Journal of Lasers in Medical Sciences

Introduction: Vaginal laxity, a symptom of pelvic floor dysfunction observed in women, has many negative biological and psychological impacts. Laser treatments and stem cell-based therapies are emerging therapeutic methods for treating this condition. This study aimed to determine changes in vaginal laxity in model rats using a combination therapy of erbium-doped yttrium aluminium garnet (Er:YAG) fractional lasers and topical treatment with amniotic membrane stem cell metabolite products (AMSC-MP).
Methods: The experimental animal population comprised 36 female white rats (Rattus norvegicus; 2-day-post-vaginal-delivery rats) allocated into the following four groups (n=9): K1, untreated two-day-post-vaginal-delivery rats; K2, two-day-post-vaginal-delivery rats treated with topical gel without AMSC-MP; P1, two-day-post-vaginal-delivery rats treated with Er: YAG fractional lasers and topical gel without AMSC-MP; P2, two-day-post-vaginal-delivery rats treated with Er: YAG fractional lasers and topical gel containing AMSC-MP. Immunohistochemical (IHC) examination was carried out for the expression and activity of heat shock protein 70 (HSP-70), collagen-1, tissue inhibitors of metalloproteinase 1 (TIMP-1), and matrix metalloproteinase 1 (MMP-1), as well as vaginal mucosal thickness.
Results: There was a significant difference (P<0.05) in the expression of HSP-70 among all groups except K2 and P1 (P>0.05); there was no significant difference in type I collagen and TIMP-1 expression between the groups (P>0.05); there was a significant difference (P<0.05) in MMP-1 activity, with the activity in the K2 group (5.79±0.83) being higher than that in the P1 group (4.44±1.82) and that in the K1 group (5.74±1.03) being higher than that in the P2 group (4.24±1.55). Also, there was a significant difference in the thickness of the vaginal mucosa in all groups except K2 and P1 (P>0.05).
Conclusion: Er:YAG fractional laser and AMSC-MP combination therapy improved vaginal laxity in model rats by increasing Hsp70 expression and vaginal mucosal thickness and decreasing MMP-1 activity.

Introduction: This study aimed to assess the effect of low-level laser therapy (LLLT) on miniscrew stability and concentrations of interleukin-1β (IL-1β) and transforming growth factor-beta (TGF-β1) in peri-miniscrew crevicular fluid in the course of orthodontic treatment.

Methods: This randomized split-mouth double-blind clinical trial evaluated 18 patients requiring anterior retraction along with maximum anchorage. Miniscrews were placed between the maxillary second premolar and first molar. A diode laser was irradiated with a 980-nm wavelength and 100-mW output power in continuous-wave mode at four-time points: T0 (1 hour after miniscrew placement), T1 (1 week later), T2 (at 1 month) and T3 (at 3 months) in one quadrant of the maxilla (laser group). The other quadrant of the maxilla underwent the pseudo-application of the laser (control group). The primary stability of mini-screws was measured by Periotest M and reported as Periotest value (PTV). Also, at each time point, samples were collected from the peri-miniscrew crevicular fluid one hour after laser irradiation to assess the concentration of IL-1β and TGF-β1.

Results: The mean PTV (inverse of the stability) was smaller in the laser group compared with the control group at all time points; this difference was significant at T2 and T3. The mean concentration of IL-1β in the laser group was lower than that in the control group at all time points, and this difference was significantly remarkable at T0 and T3. The mean concentration of TGF-β1 in the laser group was lower than that in the control group at T0, T1, and T3; however, the difference was not statistically significant.

Conclusions: The current results supported the efficacy of LLLT in increasing the miniscrew stability and decreasing the level of IL-1β pro-inflammatory cytokine

Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback after ACL reconstruction.
Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMGBF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with a full postoperative weight-bearing, knee brace (zero degrees of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function.
Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention.
Conclusion: EMG-BF is a low-risk, low-cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.

Introduction: Keloid scars and hypertrophic scars are more commonly seen after surgeries, suture placements, or other skin damage. Scars can be treated using a variety of methods, including topical compounds, surgery, and lasers. The aim of this study is to evaluate the effects of plasma exeresis on the treatment of keloid scars.
Methods: This experimental study was conducted on patients with keloid scars, defined as a treatment-resistant subtype of scars with extension beyond the primary skin defect and cauliflower appearance, in different parts of the body. The patients were treated with 2-to-3-session plasma exeresis. Scars were examined based on the Vancouver scar scale (VSS) before and 5 months after the treatment.
Results: A total number of 24 scars were enrolled in this study. The number of patients was 16. There was a decrease in the mean thickness of keloids from 2.20 to 0.54 (P=0.000). The mean pigmentation and pliability scores decreased from 1.54 and 2.16 to 0.375 and 0.541, respectively (P=0.001). There was a significant reduction in the keloid scar vascularity score from 1.666 to 0.541 (P=0.000). There was a decrease from 0.708 to 0.00 (P=0.004) in the mean itchiness score. After the intervention, the mean pain score was 0.000, compared to 0.7500 before the intervention (P=0.003). There was a decrease in the total score from 8.958 to 2.000 (P=0.000).
Conclusion: The plasma exeresis procedure is effective in destroying small keloid scars. Furthermore, results in less itching and pain, as well as no significant complications or recurrences.

Introduction: Dentures, occlusal splints, surgical guides and orthodontic appliances are examples of acrylic resin devices made in dental laboratories, which must be disinfected and even sterilized before insertion into the oral cavity. This study evaluated the antimicrobial effect of photodynamic therapy (PDT) applied to acrylic resin specimens received from different laboratories.
Methods: Three hundred standardized specimens were ordered from six randomly selected laboratories registered in the Council of Dentistry of Ceará (n=50). The PDT consisted in the association of 22 µM erythrosine, as a photosensitizer (P), and a 520-nm LED at 38 J/cm2 (L). The specimens of each laboratory were randomly distributed into five groups: positive control, sterilized with ethylene oxide; negative control, untreated (P-L-); erythrosine control, only stained (P+L-); LED control, only irradiated (P-L+); PDT (P+L+). Then, the specimens were individually sonicated in saline solution; the suspension was diluted, plated on culture mediums (blood agar, sabouraud dextrose agar, and a non-selective chromogenic agar), and incubated for 48 hours at 37°C. Colonyforming-unit (CFU) counts were done and statistical tests of Kruskal-Wallis/Dunn were carried out.
Results: The specimens from all laboratories were contaminated with bacteria and yeasts. Staphylococcus aureus, Staphylococcus saprophyticus, Escherichia coli, Enterococcus spp., Klebsiella, and Pseudomonas spp. were identified. The PDT significantly reduced CFU counts (P<0.0001), compared to P-L-.
Conclusion: PDT was able to effectively decontaminate the acrylic resin specimens provided by dental laboratories.

Introduction: A variety of laser treatments have been applied in numerous medical fields. In dentistry, laser treatments are used for caries, root canals, and periodontal disease, as well as surgical resection. Numerous reports have recently been published on the use of lasers for bone regeneration. If laser irradiation is found to promote the activation of bone metabolism, it might also be effective for periodontal treatment, peri implantitis, and bone regeneration. Therefore, the present in vitro study aimed to elucidate the mechanisms underlying the effects of erbium-doped yttrium aluminum garnet (Er: YAG) laser irradiation on the bone using osteoblast-like cells.
Methods: Osteoblast-like Saos 2 cells (5.0×104 cells) were seeded in 24-well plates. 24 hours after being seeded, the cells were subjected to 0.3 W, 0.6 W, and 2.0 W Er: YAG laser irradiation and then allowed to recover for 48 hours. The expression levels of bone metabolism-related factors alkaline phosphatase (ALP), bone sialoprotein (BSP), and osteoprotegerin (OPG) were then evaluated using reverse transcription–quantitative polymerase chain reaction and western blot analyses.
Results: Saos 2 cells subjected to Er: YAG laser irradiation at 0.3 W, 0.6 W, and 2.0 W showed normal growth. When the Er: YAG laser irradiation and control groups were compared after 48 hours, increases were observed in ALP, BSP, and OPG gene and protein expression in the 2.0 W group. Similar results were obtained in the western blot analysis.
Conclusion: These findings suggest that the Er: YAG laser irradiation of osteoblast-like cells is effective for activating bone metabolism factors.

Introduction: The development of therapeutic methods implies an understanding of the molecular mechanism of the applied methods. Due to the widespread use of UV radiation and cold physical plasma in medicine, the molecular mechanism of these two methods is compared via gene ontology.
Methods: Data were derived from Gene Expression Omnibus (GEO). The differentially expressed genes (DEGs) which discriminate the cells treated with UV radiation versus indirect cold physical plasma were analyzed via gen ontology enrichment. The related biochemical pathways were extracted from the “Kyoto Encyclopedia of Genes and Genomes” (KEGG).
Results: Among the 152 queried DEGs, 18 critical genes including SOC1, LDLR, ALO5, PTGS2, TNF, JUNB, TNFRSF1A, CD40, SMAD7, ID1, SMAD6, SERPINE1, PMAIP1, MDM2, CREB5, GADD45A, E2F3, and ETV5 were highlighted as the genes that victimize the two methods.
Conclusion: NOTCH1 and TNF as the main genes plus SEREPINE1, KLF, and BDNF were introduced as the significant genes that are involved in the processes which discriminate cold physical plasma administration and UV-radiation as the two evaluated therapeutic methods.

Introduction: Despite the advanced formulations of resin composites, microleakage is still among the commonest causes of clinical failure of these restorations. We evaluated the effect of surface coating and laser pretreatment on the microleakage of Class V resin composite restorations in primary teeth.
Methods: Sixty extracted primary molar teeth having intact lingual or facial surfaces were randomly allocated into the control, G-Coat Plus surface coating, and erbium-doped yttrium aluminum garnet (Er:YAG) laser pretreatment groups. Class V cavities were provided with the coronal and gingival margins in the dentin and enamel, respectively. Restoration of the cavities was done with Z250 resin composite and they were thermocycled, followed by immersing in 2% basic Fuchsin dye for 24 hrs. Samples underwent sectioning occlusogingivally and the microleakage was assessed under a stereomicroscope (40×). Statistical analysis was done via SPSS and Kruskal-Wallis test (α=0.05).
Results: The control and G-Coat plus groups were significantly different regarding the microleakage (P<0.001), and G-Coat Plus and laser pretreatment groups (P<0.001) at both gingival and occlusal margins. However, it showed no significant difference between the laser and the control group on the enamel (P=0.063) and dentin margins (P=0.757). Microleakage at the gingival margins was significantly greater compared to the occlusal margins in the control and laser groups (P<0.001), but not in the G-Coat Plus group (P=0.051).
Conclusion: G-Coat plus coating significantly reduced microleakage at dentin and enamel margins of Class V composite restorations in primary teeth, in comparison with other groups of the study. Also, dentin margins showed more significant amounts of microleakage versus enamel margins in all groups, except for the G-Coat Plus group.

Introduction: Considering the positive effects of a low-level laser on new bone formation, we aimed to investigate the effects of a low-level laser in the treatment of patients with class II mandibular deficiency treated with Farmand functional appliance.
Methods: Twenty-two growing patients aged 10-14 years were randomly divided into “Farmand” and “Farmand+Laser” groups. All patients were treated with Farmand functional appliances. Patients in the “Farmand+laser” group were exposed to laser irradiation (980 nm, 100 MW, 4 points around temporomandibular joints, 100 seconds each point) weekly for three months after 3-4 weeks of using the appliance. Lateral cephalometry radiographs were taken from all patients before and after the treatment period, and changes in skeletal and dental parameters were measured.
Results: The association of the particular laser irradiation with the functional appliance led to a greater increase in the effective length of the mandible (Co-Gn, P=0.048), the anterior sagittal position of the mandible (SNB, P=0.029), and the length of the ramus (Co-Go, P=0.028), and it showed a further decrease in the discrepancy between the jaws (ANB, P=0.000) compared with the functional appliance alone.
Conclusion: The application of the laser with the chosen parameters and protocol in conjunction with the functional appliance improved the effects of the functional appliance and reduced the discrepancy between the two jaws.

Introduction: Different therapies have been applied to keloids and hypertrophic scars. Intense pulsed light (IPL) has recently been used but the evidence is limited. This study was to evaluate the effectiveness and safety of IPL as monotherapy for keloids and hypertrophic scars.
Methods: This was a before-and-after interventional study on 16 patients with 50 scars who underwent IPL. Seven scars receive one IPL session, seven received two sessions, and 36 received three sessions. Outcomes were evaluated by the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), scar ultrasound, colorimeter for pigmentation and erythema, and side effects.
Results: After the treatment, most outcomes significantly improved except that the pigmentation of the scars did not change. Scar thickness significantly reduced by nearly 10% after the first IPL session, 15% after the second session, and>20% after the third session. All side effects were mild with crust (33.3-46%), blisters (8.3-40%), and hyperpigmentation around the scar (0-14%); the pain was moderate as assessed by the patients.
Conclusions: IPL is a safe and effective treatment for keloids and hypertrophic scars. More studies
are required to confirm our results.

Introduction: The coronavirus disease (COVID-19) was extended to the entire population in China and around the world, and its mortality rate was about 3.4%. The impact of laser therapy on chronic respiratory diseases has been shown in previous studies. This study was aimed at examining the effects of laser acupuncture (LA) on patients with severe COVID-19.
Methods: In the present study, 60 patients with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were assigned to the intervention and control groups (30 patients in each group). The intervention group was treated with LA, that is, laser light with low energy on acupuncture points, once a day for five consecutive days.
Results: The participants’ mean age in the intervention and control groups was 48.96±12.65 and 53.16±12.28 respectively; 70% of the patients were male and 30% of them were female. IL6 had a significant reduction in the intervention group (P value=0.038) in comparison with the control group (P value=0.535). Furthermore, the mean admission time in the control group was significantly higher than that in the intervention group (P value=0.047). However, the mortality rate in the intervention group was zero, but three patients in the control group died.
Conclusion: Our study showed that LA can be used as supportive therapy for routine treatment in patients with severe COVID-19. Moreover, due to LA safety and its low cost, it could be recommended as an adjuvant to conventional therapy in patients interested in treating their disease with such a method.

Introduction: Photobiomodulation treatment (PBMT) is a relatively invasive method for treating wounds. An appropriate type of PBMT can produce desired and directed cellular and molecular processes. The aim of this study was to investigate the impacts of PBMT on stereological factors, bacterial count, and the expression of microRNA-21 and FGF2 in an infected, ischemic, and delayed wound healing model in rats with type one diabetes mellitus.
Methods: A delayed, ischemic, and infected wound was produced on the back skin of all 24 DM1 rats. Then, they were put into 4 groups at random (n=6 per group): 1=Control group day4 (CG day4); 2=Control group day 8 (CG day8); 3=PBMT group day4 (PGday 4), in which the rats were exposed to PBMT and killed on day 4; 4=PBMT group day8 (PGday8), in which the rats received PBMT and were killed on day 8. The size of the wound, the number of microbial colonies, stereological parameters, and the expression of microRNA-21 and FGF2 were all assessed in this study throughout the inflammation (day 4) and proliferation (day 8) stages of wound healing.
Results: On days 4 and 8, we discovered that the PGday4 and PGday8 groups significantly improved stereological parameters in comparison with the same CG groups. In terms of ulcer area size and microbiological counts, the PGday4 and PGday8 groups performed much better than the same CG groups. Simultaneously, the biomechanical findings in the PGday4 and PGday8 groups were much more extensive than those in the same CG groups. On days 4 and 8, the expression of FGF2 and microRNA-21 was more in all PG groups than in the CG groups (P<0.01).
Conclusion: PBMT significantly speeds up the repair of ischemic and MARS-infected wounds in DM1 rats by lowering microbial counts and modifying stereological parameters, microRNA-21, and FGF2 expression.

Introduction: This retrospective descriptive study evaluated the Scopus-indexed dental journals and their most-cited documents affiliated with the Middle East and North Africa (MENA) countries from 2011 to 2021.
Methods: Dental journals affiliated with MENA countries, their bibliometric indicators (SJR, CiteScore, SNIP, and H-index), and the 101 most cited articles of the considered journals were extracted and studied through descriptive statistics. In addition, the “citation per year” of each top 101 articles was calculated. Spearman’s rho test was used for pairwise comparisons of the correlation coefficient values between each two of the considered bibliometric indicators.
Results: The number of citations of the 101 most-cited papers ranged from 35 to 203. The mean (SD) citations of studied articles were 61.33 (37.58) and the median was 46. Furthermore, CiteScore had the highest significant correlation with SJR (r=0.828, P˂0.001). Moreover, the citation per year of the top 101 documents had no significant relationship with any of the journals’ bibliometric indicators.
Conclusion: Because journal performance and citation rate are multi-dimensional concepts, a single metric cannot express them thoroughly despite correlations between indices. “European Journal of Dentistry” from Turkey, “Saudi Dental Journal” from Saudi Arabia, and “Iranian Endodontic Journal” and “Journal of Lasers in Medical Sciences” both from Iran had the highest ranks in the SCImago portal and the highest scores in bibliometric indices amongst the MENA dental journals.

Introduction: Cervical suction lipectomy (CSL) procedures result in practically inevitable complications after the operation, such as facial edema and bruise. Photobiomodulation therapy (PBMT) can be used for analgesia, modulation of inflammatory processes, and improved tissue healing.
Case Report: We have reported two cases of patients in which this therapy was used to manage complications related CSL. As they had already been medicated and still had these side effects, the PBMT was proposed for local analgesia, nerve repair, and modulation of the inflammatory process. Within 72 hours after a single PBMT session, there was an important reduction in the severity of all situations.
Conclusion: PBMT seems safe and effective in managing pain and edema-related CSL.

Introduction: Fixed drug eruption (FDE), is a very specific adverse drug reaction and one of the most common types of drug eruption generally resolves spontaneously within 7-10 days upon withdrawal of the causative agent; however, extensive and severe cases may also require systemic drug therapy. The present study aimed to report a case in which a broad spectrum of severe, painful lesions of FDE was managed with photobiomodulation therapy (PBMT).
Case Report: A 31-year-old Caucasian woman presented with many extremely painful mucocutaneous lesions of FDE which had arisen 8 days before, following a long period of hospitalization. The lesions were not responsive to either corticosteroids or analgesics within 5 days, and then seven daily sessions of PBMT were proposed. Pain alleviation was achieved on the 1st day of PBMT, and the lesions showed an advanced course of healing on the 3rd day. Within 7 days of PBMT, the lesions were almost completely repaired. In a 3-month follow-up period, no relapse of any FDE lesion was reported.
Conclusion: PBMT may be a promising strategy for the management of painful lesions of FDE refractory to conventional medication therapy. However, further studies are needed to confirm this hypothesis.

Our research group has recently published some case reports on the use of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT) for managing orofacial lesions in COVID-19 patients, giving a new perspective on the role of laser in daily practice during COVID-19 pandemic. Thus, considering our wide experience with these patients in Brazil, the current commentary paper aimed to briefly present some multicenter cases in which PBMT and aPDT were used concomitantly to manage orofacial lesions in critically ill patients with COVID-19, a condition that has never been addressed in the literature. The proposed laser protocol was effective in wound healing in all the cases; however, the degree of improvement and the period required varied substantially. Given the cases presented, we hope to encourage clinicians to consider using aPDT and PBMT concomitantly for managing COVID-19-related orofacial lesions in intensive care unit patients with respiratory failure requiring mechanical ventilation.