assay results demonstrated a significant dose response effect (p </= 0.05) in both cell lines with activity inversely proportional to melanin concentration. The relative PI values by MTT assay at 144 h for groups 1, 2, 3, and 4, respectively, were 1.44 +/- 0.06, 1.28 +/- 0.05, 1.20 +/- 0.07, and 1.06 +/- 0.04 for the L-929 cells, and 1.61 +/- 0.03, 1.47 +/- 0.06, 1.35 +/- 0.03, and 1.19 +/- 0.06 for the HEP-2 cells (n = 4; p < 0.05).

Conclusion: These results demonstrate that cutaneous melanin content should be taken into consideration in photobiomodulation paradigms. Further studies to quantify these effects are warranted.

Photomed Laser Surg 2007 Jun 25(3) 144-9


Efficacy of 780-nm Laser Phototherapy on Peripheral Nerve Regeneration after Neurotube Reconstruction Procedure (Double-Blind Randomized Study).

Rochkind, S Leider-Trejo, L Nissan, M Shamir, MH Kharenko, O Alon, M

Division of Peripheral Nerve Reconstruction, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.

Objective: This pilot double-blind randomized study evaluated the efficacy of 780-nm laser phototherapy on the acceleration of axonal growth and regeneration after peripheral nerve reconstruction by polyglycolic acid (PGA) neurotube.

Background Data: The use of a guiding tube for the reconstruction of segmental loss of injured peripheral nerve has some advantages over the regular nerve grafting procedure. Experimental studies have shown that laser phototherapy is effective in influencing nerve regeneration.

Methods: The right sciatic nerve was transected, and a 0.5-cm nerve segment was removed in 20 rats. A neurotube was placed between the proximal and the distal parts of the nerve for reconnection of nerve defect. Ten of 20 rats received post-operative, transcutaneous, 200-mW, 780-nm laser irradiation for 14 consecutive days to the corresponding segments of the spinal cord (15 min) and to the reconstructed nerve (15 min).

Results: At 3 months after surgery, positive somato-sensory evoked responses were found in 70% of the irradiated rats (p = 0.015), compared to 30% of the non-irradiated rats. The Sciatic Functional Index in the irradiated group was higher than in the non-irradiated group (p < 0.05). Morphologically, the nerves were completely reconnected in both groups, but the laser-treated group showed an increased total number of myelinated axons.

Conclusion: The results of this study suggest that postoperative 780-nm laser phototherapy enhances the regenerative process of the peripheral nerve after reconnection of the nerve defect using a PGA neurotube.

Photomed Laser Surg 2007 Jun 25(3) 137-43


Immunomodulatory effects of ultraviolet B irradiation on atopic dermatitis in NC/Nga mice.

Mutou, Y Ibuki, Y Kojima, S

Department of Radiation Biosciences, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan.

Background: Atopic dermatitis (AD) is a common pruritic inflammatory skin disease, which occurs primarily in childhood. Recently, narrow-band ultraviolet B (UVB) phototherapy has been used to treat AD, but the mechanism involved is unknown. In this study, we investigated whether UVB irradiation influences AD in the NC/Nga mouse.

Methods: The mice were separated into three groups: control, AD-control (immunized with mite antigens), and AD+UVB-irradiated (immunized with mite antigens and UVB irradiation) groups. The mice in the irradiation group were exposed to 1 kJ/m(2)/day twice a week from 6 to 12 weeks of age. Animals in the control and AD-control groups were shaved, but not irradiated.

Results: In the AD+UVB-irradiated group, the atopy score, ear thickness, and total immunoglobulin E (IgE) were increased in comparison with the AD-control group. On day 40, the levels of interleukin (IL)-4, IL-5, and IL-10 in the spleen lymphocytes were significantly increased compared with the AD-control group, resulting in a marked decrease of the interferon (IFN)-gamma/IL-4 ratio compared with the AD-control group. In addition, the levels of IL-6, tumor necrosis factor (TNF)-alpha, and NO(x) production by peritoneal macrophages were significantly elevated.

Conclusion: These results indicate that UVB irradiation promotes the development of AD-like skin lesions in NC/Nga mice.

Photodermatol Photoimmunol Photomed 2007 Aug 23(4) 135-44


Phototherapy in the management of atopic dermatitis: a systematic review.

Meduri, NB Vandergriff, T Rasmussen, H Jacobe, H

Department of Dermatology, University of Texas Southwestern Medical Center and Dermatology Section (Medical Service), Dallas Veterans Affairs Medical Center, and Private Practice, Dallas, TX, USA.

Background/purpose: Atopic dermatitis (AD) is a common and extremely burdensome skin disorder with limited therapeutic options. Ultraviolet (UV) phototherapy is a well tolerated, efficacious treatment for AD, but its use is limited by a lack of guidelines in the optimal choice of modality and dosing. Given this deficit, we aim to develop suggestions for the treatment of AD with phototherapy by systematically reviewing the current medical literature.

Methods: Data sources: All data sources were identified through searches of MEDLINE via the Ovid interface, the Cochrane Central Register of Controlled Trials, and a complementary manual literature search.

Study selection: Studies selected for review met these inclusion criteria, as applied by multiple reviewers: controlled clinical trials of UV phototherapy in the management of AD in human subjects as reported in the English-language literature. Studies limited to hand dermatitis and studies in which subjects were allowed unmonitored use of topical corticosteroids or immunomodulators were excluded.

Data extraction: Included studies were assessed by multiple independent observers who extracted and compiled the following data: number of patients, duration of treatment, cumulative doses of UV radiation, adverse effects, and study results. Data quality was assessed by comparing data sets and rechecking source materials if a discrepancy occurred.

Results: Nine trials that met the inclusion criteria were identified. Three studies demonstrated that UVA1 is both faster and more efficacious than combined UVAB for treating acute AD. Two trials disclosed the advantages of medium dose (50 J/cm(2)) UVA1 for treating acute AD. Two trials revealed the superiority of combined UVAB in the management of chronic AD. Two additional studies demonstrated that narrow-band UVB is more effective than either broad-band UVA or UVA1 for managing chronic AD.

Conclusion: On the basis of available evidence, the following suggestions can be made: phototherapy with medium-dose (50 J/cm(2)) UVA1, if available, should be used to control acute flares of AD while UVB modalities, specifically narrow-band UVB, should be used for the management of chronic AD.

Photodermatol Photoimmunol Photomed 2007 Aug 23(4) 106-12


Randomized controlled trial of light-emitting diode phototherapy.

Maisels, MJ Kring, EA Deridder, J

1Department of Pediatrics, William Beaumont Hospital, Royal Oak, MI USA

Objective: We wished to compare the efficacy of light-emitting diode (LED) phototherapy with special blue fluorescent (BB) tube phototherapy in the treatment of neonatal hyperbilirubinemia.

Study design: We randomly assigned 66 infants>/=35 weeks of gestation to receive phototherapy using an LED device or BB. In addition to phototherapy from above, all infants also received phototherapy from below using four BB tubes or a fiberoptic pad.

Result: After 15+/-5 h of phototherapy, the rate of decline in the total serum bilirubin (TSB) was 0.35+/-0.25 mg/dl/h in the LED group vs 0.27+/-0.25 mg/dl/h in the BB group (P=0.20).

Conclusion: LED phototherapy is as effective as BB phototherapy in lowering serum bilirubin levels in term and near-term newborns.Journal of Perinatology advance online publication, 28 June 2007; doi:10.1038/sj.jp.7211789.

J Perinatol 2007 Jun 28 


Protective Effect of Pentoxifylline on Growth Plate in Neonatal Rats Following Long-Term Phototherapy.

Atabek, ME Pirgon, O Esen, HH

Departments of Pediatric Endocrinology [M.E.A., O.P.] and Pathology [H.H.E.], School of Medicine, Selcuk University, 42080 Konya, Turkey.

We demonstrated previously that receiving long-term phototherapy was associated with early impairment of growth plate structure in neonatal rats, and oxidative stress may be the main risk factor for growth plate injury. The purpose of this study was to examine the histomorphometric effects of pentoxifylline treatment on the growth plate. Sixty weanling Sprague-Dawley rats were randomly separated into three equal groups. Group A, the control group, did not receive phototherapy and pentoxifylline. Groups B and C were exposed to phototherapy for 7 d. In addition to phototherapy, group C was also given pentoxifylline during the study period. Compared with zonal lengths on d 7 after initiation of phototherapy, group B had significantly lower values than group A for all zonal lengths (p < 0.001). Zonal lengths of growth plate were increased significantly with pentoxifylline treatment in group C for 7 d compared with group B (p < 0.001). After phototherapy, group B had significantly higher values than groups A and C for plasma malondialdehyde levels (p < 0.001). The pentoxifylline was found here to have some potential to reduce the effects of phototherapy on growth plate in neonatal rats at a relatively low dose.

Pediatr Res 2007 Jun 25 


The value of routine bilirubin screening to detect significant hyperbilirubinemia in thai healthy term newborns.

Prasarnphanich, T Somlaw, S

Department of Pediatrics, Prapokklao Hospital, Chantaburi 22000 Thailand

OBJECTIVE: To evaluate the clinical value and the predictive usefulness of the routine pre-discharge bilirubin screening in term newborn at 48-72 hours after birth.

MATERIAL AND METHOD: Blood samples of 1983 healthy term newborns for measuring total serum bilirubin level were drawn at the same time as the routine metabolic screening at Prapokklao Hospital. Newborns with total serum bilirubin levels > or = 5 mg/dL in the first 24 hours, > or = 10 mg/dL at 25 to 48 hours, > or = 13 mg/dL at 49-72 hours, and > or = 15 mg/dL at > 72 were defined to have hyperbilirubinemia and were started on phototherapy.

RESULTS: Two hundred and seventy-nine newborns (14.07%) with hyperbilirubinemia, including seven (0.35%) with severe hyperbilirubinemia were detected by the bilirubin screening program. Newborns without hyperbilirubinemia at the time of screening test were unlikely to develop subsequent significant hyperbilirubinemia. The costs for detecting hyperbilirubinemia and severe hyperbilirubinemia were 6.22 US$ and 247.87 US$ per case, respectively.

CONCLUSION: The bilirubin screening program was cost-effective and could detect a number of unexpected severe hyperbilirubinemia. Newborns without hyperbilirubinemia were unlikely to develop subsequent significant hyperbilirubinemia.

J Med Assoc Thai 2007 May 90(5) 925-30


Pathogenetic basis for the correction of adaptation reactions in children using PILER-light

Tsodikova, OA Zosimov, AM

According to the positions of systemic analysis of autoregulations and systemic reconstruction processes in children under the influence of PILER-light (Polarized polychromatic incoherent low-energy radiation) depending on the type of general non-specific adaptation reactions of the organism, the clinical blood test has been investigated using the correlation structures method. It has been established that phototherapy with polarized light causes stereotype effect of increased integration between the blood parameters, harmonizing of white and red blood parameters, elimination of the stress, decreased entropy elements. At the same time the specific adaptation reaction of the child's organism to the loadings of various origin, in particular, to the electromagnetic irradiation of optic diapason waves indicates the diverse character of the changed regulation system functions depending on the adaptation reaction type and grounds the differentiated approach to the polarized light therapy.

Fiziol Zh 2007 53(2) 56-64


Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

Bjordal, JM Johnson, MI Lopes-Martins, RA Bogen, B Chow, R Ljunggren, AE

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief.

Aims and methods: Systematic review with meta-analysis of efficacy within 1-4 weeks and 5-12 weeks.

RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n=487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n=414), 21.9 mm [95% CI: 17.3 to 26.5] (n=73) and 17.7 mm[95% CI: 8.1 to 27.3] (n=343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped.

CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK.

BMC Musculoskelet Disord 2007 Jun 22 8(1) 51


Comparison of the efficacy of local narrowband ultraviolet B (NB-UVB) phototherapy versus psoralen plus ultraviolet A (PUVA) paint for palmoplantar psoriasis.

Sezer, E Erbil, AH Kurumlu, Z Tastan, HB Etikan, I

Department of Dermatology, Gaziosmanpasa University School of Medicine, Tokat, Turkey.

Palmoplantar psoriasis is an idiopathic disabling condition, often resistant to conventional therapies. The purpose of this study was to evaluate the efficacy and safety of local narrowband ultraviolet B (NB-UVB) phototherapy and to compare it with local psoralen plus ultraviolet A (PUVA) paint in patients with palmoplantar psoriasis unresponsive to conventional therapies other than phototherapy. A cohort of 25 patients with palmoplantar psoriasis were included in this study, which was based on a left-to-right comparison pattern. The treatments were administered with local narrowband UVB irradiation on one side and local PUVA on the other side three times a week over 9 weeks. Clinical assessments were performed at baseline and every 3 weeks during the 9-week treatment. There was a statistically significant decrease in the mean clinical scores at the third, sixth and ninth week with both treatments. The difference in clinical response between the two treatment modalities was statistically significant at the end of the treatment period, with the percentage reduction in severity index scores with the PUVA-paint-treated side being 85.45% compared with 61.08% for the NB-UVB treated side (t = 5.379, P = 0.0001, Student's t-test for unpaired samples). Our results show that, although some clinical improvement was achieved with local NB-UVB phototherapy, the results were better with local PUVA, and such a treatment option may be reserved for patients with palmoplantar psoriasis who experience phototoxic reaction to psoralens.

J Dermatol 2007 Jul 34(7) 435-40


Influence of He-Ne laser therapy on the dynamics of wound healing in mice treated with anti-inflammatory drugs.

Goncalves, WL Souza, FM Conti, CL Cirqueira, JP Rocha, WA Pires, JG Barros, LA Moyses, MR

Departamento de Ciencias Fisiologicas, Centro de Ciencias da Saude, Universidade Federal do Espirito Santo.

We determined the effects of helium-neon (He-Ne) laser irradiation on wound healing dynamics in mice treated with steroidal and non-steroidal anti-inflammatory agents. Male albino mice, 28-32 g, were randomized into 6 groups of 6 animals each: control (C), He-Ne laser (L), dexamethasone (D), D + L, celecoxib (X), and X + L. D and X were injected im at doses of 5 and 22 mg/kg, respectively, 24 h before the experiment. A 1-cm long surgical wound was made with a scalpel on the abdomens of the mice. Animals from groups L, D + L and X + L were exposed to 4 J (cm(2))-1 day-1 of He-Ne laser for 12 s and were sacrificed on days 1, 2, or 3 after the procedure, when skin samples were taken for histological examination. A significant increase of collagen synthesis was observed in group L compared with C (168 +/- 20 vs 63 +/- 8 mm(2)). The basal cellularity values on day 1 were: C = 763 +/- 47, L = 1116 +/- 85, D = 376 +/- 24, D + L = 698 +/- 31, X = 453 +/- 29, X + L = 639 +/- 32 U/mm(2). These data show that application of L increases while D and X decrease the inflammatory cellularity compared with C. They also show that L restores the diminished cellularity induced by the anti-inflammatory drugs. We suggest that He-Ne laser promotes collagen formation and restores the baseline cellularity after pharmacological inhibition, indicating new perspectives for laser therapy aiming to increase the healing process when anti-inflammatory drugs are used.

Braz J Med Biol Res 2007 Jun 40(6) 877-84


A prospective, randomized, placebo-controlled, double-blinded, and split-face clinical study on LED phototherapy for skin rejuvenation: Clinical, profilometric, histologic, ultrastructural, and biochemical evaluations and comparison of three different treatment settings.

Lee, SY Park, KH Choi, JW Kwon, JK Lee, DR Shin, MS Lee, JS You, CE Park, MY

Department of Dermatology, National Medical Center, 18-79, Euljiro 6-ga, Jung-ku, Seoul, Republic of Korea.

Light-emitting diodes (LEDs) are considered to be effective in skin rejuvenation. We investigated the clinical efficacy of LED phototherapy for skin rejuvenation through the comparison with three different treatment parameters and a control, and also examined the LED-induced histological, ultrastructural, and biochemical changes. Seventy-six patients with facial wrinkles were treated with quasimonochromatic LED devices on the right half of their faces. All subjects were randomly divided into four groups treated with either 830nm alone, 633nm alone, a combination of 830 and 633nm, or a sham treatment light, twice a week for four weeks. Serial photography, profilometry, and objective measurements of the skin elasticity and melanin were performed during the treatment period with a three-month follow-up period. The subject's and investigator's assessments were double-blinded. Skin specimens were evaluated for the histologic and ultrastructural changes, alteration in the status of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), and the changes in the mRNA levels of IL-1ss, TNF-alpha, ICAM-1, IL-6 and connexin 43 (Cx43), by utilizing specific stains, TEM, immunohistochemistry, and real-time RT-PCR, respectively. In the results, objectively measured data showed significant reductions of wrinkles (maximum: 36%) and increases of skin elasticity (maximum: 19%) compared to baseline on the treated face in the three treatment groups. Histologically, a marked increase in the amount of collagen and elastic fibers in all treatment groups was observed. Ultrastructural examination demonstrated highly activated fibroblasts, surrounded by abundant elastic and collagen fibers. Immunohistochemistry showed an increase of TIMP-1 and 2. RT-PCR results showed the mRNA levels of IL-1ss, TNF-alpha, ICAM-1, and Cx43 increased after LED phototherapy whereas that of IL-6 decreased. This therapy was well-tolerated by all patients with no adverse effects. We concluded that 830 and 633nm LED phototherapy is an effective approach for skin rejuvenation.

J Photochem Photobiol B 2007 May 1 


Effects of diode 808 nm GaAlAs low-power laser irradiation on inhibition of the proliferation of human hepatoma cells in vitro and their possible mechanism.

Liu, YH Cheng, CC Ho, CC Pei, RJ Lee, KY Yeh, KT Chan, Y Lai, YS

Center for Research and Development, Chung-tai Institute of Health Sciences and Technology, Taichung, Taiwan.

Low-power laser irradiation (LPLI) has come into a wide range of use in medical field. Considering basic research, LPLI can enhance DNA synthesis and increases proliferation rate of human cells. But only a few data about the effects of LPLI on human liver or hepatoma cells are available. The cytoskeleton plays important roles in cell function and therefore is implicated in the pathogenesis of many human liver diseases, including malignant tumors. In our previous study, we found the stability of cytokeratin molecules in human hepatocytes was related to the intact microtubule network that was influenced by colchicine. In this study, we are going to search the effect of LPLI on proliferation of human hepatoma cell line HepG2 and J-5 cells. In addition, the stability of cytokeratin and synemin (one of the intermediate filament-associated proteins) were analyzed under the action of LPLI to evaluate the possible mechanism of LPLI effects on proliferation of human hepatoma cells. In experiment, HepG2 and J-5 cells were cultured in 24-well plate for 24 hours. After irradiation by 130 mW diode 808 nm GaAlAs continue wave laser in different time intervals, the cell numbers were counted. Western blot and immunofluorescent staining examined the expression and distribution of PCNA, cytokeratin and synemin. The cell number counting and PCNA expression were evaluated to determine the proliferation. The organization and expression of cytokeratin and synemin were studied to identify the stability of cytoskeleton affected by LPLI. The results revealed that proliferation of HepG2 and J-5 cells was inhibited by LPLI since the cell number and PCNA expression was reduced. Maximal effect was achieved with 90 and 120 seconds of exposure time (of energy density 5.85 J/cm2 and 7.8 J/cm2, respectively) for HepG2 and J-5, respectively. The decreased ratio of cell number by this dose of irradiation was 72% and 66% in HepG2 and J-5 cells, respectively. Besides that, the architecture of intermediate filaments in these cells was disorganized by laser irradiation. The expression of intermediate filament-associated protein, synemin, was also reduced. Two significant findings are raised in this study: (1) Diode 808 nm GaAlAs continuous wave laser has an inhibitory effect on the proliferation of human hepatoma cells line HepG2 and J-5. (2) The mechanism of inhibition might be due to down-regulation of synemin expression and alteration of cytokeratin organization that was caused by laser irradiation.

Res Commun Mol Pathol Pharmacol 2004 115-116 185-201


Histologic Comparison of Light Emitting Diode Phototherapy-Treated Hydroxyapatite-Grafted Extraction Sockets: A Same-Mouth Case Study.

Brawn, PR Kwong-Hing, A

Private Practice, Nanaimo, British Columbia, Canada. daggerAdjunct Professor, Division of Periodontics, Schulich School of Medicine and Dentistry, University of Western Ontario and Private Practice of Dentistry, Toronto, Ontario, Canada.

BACKGROUND:: The stimulating effect of red and near-infrared (NIR) laser phototherapy on bone regeneration and growth has been shown in a number of in vitro and animal studies. However, the effect of NIR phototherapy on the bone regeneration of hydroxyapatite (HA) -treated extraction sockets has not been previously demonstrated.

MATERIALS AND METHODS:: An investigational Biolux extraoral light emitting diode phototherapy device was used daily for 21 days postextraction and socket grafting with HA (Osteograf LD300) unilaterally. Bone regeneration of the phototherapy-treated and nontreated side wascompared in same-mouth extraction sockets.

RESULTS:: Histologic evaluations showed enhanced bone formation and faster particle resorption associated with the phototherapy-treated socket graft compared with the non-phototherapy-treated socket.

CONCLUSIONS:: The accelerated bone healing in the phototherapy-treated HA socket graft may provide faster implant placement compared to nonorphototherapy-treated socket grafts.

Implant Dent 2007 Jun 16(2) 204-211


Transcranial application of low-energy laser irradiation improves neurological deficits in rats following acute stroke.

Detaboada, L Ilic, S Leichliter-Martha, S Oron, U Oron, A Streeter, J

Photothera, Inc., 2260 Rutherford Road, Carlsbad, California 92008, USA.

BACKGROUND AND OBJECTIVES: Low-level laser therapy (LLLT) has been shown to have beneficial effects on ischemic skeletal and heart muscles tissues. The aim of the present study was to approve the effectiveness of LLLT treatment at different locations on the brain in acute stroked rats.

STUDY DESIGN/MATERIALS AND METHODS: Stroke was induced in 169 rats that were divided into four groups: control non-laser and three laser-treated groups where laser was employed ipsilateral, contralateral, and both to the side of the induced stroke. Rats were tested for neurological function.

RESULTS: In all three laser-treated groups, a marked and significant improvement in neurological deficits was evident at 14, 21, and 28 days post stroke relative to the non-treated group.

CONCLUSIONS: These observations suggest that LLLT applied at different locations in the skull and in a rather delayed-phase post stroke effectively improves neurological function after acute stroke in rats.

Lasers Surg Med 2006 Jan 38(1) 70-3


Effect of magnet-laser therapy on the central nervous system functional state in patients with ischemic stroke

Datsenko, IV

Twenty three patients aged from 41 to 75, which have had ischemic stroke in the carotid basin (up to 2 years after an acute period of the stroke), have been examined. The course of magneto-laser therapy lasted 15 days. The author carried out neurological examinations, determined the state of psychoemotional activity, cerebral hemodynamics and frequency-amplitude indices of the brain to assess the mechanisms of MLT effect on the CNS functional state in patients being in a rehabilitative period after ischemic stroke. The course of MLT administration improves cerebral hemodynamics, increases the level of the bioelectrical activity of the brain. We can recommend based on obtained results MLT in the system of rehabilitation of patients which had had ischemic stroke.

Lik Sprava 2006 Apr-May (3) 51-4


Magnetic and laser therapy of acute ischemic stroke

Samosiuk, NI

The paper presents the technique of frequency-modulated magnetolaser therapy (FMMLT) used in combined treatment of 121 patients with ischemic stroke in acute period. The results were compared with those in the control group of 30 patients who received conventional drug treatment. The results of the comparison allowed the author to recommend FMMLT in ischemic stroke especially in the period of "therapeutic window".

Vopr Kurortol Fizioter Lech Fiz Kult 2003 Mar-Apr (2) 19-20


New potentialities of laser therapy and electrostimulation after cheilorhinoplasty

Gerasimenko, MIu Filatova, EV Nikitin, AA Spiridonova, NZ

A method for stimulation of the central regulation mechanisms has been used in 53 patients during the early period after cheilorhinoplasty. Electrostimulation by the flickering reflex method is a nonspecific method stimulating sanogenesis which can be used for repair of the neuromuscular function after correction of secondary deformation of the upper lip and palate. Transcerebral laser stimulation indirectly affected the reparative processes in the maxillofacial area by improving metabolism in the cerebrocortical projection zones.

Stomatologiia (Mosk) 2001 80(6) 52-5


The effect of the blood serum from patients subjected to intravenous laser therapy on the parameters of synaptic transmission

Azbel', DI Egorushkina, NV Kuznetsova, IIu Ratushniak, AS Shergin, SM Shurgaia, AM Shtark, MB

The effect of serum of patients with myocardial ischemia after low-level laser therapy on parameters of synaptic conductance of rat hippocampal neurons was investigated. The serum from patients with an initially low level of neuronal activity obtained after determination of laser irradiation increased the amplitude and that from patients with high activity. Thus the process of normalization of these parameters was observed. Our results may help to optimize the course of medical treatment, and subsequently give an insight to understanding of the mechanism of therapeutic effect of laser irradiation.

Biull Eksp Biol Med 1993 Aug 116(8) 149-51


Low-level laser therapy applied transcranially to rats after induction of stroke significantly reduces long-term neurological deficits.

Oron, A Oron, U Chen, J Eilam, A Zhang, C Sadeh, M Lampl, Y Streeter, J DeTaboada, L Chopp, M

Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin 70300, Israel. amiroronmd@gmail.com

BACKGROUND AND PURPOSE: Low-level laser therapy (LLLT) modulates various biological processes. In the present study, we assessed the hypothesis that LLLT after induction of stroke may have a beneficial effect on ischemic brain tissue.

METHODS: Two sets of experiments were performed. Stroke was induced in rats by (1) permanent occlusion of the middle cerebral artery through a craniotomy or (2) insertion of a filament. After induction of stroke, a battery of neurological and functional tests (neurological score, adhesive removal) was performed. Four and 24 hours poststroke, a Ga-As diode laser was used transcranially to illuminate the hemisphere contralateral to the stroke at a power density of 7.5 mW/cm2.

RESULTS: In both models of stroke, LLLT significantly reduced neurological deficits when applied 24 hours poststroke. Application of the laser at 4 hours poststroke did not affect the neurological outcome of the stroke-induced rats as compared with controls. There was no statistically significant difference in the stroke lesion area between control and laser-irradiated rats. The number of newly formed neuronal cells, assessed by double immunoreactivity to bromodeoxyuridine and tubulin isotype III as well as migrating cells (doublecortin immunoactivity), was significantly elevated in the subventricular zone of the hemisphere ipsilateral to the induction of stroke when treated by LLLT.

CONCLUSIONS: Our data suggest that a noninvasive intervention of LLLT issued 24 hours after acute stroke may provide a significant functional benefit with an underlying mechanism possibly being induction of neurogenesis.

Stroke 2006 Oct 37(10) 2620-4


low-level laser therapy applied transcranially to mice following traumatic brain injury significantly reduces long-term neurological deficits.

Oron, A Oron, U Streeter, J de Taboada, L Alexandrovich, A Trembovler, V Shohami, E

Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin, Israel. amiroronmd@gmail.com

Low-level laser therapy (LLLT) has been evaluated in this study as a potential therapy for traumatic brain injury (TBI). LLLT has been found to modulate various biological processes. Following TBI in mice, we assessed the hypothesis that LLLT might have a beneficial effect on their neurobehavioral and histological outcome. TBI was induced by a weight-drop device, and motor function was assessed 1 h post-trauma using a neurological severity score (NSS). Mice were then divided into three groups of eight mice each: one control group that received a sham LLLT procedure and was not irradiated; and two groups that received LLLT at two different doses (10 and 20 mW/cm(2) ) transcranially. An 808-nm Ga-As diode laser was employed transcranially 4 h post-trauma to illuminate the entire cortex of the brain. Motor function was assessed up to 4 weeks, and lesion volume was measured. There were no significant changes in NSS at 24 and 48 h between the laser-treated and non-treated mice. Yet, from 5 days and up to 28 days, the NSS of the laser-treated mice were significantly lower (p < 0.05) than the traumatized control mice that were not treated with the laser. The lesion volume of the laser treated mice was significantly lower (1.4%) than the non-treated group (12.1%). Our data suggest that a non-invasive transcranial application of LLLT given 4 h following TBI provides a significant long-term functional neurological benefit. Further confirmatory trials are warranted.

J Neurotrauma 2007 Apr 24(4) 651-6


Infrared laser therapy for ischemic stroke: a new treatment strategy: results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1).

Lampl, Y Zivin, JA Fisher, M Lew, R Welin, L Dahlof, B Borenstein, P Andersson, B Perez, J Caparo, C Ilic, S Oron, U

Wolfson Medical Center, Department of Neurology, Holon, Israel.

BACKGROUND AND PURPOSE: The NeuroThera Effectiveness and Safety Trial-1 (NEST-1) study evaluated the safety and preliminary effectiveness of the NeuroThera Laser System in the ability to improve 90-day outcomes in ischemic stroke patients treated within 24 hours from stroke onset. The NeuroThera Laser System therapeutic approach involves use of infrared laser technology and has shown significant and sustained beneficial effects in animal models of ischemic stroke.

METHODS: This was a prospective, intention-to-treat, multicenter, international, double-blind, trial involving 120 ischemic stroke patients treated, randomized 2:1 ratio, with 79 patients in the active treatment group and 41 in the sham (placebo) control group. Only patients with baseline stroke severity measured by National Institutes of Health Stroke Scale (NIHSS) scores of 7 to 22 were included. Patients who received tissue plasminogen activator were excluded. Outcome measures were the patients' scores on the NIHSS, modified Rankin Scale (mRS), Barthel Index, and Glasgow Outcome Scale at 90 days after treatment. The primary outcome measure, prospectively identified, was successful treatment, documented by NIHSS. This was defined as a complete recovery at day 90 (NIHSS 0 to 1), or a decrease in NIHSS score of at least 9 points (day 90 versus baseline), and was tested as a binary measure (bNIH). Secondary outcome measures included mRS, Barthel Index, and Glasgow Outcome Scale. Primary statistical analyses were performed with the Cochran-Mantel-Haenszel rank test, stratified by baseline NIHSS score or by time to treatment for the bNIH and mRS. Logistic regression analyses were conducted to confirm the results.

RESULTS: Mean time to treatment was >16 hours (median time to treatment 18 hours for active and 17 hours for control). Time to treatment ranged from 2 to 24 hours. More patients (70%) in the active treatment group had successful outcomes than did controls (51%), as measured prospectively on the bNIH (P=0.035 stratified by severity and time to treatment; P=0.048 stratified only by severity). Similarly, more patients (59%) had successful outcomes than did controls (44%) as measured at 90 days as a binary mRS score of 0 to 2 (P=0.034 stratified by severity and time to treatment; P=0.043 stratified only by severity). Also, more patients in the active treatment group had successful outcomes than controls as measured by the change in mean NIHSS score from baseline to 90 days (P=0.021 stratified by time to treatment) and the full mRS ("shift in Rankin") score (P=0.020 stratified by severity and time to treatment; P=0.026 stratified only by severity). The prevalence odds ratio for bNIH was 1.40 (95% CI, 1.01 to 1.93) and for binary mRS was 1.38 (95% CI, 1.03 to 1.83), controlling for baseline severity. Similar results held for the Barthel Index and Glasgow Outcome Scale. Mortality rates and serious adverse events (SAEs) did not differ significantly (8.9% and 25.3% for active 9.8% and 36.6% for control, respectively, for mortality and SAEs).

CONCLUSIONS: The NEST-1 study indicates that infrared laser therapy has shown initial safety and effectiveness for the treatment of ischemic stroke in humans when initiated within 24 hours of stroke onset. A larger confirmatory trial to demonstrate safety and effectiveness is warranted.

Stroke 2007 Jun 38(6) 1843-9


Effects of power densities, continuous and pulse frequencies, and number of sessions of low-level laser therapy on intact rat brain.

Ilic, S Leichliter, S Streeter, J Oron, A DeTaboada, L Oron, U

Photothera Inc., Carlsbad, California, USA.

OBJECTIVE: The aim of the present study was to investigate the possible short- and long-term adverse neurological effects of low-level laser therapy (LLLT) given at different power densities, frequencies, and modalities on the intact rat brain.

BACKGROUND DATA: LLLT has been shown to modulate biological processes depending on power density, wavelength, and frequency. To date, few well-controlled safety studies on LLLT are available.

METHODS: One hundred and eighteen rats were used in the study. Diode laser (808 nm, wavelength) was used to deliver power densities of 7.5, 75, and 750 mW/cm2 transcranially to the brain cortex of mature rats, in either continuous wave (CW) or pulse (Pu) modes. Multiple doses of 7.5 mW/cm2 were also applied. Standard neurological examination of the rats was performed during the follow-up periods after laser irradiation. Histology was performed at light and electron microscopy levels.

RESULTS: Both the scores from standard neurological tests and the histopathological examination indicated that there was no long-term difference between laser-treated and control groups up to 70 days post-treatment. The only rats showing an adverse neurological effect were those in the 750 mW/cm2 (about 100-fold optimal dose), CW mode group. In Pu mode, there was much less heating, and no tissue damage was noted.

CONCLUSION: Long-term safety tests lasting 30 and 70 days at optimal 10x and 100x doses, as well as at multiple doses at the same power densities, indicate that the tested laser energy doses are safe under this treatment regime. Neurological deficits and histopathological damage to 750 mW/cm2 CW laser irradiation are attributed to thermal damage and not due to tissue-photon interactions.

Photomed Laser Surg 2006 Aug 24(4) 458-66


Analysis of 602 Chinese cases of nevus of Ota and the treatment results treated by Q-switched alexandrite laser.

Wang HW, Liu YH, Zhang GK, Jin HZ, Zuo YG, Jiang GT, Wang JB

Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, and Department of Statistics, Great Wall Hospital, Beijing China

BACKGROUND: Nevus of Ota is a congenital or acquired pigmentary disorder of the skin and mucous membranes, which are areas innervated by the first and second branches of the trigeminal nerve. Nevus of Ota is very common in Asia. Nevus of Ota was effectively treated with Q-switched alexandrite (755 nm) laser, but no detailed report existed on many Chinese cases treated with Q-switched alexandrite laser.

OBJECTIVE: The objective was to gauge clinical and treatment data and material statistics for 602 cases of nevus of Ota and analyze its pathogenic mechanism and therapeutic results.

METHODS: A total of 602 cases of clinical data on nevus of Ota were collected by means of clinical registration, photo verification, and telephone inquiry or correspondence.

CONCLUSIONS: There are some differences in sex, age, and local regions in nevus of Ota. Nevus of Ota can combine with other diseases. The treatment of Nevus of Ota by a Q-switched alexandrite laser is safe and effective. Additional treatment will achieve good results. The results correlate to the eyelids and Tanino's classification.

Dermatol Surg. 2007 Apr;33(4):455-60.


An in-vivo experimental evaluation of He-Ne laser photostimulation in healing Achilles tendons

Elwakil TF

National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo Egypt

There is no method of treatment that has been proven to accelerate the rate of tendon healing or to improve the quality of the regenerating tendon. Low level laser photostimulation has gained a considerable attention for enhancing tissue repair in a wide spectrum of applications. However, there is controversy regarding the effectiveness of laser photostimulation for improvement of the healing process of surgically repaired tendons. Accordingly, the present study was conducted to evaluate the role of helium-neon (He-Ne) laser photostimulation on the process of healing of surgically repaired Achilles tendons. Thirty unilateral Achilles tendons of 30 Raex rabbits were transected and immediately repaired. Operated Achilles tendons were randomly divided into two equal groups. Tendons at group A were subjected to He-Ne laser (632.8 nm) photostimulation, while tendons at group B served as a control group. Two weeks later, the repaired Achilles tendons were histopathologically and biomechanically evaluated. The histopathological findings suggest the favorable qualitative pattern of the newly synthesized collagen of the regenerating tendons after He-Ne laser photostimulation. The biomechanical results support the same favorable findings from the functional point of view as denoted by the better biomechanical properties of the regenerating tendons after He-Ne laser photostimulation with statistical significance (p <or= 0.01) at most of the biomechanical parameters. He-Ne laser photostimulation reported a great value after surgical repair of ruptured and injured tendons for a better functional outcome. It could be applied safely and effectively in humans, especially with respect to the proposed long-term clinical outcome.

Lasers Med Sci. 2007 Mar;22(1):53-9


Irradiation at 634 nm releases nitric oxide from human monocytes.

Lindgard A, Hulten LM, Svensson L,Soussi B.

Wallenberg Laboratory, Sahlgrenska University Hospital, Goteborg University, Gothenburg, 413 45 Sweden

Previous studies have shown that irradiation at 634 nm decreases the release of extracellular reactive oxygen species (ROS) without affecting viability in human monocytes. Here, we examined the effect of irradiation at 634 nm on the release of nitric oxide (NO), activation of inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS), and release of intracellular ROS. Chemiluminescence assays were used to measure NO release, intracellular ROS, and adenosine triphosphate levels (to assess cell viability). Levels of iNOS and eNOS mRNA were analyzed using PCR. Irradiation resulted in elevated levels of NO but had no effect on iNOS or eNOS. Irradiation also caused a decrease in levels of intracellular ROS and had no effect on cell viability. Our studies indicate that irradiation at 634 nm releases NO, possibly from a preformed store, and reduces the production of intracellular ROS without affecting cell viability. Irradiation at 634 nm may have a wide range of clinical applications, including a reduction in oxidative stress-mediated injury in the vasculature.

Lasers Med Sci. 2007 Mar;22(1):30-6. Epub 2006 Nov 21


Effect of low-level laser treatment after installation of dental titanium implant-immunohistochemical study of RANKL, RANK, OPG: An experimental study in rats.

Kim YD, Kim SS, Hwang DS, Kim SG, Kwon YH, Shin SH, Kim UK, Kim JR, Chung IK.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Busan Korea

BACKGROUND AND OBJECTIVES: This experiment using an animal experimental model was conducted in order to investigate the effect of low-level laser therapy (LLLT) on the healing of the dental titanium implant.

STUDY DESIGN/MATERIALS AND METHODS: The experimental group received LLLT for a week and the control group did not. Each group consisted of 10 rats. Two rats from the groups were euthenized on the days 1, 3, 7, 14, and 21 of the experiment. The expression of receptor activator of nuclear factor kB ligand (RANKL), osteoprotegerin (OPG), and receptor activator of nuclear factor kB (RANK) were investigated.

RESULTS: The expression of RANKL was observed from the initial stage of the installation of the implant for both the experimental and control groups. However, the degree of expression was higher in the experimental group. The degree of expression of OPG increased remarkably in the experimental group, while in the control group the degree of expression increased only slightly. In the experimental group, the expression of RANK was observed from the first day, but in the control group, it was weakly observed after day 3. The overall expression within the bone was slight on day 7 in the control group, while an active expression was observed in the experimental group. Bone density after installation of dental titanium implant during osseointegration in the experimental group was higher than the control group. The surface and structure of the titanium implant was not damaged by low-level laser (LLL).

CONCLUSIONS: From the above results, the expression of OPG, RANKL, and RANK during the osseointegration of the dental titanium implant was observed within bone tissue. The application of the LLL influenced the expression of OPG, RANKL, and RANK, and resulted in the expansion of metabolic bone activity and increased the activity of bone tissue cells

Lasers Surg Med. 2007 May 23; [Epub ahead of print]


Effect of superpulsed laser irradiation on bone formation in a human osteoblast-like cell line

Martinasso G, Mozzati M, Pol R, Canuto RA, Muzio G.

Department of Medicine and Experimental Oncology, Turin University, Turin Italy

AIM: The effect superpulsed of low-level laser therapy (SLLLT) on bone regeneration has been the focus of recent research. This preliminary study investigated the effect of superpulsed laser irradiation on proliferation and bone formation in human osteoblast-like cells MG-63.

METHODS: Human osteoblast-like cells MG-63 were exposed every 24 h to superpulsed low-level laser produced by the device Lumix 2 HFPL Dental (Fisioline s.n.c., Verduno, Cuneo, Italy); the experimental protocol comprised 4 days of treatment. At each experimental time, cell proliferation and some markers of osteoblast activity were evaluated.

RESULTS: Numbers of laser-treated cells increased starting from day 2 of treatment. The ability of SLLLT irradiation to stimulate bone production was evaluated by determining the expression of osteocalcin and alkaline phosphatase, proteins involved in calcium nodule formation. These proteins increased markedly after 3 days of laser treatment.

CONCLUSIONS: These preliminary results show that repeated SLLLT irradiation stimulates cell proliferation in human osteoblast-like cells and, importantly, increases the expression of proteins essential for bone formation.

Minerva Stomatol. 2007 Jan-Feb;56(1-2):27-30


Cultured epithelial cells response to phototherapy with low intensity laser.

Eduardo FP, Mehnert DU, Monezi TA, Zezell DM, Schubert MM, Eduardo CP, Marques MM.

Department of Oral Diagnosis, School of Dentistry, University of Sao Paulo, Sao Paulo Brazil

BACKGROUND AND OBJECTIVES: Little is known about the intracellular response of epithelial cells to phototherapy. The aim of this in vitro study was to analyze the effect of phototherapy with low-energy lasers with different wavelengths and powers on cultured epithelial cell growth under different nutritional conditions.

STUDY DESIGN/MATERIALS AND METHODS: Epithelial cell cultures (Vero cell line) grown in nutritional deficit in culture medium supplemented with 2% fetal bovine serum (FBS) were irradiated with low-energy laser from one to three times with a GaAlAs laser (660 nm) and InGaAlP (780 nm), 40 and 70 mW, respectively, with 3 or 5 J/cm(2). Cell growth was indirectly assessed by measuring the cell mitochondrial activity.

RESULTS: Nonirradiated cell cultures grown in nutritional regular medium supplemented with 10% FBS produced higher cell growth than all cultures grown in nutritional deficit irradiated or not. The overall cell growth of cultures grown under nutritionally deficit conditions was significantly improved especially when irradiated with 780 nm for three times.

CONCLUSIONS: Phototherapy with the laser parameters tested increases epithelial cell growth rate for cells stressed by growth under nutritionally deficient states. This cell growth improvement is directly proportional to the number of irradiations; however, was not enough to reach the full cell growth potential rate of Vero epithelial cell line observed when growing under nutritional regular condition. Lasers Surg. Med. 39: 365-372, 2007

Lasers Surg Med. 2007 Apr 24;39(4):365-372 [Epub ahead of print]

Optimal Low-Energy Laser Irradiation Causes Temporal G(2)/M Arrest on Rat Calvarial Osteoblasts.

Fukuhara E, Goto T, Matayoshi T, Kobayashi S, Takahashi T. Div ision of Oral and Maxillofacial Reconstructive Surgery, Kyushu

Dental College, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, 803-8580 Japan

Low-energy laser irradiation (LELI) accelerates wound healing and is thought to accelerate bone formation. However, the mechanism of laser healing is not clear. To clarify the biological mechanism of LELI healing, we investigated the effects of LELI on rat osteoblasts in vitro. Osteoblastic cells from 3-day-old Wistar rat calvaria were irradiated using a low-energy gallium-aluminum-arsenide (Ga-Al-As) diode laser. Bone formation, osteoblast differentiation, and cell proliferation were evaluated by von Kossa staining, reverse-transcription polymerase chain reaction, alkaline phosphatase (ALP) staining, 5-bromo-2'-deoxyuridine (BrdU) uptake, and fluorescence-activated cell sorter (FACS) analysis. At 21 days after LELI, the greatest bone formation was observed with irradiation energy of 3.75 J/cm(2) and the first week after seeding. LELI (3.75 J/cm(2)) induced an increased number of cells at day 3. LELI-stimulated differentiation in osteoblastic cells was demonstrated by the increases of Runx2 expression and ALP-positive colonies. By contrast, at 1 day after laser irradiation, the number of cells in the irradiation group was significantly lower than that in the control group. BrdU uptake indicated lower proliferation 12 and 24 hours after irradiation compared with the control. Furthermore, FACS data demonstrated a higher proportion of cells in the G(2)/M phase of the cell cycle 12 hours after irradiation compared with the control. G(2)/M arrest was confirmed by the appearance of G(2)/M arrest marker 14-3-3-sigma or phospho-p53. These results demonstrate that LELI induces not only acceleration of bone formation but also initial G(2)/M arrest, which may cause wound healing like tissue repair.

Calcif Tissue Int. 2006 Dec 8; [Epub ahead of print]

Effect of low-level laser therapy on hemorrhagic lesions induced by immune complex in rat lungs.

Aimbire F, Lopes-Martins RA, Albertini R, Pacheco MT, Castro-Faria-Neto HC, Martins PS, Bjordal JM.

Laboratory of Animal Experimentation, Research and Development Institute (IP&D), Vale do Paraiba University (UNIVAP), Sao Jose dos Campos Brazil

Objective: The aim of this study was to investigate if low-level laser therapy (LLLT) can modulate formation of hemorrhagic lesions induced by immune complex.

Background Data: There is a lack of information on LLLT effects in hemorrhagic injuries of high perfusion organs, and the relative efficacy of LLLT compared to anti-inflammatory drugs.

Methods: A controlled animal study was undertaken with 49 male Wistar rats randomly divided into seven groups. Bovine serum albumin (BSA) i.v. was injected through the trachea to induce an immune complex lung injury. The study compared the effect of irradiation by a 650-nm Ga-Al-As laser with LLLT doses of 2.6 Joules/cm(2) to celecoxib, dexamethasone, and control groups for hemorrhagic index (HI) and myeloperoxide activity (MPO) at 24 h after injury.

Results: The HI for the control group was 4.0 (95% CI, 3.7-4.3). Celecoxib, LLLT, and dexamethasone all induced significantly (p < 0.01) lower HI than control animals at 2.5 (95% CI, 1.9-3.1), 1.8 (95% CI, 1.2-2.4), and 1.5 (95% CI, 0.9-2.1), respectively, for all comparisons to control. Dexamethasone, but not celecoxib, induced a slightly, but significantly lower HI than LLLT (p = 0.04). MPO activity was significantly decreased in groups receiving celecoxib at 0.87 (95% CI, 0.63-1.11), dexamethasone at 0.50 (95% CI, 0.24-0.76), and LLLT at 0.7 (95% CI, 0.44-0.96) when compared to the control group, at 1.6 (95% CI, 1.34-1.96; p < 0.01), but there were no significant differences between any of the active treatments.

Conclusion: LLLT at a dose of 2.6 Joules/cm(2) induces a reduction of HI levels and MPO activity in hemorrhagic injury that is not significantly different from celecoxib. Dexamethasone is slightly more effective than LLLT in reducing HI, but not MPO activity.

Photomed Laser Surg. 2007 Apr;25(2):112-7

Photobiomodulation on the angiogenesis of skin wounds in rats using different light sources.

Corazza AV, Jorge J, Kurachi C, Bagnato VS.

University of Sao Paulo (USP), Sao Carlos; and School of Physiotherapy, Americana School, Americana Brazil

Objective: The aim of this study was to compare the angiogenic effects of laser and light-emitting diode (LED) illumination on wounds induced in rats, with varied fluence.

Background Data: The LED is an alternative light source that accelerates wound healing, and its efficiency concerning the angiogenic effect was compared to low-level laser therapy (LLLT).

Methods: The experimental model consisted of a circular wound inflicted on the quadriceps of 120 rats, using a 15-mm-diameter "punch." Animals were divided randomly into five groups: two groups of laser, with dosages of 5 and 20 J/cm(2), respectively, two groups of LED, also with dosages of 5 and 20 J/cm(2), and a control group. Six hours after wound infliction, the treated groups received the diverse applications accordingly and were irradiated every 24 h. Angiogenesis was studied through histomorphometry on days 3, 7, 14, and 21 after the wounds were inflicted.

Results: On days 3, 7, and 14, the proliferation of blood vessels in all irradiated groups was superior in comparison to those of the control group (p < 0.05). Treatment with fluence of 5 J/cm(2) was better than the laser group with 20 J/cm(2) on day 21.

Conclusion: Red LLLT and LED demonstrated expressive results in angiogenesis. Light coherence was shown not to be essential to angiogenesis. However, further studies are needed in order to investigate the photobiomodulatory effects of LED in relation to LLLT in various biological tissues.

Photomed Laser Surg. 2007 Apr;25(2):102-6

Influence of low-energy laser in the prevention of oral mucositis in children with cancer receiving chemotherapy.

Cruz LB, Ribeiro AS, Rech A, Rosa LG, Castro CG Jr, Brunetto AL.

Pediatric Oncology Unit, Federal University of Rio Grande do Sul, Porto Alegre Brazil

BACKGROUND: This study assessed the use of low-energy laser in the prevention or reduction of the severity of oral mucositis.

PROCEDURE: A randomized clinical trial was carried out. Patients from 3 to 18 years of age treated with chemotherapy or hematopoietic stem-cell transplantation between May, 2003 and February, 2005 were eligible. The intervention group received laser application for 5 days following the start of chemotherapy. The grade of oral mucositis was assessed by the WHO per NCI-CTC common toxicity criteria and the assessments were made on days 1, 8 and 15 by a trained examiner blind to the intervention.

RESULTS: Sixty patients were evaluable for analysis; thirty-nine (65%) were males, 35 (58%) patients had a diagnosis of leukemia or lymphoma, and 25 (42%) had solid tumors. The mean age was 8.7 +/- 4.3 years. Twenty-nine patients were randomized in the laser group and 31 in the control group. On day 1, no patients presented with mucositis. On day 8, of 20 patients (36%) who developed mucositis, 13 of them were from the laser group and 7 from the control group. On day 15, of 24 patients (41%) who developed mucositis, 13 of them were from the laser group and 11 from the control group. There was no significant difference between groups concerning the grades of mucositis on day 8 (P = 0.234) or on day 15 (P = 0.208).

CONCLUSIONS: This study showed no evidence of benefit from the prophylactic use of low-energy laser in children and adolescents with cancer treated with chemotherapy when optimal dental and oral care was provided.

Pediatr Blood Cancer. 2007 Apr;48(4):435-40.

Influence of low-level laser treatment on bone regeneration and osseointegration of dental implants following sinus augmentation: An experimental study on sheep.

Jakse N, Payer M, Tangl S, Berghold A, Kirmeier R, Lorenzoni M.

Department of Oral Surgery and Radiology, School of Dentistry, Medical University Graz, Graz Austria

Objectives: The aim of this experimental study was to evaluate if low-level laser treatment (LLLT) enhances bone regeneration and osseointegration of dental implants in a sinus graft model.

Material and methods: Twelve sheep underwent a bilateral sinus floor elevation procedure with cancellous bone from the iliac crest. Implant insertion followed 4 weeks (six sheep) and 12 weeks (six sheep) later. Sixteen weeks after second-stage surgery, animals were sacrificed. Unilaterally, the grafted sinus and during the second-stage surgery the implant sites were irradiated intraoperatively and three times during the first postoperative week with a diode laser (75 mW, 680 nm). The overall energy density per irradiation was 3-4 J/cm(2). Biopsies of the augmented area were obtained during implant insertion and after scarification.

Results: Bone regeneration within the grafted sinus histomorphometric analysis hardly differed between control and test side both 4 and 12 weeks after sinus grafting. Osseointegration measurements resulted in a significantly higher bone/implant contact (BIC) on the test side (P=0.045). Further evaluation of peri-implant bone tends to amount in significant higher percentage on the laser side (P=0.053).

Conclusion: The presented experimental study on sheep did not confirm a positive LLLT effect on bone regeneration within a cancellous sinus graft. Nevertheless, LLLT possibly has a positive effect on osseointegration of dental implants inserted after sinus augmentation.

Clin Oral Implants Res. 2007 Apr 19; [Epub ahead of print]

Low level laser therapy for nonspecific low-back pain.

Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri S, Mortaz Hejri S, Jonaidi A.


BACKGROUND: Low-back pain (LBP) and related disabilities are major public health problems and a major cause of medical expenses, absenteeism and disable ment. Low level laser therapy (LLLT) can be used as a therapeutic intervention for musculoskeletal disorders such as back pain.

OBJECTIVES: To assess the effects of LLLT in patients with non-specific low-back pain and to explore the most effective method of administering LLLT for this disorder.

SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE and CINAHL from their start to January 2007 and EMBASE, AMED and PEDro from their start to 2005 with no language restrictions. We screened references in the included studies and in reviews of the literature and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts.

SELECTION CRITERIA: Only randomised controlled clinical trials (RCTs) investigating low level laser therapy as a light source treatment for non-specific low-back pain were included.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Consensus was used to resolve disagreements. Clinically and statistically homogeneous studies were pooled using the fixed-effect model; clinically homogeneous and statistically heterogeneous studies were pooled using the random-effects model.

MAIN RESULTS: Six RCTs with reasonable quality were included in the review. All of them were published in English. There is some evidence of pain relief with LLLT, compared to sham therapy for subacute and chronic low-back pain. These effects were only observed at short-term and intermediate-term follow-ups. Long-term follow-ups were not reported. There was no difference between LLLT and comparison groups for pain-related disability.There is insufficient evidence to determine the effectiveness of LLLT on antero-posterior lumbar range of motion compared to control group in short-term follow-up. The relapse rate in the LLLT group was significantly lower than in the control group at six months follow-up period according to the findings of two trials.

AUTHORS' CONCLUSIONS: No side effects were reported. However, we conclude that there are insufficient data to draw firm conclusions.There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, different wavelengths and different dosages. Comparison of different LLLT treatments will be more reasonable if dose calculation methods are harmonized.

Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005107.

Low-Level Laser Therapy Applied Transcranially to Mice following Traumatic Brain Injury Significantly Reduces Long-term Neurological Deficits.

Oron A, Oron U, Streeter J, Taboada LD, Alexandrovich A, Trembovler V, Shohami E.

Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin Israel

Low-level laser therapy (LLLT) has been evaluated in this study as a potential therapy for traumatic brain injury (TBI). LLLT has been found to modulate various biological processes. Following TBI in mice, we assessed the hypothesis that LLLT might have a beneficial effect on their neurobehavioral and histological outcome. TBI was induced by a weight-drop device, and motor function was assessed 1 h post-trauma using a neurological severity score (NSS). Mice were then divided into three groups of eight mice each: one control group that received a sham LLLT procedure and was not irradiated; and two groups that received LLLT at two different doses (10 and 20 mW/cm(2) ) transcranially. An 808-nm Ga-As diode laser was employed transcranially 4 h post-trauma to illuminate the entire cortex of the brain. Motor function was assessed up to 4 weeks, and lesion volume was measured. There were no significant changes in NSS at 24 and 48 h between the laser-treated and non-treated mice. Yet, from 5 days and up to 28 days, the NSS of the laser-treated mice were significantly lower (p < 0.05) than the traumatized control mice that were not treated with the laser. The lesion volume of the laser treated mice was significantly lower (1.4%) than the non-treated group (12.1%). Our data suggest that a non-invasive transcranial application of LLLT given 4 h following TBI provides a significant long-term functional neurological benefit. Further confirmatory trials are warranted.

 J Neurotrauma. 2007 Apr;24(4):651-6.

Macroscopic and microscopic effects of GaAIAs diode laser and dexamethasone therapies on oral mucositis induced by fluorouracil in rats.

Lara RN, da Guerra EN, de Melo NS.

Oral Medicine, Department of Dentistry, School of Health Science, University of Brasilia, Brasilia Brazil

PURPOSE: To present an animal model for mucositis induced by fluorouracil in rats, and test two therapeutic options, the GaAIAs laser and topical dexamethasone, analysing them with regard to the quality and quantity of tissue alterations and comparing them with the phases of mucositis.

MATERIALS AND METHODS: Forty-five Wistar rats (250 g) were treated with fluorouracil (60 mg/kg) and, in order to mimic the clinical effect of chronic irritation, the palatal mucosa was irritated by superficial scratching with an 18-gauge needle. When all of the rats presented oral ulcers of mucositis, they were randomly allocated to one of three groups: group I was treated with laser (GaAIAs), group II was treated with topical dexamethasone, and group III was not treated. Excisional biopsies of the palatal mucosa were then performed, and the rats were killed. Tissue sections were stained with haematoxylin and eosin for morphological analyses, and with toluidine blue for mast-cell counts.

RESULTS: Group I specimens showed higher prevalence of ulcers, bacterial biofilm, necrosis and vascularisation, while group II specimens showed higher prevalance of granulation tissue formation. There were no significant statistical differences in the numbers of mast cells and epithelial thickness between groups.

CONCLUSION: For the present model of mucositis, rats with palatal mucositis treated with laser (GaAIAs) showed characteristics compatible with the ulcerative phase of oral mucositis, and rats treated with topical dexamethasone showed characteristics compatible with the healing phase of mucositis. Topical dexamethasone was more efficient in the treatment of rats' oral mucositis than the laser.

Oral Health Prev Dent. 2007;5(1):63-71.

Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial.

Markovic A, Todorovic Lj.

Clinic of Oral Surgery, Faculty of Dentistry, Dr Subotica 4, 11000 Belgrade Serbia

Postoperative oedema is common following removal of impacted lower third molars. Several types of drug therapy (corticosteroids, non-steroidal anti-inflammatory drugs, enzymes) have been tried. The aim of this study was to compare the effectiveness of low-power laser (LPL) and dexamethasone after surgical removal of impacted lower third molars under local anaesthesia (2% lidocaine/epinephrine).

MATERIAL AND METHODS: There were 120 healthy patients divided into four groups of 30 each. Group 1 received LPL irradiation immediately after operation (energy output 4 J/cm2 with constant power density of 50 mW, wavelength 637 nm); group 2 also received i.m. injection of 4 mg dexamethasone (Dexason) into the internal pterygoid muscle; group 3 received LPL irradiation supplemented by systemic dexamethasone (Dexason), 4 mg i.m. in the deltoid region, followed by 4 mg of dexamethasone intraorally 6h postoperatively; and the fourth (control) group received only the usual postoperative recommendations (cold packs, soft diet, etc.).

RESULTS: LPL irradiation with local use of dexamethasone (group 2) resulted in a statistically significant reduction of postoperative oedema in comparison to the other groups. No adverse effects of the procedure or medication were observed.

CONCLUSION: LPL irradiation after lower third molar surgery can be recommended to minimize swelling. The effect is enhanced by simultaneous local intramuscular use of dexamethasone.

Int J Oral Maxillofac Surg. 2007 Mar;36(3):226-9. Epub 2006 Dec 8.

Low-level laser therapy can reduce lipopolysaccharide-induced contractile force dysfunction and TNF-alpha levels in rat diaphragm muscle.

Aimbire F, Lopes-Martins RA, Castro-Faria-Neto HC, Albertini R, Chavantes MC, Pacheco MT, Leonardo PS, Iversen VV, Bjordal JM.

Research Group of Animal Experimental, IP & D UNIVAP R. Shishima Hifumi, 2911, 12240-000, Sao Jose dos Campos, SP Brazil

Our objective was to investigate if low-level laser therapy (LLLT) could improve respiratory function and inhibit tumor necrosis factor (TNF-alpha) release into the diaphragm muscle of rats after an intravenous injection of lipopolysaccharide (LPS) (5 mg/kg). We randomly divided Wistar rats in a control group without LPS injection, and LPS groups receiving either (a) no therapy, (b) four sessions in 24 h with diode Ga-AsI-Al laser of 650 nm and a total dose of 5.2 J/cm2, or (c) an intravenous injection (1.25 mg/kg) of the TNF-alpha inhibitor chlorpromazine (CPZ). LPS injection reduced maximal force by electrical stimulation of diaphragm muscle from 24.15+/-0.87 N in controls, but the addition of LLLT partly inhibited this reduction (LPS only: 15.01+/-1.1 N vs LPS+LLLT: 18.84+/-0.73 N, P<0.05). In addition, this dose of LLLT and CPZ significantly (P<0.05 and P<0.01, respectively) reduced TNF-alpha concentrations in diaphragm muscle when compared to the untreated control group.

 Lasers Med Sci. 2006 Dec;21(4):238-44. Epub 2006 Oct 11.

A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation.

Schubert MM, Eduardo FP, Guthrie KA, Franquin JC, Bensadoun RJ, Migliorati CA, Lloid CM, Eduardo CP, Walter NF, Marques MM, Hamdi M.

Department of Oral Medicine, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Ave E, Seattle, WA, 98109 USA

INTRODUCTION: Oral mucositis (OM) is a significant early complication of hematopoietic cell transplantation (HCT). This phase III randomized double-blind placebo-controlled study was designed to compare the ability of 2 different low level GaAlAs diode lasers (650 nm and 780 nm) to prevent oral mucositis in HCT patients conditioned with chemotherapy or chemoradiotherapy.

MATERIALS AND METHODS: Seventy patients were enrolled and randomized into 1 of 3 treatment groups: 650 nm laser, 780 nm laser or placebo. All active laser treatment patients received daily direct laser treatment to the lower labial mucosa, right and left buccal mucosa, lateral and ventral surfaces of the tongue, and floor of mouth with energy densities of 2 J/cm(2). Study treatment began on the first day of conditioning and continued through day +2 post HCT. Mucositis and oral pain was measured on days 0, 4, 7, 11, 14, 18, and 21 post HCT.

RESULTS: The 650 nm wavelength reduced the severity of oral mucositis and pain scores. Low level laser therapy was well-tolerated and no adverse events were noted.

DISCUSSION: While these results are encouraging, further study is needed to truly establish the efficacy of this mucositis prevention strategy. Future research needs to determine the effects of modification of laser parameters (e.g., wavelength, fluence, repetition rate of energy delivery, etc.) on the effectiveness of LLE laser to prevent OM.

Support Care Cancer. 2007 Mar 29; [Epub ahead of print]

Protective effect of low-power laser radiation in acute toxic stress

Novoselova EG, Glushkova OV, Khrenov MO, Chernenkov DA, Lunin SM , Novoselova TV, Chudnovskii VM, Iusupov VI, Fesenko EE. Russia

The effect of preliminary short-term irradiation with He-Ne laser light (632.8 nm, 0.2 mW/cm2) of the thymus zone projection of male NMRI mice subjected to acute toxic stress on the responses of immune cells was studied. Stress was modeled by lipopolysaccharide injection, 250 mg/100 g of body weight, which induced a significant increase in the production of several macrophage cytokines, IL-1alpha, IL-1beta, IL-6, IL-10 and TNF-alpha. A single irradiation with laser light did not provoke considerable variations in NO production in cells but induced an enhancement in the production of heat shock proteins Hsp25, Hsp70, and Hsp90. Nevertheless, when irradiation with red laser light was applied prior to toxic stress, considerable normalization of production of nearly all cytokines studied and nitric oxide was observed. Moreover, the normalization of production of heat shock proteins has been shown in these conditions. Thus, preliminary exposure of a small area of animal skin surface provoked a significant lowering in the toxic effect of lipopolysaccharide.

Biofizika. 2007 Jan-Feb;52(1):137-40.

Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials.

Bjordal JM, Klovning A, Ljunggren AE, Slordal L.

Department of Public Health and Primary Health Care, University of Bergen, 5018 Bergen Norway

BACKGROUND: Pain is the most debilitating symptom in osteoarthritis of the knee (OAK).

AIM AND METHODS: To determine the short-term pain-relieving effects of seven commonly used pharmacological agents for OAK pain by performing a systematic review of randomised placebo-controlled trials.

RESULTS: In total, 14,060 patients in 63 trials were evaluated. Opioids and oral NSAIDs therapy in patients with moderate to severe pain (mean baseline 64.3 and 72.8 mm on VAS respectively) had maximum efficacies compared to placebo at 2-4 weeks of 10.5 mm [95% CI: 7.4-13.7] and 10.2 mm [95% CI: 8.8-11.2] respectively. The efficacy of opioids may be inflated by high withdrawal rates (24-50%) and "best-case" scenarios reported in intention-to-treat analyses. In patients with moderate pain scores on VAS (mean range from 51 to 57 mm), intra-articular steroid injections and topical NSAIDs had maximum efficacies at 1-3 weeks of 14.5mm [95% CI: 9.7-19.2] and 11.6 mm [95% CI: 7.4-15.7], respectively. Paracetamol, glucosamin sulphate and chondroitin sulphate had maximum mean efficacies at 1-4 weeks of only 4.7 mm or lower. Heterogeneity tests revealed that best efficacy values of topical NSAIDs may be slightly deflated, while data for oral NSAIDs may be slightly inflated due to probable patient selection bias.

CONCLUSION: Clinical effects from pharmacological interventions in OAK are small and limited to the first 2-3 weeks after start of treatment. The pain-relieving effects over placebo in OAK are smaller than the patient-reported thresholds for relevant improvement.

Eur J Pain. 2007 Feb;11(2):125-38. Epub 2006 May 8.

The effect of low-level laser therapy during orthodontic movement: a preliminary study.

Youssef M, Ashkar S, Hamade E, Gutknecht N, Lampert F, Mir M.

Dental School, Damascus University, Damascus

SyriaIt has been emphasized that one of the most valuable treatment objectives in dental practice is to afford the patient a pain-free treatment. By the evolution of the laser applications, the dental committee aimed to achieve this goal without analgesic drugs and painful methods. Orthodontic treatment is one of these concerns, that one of the major components of patient to reject this treatment is the pain accompanied during the different treatment phases. Another great concern of the patient is not to get through prolonged periods of treatment. The aim of this study is to evaluate the effect of the low-level (GaAlAs) diode laser (809 nm, 100 mW) on the canine retraction during an orthodontic movement and to assess pain level during this treatment. A group of 15 adult patients with age ranging from 14 to 23 years attended the orthodontic department at Dental School, Damascus University. The treatment plan for these patients included extraction of the upper and lower first premolars because there was not enough space for a complete alignment or presence of biprotrusion. For each patient, this diagnosis was based on a standard orthodontic documentation with photographs, model casts, cephalometric, panorama, and superior premolar periapical radiographies. The orthodontic treatment was initiated 14 days after the premolar extraction with a standard 18 slot edgewise brackets [Rocky Mountain Company (RMO)]. The canine retraction was accomplished by using prefabricated Ricketts springs (RMO), in both upper and lower jaws. The right side of the upper and lower jaw was chosen to be irradiated with the laser, whereas the left side was considered the control without laser irradiation. The laser was applied with 0-, 3-, 7-, and 14-day intervals. The retraction spring was reactivated on day 21 for all sides. The amount of canine retraction was measured at this stage with a digital electronic caliper (Myoto, Japan) and compared each side of the relative jaw (i.e., upper left canine with upper right canine and lower left canine with lower right canine). The pain level was prompted by a patient questionnaire. The velocity of canine movement was significantly greater in the lased group than in the control group. The pain intensity was also at lower level in the lased group than in the control group throughout the retraction period. Our findings suggest that low-level laser therapy can highly accelerate tooth movement during orthodontic treatment and can also effectively reduce pain level.

Lasers Med Sci. 2007 Mar 15; [Epub ahead of print]

Effect of low intensity laser irradiation on surgically created bony defects in rats.

Nissan J, Assif D, Gross MD, Yaffe A, Binderman I.

Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv Israel

Low intensity lasers have been used by clinicians to improve healing and reduce pain in humans. Lasing also results in new bone formation around hydroxyapatite implants and a significant increase in the total bone area. However, the exact mechanism of cell biostimulation by laser is still unclear. This study biochemically assessed the effects of low intensity laser (Gallium-Arsenide) using 4 and 22.4 mW cm(-2) power density on the bone healing process after surgically creating bony cavities in rat mandibles. Rats (n = 24) were divided into two groups each treated with specific energy, 4 or 22.4 mW cm(-2), for 3 min each day post-surgery. Surgical cavities were created on both sides of the mandible: the left served as an untreated control, the right was treated with laser. All rats were sacrificed after 1, 2 and 4 weeks of treatment. In the newly formed callus, accumulation of radiocalcium and alkaline phosphatase activity was measured to indicate osteogenic activity. One-way anova with repeated measures showed that the low intensity laser using 4 mW cm(-2) power density significantly increased radiocalcium accumulation from 2 weeks post-surgery, whereas 22.4 mW cm(-2) had no effect. No changes were noted in the activity of alkaline phosphatase with the laser treatment. These results suggest that laser therapy of low power density is effective on the bone healing process in artificially created osseous cavities by affecting calcium transport during new bone formation

J Oral Rehabil. 2006 Aug;33(8):619-924.

Increases in Central Retinal Artery Blood Flow in HumansFollowing Carotid Artery and Stellate Ganglion Irradiation with0.6 to 1.6 mum Irradiation.

Mii S, Kim C, Matsui H, Oharazawa H, Shi wa T, Takahashi H, Sakamoto A.

Department of Anesthesiology, Nippon Medical School. Japan

The authors applied near-infrared low-level laser irradiation (LLLI) directed to the stellate ganglion (SG) and to the common carotid artery (CCA), and compared the effects on central retinal artery blood flow using color pulse Doppler sonography. In 10 healthy volunteers, LLLI (0.92 W, 1 : 1 duty cycle, 10 min) to both the SG and CCA significantly increased peak systolic blood velocity in the ophthalmic artery (p<0.001, each) and central retinal artery (p<0.001, each) without changes in vessel resistance. Irradiation to the CCA produced a stronger effect than that to the SG in the ophthalmic artery (p=0.007) and central retinal artery (p=0.031). These data suggest that LLLI to the SG or to the CCA is a useful therapy for increasing the retrobulbar blood flow, with irradiation directed to the CCA being more effective than that directed to the SG in clinical settings

J Nippon Med Sch. 2007 Feb;74(1):23-9.

Re: "low-level laser therapy and lateral epicondylitis" Maher S. Phys Ther.2006;86:1161-1167.

Bjordal JM. Norway

Low level laser therapy (LLLT) in lateral  epicondylitis by Maher (1) in the August issue of Physical  Therapy's Evidence in Practice section needs some  commentary. The negative conclusion is not surprising  based on the few studies the author was able to retrieve;  however, the conclusion may still be wrong for a number of  reasons:

Phys Ther. 2007 Feb;87(2):224-5; author reply 225-6. No abstract available.


Stimulatory effects of hydroxyl radical generation by Ga-Al-As laser irradiation on mineralization ability of human dental pulp cells.

Matsui S, Tsujimoto Y, Matsushima K.

Department of Endodontics, Nihon University School of Dentistry at Matsudo, Chiba Japan

The present study was conducted to investigate the effects of Ga-Al-As laser irradiation on the mineralization ability of human dental pulp (HDP) cells. HDP cells in vitro were irradiated once with a Ga-AL-As laser at 0.5 W for 500 s and at 1.0 W for 500 s in order to investigate free radicals as one mechanism for transmission of laser photochemical energy to cells. Production of the hydroxyl radical (*OH) was measured using the ESR spin-trapping method and was found to be increased by laser irradiation. The DMPO-OH was not detected in the presence of dimethyl sulfoxide (DMSO), a *OH scavenger. The formation of calcification nodule was also investigated by von Kossa staining. The number of calcified nodules was increased by 1.0 W-laser irradiation. Alkaline phosphatase (ALP) activity was higher in the 1.0 W-laser irradiation group. Expression of mRNAs for heat shock protein 27, bone morphogenetic proteins (BMPs) and ALP were greater in the 1.0 W-laser irradiation group. Expression of BMPs in the conditioned medium was also higher in the 1.0 W-laser irradiation group. In particular, DMSO decreased the number of calcified nodule produced by 1.0 W-laser irradiation. These results supposed that the mineralization of HDP cells is stimulated by laser irradiation, and that *OH generated by laser irradiation is a trigger for promotion of HDP cell mineralization.

Biol Pharm Bull. 2007 Jan;30(1):27-31.


Low-level laser effect on mandibular distraction osteogenesis.

Miloro M, Miller JJ, Stoner JA.

Section of Oral and Maxillofacial Surgery, University of Nebraska Medical Center, Omaha, NE 68198-5180 USA

PURPOSE: The purpose of this study was to determine whether low-level laser (LLL) application during distraction osteogenesis could accelerate bone regeneration and decrease the length of the consolidation phase and thereby reduce potential patient morbidity.

MATERIALS AND METHODS: Nine adult female New Zealand white rabbits underwent bilateral mandibular corticotomies and placement of unidirectional distraction devices (KLS-Martin LP, Jacksonville, FL). Each rabbit served as its own internal control. After a latency of 1 day, distraction progressed bilaterally at 1 mm per day for 10 days. Immediately after each device activation, the experimental side, chosen randomly, was treated with real LLL (Laser Medical Systems, Hedehusene, Denmark) of 6.0 J x 6 transmucosal sites in the area of the distraction gap. Radiographs were taken presurgically, immediately postsurgically, and weekly until sacrifice, and the bone was analyzed using a semiquantitative 4-point scale (Bone Healing Score [BHS]). Three animals each were sacrificed at 2, 4, and 6 weeks postdistraction, and each hemimandible was prepared for histologic examination in a blinded fashion.

RESULTS: Ten millimeters of distraction was achieved in each rabbit bilaterally. Radiographically, the BHS was higher for the LLL-treated group at all time periods. Histologically, the area of new bone trabeculation and ossification was more advanced for the LLL-treated group, with less intervening fibrovascular intermediate zone in the bony regenerate, at all time periods. The formation of a complete inferior border occurred sooner in the treatment group than in the controls.

CONCLUSIONS: LLL accelerates the process of bone regeneration during the consolidation phase after distraction osteogenesis. The adjunctive use of LLL may allow a shortened period of consolidation and therefore permit earlier device removal, with the avoidance of morbidity associated with prolonged device retention.

J Oral Maxillofac Surg. 2007 Feb;65(2):168-76.


Increase of bone volume by a nanosecond pulsed laser irradiation is caused by a decreased osteoclast number and an activated osteoblasts.

Ninomiya T, Hosoya A, Nakamura H, Sano K, Nishisaka T, Ozawa H.

Division of Hard Tissue Research, Institute for Oral Science, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781 Japan

The biostimulatory effects of laser irradiation focus not only in the field of soft tissue but also bone formation. Studies have shown that the light of a nanosecond pulsed laser which has a high peak power can produce stress waves in tissue. We have hypothesized that nanosecond pulsed laser irradiation stimulates bone formation. Our aim was to clarify the mechanism of increased bone volume by nanosecond pulsed laser irradiation. Rat femur was irradiated with a Q-switched Nd:YAG laser, which has a wavelength of 1064 nm. The quantification of trabecular architecture using three-dimensional morphometric analysis and measurement of bone mineral density (BMD) using pQCT was performed on day 1, day 3, day 5, and day 7 after laser irradiation. The laser effects on bone cells were also investigated using histological and immunohistochemical analysis. On day 1 after laser irradiation, bone volume (BV/TV), trabecular thickness (Tb.Th), and other parameters of the irradiated group did not significantly differ from the non-irradiation group (control). However, the mean BV/TV, Tb.Th, mineral apposition rate, and BMD of the laser group on day 7 after laser irradiation were significantly greater than those of the control. On histological analysis, the number of TRAP-positive osteoclasts was lower on day 3 after laser irradiation. Osteoblasts with activated clearance were seen in the laser irradiated group on day 1 and day 3. These data reveal that the increased bone volume by nanosecond pulsed laser irradiation causes an increase in osteoblast activity and a decrease in osteoclast number.

Bone. 2007 Jan;40(1):140-8. Epub 2006 Sep 15.


Acrodermatitis paraneoplastica responding to topical PUVA treatment.

Abrou AE, Hope J, Jackson-Richards D, Lim HW, Ozog DM.

Department of Dermatology, Henry Ford Hospital, Detroit, MI 48322 USA

Acrodermatitis paraneoplastica is a rare paraneoplastic entity that has been associated with multiple neoplasms, most commonly squamous cell carcinoma of the aerodigestive tract. Therapies have focused on treatment of the underlying carcinoma. We report a case of acrodermatitis paraneoplastica successfully treated with PUVA therapy.

Photodermatol Photoimmunol Photomed. 2007 Feb;23(1):37-8.


What is safe?: an introduction.

Anderson RR.

Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Nassachusetts 02114 USA

Safety is an illusion; our best hope is to estimate and  minimize degrees of risk. In this issue, Dr. Henry Chan and  colleagues report their laudable attempt to assess the  degree of risk for carcinogenesis after many treatments  with non-ablative lasers and a xenon flashlamp intense  pulsed light source. They are pioneers. They did not find  anything "scary." phew!  We have been assuming that numerous treatments  causing well-controlled local thermal injury have an  extremely low (not zero) risk for inducing cancer. Chan  et al. tested a pulsed dye laser like those repeatedly used for  babies with birthmarks, a non-ablative mid-infrared laser  like those used for adults with photoaging, and an intense  pulsed light representative of the popular genre. After  about 50 treatments of mice over 6 months, no cancers or  evidence of skin toxicity occurred. Another risk-assessing  pioneer, Harold Blum did similar experiments with ultra-  violet light over 60 years ago. He also chose mice, a similar  dosing schedule, and used a moderate sunburn dose. The  mice developed hundreds of skin cancers. That work led in  part and eventually, to our present and still incomplete  understanding of DNA damage, repair, faulty repair,  mutagenesis, immune modulation, and photo-carcinogen-  esis. Unlike Chan et al., Blum was not able to look at gene  expression, because the basic machinery of DNA had not  yet been deciphered. What is the signi icance of Chan et al.Õs finding that p16  and PCNA expression are increased after so many laser  treatments in mice? These are markers for cell prolifera-  tion, not mutagenesis or carcinogenesis per se. Laser and  other treatments consist, essentially, of rather precisely  wounding the skin to the point that it has to repair itself (oh,  what a misnomer that word "rejuvenation" really is!). Cell  proliferation is part of the induced repair, which includes  upregulation of these and other cellular genes, plus many  genes coding for extracellular matrix repair. The observed  increases in p16 and PCNA expression are therefore an  expected part of therapeutic responseÑbut how are we to  be sure that this is "normal"? What distinguishes cancer  and other processes requiring cell division is a sustained  increase in cell proliferation. Unfortunately, the duration  of increased p16 and PCNA expression was apparently not  examined. What do we really know about repeated, laser-induced  skin injury and carcinogenesis? Lasers (and many other  tools) heat the tissue. Heat is not a primary mutagen, but   repeated thermal injury of the skin and eyes is known to be  either carcinogenic or to act as a carcinogen promoter. The  classic example in dermatology is an atrophic condition on  the lower legs of people who sit in front of coal stoves for  years, called erythema ab igne (literally, "redness from  fire"), which entails a high risk of developing squamous cell  carcinoma. Indeed, many things that induce cell prolifera-  tion including common irritants and simple skin abrasion  can "promote" cancer if delivered in concert with a  mutagen. A bunch of laser treatments are therefore more  likely to act as promoter, than as a primary carcinogen. This is played out in practice every dayÑwhen we treat  photoaged skin, it has already suffered UV-induced muta-  tions in p16, p53 and other cancer-associated genes. The solar fusion reactor is just plain nasty for our hides,  even though it does sustain all life on earth. A good  next step following Chan, et al. may be to see how well  laser treatments act as a promoter in mice exposed to  carcinogen. The authors also note some (transient?) hypopigmentation in an asian after repeated treatment with Q-switched  Nd:YAG laser at 1,064 nm. When we first studied that type  of laser, it was clear that melanin-containing cells in  epidermis and hair follicles were the primary targets. So, it  is not surprising to find some pigmentary loss. Again, the  genetic risk potential is not zero. In the early days after  invention of "giant" pulses from the Q-switched ruby laser,  investigators noted that shock waves causing chromosome  breaks were formed. Fortunately, breaks are usually  lethal, and bacterial assays showed little or no measurable  mutagenesis from Q-switched pulses. It was 1981 when I met the first dermatologist to use  "the" laser, Dr. Leon Goldman. Like Chan et al., he had  been wondering about the effects of repeated laser  exposure. Leon showed me a 1-cm spot on his own forearm,  that he had exposed to one pulse from his ruby laser,  almost every workday morning for most of the 1960s and  the early part of the 1970s. There was nothing to see, except  a patch of normal skin on the guy who started all this stuff.

Lasers Surg Med. 2007 Jan;39(1):7. No abstract available.


Effect of low intensity laser interaction with human skin fibroblast cells using fiber-optic nano-probes.

Pal G, Dutta A, Mitra K, Grace MS, Amat A, Romanczyk TB, Wu X, Chakrabarti K, Anders J, Gorman E, Waynant RW, Tata DB.

Mechanical & Aerospace Engineering Department, Department of Biological Sciences

Florida Institute of Technology, FL. Uniformed Services University of the Health Sciences, MD. Food & Drug Administration, MD USA

Over the past forty years, many efforts have been devoted to study low power laser  light interactions with biological systems. Some of the investigations were performed in-  vitro, on bulk cell populations. Our present work was undertaken to apply specially  engineered fiber-optic based nano-probes for the precise delivery of laser light on to a  single cell and to observe production of low power laser light induced reactive oxygen  species (ROS). A normal human skin fibroblast (NHF) cell line was utilized in this  investigation and the cells were irradiated under two different schemes of exposure: (1) an  entire NHF cell population within a Petri dish using a fan beam methodology, and (2)  through the precise delivery of laser energy on to a single NHF cell using fiber-optic nano-  probe. Photobiostimulative studies were conducted through variation of laser intensity,  exposure time, and the energy dose of exposure. Laser irradiation induced enhancement in  the rate of cell proliferation was observed to be dependent on laser exposure parameters and  the method of laser delivery. The total energy dose (fluence) had a greater influence on the  enhancement in the rate of cellular proliferation than compared to laser intensity. The  enhancement in the growth rate was observed to have a finite life-time of several days after  the initial laser exposure. Fluorescent life-time imaging of ROS was performed during the  nano Ð based single cell exposure method. The kinetics of ROS generation was found to  depend strongly on the laser fluence and not on the laser intensity.  

J Photochem Photobiol B. 2007 Mar 1;86(3):252-61. Epub 2007 Jan 16.


Verifiable CPD paper: introduction, history of lasers and laser light production.

Parker S.

Harrogate, North Yorkshire

The word laser conjures in the mind's eye many aspects of what might be described as 'modern' life. The words 'powerful', 'precise' and 'innovative' complement our conception of the world in terms of technology, whereas patients often associate the words 'magical' and 'lightening quick' with the use of lasers in medical practice. The purpose of this series of articles is to explore the history and development of lasers, the integration of lasers into clinical dentistry and the safeguards as to their regulated use.

Br Dent J. 2007 Jan 13;202(1):21-31.



K.R. Byrnes 1, R.W. Waynant 2, I.K. Ilev 2, B. Johnson 1, Pollard H. 1, Srivastava M. 1, Eidelman O. 1, Huang, W. 1, J.J. Anders1

1. Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA;
2. Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD, USA

Secondary injury in the spinal cord, which results in axonal degeneration, scar and cavity formation and cell death, occurs around the site of the initial trauma and is a primary cause for the lack of axonal regeneration observed after spinal cord injury (SCI). The immune response after SCI is under investigation as a potential mediator of secondary injury. Treatment of SCI with 810 nm light suppresses the immune response and improves axonal regeneration.

We hypothesize that these beneficial effects observed in the injured spinal cord are accompanied by alterations in gene expression within the spinal cord, particularly of those genes involved in secondary injury and the immune response. To test this hypothesis, a dorsal hemisection at vertebral level T9 was performed. The injured spinal cord from rat was then exposed to laser light (810nm, 150mW, 2,997 seconds, 0.3cm2 spot area, 1589 J/cm2) and spinal cord samples, including the injury site, were harvested at 6 and 48 hours and 4 days post-injury. Total RNA was extracted and purified from the lesioned spinal cord and cDNA copies were either labeled with [32P] for microarray analysis or amplified and analyzed with a polymerase chain reaction (PCR).

Microarray results revealed a suppression of genes involved in the immune response and excitotoxic cell death at 6 hours post-injury, as well as cell proliferation and scar formation at 48 hours post-injury in the light treated group. Analysis of the PCR products revealed that light treatment resulted in a significant suppression of expression of genes that normally peak between 6 and 24 hours post-injury, including the pro-inflammatory cytokine interleukin 6 (IL6), the chemokine monocyte chemoattractant protein 1 (MCP-1) and inducible nitric oxide synthase (iNOS; p<0.05). Genes expressed earlier than 6 hours post-injury, such as IL1b, tumor necrosis factor a (TNFa) and macrophage inflammatory protein 1a (MIP-1a) were not affected by light treatment.

Although the precise role some of these genes play in axonal regeneration after spinal cord injury is currently unclear, these data demonstrate that light therapy has an anti-inflammatory effect on the injured spinal cord, and may reduce secondary injury, thus providing a possible mechanism by which light therapy may result in axonal regeneration.


Schubert V. - Karolinska Institute, Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Huddinge University Hospital, Stockholm, Sweden.

BACKGROUND: The effects of infrared and red pulsed monochromatic light, with varied pulsations and wavelengths, on the healing of pressure ulcers were evaluated in this prospective, randomized, controlled study.

METHODS: Elderly patients (> or =65 years) with Stage 2 or 3 skin ulcers were enrolled and assigned to one of two groups. Both groups were given the same standard ulcer therapy. One group was also given phototherapy with pulsed monochromatic infrared (956 nm) and red (637 nm) light. Treatments lasted 9 min each time using a regimen with pulse repetition frequency varied between 15.6 Hz and 8.58 kHz. Patients were followed for 10 weeks or until the ulcer was healed, whichever occurred first. The ulcer surface area was traced weekly.

RESULTS: Patients treated with pulsed monochromatic light had a 49% higher ulcer healing rate, and a shorter time to 50% and to 90% ulcer closure compared with controls. Their mean ulcer area was reduced to 10% after 5 weeks compared with 9 weeks for the controls.

CONCLUSION: The results are encouraging as pulsed monochromatic light increased healing rate and shortened healing time. This will positively affect the quality of life in elderly patients with pressure ulcer.

Photodermatol Photoimmunol Photomed. 2001 Feb;17(1):32-8.


D. Lichtenstein FICA, B Morag, Maccabi Health Care Services and Department of Vascular Surgery, Sourasky Medical Center, Sakler Faculty of Medicine, Tel Aviv Israel

The effectiveness of Laser Therapy (LLLT) in accelerating wound healing has been clinically well documented. We used two devices: one, a He-Ne laser with a wavelength of 632.8nm and power output of 120mW. The indication for treatment was stasis ulcers (Ulcer cruris) due to chronic venous insufficiency syndrome. Sixty-two patients were treated in this study. The challenge of obtaining good results when treating patients with long-standing vascular ulcers and wounds caused us to explore this technique. We achived complete healing, classified as good, in 53 patients (85.48%) of the patients during a two week period of treatment, and moderate partial wound closure with clinical improvement in 4 patients (6.46%) with chronic long-term venous leg ulcers. The efficacy of the treatment was (91.94%). No patient had to stop treatment because of adverse side effects. Two patients (3.2%) had recurrent ulcers. These findings indicate that appropriate doses of laser can be beneficial in promoting tissue repair.

Laser Therapy Vol 11 - 2


M.E. Sugrue, FRCSI, J. Carolan, BSc, E.J. Leen, MB, T.M. Feeley, FRCSI, D.J. Moore, FRCSI, G.D. Shanik, FRCSI, Dublin Ireland.

Management of intractable venous ulceration remains an unrewarding task, which is increasingly delegated to the realm of the vascular surgeon. The purpose of this pilot study was to assess the ulcer-healing effects of the newest form of biostimilation—the low power laser (LLLT). Twelve patients with chronic venous ulcers unresponsive to conservative measures were treated with infrared laser irradiation for twelve weeks. Two ulcers healed completely and there was a 27% (p<0.01) reduction in size of the remaining ulcers. Treatment resulted in a 44% (p<0.01) increase in ulcer floor area occupied by healthy granulation tissue. The most dramatic effect of laser treatment was the reduction in ulcer pain, from 7.5 to 3.5 (linear analogue scale) (p<0.001). Laser irradiation had no effect on TcPO2, number of skin capillaries of pericapillary fibrin deposition in the lipodermatosclerotic area around the ulcer. The results of this pilot study are encouraging and a carefully controlled randomized study is indicated to compare low power laser irradiation to conventional treatment in the management of venous ulcers.

(Ann Vasc Surg 1990;4:179-181).


Physical and Occupational Therapy in Geriatrics. 2000, 18/2 (1-19) Verdote-Robertson-R, Munchua-M-M, Reddon-J-R.

The effect of low intensity laser therapy (LLLT) on wound healing in a largely psychogeriatric population was assessed over a period of 6 years (1991-1996). In total, 84 psychiatric patients were referred for the treatment of open wounds of varying severity and etiology. The wound status, nutritional status, walking status, and psychiatric condition of each patient were assessed prior to the administration of laser therapy treatment. Traditional wound care management was also used in addition to laser therapy. According to laser therapy treatment protocol for open wounds, a single diode laser probe was used for biostimulation of the wound bed and the wound periphery. Pre- and post-treatment measurements of wound size were obtained periodically for a total of 188 open wounds. 84% of these wounds completely healed, 11.2% partially healed, 2.1% did not change, and 2.7% got worse. The number of treatments for the 158 completely-healed wounds ranged from 3 to 133 (mean 18.5) and the treatment period ranged from 5 to 383 days (mean 47.7). Wound healing was found to be related to nutritional status but neither walking status nor wound size. Results indicate that LILT is effective in the treatment of open wounds when it is used as a component of a total wound management program.


Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. jmb@hib.no

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

Aust J Physiother 2003;49(2):107-16


Ozdemir F, Birtane M, Kokino S.

Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.

Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LLLT) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

Clin Rheumatol 2001;20(3):181-4


Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD, Michal Rosenthal, MD, Iulian Abramovici, MD, Nathalia Kutok, MD, and Auni Khahil, MD

Objective: To evaluate the effects of low-power light therapy (LLLT) on pain and disability in elderly patients with degenerative osteoarthritis in the knee.

Design: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters.

Patients: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients) and placebo (17 patients). Infrared and placebo emitters were double-blinded.

Interventions: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.

Main Outcome Measures: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient’s request to be retreated was summed up 1 year after the trial. Results: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red and infrared treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo respectively)

Conclusions: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee. Degenerative osteoarthritis (DOA) is the most common rheumatic disorder of man and causes pain and disability especially in elderly people.1 Autopsy surveys show that degenerative changes in joints begin as early as the second decade of life. 2 Roentgenographic studies conducted in the United States showed osteoarthritic changes in 4 percent of persons under 24 years of age in 85 percent at 75 to 79 years of age. Symptomatic manifestations of osteoarthritis increase with ageing, reflecting disease changes that begin in early life and progress slowly over a period of many decades. 3-4

J Am Geriatr Soc. 1992; 40: 23-26


M. A. Trelles, J. Rigau, P. Sala, G. Calderhead and T. Ohshiro

Degenerative joint disease (DJD) in particular in the knee. is difficult to, cure successfully at present often requiring surgical intervention. In addition the chronic DJD patient often exhibits symptoms cl both a physiological and psychological nature. A study is presented using high reactive-level laser therapy (LLLT) with an 830 nm infra red continuous wave gallium aluminium (or aluminium) arsenide (GaAlAs) diode laser with an output power of 60 mW. in light contact Laser therapy for a population of 40 patients (power density of approximately 3 W/cm2). Four points around the patella were irradiated for 60 s each (energy density of 18 J/cm2 per point. total of 72 J/cm2 per session) two sessions per week for eight weeks. Radiological, pain score and joint mobility assessments were made before the first session, immediately after at 4 months after the final LLT session. All other medication and physical therapy was discontinued at least 15 days prior to the first treatment session. Thirty-three patients (82%) reported significant removal of pain and recovery of articular joint mobility. The remaining seven patients felt there was no significant effect following LLLT and returned to their original pretherapy medication. The side effects were minimal LLLT is concluded to to be safe, effective and non-invasive alternative to conventional surgical and medical treatment modalities for DJD patients.

Laser Therapy 1991, 3:149-153


Kanji Aoada, Yasutaka Ytani, Akira Sakawa and Akira Shimazu - Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected Joints, thereby seriously restricting the patient's quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient's QOL at a reasonable level. The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognised in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data). From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAIAs diode laser system (830 nm, 60 mW CIW). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement?, good (clearly apparent improvement), and unchanged (little or no improvement). For, pam attenuation, scores were: excellent — 59.6%; good — 30.4%; unchanged — 10%. For ROM improvement the scores were: excellent — 12.6%; good — 43.7%; unchanged — 43.7 Yo. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.


Kevin C Moore MB ChB FRCA Naru Hira. Parswanath Kramer, Copparam Jayakumar & Toshio Ohshiro

Department of Anaesthesia, The Royal Oldham Hospital,

Post herpetic neuralgia can be an extremely painful condition which in many cases proves resistant lo all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course. This trial was designed as a double blind assessment of the efficacy of low level laser therapy (LLLT) in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received four consecutive laser treatments. The results demonstrate a significant reduction in the pain intensity and distribution following a course of low level laser therapy.

Laser Therapy. 1988; 1: 7.


Osamu Kemmotsu, Kenichi Sato, Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Sigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males, 38 females with an average age of 69 years) managed at our pain clinic over the past 4 years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminium arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave) Pain scores (PS) were obtained using a linear analog scale (0 to 10) before and after LLLT. The immediate effect after the initial LLLT was very good (PS: 0-3) in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 +/- 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a non invasive, painless and safe method of therapy, it is well acceptable by patients.

0898-5901/91/020071-05$05.00 Ì 1991 by John Wiley & Sons, Ltd.


Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan

In the present study we evaluate the effects of laser irradiation (LLLT) on the area near the stellate ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover and placebo-controlled study was designed to deny the placebo effect of laser irradiation. Eight inpatients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three session s of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS). Measurement were performed before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no changes in VAS were obtained by placebo treatment. These changes in the temperature and VAS were further dependent on the energy density, i.e the dose. Results demonstrate that laser irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Laser Therapy 1997:9:7-- 12


Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K., General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of postoperative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6- 8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand postoperative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups. Controls n = 5.5: LLLT n = 2.5. No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group. Controls n = 9: LLLT n = 4. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

0898-5901/92/040145-05$07.50 @) 1992 by John Wiley & Sons, Ltd.


ArneEckerdal and and Lehmann Bastian

Department of Oral and Maxillofacial Surgery and Oral Medicine,
Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a doubleblind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks. The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year only one patient was still completely free from pain. The use of analgesics was recorded and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Laser Therapy, 1996:: 8: 247-252


Adltya K. Gupta, MD, FRCP(C)), Natalia Filonenko, PhD, Norman Salansky, PhD, flms, Daniel N. Sadder, MD, FRCP(C)

BACKGROUND. Venous ulcers are estimated to be present in 0.2 to 0.4% of the population. Although new therapies have significant promise, nonhealing ulcers still represent a significant problem. Objective. To evaluate the efficacy of low energy photon therapy (LEPT) in the treatment of venous leg ulcers.

METHODS. A placebo-controlled, double-blind study using low energy photon therapy was performed in nine patients with 12 venous ulcers. Treatment was given three times a week for 10 weeks, using two monochromatic optical sources. One source provided a wavelength (A) of 660 nm (red) while the second source delivered a wavelength of 880 nm (infrared). Two optical probes were used, one consisted of an array of 22 monochromatic sources, operating at a wavelength of 660 nm and covering an area 6 x 10 cm2. The second probe had seven infrared sources, operating at a wavelength of 880 nm and covering an area of 4 cm2 The above configuration of optical probes was selected to cover the majority of the ulcer area being treated. The patients who were randomized to placebo treatment received sham therapy from an identical-appearing light source from the same delivery system.

RESULTS. Nine patients with 12 venous ulcers were randomized to receive LEPT or placebo therapy. At the conclusion of the study, the percentage of the initial ulcer area remaining unhealed in the LEPT and placebo groups was 24.4% and 84.7%, respectively (P = 0.0008). The decrease in ulcer area (compared to baseline) observed in the LEPT and placebo groups was 193.0 mm2 and 14.7 222, respectively (P = 0.0002). One patient dropped out of the study, complaining of lack of treatment efficacy; he was found to be randomized to the placebo group. There were no adverse effects.

CONCLUSION. In this placebo-controlled, double-blind study LEPT was an effective modality for the treatment of venous leg ulcers. © 1998 by the American Society for Dermatologic Surgery, Inc. Dermatol Surg 1998;24:1383-1386. From the Division of Dermatology, Department of Medicine, University of Toronto; International Medical Instruments Inc.; and Selye-Toffler University, Toronto, Ontario, Canada.

© 1998 by the American Society for Dermatologic Surgery, Inc. - Published by Elsevier Science Inc. 1076-0512/98/$19.00 - PII S1076-0512(98)00168-X

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