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LLLT Research AbstractsLatest LLLT / Cold Laser Literature watch with abstracts Jan 09Our latest LLLT literature review with 20 abstracts including another muscle fatigue paper from Brazil, two Oral Mucositis papers, a "strong" rating for laser on myofascial trigger points in a Chiropractic systematic review and a Carpal Tunnel Syndrome clinical trial paper. Latest LLLT literature review with abstractsOur latest LLLT literature review with abstracts including muscle fatigue, TMJ, myofacial pain, acne and a possible application for morphine withdrawal. Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans. Laboratory of Human Movement, University of Caxias do Sul, Caxias do Sul, RS, Brazil. ecplealj@ucs.br OBJECTIVE: To investigate if development of skeletal muscle fatigue during repeated voluntary biceps contractions could be attenuated by low-level laser therapy (LLLT)z. BACKGROUND DATA: Previous animal studies have indicated that LLLT can reduce oxidative stress and delay the onset of skeletal muscle fatigue. Literature watch for July & August 2008This our biggest bimonthly Literature Watch ever. There is so much interesting clinical and lab work being published including LLLT treatment of Meniere’s Disease, muscle fatigue, stroke, bone healing, Oral Mucositis, TMJ, Carpal Tunnel Syndrome, TB, burns and even Snake Venom. Effect of Low-Level Laser Therapy on Mast Cells in Viability of the Transverse Rectus Abdominis Musculocutaneous Flap. Department of Plastic Surgery and Professor of IMES-FAFICA, Sao Paulo Federal University (UNIFESP), Sao Paulo, SP, Brazil. Abstract Objective: To assess the effect of low-level laser therapy (LLLT) on viability of mast cells of the transverse rectus abdominis musculocutaneous (TRAM) flap. Background Data: LLLT has been recently used on the TRAM flap to stimulate mast cells. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow).Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI METHODS: Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures. RESULTS: 18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger's graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported. CONCLUSION: LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses. Electrophysiologic Effects of a Therapeutic Laser on Myofascial Trigger Spots of Rabbit Skeletal Muscles.Chen KH, Hong CZ, Kuo FC, Hsu HC, Hsieh YL DESIGN:: In eight rabbits, one MTrS in each biceps femoris muscle was irradiated with a 660-nm, continuous-wave, gallium-aluminum-arsenate (GaAlAs) laser, at 9 J/cm. The contralateral side of muscle was treated with a sham laser. Each rabbit received six treatments. The immediate and cumulative effects were assessed by the prevalence of EPN with electromyographic (EMG) recordings after the first and last treatments. RESULTS:: Compared with pretreatment values, the percentages of EPN prevalence in the experimental side after the first and last treatments were significantly reduced (P < 0.01 for both). The change in EPN prevalence in the experimental side was significantly greater than in the control side immediately after the first and last treatments (P < 0.05). However, no significant differences were noted between the first and last treatments (P > 0.05). CONCLUSIONS:: In our study, immediate and cumulative effects of a GaAlAs laser applied on MTrS were demonstrated on the basis of the assessment of EPN prevalence. It seems that laser irradiation may inhibit the irritability of an MTrS in rabbit skeletal muscle. This effect may be a possible mechanism for myofascial pain relief with laser therapy. Effect of laser phototherapy on the release of fibroblast growth factors by human gingival fibroblasts.Damante CA, De Micheli G, Miyagi SP, Feist IS, Marques MM Low-level laser therapy improves vision in patients with age-related macular degeneration.Ivandic BT, Ivandic T Background Data: AMD affects a large proportion of the elderly population; current therapeutic options for AMD are limited, however. Patients and Methods: In total, 203 patients (90 men and 113 women; mean age 63.4 +/- 5.3 y) with beginning (dry) or advanced (wet) forms of AMD (n = 348 eyes) were included in the study. One hundred ninety-three patients (mean age 64.6 +/- 4.3 y; n = 328 eyes) with cataracts (n = 182 eyes) or without cataracts (n = 146 eyes) were treated using LLLT four times (twice per week). A semiconductor laser diode (780 nm, 7.5 mW, 292 Hz, continuous emission) was used for transconjunctival irradiation of the macula for 40 sec (0.3 J/cm(2)) resulting in a total dose of 1.2 J/cm(2). Ten patients (n = 20 eyes) with AMD received mock treatment and served as controls. Visual acuity was measured at each visit. Data were analyzed retrospectively using a t-test. Results: LLLT significantly improved visual acuity (p < 0.00001 versus baseline) in 162/182 (95%) of eyes with cataracts and 142/146 (97%) of eyes without cataracts. The prevalence of metamorphopsia, scotoma, and dyschromatopsia was reduced. In patients with wet AMD, edema and bleeding improved. The improved vision was maintained for 3-36 mo after treatment. Visual acuity in the control group remained unchanged. No adverse effects were observed in those undergoing therapy. Conclusion: In patients with AMD, LLLT significantly improved visual acuity without adverse side effects and may thus help to prevent loss of vision. Influence of laser photobiomodulation upon connective tissue remodeling during wound healing.Medrado AP, Soares AP, Santos ET, Reis SR, Andrade ZA Influence of low-level laser therapy on biomaterial osseointegration: a mini-review.Obradovic RR, Kesic LG, Pesevska S Low-Intensity Laser Irradiation Improves the Mitochondrial Dysfunction of C2C12 Induced by Electrical Stimulation.Xu X, Zhao X, Liu TC, Pan H Background Data: Many other studies in the past demonstrated that LIL had a cytoprotective effect, and a recent study also found that LIL could reduce muscular fatigue during tetanic contractions in rats. Methods: Cultured C2C12 myotubes were subjected to electrical stimulation or/and LIL irradiation at various intensities. Reactive oxygen species (ROS) were detected with a fluorescent probe (DCFH-DA) and mitochondrial function was assessed with an MTT assay. Results: The results showed that electrical stimulation at 20 ms, 5 Hz, and 45 V for 75 min can induce mitochondrial dysfunction in cultured C2C12 myotubes. Electrical stimulation-induced mitochondrial dysfunction was improved, but degeneration occurred with LIL at doses of 0.33-8.22 and 11.22-14.16 J/cm(2), respectively, and these changes were markedly increased with LIL at 0.33 and 1.34 J/cm(2), respectively. Conclusions: We conclude that treatment of myotubes with the proper dosage of LIL irradiation significantly diminished production of ROS and restored mitochondrial function, and this may provide a foundation for the use of photobiomodulation to treat exercise-induced mitochondrial dysfunction or skeletal muscular fatigue. Low-power laser irradiation activates Src tyrosine kinase through reactive oxygen species-mediated signaling pathway.Zhang J, Xing D, Gao X Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes With Chronic Achilles Tendinopathy.Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM Peloponnese University, Sparta, Laconia, Greece. BACKGROUND: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset. HYPOTHESIS: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (lambda = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm(2) and a total dose of 5.4 J per session. RESULTS: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group. CONCLUSION: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks. Am J Sports Med 2008 Feb 13 Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial.Antunes HS, de Azevedo AM, da Silva Bouzas LF, Adao CA, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, D'Aiuto de Matos V, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG. Section of Dentistry, Instituto Nacional de Cancer (INCA), Rio de Janeiro. Brazil We investigated the clinical effects of low-power laser therapy (LPLT) on prevention and reduction of severity of conditioning-induced oral mucositis (OM) for hematopoietic stem cell transplantation (HSCT). We randomized 38 patients who underwent autologous (AT) or allogeneic (AL) HSCT. A diode InGaAlP was used, emitting light at 660 nm, 50 mW, and 4 J/cm2, measured at the fiberoptic end with 0.196 cm2 of section area. The evaluation of OM was done using the Oral Mucositis Assessment Scale (OMAS) and the World Health Organization (WHO) scale. In the LPLT group, 94.7% of patients had an OM grade (WHO) lower than or equal to grade 2, including 63.2% with grade 0 and 1, whereas in the controls group, 31.5% of patients had an OM grade lower than or equal to grade 2 (P < .001). Remarkably, the hazard ratio (HR) for grades 2, 3, and 4 OM was 0.41 (range, 0.22-0.75; P = .002) and for grades 3 and 4 it was 0.07 (range, 0.11-0.53; P < .001). Using OMAS by the calculation of ulcerous area, 5.3% of the laser group presented with ulcers of 9.1 cm2 to 18 cm2, whereas 73.6% of the control group presented with ulcers from 9.1 cm2 to 18 cm2 (P = .003). Our results indicate that the use of upfront LPLT in patients who have undergone HSCT is a powerful instrument in reducing the incidence of OM and is now standard in our center. Blood. 2007 Mar 1;109(5):2250-5. Epub 2006 Oct 19. The use of low energy photon therapy (LEPT) in venous leg ulcers: a double-blind, placebo-controlled study.Gupta AK, Filonenko N, Salansky N, Sauder DN Department of Medicine, University of Toronto, Ontario, Canada 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 (lambda) 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 mm2, 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. Dermatol Surg. 1998 Dec;24(12):1383-6 The Impact of low power laser in the treatment of conditioning-induced oral mucositis: a report of 11 clinical cases and their review.Antunes HS, Ferreira EM, de Matos VD, Pinheiro CT, Ferreira CG Serviso de Pesquisa Clinica, Instituto Nacional de Cancer, Rua Andre Cavalcante, Rio de Janeiro, Brasil. hspindola@inca.gov.br We have investigated the clinical effects of low power laser therapy (LPLT) on the treatment of conditioning-induced oral mucositis (OM) in patients submitted to hematopoietic stem cell transplantation (HSCT). The evaluation of OM was done using the Oral Mucositis Assessment Scale (OMAS) and World Health Organization (WHO) scale. In the context of a randomized placebo-controlled trial with 38 patients for the evaluation of preventive LPLT, eleven individuals were submitted to allogeneic (AL) HSCT and developed oral mucositis grade 4 (WHO) or a total area of OM of 12 cm (OMAS) and due to that were treated with LPLT with the purpose of symptom relief. The irradiation used was a diode InGaAlP, emitting light at 660 nm, 50 mW and 8 J/cm(2) measured at the end of fiber optic with 0.196 cm(2) of section area during the treatment. The tip of the laser device touched the oral mucosa and patients recovered on average 6 days (3-12 days) from the beginning of the laser application. Our results have indicated that the use of LPLT in HSCT patients is a powerful instrument in the treatment of overt OM and is now a standard procedure in this group of patients in our hospital. Med Oral Patol Oral Cir Bucal 2008 Mar 13(3) E189-92 Clinical Effect of CO(2) Laser in Reducing Pain in Orthodontics.Fujiyama K, Deguchi T, Murakami T, Fujii A, Kushima K, Takano-Yamamoto T Objective: To test the hypothesis that there is no difference in the pain associated with orthodontic force application after the application of local CO(2) laser irradiation to the teeth involved. Materials and Methods: Separation modules were placed at the distal contacts of the maxillary first molars in 90 patients in this single-blinded study. In 60 of these patients (42 females and 18 males; mean age = 19.22 years) this was immediately followed by laser therapy. The other 30 patients (18 females and 12 males; mean age = 18.8 years) did not receive active laser irradiation. Patients were then instructed to rate their levels of pain on a visual analog scale over time, and the amount of tooth movement was analyzed. Results: Significant pain reductions were observed with laser treatment from immediately after insertion of separators through day 4, but no differences from the nonirradiated control side were noted thereafter. No significant difference was noted in the amount of tooth movement between the irradiated and nonirradiated group. Conclusions: The hypothesis was rejected. The results suggest that local CO(2) laser irradiation will reduce pain associated with orthodontic force application without interfering with the tooth movement. Angle Orthod 2008 Mar 78(2) 299-303 Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases.Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M, Rocca JP, Nammour S Unit of Oral Pathology and Medicine, Section of Dentistry, Department of ENT/Dental/Ophthalmological and Cervico-Facial Sciences, University of Parma, Parma, Italy. paolo.vescovi@unipr.it OBJECTIVE: To research an efficient treatment for the management of bisphosphonate-associated osteonecrosis. BACKGROUND DATA: Necrosis of the jawbone has recently been described in association with systemic bisphosphonate therapy with drugs including zoledronic acid, pamidronate, and alendronate. The extent and clinical characteristics of bisphosphonate-associated osteonecrosis (BON) of the jaw are extremely variable, and range from the presence of fistulae in the oral mucosa or orofacial tissues, to large exposed areas of necrotic bone within the oral cavity. Clinical signs and symptoms commonly reported include pain, swelling, the presence of pus, loose teeth, ill-fitting dentures, and paresthesias of the inferior alveolar nerve when the necrosis affects the mandible. Fractures have also been reported. The treatment of BON of the jaw is still controversial since no therapy has proven to be efficacious as shown by the literature on the subject. MATERIALS AND METHODS: In this study we report results achieved with 28 patients affected by BON of the jaw, who received treatment with the Nd:YAG laser alone or in combination with conventional medical or surgical treatment. Clinical variables such as severity of symptoms, presence of pus, and closure of mucosal flaps before and after therapy were evaluated to establish the effectiveness of laser irradiation. The 28 patients with BON were subdivided into four groups: eight patients were treated with medical therapy only (antibiotics with or without antimycotics and/or antiseptic rinses), six patients were treated with medical and surgical therapy (necrotic bone removal and bone curettage), six patients were treated with medical therapy associated with laser biostimulation, and eight patients were treated with medical therapy associated with both surgical therapy and laser biostimulation. RESULTS: Of the 14 patients who underwent laser biostimulation, nine reported complete clinical success (no pain, symptoms of infection, or exposed bone or draining fistulas), and three improved their symptomatology only, with a follow-up of between 4 and 7 mo. CONCLUSIONS: While the results reported in this study are not conclusive, they indicate that laser therapy has potential to improve management of BON. Photomed Laser Surg 2008 Feb 26(1) 37-46 Effect of lower-level laser therapy on rabbit tibial fracture.Liu X, Lyon R, Meier HT, Thometz J, Haworth STMusculoskeletal Functional Assessment Center, Medical College of Wisconsin, Milwaukee, Wisconsin. Objective: The purpose of the study was to demonstrate the biological effects of low-level laser therapy (LLLT) on tibial fractures using radiographic, histological, and bone density examinations. Methods: Fourteen New Zealand white rabbits with surgically induced mid-tibial osteotomies were included in the study. Seven were assigned to a group receiving LLLT (LLLT-A) and the remaining seven served as a sham-treated control group (LLLT-C). A low-energy laser apparatus with a wavelength of 830 nm, and a sham laser (a similar design without laser diodes) were used for the study. Continuous outflow irradiation with a total energy density of 40 J/cm(2) and a power level of 200 mW/cm(2) was directly delivered to the skin for 50 seconds at four points along the tibial fracture site. Treatment commenced immediately postsurgery and continued once daily for 4 weeks. Results: Radiographic findings revealed no statistically significant fracture callus thickness difference between the LLLT-A and LLLT-C groups (p > 0.05). However, the fractures in the LLLT-A group showed less callus thickness than those in LLLT-C group 3 weeks after treatment. The average tibial volume was 14.5 mL in the LLLT-A group, and 11.25 mL in the LLLT-C group. The average contralateral normal tibial volume was 7.1 mL. Microscopic changes at 4 weeks revealed an average grade of 5.5 and 5.0 for the LLLT-A group and the LLLT-C group, respectively. The bone mineral density (BMD) as ascertained using a grey scale (graded from 0 to 256) showed darker coloration in the LLLT-A group (138) than in the LLLT-C group (125). Conclusion: The study suggests that LLLT may accelerate the process of fracture repair or cause increases in callus volume and BMD, especially in the early stages of absorbing the hematoma and bone remodeling. Further study is necessary to quantify these findings. Photomed Laser Surg 2007 Dec 25(6) 487-94 Anti-inflammatory effects of low-level laser therapy (LLLT) with two different red wavelengths (660nm and 684nm) in carrageenan-induced rat paw edema.Albertini R, Villaverde AB, Aimbire F, Salgado MA, Bjordal JM, Alves LP, Munin E, Costa MS Instituto de Pesquisa & Desenvolvimento - IP&D, Universidade do Vale do Paraiba - UNIVAP, Av. Shishima Hifumi, 2911, CEP: 12244-000 Sao Jose dos Campos, SP. Brazil It has been suggested that low-level laser therapy (LLLT) can modulate inflammatory processes. The aim of this experiment was to investigate what effects red laser irradiation with two different wavelengths (660nm and 684nm) on carrageenan-induced rat paw edema and histology. Thirty two male Wistar rats were randomly divided into four groups. One group received a sterile saline injection, while inflammation was induced by a sub-plantar injection of carrageenan (1mg/paw) in the three other groups. After 1h, LLLT was administered to the paw in two of the carrageenan-injected groups. Continuous wave 660nm and 684nm red lasers respectively with mean optical outputs of 30mW and doses of 7.5J/cm(2) were used. The 660nm and 684nm laser groups developed significantly (p<0.01) less edema (0.58ml [SE+/-0.17] ml and 0.76ml [SE+/-0.10] respectively) than the control group (1.67ml [SE+/-0.19]) at 4h after injections. Similarly, both laser groups showed a significantly lower number of inflammatory cells in the muscular and conjunctive sub-plantar tissues than the control group. We conclude that both 660nm and 684nm red wavelengths of LLLT are effective in reducing edema formation and inflammatory cell migration when a dose of 7.5J/cm(2) is used. J Photochem Photobiol B 2007 Nov 12 89(1) 50-5 Transcranial near-infrared light therapy improves motor function following embolic strokes in rabbits: An extended therapeutic window study using continuous and pulse frequency delivery modes.Lapchak, PA Salgado, KF Chao, CH Zivin, JA University of California San Diego, Department of Neuroscience, MTF 316, 9500 Gilman Drive, La Jolla, CA 92093-0624, USA; Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Drive, Room 6197, San Diego, CA 92161, USA; Veterans Medical Research Foundation, 3350 La Jolla Village Drive, San Diego, CA 92161 USA Photon or near-infrared light therapy (NILT) may be an effective neuroprotective method to reduce behavioral dysfunction following an acute ischemic stroke. We evaluated the effects of continuous wave (CW) or pulse wave (P) NILT administered transcranially either 6 or 12 h following embolization, on behavioral outcome. For the studies, we used the rabbit small clot embolic stroke model (RSCEM) using three different treatment regimens: 1) CW power density of 7.5 mW/cm(2); 2) P1 using a frequency of 300 mus pulse at 1 kHz or 3) P2 using a frequency of 2 ms pulse at 100 Hz. Behavioral analysis was conducted 48 h after embolization, allowing for the determination of the effective stroke dose (P(50)) or clot amount (mg) that produces neurological deficits in 50% of the rabbits. Using the RSCEM, a treatment is considered beneficial if it significantly increases the P(50) compared with the control group. Quantal dose-response analysis showed that the control group P(50) value was 1.01+/-0.25 mg (n=31). NILT initiated 6 h following embolization resulted in the following P(50) values: (CW) 2.06+/-0.59 mg (n=29, P=0.099); (P1) 1.89+/-0.29 mg (n=25, P=0.0248) and (P2) 1.92+/-0.15 mg (n=33, P=0.0024). NILT started 12 h following embolization resulted in the following P(50) values: (CW) 2.89+/-1.76 mg (n=29, P=0.279); (P1) 2.40+/-0.99 mg (n=24, P=0.134). At the 6-h post-embolization treatment time, there was a statistically significant increase in P(50) values compared with control for both pulse P1 and P2 modes, but not the CW mode. At the 12-h post-embolization treatment time, neither the CW nor the P1 regimens resulted in statistically significant effect, although there was a trend for an improvement. The results show that P mode NILT can result in significant clinical improvement when administered 6 h following embolic strokes in rabbits and should be considered for clinical development. Neuroscience 2007 Jul 12Reciprocity of exposure time and irradiance on energy density during photoradiation on wound healing in a murine pressure ulcer model.Lanzafame, RJ Stadler, I Kurtz, AF Connelly, R Timothy, PA Sr Brondon, P Olson, D Laser Center, Rochester General Hospital, Rochester, New York, USA. ray.lanzafame@viahealth.org BACKGROUND: Energy density and exposure time reciprocity is assumed and routinely used in low-level light therapy (LLLT) regimens. This study examined dose reciprocity effects on wound healing. METHODS: Pressure ulcers were created on seven groups of C57/BL mice (n = 18). Photoradiation was administered (18 days; 5 J/cm(2)/day @ 670 nm) using a custom LED apparatus and treatment matrix varying both intensity and exposure. Control animals were treated similarly, without photoradiation. Ulcer staging was performed using a standardized scale. Changes in stage, wound area and wound closure rates were measured. Histology was performed. RESULTS: Photostimulatory effects at day 7 occurred with parameters of 125 seconds @ 40 mW x 1/day; 625 seconds @ 8 mWx1/day; 62.5 seconds @ 40 mWx2/day; and 312.5 seconds @ 8 mWx2/day; and at day 18 using 625 seconds @ 8 mW and 312.5 seconds @ 8 mWx2/day. Statistically significant increases in wound closure rates occurred using 625 seconds @ 8 mW; 62.5 seconds @ 40 mWx2/day; and 312.5 seconds @ 8 mWx2/day treatments. Mean ulcer grade scores were similar to controls. CONCLUSIONS: Varying irradiance and exposure time to achieve a specified energy density affects phototherapy outcomes in this model. Variation of exposure time and irradiance may account for conflicting results in the literature. Further studies of these effects are warranted. Lasers Surg Med 2007 Jul 39(6) 534-42 Low-level laser therapy for zymosan-induced arthritis in rats: Importance of illumination time.Castano, AP Dai, T Yaroslavsky, I Cohen, R Apruzzese, WA Smotrich, MH Hamblin, MR Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. BACKGROUND: It has been proposed for many years that low-level laser (or light) therapy (LLLT) can ameliorate the pain, swelling, and inflammation associated with various forms of arthritis. Light is thought to be absorbed by mitochondrial chromophores leading to an increase in adenosine triphosphate (ATP), reactive oxygen species and/or cyclic AMP production and consequent gene transcription via activation of transcription factors. However, despite many reports about the positive effects of LLLT in arthritis and in medicine in general, its use remains controversial. For all indications (including arthritis) the optimum optical parameters have been difficult to establish and so far are unknown. METHODS: We tested LLLT on rats that had zymosan injected into their knee joints to induce inflammatory arthritis. We compared illumination regimens consisting of a high and low fluence (3 and 30 J/cm(2)), delivered at high and low irradiance (5 and 50 mW/cm(2)) using 810-nm laser light daily for 5 days, with the positive control of conventional corticosteroid (dexamethasone) therapy. RESULTS: Illumination with 810-nm laser was highly effective (almost as good as dexamethasone) at reducing swelling and a longer illumination time (10 or 100 minutes compared to 1 minute) was more important in determining effectiveness than either the total fluence delivered or the irradiance. LLLT induced reduction of joint swelling correlated with reduction in the inflammatory marker serum prostaglandin E2 (PGE2). CONCLUSION: LLLT with 810-nm laser is highly effective in treating inflammatory arthritis in this model. Longer illumination times were more effective than short times regardless of total fluence or irradiance. These data will be of value in designing clinical trials of LLLT for various arthritides. Lasers Surg Med 2007 Jul 39(6) 543-50 Ga-As (808 nm) Laser Irradiation Enhances ATP Production in Human Neuronal Cells in Culture.Oron, U Ilic, S De Taboada, L Streeter, J Photothera Inc., Carlsbad, California. USA Objective: The aim of the present study was to investigate whether Ga-As laser irradiation can enhance adenosine triphosphate (ATP) production in normal human neural progenitor (NHNP) cells in culture. Methods: NHNP were grown in tissue culture and were treated by Ga-As laser (808 nm, 50 mW/cm(2), 0.05 J/cm(2)), and ATP was determined at 10 min after laser application. Results: The quantity of ATP in laser-treated cells was 7513 +/- 970 units, which was significantly higher (p < 0.05) than the non-treated cells, which comprised 3808 +/- 539 ATP units. Conclusion: Laser application to NHNP cells significantly increases ATP production in these cells. These findings may explain the beneficial effects of low-level laser therapy (LLLT) in stroked rats. Tissue culture of NHNP cells might offer a good model to study the mechanisms associated with promotion of ATP production in the nervous system by LLLT. Photomed Laser Surg 2007 Jun 25(3) 180-2 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. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17439348 Laser biostimulation in end-stage multivessel coronary artery disease - a preliminary observational study.Zycinski P, Krzeminska-Pakula M, Peszynski-Drews C, Kierus A, Trzos E, Rechcinski T, Figiel L, Kurpesa M, Plewka M, Chrzanowski L, Drozdz J. II Katedra i Klinika Kardiologii Uniwersytetu Medycznego, ul. Kniaziewicza 1/5, Lodz Poland Background: Low-energy laser radiation through its direct influence on tissue repair processes without heating effect may have vital importance in the therapy of patients with advanced coronary artery disease (CAD). Aim: The introductory assessment of the effects of laser biostimulation applied to patients with advanced multivessel CAD. Methods: 39 patients with advanced CAD were assigned (mean age 64.8+/-9.6, male gender 64%, CCS class 2.5+/-0.5, EF=46+/-11%, 69% with a history of acute myocardial infarction), to undergo two sessions of irradiation of low-energy laser light on skin in the chest area from helium-neon B1 lasers. The time of irradiation was 15 minutes while operations were performed 6 days a week for one month. Before including the patients in the experimental group a full clinical evaluation, basic biochemical tests, ECG, 24h Holter recordings, 6-minute walk test, treadmill test using Bruce protocol and full echocardiographic examination were performed. After the first and second period of laser therapy with a one-month break between them analogical parameters with the initial examination were measured. Results: No side effects associated with the laser biostimulation or performed clinical tests were noted. Lower CCS class (2.5+/-0.5 --> 2.2+/-0.4 --> 2.0+/-0.4, p<0.001), higher exercise capacity (5.1+/-2.2 --> 5.8+/-2.2 --> 6.6+/-2.5 [METS], p=0.023), longer exercise time (257+/-126 --> 286+/-127 --> 325+/-156 [s], p=0.06), less frequent angina symptoms during the treadmill test (65% --> 44% --> 38%, p=0.02), longer distance of 6-minute walk test (341+/-93 --> 405+/-113 --> 450+/-109 [m], p <0.001), lower systolic blood pressure values (SP 130+/-14 --> 125+/-12 --> 124+/-14 [mmHg], p=0.05) and trend towards less frequent 1 mm ST depression lasting 1 min during Holter recordings were noted. Conclusions: An improvement of functional capacity and less frequent angina symptoms during exercise tests without a significant change in the left ventricular function were observed. Laser biostimulation in short-term observation was a very safe method. These encouraging results should be confirmed in a larger, placebo-controlled study Kardiol Pol. 2007 Jan;65(1):13-21 Low-level laser irradiation (LLLI) promotes proliferation of mesenchymal and cardiac stem cells in culture.Tuby H, Maltz L, Oron U. Department of Zoology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv 69978, Israel. BACKGROUND AND OBJECTIVES: Low-level laser irradiation (LLLI) was found to promote the proliferation of various types of cells in vitro. Stem cells in general are of significance for implantation in regenerative medicine. The aim of the present study was to investigate the effect of LLLI on the proliferation of mesenchymal stem cells (MSCs) and cardiac stem cells (CSCs). STUDY DESIGN/MATERIALS AND METHODS: Isolation of MSCs and CSCs was performed. The cells were cultured and laser irradiation was applied at energy densities of 1 and 3 J/cm(2). RESULTS: The number of MSCs and CSCs up to 2 and 4 weeks respectively, post-LLLI demonstrated a significant increase in the laser-treated cultures as compared to the control. CONCLUSION: The present study clearly demonstrates the ability of LLLI to promote proliferation of MSCs and CSCs in vitro. These results may have an important impact on regenerative medicine. Lasers Surg Med. 2007 Apr 24;39(4):373-378 [Epub ahead of print] 17457844 A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders.McNeely ML, Armijo Olivo S, Magee DJ. Department of Physical Therapy, 2-50 Corbett Hall, University of Alberta, Edmonton, Alberta, Canada T6G 2G4 Canada BACKGROUND AND PURPOSE: The purpose of this qualitative systematic review was to assess the evidence concerning the effectiveness of physical therapy interventions in the management of temporomandibular disorders. METHODS: A literature search of published and unpublished articles resulted in the retrieval of 36 potential articles. RESULTS: Twelve studies met all selection criteria for inclusion in the review: 4 studies addressed the use of therapeutic exercise interventions, 2 studies examined the use of acupuncture, and 6 studies examined electrophysical modalities. Two studies provided evidence in support of postural exercises to reduce pain and to improve function and oral opening. One study provided evidence for the use of manual therapy in combination with active exercises to reduce pain and to improve oral opening. One study provided evidence in support of acupuncture to reduce pain when compared with no treatment; however, in another study no significant differences in pain outcomes were found between acupuncture and sham acupuncture. Significant improvements in oral opening were found with muscular awareness relaxation therapy, biofeedback training, and low-level laser therapy treatment. DISCUSSION AND CONCLUSION: Most of the studies included in this review were of very poor methodological quality; therefore, the findings should be interpreted with caution. Phys Ther. 2006 May;86(5):710-25. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a metaanalysis.Brosseau L, Welch V, Wells G, Tugwell P, de Bie R, Gam A, Harman K, Shea B, Morin M. Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada OBJECTIVE: Osteoarthritis (OA) and rheumatoid arthritis (RA) affect a large proportion of the population. Low level laser therapy (LLLT) was introduced as an alternative noninvasive treatment for RA and OA about 10 years ago, but its effectiveness is still controversial. We assessed the effectiveness of LLLT in the treatment of RA and OA. METHODS: A systematic review was conducted, following an a priori protocol, according to the methods recommended by the Cochrane Collaboration. Trials were identified by a literature search of Medline, Embase, and the Cochrane Controlled Trials Register. Only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA or OA were eligible. Thirteen trials were included, with 212 patients randomized to laser and 174 patients to placebo laser, and 68 patients received active laser on one hand and placebo on the opposite hand. Treatment duration ranged from 4 to 10 weeks. Followup was reported by only 2 trials for up to 3 months. RESULTS: In patients with RA, relative to a separate control group, LLLT reduced pain by 70% relative to placebo and reduced morning stiffness by 27.5 min (95% CI -52.0 to -2.9), and increased tip to palm flexibility by 1.3 cm (95% CI -1.7 to -0.8). Other outcomes such as functional assessment, range of motion, and local swelling were not different between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application, or treatment length. In RA, relative to a control group using the opposite hand, there was no difference between control and treatment hand, but all hands were improved in terms of pain relief and disease activity. For OA, a total of 197 patients were randomized. Pain was assessed by 3 trials. The pooled estimate (random effects) showed no effect on pain (standardized mean difference -0.2, 95% CI -1.0 to +0.6), but there was statistically significant heterogeneity (p > 0.05). Other outcomes of joint tenderness, joint mobility, and strength were not significant. CONCLUSION: LLLT should be considered for short term relief of pain and morning stiffness in RA, particularly since it has few side effects. For OA, the results are conflicting in different studies and may depend on the method of application and other features of the LLLT. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this metaanalysis lacked data on how effectiveness of LLLT is affected by 4 factors: wavelength, treatment duration of LLLT, dosage, and site of application over nerves instead of joints. There is a need to investigate the effects of these factors on effectiveness of LLLT for RA and OA in randomized controlled clinical trials. J Rheumatol. 2000 Aug;27(8):1961-9. Elementary Processes in Cells after Light Absorption Do Not Depend on the Degree of Polarization: Implications for the Mechanisms of Laser Phototherapy.Karu TI, Pyatibrat LV, Moskvin SV, Andreev S, Letokhov VS Institute of Laser and Information Technologies of Russian Academy of Sciences, Troitsk, Moscow Region, Russian Federation. ABSTRACT Objective: The objective of this work was to evaluate the importance of the degree of light polarization in stimulation of cellular metabolism. Background Data: Although the possible role of polarization's effects on the mechanisms of laser phototherapy is sometimes discussed in the literature, there are still no clear answers. Material and Methods: A model system (HeLa cell suspension) was used in which the lengths of light scattering (l(sc)) and absorption (l(a)) were much larger than the thickness of the irradiated layer (L = 3 mm). The cell suspension (1 x 10(6) cells/cm(3)) was irradiated with a diode laser (lambda = 637 nm, D = 65.7 J/m(2), tau = 10 sec, I = 6.57 W/m(2)). The polarization degree (99.4%, 60.9%, and 34.2%) of the beam was changed by means of optical fibers of different lengths. The irradiated suspension was incubated at 37 degrees C for 30 min, and the attached cells were counted afterwards. Results: The cell fraction stimulated to adhere by red light at 637 nm was nearly the same in all three experimental groups (58.1% +/- 2.5%, 57.6% +/- 3.5%, and 62.5% +/- 3.2% for degree of beam polarization of 99.4%, 66.9%, and 34.2%, respectively). There was no statistically significant difference in these results (p <0.8, <0.6, and <0.7, respectively). At the same time, all three groups had statistically significant differences (p < 0.01) in adherence from the sham-irradiated control group (39.1% +/- 2.2%). Conclusion: The biological effect (stimulation of cell attachment) of light with lambda = 637 nm on cells in our model system was pronounced, but did not depend on the degree of light polarization. Elementary processes in cells (light absorption and photochemistry) do not appear to depend on the degree of light polarization. Photomed Laser Surg 2008 Feb 28Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study.Ozcelik O, Cenk Haytac M, Kunin A, Seydaoglu G Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey AIM: Low-level laser therapy (LLLT) may induce morphological, molecular and cellular processes, which are involved in wound healing. The aim of this split-mouth controlled clinical trial was to assess the effects of LLLT on healing of gingiva after gingivectomy and gingivoplasty. MATERIAL AND METHODS: Twenty patients with inflammatory gingival hyperplasias on their symmetrical teeth were included in this study. After gingivectomy and gingivoplasty, a diode laser (588 nm) was randomly applied to one side of the operation area for 7 days. The surgical areas were disclosed by a solution (Mira-2-tones) to visualize the areas in which the epithelium is absent. Comparison of the surface areas on the LLLT-applied sites and controls were made with an image-analysing software. RESULTS: Despite the prolonged time needed for application, patients have tolerated LLLT well. While there were no statistically significant differences between the stained surface areas of the LLLT applied and the control sites immediately after the surgery, LLLT-applied sites had significantly lower stained areas compared with the controls on the post-operative third, seventh and 15th day (p<0.001 for each). CONCLUSIONS: Within the limitations of this study, the results indicated that LLLT may enhance epithelization and improve wound healing after gingivectomy and gingivoplasty operations. J Clin Periodontol 2008 Mar 35(3) 250-4 Effect of the CO2 laser combined with fluoridated products on the inhibition of enamel demineralization.Steiner-Oliveira C, Rodrigues LK, Lima EB, Nobre-dos-Santos M Piracicaba School of Dentistry at the State University of Campinas in Piracicaba, SP, Brazil. AIM: This in vitro study evaluated the combined effects of a 10.6 microm CO2 laser, fluoridated dentifrice, and mouthrinse on the reduction of lesion progression in carious human enamel. METHODS AND MATERIALS: Slabs of previously demineralized dental enamel were assigned to nine groups, either treated with/without a CO2 laser, with/without fluoridated dentifrice, and with/without fluoridated mouthrinse. After a pH-cycling regime, fluoride concentrations were determined in the demin- and remineralizing solutions. A qualitative polarized light analysis was performed on enamel, and enamel mineral loss was determined by cross-sectional microhardness testing. RESULTS: All treatments were able to decrease mineral loss, and the inhibition of demineralization progression ranged from 48% to 60%. CONCLUSION: The 10.6 microm CO2 laser irradiation alone or combined with fluoridated products reduced demineralization progression in enamel. However, there was no significant additional demineralization inhibitory effect with the use of the combined laser-fluoride treatments. CLINICAL SIGNIFICANCE: CO2 lasers have proven to be efficient in reducing subsurface enamel demineralization. Its association with a high frequent fluoride therapy may enhance this protective effect. J Contemp Dent Pract 2008 9(2) 113-21 Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Cote P, Hogg-Johnson S, Cassidy JD, Haldeman S Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96822, USA. ehurwitz@aii.edu STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders. SUMMARY OF BACKGROUND DATA: No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. METHODS: We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. RESULTS: Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. CONCLUSION: Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies. Spine 2008 Feb 15 33(4 Suppl) S123-52 Laser therapy in the treatment of achilles tendinopathy: a pilot study.Tumilty S, Munn J, Abbott JH, McDonough S, Hurley DA, Baxter GD School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand OBJECTIVE: To test the feasibility of a randomized controlled trial to assess the clinical effectiveness of low-level laser therapy (LLLT) when used in addition to eccentric exercise in the management of Achilles tendinopathy. BACKGROUND DATA: LLLT has emerged as a possible treatment modality for tendon injuries. Over the past 20 years only three human studies have investigated LLLT for Achilles tendinopathy. MATERIALS AND METHODS: Twenty patients were randomized into an active laser or placebo group; all patients, therapists, and investigators were blinded to allocation. All patients were given a 12-week eccentric exercise program and irradiated three times per week for 4 wk with either an active or placebo laser at standardized points over the affected tendons. Irradiation parameters in the active treatment group were: 810 nm, 100 mW, applied to six points on the tendon for 30 s, for a total dose of 3 J per point and 18 J per session. Outcome measures were the VISA-A questionnaire, pain, and isokinetic strength. Patients were measured before treatment and at 4 and 12 wk. Analysis of covariance was used to analyze data, using the effects of baseline measurements as a covariate. RESULTS: Within groups, there were significant improvements (p < 0.05) at 4 and 12 wk for all outcome measures, except eccentric strength for the placebo group at 4 wk (p = 0.11). Based on the results of the current study, recruitment of 20 subjects per group would be required to perform an adequately powered study based on minimally important clinical differences in VISA-A scale. CONCLUSION: This study has demonstrated the feasibility of undertaking a randomized controlled trial of LLLT for Achilles tendinopathy. Conclusions regarding effectiveness cannot be made due to the low statistical power of this pilot study. Photomed Laser Surg 2008 Feb 26(1) 25-30 A randomized double-blind comparative study of Biolight light therapy following surgical extraction of impacted lower third molars.Kashani H, Kanagaraja S, Kahnberg KE Department of Oral & Maxillofacial Surgery, NAL Medical Center Hospital, Trollhattan, Sweden. hossein.kashani@vgregion.se Monochromatic light has been used in many studies and indicated that phototherapy might be effective in the treatment of pain relief. The aim of this investigation was to evaluate the efficacy of monochromatic light phototherapy on patients who had undergone impacted third molar surgery. Sixty adult patients were included in the study. The patients were divided into 2 groups; the Biolight therapy group and the placebo therapy group. All the subjects received phototherapy 6 minutes preoperative and 10 minutes postoperative.They were examined 3 and 7 days after surgery to evaluate postoperative pain and wound healing. One patient was excluded from the study due to extraction of the third molar in maxilla. All the patients received a questionnaire to answer regarding pain and the number of pain killers consumed.The results from this study showed that Phototherapy using monochromatic light Biolight therapy had no significant differences compared to the placebo group. Swed Dent J 2007 31(4) 165-70 Effect of combined laser acupuncture on knee osteoarthritis: a pilot study.Shen X, Zhao L, Ding G, Tan M, Gao J, Wang L, Lao LShanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203. China Our objective was to assess the efficacy and safety of combined 10.6 micron and 650 nm laser irradiation on patients with knee osteoarthritis (OA). Forty patients with OA were randomly allocated to an active laser group or to a placebo laser group (20 per group). They either received active or sham laser treatment at acupoint Dubi (ST 35) in a total of 12 sessions. There was significant difference between the two groups in the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index pain score change from baseline after 2 weeks of treatment (P = 0.047). The pain reduction of the active laser treatment group was 49%, whereas that of the placebo control group was only 13%. However, due to the high patient drop-out rate, the 4-week assessment could not be analyzed. Combined laser treatment seems beneficial to patients with knee OA. However, due to the small sample size and the high drop-out rate of patients in the placebo group, a large sample-size clinical trial is warranted to determine further the therapeutic efficacy of the device. Lasers Med Sci 2008 Jan 5Monochromatic phototherapy: effective treatment for grade II chronic pressure ulcers in elderly patients.Dehlin O, Elmstahl S, Gottrup FDepartment of Community Medicine, Malmo University Hospital, 20502 Malmo Sweden BACKGROUND AND AIMS: Monochromatic pulsating light may have effects on wound healing. In an earlier study of grade II ulcers, there was a tendency toward better healing in the phototherapy group (p=0.06). The present study on patients with grade II ulcers was performed to verify these findings. Data from this study were pooled with data from the earlier study. METHODS: Ninety-four patients were offered participation in the new study and 76 patients were evaluated. They were pooled with 87 patients from the earlier study, bringing the total to 163. All patients were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specified program up to 12 weeks. RESULTS: The mean normalized reduction in pressure ulcer size at week 12 was 0.79 for the phototherapy group and 0.50 for the placebo group (95% confidence interval 0.01-0.53; p=0.039). No serious side-effects were noted. CONCLUSIONS: Monochromatic pulsating light accelerates healing in grade II pressure ulcers in elderly patients. Aging Clin Exp Res 2007 Dec 19(6) 478-83 Neural substrates of awakening probed with optogenetic control of hypocretin neurons.Adamantidis AR, Zhang F, Aravanis AM, Deisseroth K, de Lecea L [1] Department of Psychiatry and Behavioral Sciences, Stanford University, 701B Welch Road, Palo Alto, California 94304, USA [2] These authors contributed equally to this work. The neural underpinnings of sleep involve interactions between sleep-promoting areas such as the anterior hypothalamus, and arousal systems located in the posterior hypothalamus, the basal forebrain and the brainstem. Hypocretin (Hcrt, also known as orexin)-producing neurons in the lateral hypothalamus are important for arousal stability, and loss of Hcrt function has been linked to narcolepsy. However, it is unknown whether electrical activity arising from Hcrt neurons is sufficient to drive awakening from sleep states or is simply correlated with it. Here we directly probed the impact of Hcrt neuron activity on sleep state transitions with in vivo neural photostimulation, genetically targeting channelrhodopsin-2 to Hcrt cells and using an optical fibre to deliver light deep in the brain, directly into the lateral hypothalamus, of freely moving mice. We found that direct, selective, optogenetic photostimulation of Hcrt neurons increased the probability of transition to wakefulness from either slow wave sleep or rapid eye movement sleep. Notably, photostimulation using 5-30 Hz light pulse trains reduced latency to wakefulness, whereas 1 Hz trains did not. This study establishes a causal relationship between frequency-dependent activity of a genetically defined neural cell type and a specific mammalian behaviour central to clinical conditions and neurobehavioural physiology. Nature 2007 Oct 17Excimer laser for psoriasis: a review of theories regarding enhanced efficacy over traditional UVB phototherapy.Zakarian, K Nguyen, A Letsinger, J Koo, J Department of Pediatrics, University of California, Irvine, CA, USA. kzakaria@uci.edu BACKGROUND: Fiber-optically targeted ultraviolet B (UVB) therapy has been shown to clear plaques of psoriasis in a significantly fewer number of treatments and reduce overall cumulative UVB dose than traditional UVB phototherapy. OBJECTIVE: This article reviews existing theories in the literature attempting to explain the superior efficacy of targeted UVB. METHODS: Medline was used to perform a comprehensive review of the literature from 1965 to present. Only information from the English language journals are reported in this study. RESULTS: The theories proposed to explain the higher efficacy of the excimer (XeCl) laser relative to traditional UVB include the ability to use higher intensities of ultraviolet (UV) light and a more efficient induction of T cell apoptosis. CONCLUSION: The possible explanations for the superior efficacy of the excimer laser over traditional UVB therapy for psoriasis include: 1) a higher intensity UV light to plaques, which is more effective in clearing psoriasis; 2) penetration into the dermis where it may induce T cell apoptosis, potentially to a greater extent than the wavelength or given energy level predicts; and 3) the difference in the delivery of UVB light may result in cell death and skin immune system suppression more effectively than traditional UVB. J Drugs Dermatol 2007 Aug 6(8) 794-8 Time-dependent responses of wounded human skin fibroblasts following phototherapy.Hawkins, DH Abrahamse, H Laser Research Group, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein, Johannesburg 2028 South Africa BACKGROUND AND OBJECTIVE: The penetration and distribution of laser light in target tissue is dependent on the wavelength of the light. One problem with most of the published data on laser irradiation is that most studies do not record the duration between the exposure and the evaluation. This study aimed to establish if the dose, wavelength or duration of effect (1h or 24h) influences the biological responses of irradiated fibroblasts. MATERIALS AND METHODS: The study established cellular responses of normal and wounded human skin fibroblasts to helium-neon (632.8nm), diode (830nm) and Nd:YAG (1064nm) laser irradiation using one exposure of 5J/cm(2) or 16J/cm(2) on day 1 and again on day 4. Cellular responses to laser irradiation were evaluated by measuring changes in cell viability (ATP viability and caspase 3/7 activity) and cell proliferation (ALP enzyme activity and bFGF expression), 1h and 24h post irradiation. RESULTS: Wounded cells exposed to 5J/cm(2) using 632.8nm showed an increase in ATP viability after 1h, a decrease in caspase 3/7 activity after 24h and an increase in cell proliferation after 24h. The results suggest that changes in parameters such as ATP viability should be observed directly after laser irradiation (1h) whereas other parameters such as caspase 3/7 activity, bFGF expression and ALP enzyme activity should be measured at least 24h after the final exposure. CONCLUSION: This study confirms that the duration of effect should be included as one of the main laser parameters when reporting on the effects of laser irradiation. It is important to establish time-dependent responses as the results may provide an understanding of the cellular responses following laser irradiation. J Photochem Photobiol B 2007 Jul 28The effect of mastectomy and radiotherapy for breast carcinoma on soft tissues of the shoulder and its joint mobility among Egyptian patients.Saied, GM Kamel, RM Dessouki, NR Department of General Surgery, Faculty of Medicine, Cairo University Egypt Patients with post mastectomy soft tissue shoulder disorders usually benefit from various lines of physiotherapy treatment. However, the controversy about their efficacy persists. The aim of this work was to study and assess the efficacy of each, and to identify the best intervention. One hundred female patients with ipsilateral post mastectomy shoulder problems were enrolled in the study, from September 2003 until December 2004. They were followed up for 32 weeks. Mastectomy, both radical and conservative and axillary lymph node clearance, was the standard surgery applied for operable breast carcinoma in this series. Clinical examination was followed by testing for the shoulder complaint by measuring maximal protrusion at the inferior scapular angle, scapular stabilization and the lift-off tests. Approved physiotherapy modalities were then applied, viz: no treatment (randomly chosen 12 patients), passive and active motion therapy (14 patients), oral diclofenac sodium (19 patients), local triamcinilone injection (40 patients) and manually applied low intensity laser therapy (15 patients). Assessment was by determining overall success rate for each intervention modality. Intervention outcome was assessed at 8, 16, and 32 weeks as shown by physical examination using the healthy shoulder as a reference, and by measuring restricted mobility during passive lateral rotation and glenohumeral abduction. "Success rate" was determined separately for each group at the end of the intervention period. The applied surgery was followed by radiotherapy in 96%, chemotherapy in 24% and both in 11%. The presenting post mastectomy symptoms at the shoulder were pain (100%), shoulder weakness (88%), winging of the scapula (11%) and inability to perform everyday shoulder movements (23%). Evaluation was by overall improvement score. The results were: 14.3% for untreated patients, 43.3% for those treated by motion therapy, 42% for diclofenac therapy, 80.7% for local triamcinolone, and lastly 68% for low intensity laser therapy. All treatment regimens for shoulder disabilities in those patients gave little long-term advantage, local steroid injections were the most effective. Low level laser therapy may augment its effect. It is concluded that all treatment regimens provide little long-term advantage; however, trimcinilone local injections may be the most useful in terms of pain relief and improvement in shoulder movement. Tanzan Health Res Bull 2007 May 9(2) 121-5 Low intensity laser application in temporomandibular disorders: a phase I double-blind study.Mazzetto, MO Carrasco, TG Bidinelo, EF de Andrade Pizzo, RC Mazzetto, RG Department of Restorative Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo (FORP-USP) Brazil The purpose of this study was to evaluate the effectiveness of low intensity laser therapy (LILT) for the control of pain from temporomandibular disorder (TMD) in a random and double-blind research design. Forty-eight (48) patients presenting temporomandibular joint (TMJ) pain were divided into an experimental group (GI) and a placebo group (GII). The sample was submitted to the treatment with infrared laser (780 nm, 70 mW, 10 s, 89.7 J/cm2) applied in continuous mode on the affected temporomandibular region, at one point: inside the external auditive duct toward the retrodiskal region, twice a week, for four weeks. For the control group, two identical probes (one active and one that does not emit radiation) were used unknown by the clinician and the subjects. A tip planned for laser acupuncture was used and connected to the active point of the probe. The parameter evaluated was the intensity of pain after palpation of the condylar lateral pole, pre-auricular region and external auditive duct, according to the Visual Analogue Scale (VAS). Four evaluations were performed: Ev1 (before laser application), Ev2 (after 4th application), Ev3 (after 8th application) and Ev4 (30 days after the last application). Data were submitted to statistical analysis. The results showed a decrease in the pain level mainly for the active probe. Among the evaluations, the Ev3 exhibited lower sensitivity to palpation. In conclusion, the results show that low intensity laser is an effective therapy for the pain control of subjects with TMD. Cranio 2007 Jul 25(3) 186-92 The analgesic effectiveness of laser therapy in patients with gonarthrosis: an evaluation.Kujawa, J Talar, J Gworys, K Gworys, P Pieszynski, I Janiszewski, M Background. Osteoarthrosis is a very common disease of the musculo-skeletal system. Laser therapy can be used to alleviate the pain associated with this syndrome, which markedly impinge the patients physical comfort and limit physical activity. Material and methods. The research involved 32 patients (26 women and 6 men, average age 57.3 A+/-12.1 years) with pain complaints in one knee joint and radiologically confirmed degenerative changes. The control group consisted of 32 matched patients awaiting treatment. Laser biostimulation was applied with a semiconductor laser (400 mW, wave length 810 nm). Contact (point) irradiation was applied, with a surface energy density of 12.7 J/cm2. One series of 10 procedures was performed on one knee joint, 5 days a week. Pain intensity was evaluated with the Visual Analogue Scale (VAS) and a modified version of the Laitinen questionnaire. Results. In 29 patients (91%) there was a statistically significant reduction in pain complaints in the affected knee measured by VAS. In 19 patients (59%) there was a statistically significant reduction in the frequency and intensity of pain complaints on the Laitinen questionnaire. The improvement in daily motor activity and the reduced use of antalgesic drugs were not statistically significant. Conclusions. Laser biostimulation in patients with knee pain reduces symptoms on the VAS, and significantly reduces the intensity and frequency of pain as assessed by the Laitinen questionnaire. One series of laser treatments has no significant effect on motor activity and use of painkillers in patients with chronic knee pain due to osteoarthrosis. Ortop Traumatol Rehabil 2004 Jun 30 6(3) 356-66 Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311-313 nm) in the treatment of vitiligo - a multicentre controlled study.Casacci, M Thomas, P Pacifico, A Bonnevalle, A Paro Vidolin, A Leone, G Dermatology Clinic, Huriez Hospital, University of Lille 2, France. Background Vitiligo is an acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Recently, it has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some advantages as compared to NB-UVB for the treatment of vitiligo. Aim The aim of this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm MEL in vitiligo patients. Methods The study was done in a randomized, investigator-blinded and half-side comparison design. Twenty-one subjects with symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB phototherapy was used to treat lesions on the opposite side. Results At the end of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion (6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with NB-UVB showed a good repigmentation (score 3). Conclusions It appears that 308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it induces repigmentation more rapidly. J Eur Acad Dermatol Venereol 2007 Aug 21(7) 956-63 Alteration of extracellular matrix modulators after nonablative laser therapy in skin rejuvenation.Oh, J Kim, N Seo, S Kim, IH Laboratory of Cellular Oncology, Korea University Ansan Hospital, Gojan 1-dong, Danwon gu, Ansan, Gyeonggi do 425-707 Korea BACKGROUND: Nonablative laser therapy is widely practised for skin rejuvenation, which stimulates collagen production and dermal matrix remodelling. Matrix remodelling is primarily modulated by a coordinated action of matrix metalloproteinases (MMPs) and their inhibitors, but the effects of nonablative lasers on these matrix modulators are not fully investigated. OBJECTIVES: To evaluate the changes in matrix modulators, such as MMP-1, MMP-2, MMP-3, MMP-9 and MT1-MMP, and their inhibitors (TIMP-1, TIMP-2 and RECK in particular), after nonablative laser treatments of human facial skin. METHODS: Twenty-four adult volunteers received a series of four nonablative laser treatments separated by 3-week intervals on facial skin. Two-millimetre skin punch biopsies were obtained at baseline and 3 weeks after the last treatment. RESULTS: Nonablative laser treatments led to a robust increase in two major dermal matrix components, type I collagen and tropoelastin. Among MMPs tested, levels of MMP-2 mRNA were statistically significantly increased, but the amount of active MMP-2 was rather reduced. More importantly, the expression level of RECK was significantly enhanced by laser treatments. CONCLUSIONS: Clinical outcomes following nonablative laser treatments may result not only from increased biosynthesis but also from decreased degradation, via an induction of RECK expression, of matrix proteins. Br J Dermatol 2007 Aug 157(2) 306-10 Polychromatic Light Similar to the Terrestrial Solar Spectrum Without its UV Component Stimulates DNA Synthesis in Human Peripheral Blood Lymphocytes in vivo and in vitroKira Samoilova,1 Natalya Zhevago,2 and R. Glen Calderhead3 1Institute of Cytology of Russian Academy of Sciences 2Institute of Cytology of Russian Academy of Sciences 3Japan Phototherapy Laboratory Russia, Japan Immunosuppressive effects of the minor component of the terrestrial solar spectrum, UV radiation have been substantiated over the past years. This raises the question what influence the dominant part of the solar spectrum, visible and IR light, would have on the human immune system. In the present randomized, placebo-controlled double blind study a small area of the volunteers' body surface was irradiated with polychromatic light (480-3400 nm), simulating the significant part of the terrestial sunlight irradiance spectrum and its power density. An average 2.5-3-fold increase in the spontaneous and PHA-induced DNA synthesis in peripheral blood lymphocytes (Lym) was revealed at 0.5-24 h after irradiation at a therapeutic dose (12 J/cm2) of subjects with low preirradiation levels of both processes. The in vivo findings were echoed in parallel in vitro experiments, when blood drawn from the same subjects was directly irradiated (2.4 J/cm2), or when the irradiated blood was mixed 1:10 with non-irradiated autologous blood to model events in the circulation following transcutaneous blood photomodification. Our data suggest that exposure of the human body to polychromatic visible + IR light may photomodify blood in the dermal vasculature of the irradiated area to lead to an immediate transfer of the light-induced effects to Lym of the entire circulating blood, which can result in modulation of Lym functional state at the systemic level. A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders.McNeely ML, Armijo Olivo S, Magee DJ. 2-50 Corbett Hall, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada T6G 2G4. sla4@ualberta.ca. Canada BACKGROUND AND PURPOSE: The purpose of this qualitative systematic review was to assess the evidence concerning the effectiveness of physical therapy interventions in the management of temporomandibular disorders. METHODS: A literature search of published and unpublished articles resulted in the retrieval of 36 potential articles. RESULTS: Twelve studies met all selection criteria for inclusion in the review: 4 studies addressed the use of therapeutic exercise interventions, 2 studies examined the use of acupuncture, and 6 studies examined electrophysical modalities. Two studies provided evidence in support of postural exercises to reduce pain and to improve function and oral opening. One study provided evidence for the use of manual therapy in combination with active exercises to reduce pain and to improve oral opening. One study provided evidence in support of acupuncture to reduce pain when compared with no treatment; however, in another study no significant differences in pain outcomes were found between acupuncture and sham acupuncture. Significant improvements in oral opening were found with muscular awareness relaxation therapy, biofeedback training, and low-level laser therapy treatment. DISCUSSION AND CONCLUSION: Most of the studies included in this review were of very poor methodological quality; therefore, the findings should be interpreted with caution. Retrospective Study of Adjunctive Diode LaserTherapy for Pain Attenuation in 662 Patients: Detailed Analysis by Questionnaire SHIGEYUKI NAKAJI, M.D., Ph.D.,1 CHIYUKI SHIROTO, 2 MISAKO YODONO,2 TAKASHI UMEDA,1 QIANG LIU, 1 Department of Hygiene Hirosaki University School of Medicine Zaifu-cho 5, Hirosaki City Aomori 036-8562 Japan ABSTRACT Background Data: The use of LLLT for chronic pain attenuation has been reported in the international literature for over 20 years. Methods: We used a series of diode laser systems in which the most effective wavelength was consistently found to be 830nm with an output power in continuous-wave of 60mW. Subjects were 1,087 patients treated by LLLT at the Shiroto Clinic from April 1992 to August 1995. Questionnaires were sent to subjects in September and October 1996. Results: The reply rate was 60.9%, comprising 662 questionnaires (265 males, 397 females, mean age of 53.4 years). The total efficacy rating (excellent plus good) immediately after LLLT was 46.8% in men and 47% in women. At the time of the survey, this rose to 73.3% in men and 76.8% in women, with positive effects also recorded on psychosomatic factors such as well-being, physical energy, general fatigue, menta |
