Vol. 14 (2023)

Letter to editor

Critically Ill Patients With COVID-19: Are Phototherapies Advantageous for Managing Orofacial Lesions? Our Experience With Brazilian Hospitals

Luana Campos, Inessa Teixeira, Marcia Christina Camargo Hernandes Ramires, Regina Raffaele, Luiz Felipe Palma

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e5

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.

Review Article

The Immune Response in Laser Tattoo Removal: A Systematic Review

Arya Tjipta, Hafiz Ramadhan, Rahmi Lubis

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e66

Introduction: The immune response to laser tattoo removal poses a significant challenge in its management, primarily due to its unpredictable nature, which can range from mild hypersensitivity reactions to severe anaphylaxis. Such responses can potentially hinder the effectiveness of laser tattoo removal procedures. Therefore, gaining a comprehensive understanding of the immune response to tattoo removal using laser techniques is of utmost importance to develop more efficient management strategies. This study aims to address this need by analyzing eight carefully selected articles obtained through a thorough literature review.
Methods: To explore the immune response associated with laser techniques in tattoo removal, we employed a rigorous research methodology. A thorough literature review was conducted using reputable search engines such as Google Scholar, SagePub, and PubMed to collect relevant articles. Initially, 788 potential articles were identified through this process. Following meticulous scrutiny, only eight articles that met stringent inclusion criteria were selected for our study. This meticulous selection process ensures that the information presented here is derived from high quality and pertinent research.
Results: Based on the analysis of the eight selected articles, our findings illuminate the various immune responses that emerge following tattoo removal using laser techniques. These responses include hypersensitivity reactions, allergic manifestations, and, in certain instances, anaphylaxis. Hypersensitivity reactions typically manifested as erythema, edema, and pruritus, while allergic responses were observed in the form of urticaria. In summary, our study highlights that the immune response to laser tattoo removal primarily elicits hypersensitivity and, in some cases, anaphylaxis reactions.
Conclusion: Our study underscores the significance of clinicians being vigilant regarding potential immune responses during laser tattoo removal. It is crucial to closely monitor patients to promptly address any adverse reactions. Further research holds the potential to enhance our understanding, paving the way for improved management strategies that can enhance patient safety and treatment success.

A Bibliometric Study on the Top 101 Most-Cited Articles of Dental Journals of the Middle East/North Africa Countries From 2011 to 2021

Leyla Roghanizadeh, Alireza Akbarzadeh Baghban, Jila Azizzadeh, Saeed Asgary

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e15

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.

Efficacy of Low-Level Laser Therapy in Wound Healing and Pain Reduction After Gingivectomy: A Systematic Review and Meta-analysis

Farida Abesi, Nahid Derikvand

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e17

Introduction: Complete healing of a gingivectomy wound usually takes between one and two months. To speed up this process, different topical medications have been reported. In addition, there are different studies assessing the efficacy of low-level laser therapy (LLLT) in terms of wound healing and pain relief subsequent to gingivectomy, yielding inconsistent outcomes. In the present study, we systematically reviewed the existing evidence in the literature to resolve the given conflicts.
Methods: We searched for the studies published from inception to 1 April 2023 in Embase, PubMed, and Scopus databases without language limitation by the use of appropriate keywords. We included randomized or non-randomized clinical trial studies that appraised the efficacy of LLLT in pain reduction and wound healing in adult patients who underwent gingivectomy. We pooled the continuous data concerning the pain visual analog scale and the healing index extracted from the individual studies to provide a standardized mean difference (SMD) with a 95% confidence interval (CI), using a random-effects model.
Results: Out of 188 sources initially captured from the database search, six studies were ultimately included. Regarding wound healing, the LLLT group exhibited a significantly higher mean value of the healing index compared to the control group on days 3 (SMD, 0.93; 95% CI, 0.39 to 1.47) and 7 (SMD, 1.03; 95% CI, 0.49 to 1.57) post-surgery. Also, significant differences were noted in the postoperative pain reduction between the two groups on days 3 (SMD, -2.00; 95% CI, -2.48 to -1.51) and 7 (SMD, -2.44; 95% CI, -4.66 to -0.22) post-surgery.
Conclusion: According to the present systematic review, LLLT could potentially be an efficient adjunctive treatment after gingivectomy for wound healing acceleration and patient pain alleviation.

The Effect of Photobiomodulation on Temporomandibular Pain and Functions in Patients With Temporomandibular Disorders: An Updated Systematic Review of the Current Randomized Controlled Trials

Nima Farshidfar, Golnoush Farzinnia, Nazafarin Samiraninezhad, Sahar Assar, Parsa Firoozi, Fahimeh Rezazadeh, Neda Hakimiha

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e24

Introduction: Temporomandibular disorders (TMDs) are the most prevalent non-dental origin orofacial pain affecting the temporomandibular joints and orofacial muscles. This systematic review was conducted to update evidence about the effects of Photobiomodulation therapy (PBMT) on pain intensity, TMJ movements, electromyography (EMG) activity, pressure pain threshold (PPT), and TMJ sound in patients with TMDs.
Methods: A search was conducted in Web of Science, PubMed/Medline, and Scopus databases using from January 2000 to September 2022. 
Results: A total of 40 studies were included. All included studies except one provided information on pain intensity; 27 studies showed a reduction in pain intensity in PBMT groups compared to control groups. Seven out of 15 studies, which reported maximum mouth opening (MMO), showed a greater MMO in PBMT groups than in placebo groups. In eight out of ten studies, lateral movement (LM) was greater in PBMT groups. Moreover, in three studies out of four, protrusive movement (PM) was reported to be greater in the PBMT group. Four out of nine studies showed a greater PPT in the PBMT group. Reduced TMJ sounds in the PBMT group were reported in two out of five studies. In addition, in most studies, no difference in EMG activity was detected between the two groups.
Conclusion: This updated systematic review showed the promising effects of PBMT on the alleviation of pain and improvement in MMO. Using the infrared diode laser with a wavelength ranging between 780-980 nm, an energy density of<100 J/ cm2, and an output power of≤500 mW for at least six sessions of treatment seems to be a promising option for treating mentioned TMDs signs and symptoms based on the previously reported findings.

Therapeutic Effects of Low-Level Laser on Male Infertility: A Systematic Review

Amirreza Eghbaldoost, Seyed Pooria Salehi Mashhadsari, Erfan Ghadirzadeh, Alireza Ghoreifi, Farzad Allameh

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e36

Introduction: The objective of this study was to assess the effectiveness and safety of photobiomodulation (PBM) in the treatment of male infertility.
Methods: We searched Google Scholar, PubMed, and the reference sections of relevant papers published from January 1, 2000 to September 23, 2022. We retrieved all publications related to the impact of PBM on male infertility. After reviewing the titles, abstracts, and full texts, we included fifteen papers in the research. The studies involved 477 semen samples (in vitro studies) and 70 male participants (randomized clinical trials).
Results: All 14 in vitro studies that evaluated effectiveness reported that PBM was successful in increasing the proportion of progressive sperms in semen samples. Various methods were used to evaluate the safety. One study with a sample size of 58 concluded that PBM was not a safe treatment, whereas the other ten studies confirmed its safety. Only one clinical trial evaluated the effect of laser acupuncture on male infertility and found improvements in sperm progressive motility without any serious adverse effects.
Conclusion: All 15 studies evaluating effectiveness reported that the low-level laser was effective for increasing the proportion of progressive sperm in semen samples and that it was safe to use. However, due to the heterogeneity of population characteristics, source characteristics, duration of exposure, sample size, and instruments for measuring safety and efficacy, we cannot conclude that the positive results obtained from the reviewed studies are solely attributable to the low-level laser on the sperm samples.

The Effect of Photobiomodulation on the Treatment of Hereditary Mitochondrial Diseases

Richard Baskerville, Nykle Krijgsveld, patrick esser, Glen Jeffery, Jo Poulton

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e41

Introduction: Despite a wide variety of clinical presentations in hereditary Mitochondrial Diseases, muscle fatigue is a common theme and impairs a patient’s quality of life and ability to function. Current treatments are only supportive and include nutritional supplementation and physical therapy. Photobiomodulation therapy (PBMT) using low-intensity, narrow spectrum light in the red/near infrared (NIR) range, from a low-level laser or light-emitting diode sources, enhances mitochondrial function in preclinical and clinical studies on a range of conditions. However, little research has been done on the effectiveness of photobiomodulation in hereditary mitochondrial disorders.

Methods: We performed a scoping review of the evidence of the beneficial effects of photobiomodulation for treating the muscle-related symptoms of hereditary mitochondrial disease.

Results: No studies regarding photobiomodulation in hereditary mitochondrial disease were identified. However, in other clinical conditions featuring acquired mitochondrial impairment, we identified studies that suggested improved function, although sample sizes were small in number and statistical power.

Conclusion: There is emerging evidence of efficacy for PBMT for diseases involving acquired mitochondrial insufficiency. We identified no published research on PBMT in hereditary mitochondrial disease, but this review confirms a theoretical rationale for a positive effect and suggests further research.

Evaluation of the Effectiveness of the Carbon Dioxide (CO2) Laser in Minor Oral Surgery: A Systematic Review

Mohammad Asnaashari, Mohammadreza Behnam Roudsari, Maryam Sadat Shirmardi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e44

Introduction: Lasers in oral surgery have been extensively studied in recent years. Laser treatment is now a well-known technology that is frequently employed on oral soft tissues. The carbon dioxide (CO2) laser was one of the first soft tissue removal lasers. Because of the strong affinity of the CO2 laser to water, it is best used for removing, vaporizing, and coagulating these tissues. In minor oral surgery, CO2 laser therapy has shown advantages. Therefore, this study examined the CO2 laser used in minor oral soft tissue surgery.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed in this study. A question for research encompassing the inclusion criteria for the participants, intervention, comparison, outcome, and study design (PICOS) was formulated. The search queries were entered into the PubMed/Medline, Scopus, and Embase databases. Consideration was given to publications published between January 1, 2018, and March 15, 2023.
Results: The research included 37 studies after narrowing search results, eliminating duplicate titles,    and conducting an eligibility review (three animal studies, seven case reports, three case series, and twenty-four clinical studies). CO2 lasers alone or in combination with other therapies successfully treated oral potentially malignant disorders (OPMDs), oral tumors, oral fibrous-epithelial lesions, gingival melanin hyperpigmentation, pyogenic granuloma, socket preservation, mucocele, high labial frenulum attachment, and so on. CO2 lasers reduced intra- and postoperative complications and adverse effects, improved postoperative functional results, ablated tissues with precision, and minimized disease recurrence and malignant transformation.
Conclusion: Our study found that the CO2 laser in oral minor surgeries is successful, but further randomized clinical trials and multicenter studies are recommended to compare CO2 laser surgery to other treatments.

Effect of Low-Level Laser Therapy on Differentiation and Proliferation of Human Dental Pulp Stem Cells: A Systematic Review

Hamed Karkehabadi, Jaber Zafari, Elham Khoshbin, Roshanak Abbasi, Sogand Esmailnasab, Amin Doosti-Irani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e47

Introduction: Considering the positive impact of laser treatment on the proliferation of certain cell types, we opted to perform a systematic review aimed at evaluating the effects of laser therapy and photobiomodulation on the proliferation and differentiation of human dental pulp stem cells (hDPSCs).
Methods: We included all research studies examining the impact of laser therapy on hDPSCs, without limitations on publication dates or article languages. The major international databases, including PubMed, ISI Web of Science, and Scopus, were searched from inception to April 2022 by the relevant keywords.
Results: In total, 1886 studies were identified in the initial search from the mentioned databases and other sources. Finally, 17 relevant studies were included in the present systematic review after removing duplicates and non-relevant articles. The results indicated the useful effect of low-level laser therapy (LLLT) on the hDPSCs.
Conclusion: The findings of this systematic review indicate the useful role of LLLT in cell therapy, proliferation, and differentiation associated with hDPSCs.

Unveiling Therapeutic Potential: A Systematic Review of Photobiomodulation Therapy and Biological Dressings for Diabetic Foot Ulcers

Sina Karimpour, Mohammad Hussein Amirmotamed, Fariborz Rashno, Foozhan Tahmasebinia, Aliasghar Keramatinia, Fatemeh Fadaee Fathabadi, Hojjat-allah Abbaszadeh, Shahram Darabi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e49

Introduction: Diabetes poses a global health challenge, giving rise to various complications, including diabetic foot ulcers (DFUs). DFUs, marked by ischemic ulcers susceptible to infection and amputation, underscore the urgency for innovative treatments. This study investigated the impact of photobiomodulation therapy (PBT) and autologous platelet gel (APG) on DFUs recovery.
Methods: We systematically searched Web of Science, EMBASE, MEDLINE, Cochrane Library, Scopus, and Google Scholar (2015-2023) by using pertinent terms like “photobiomodulation therapy,” “low level light therapy,” and “platelet gel.” After meticulous data extraction and review, 57 articles were chosen and categorized. Among these, three randomized controlled trials involving 186 participants were selected for APG analysis.
Results: Findings demonstrate that APG application carries minimal risk and offers promising improvements in healing time, grade, pain reduction, and granulation tissue formation. Similarly, diverse PBT modalities involving distinct probes and wavelengths exhibit the potential to enhance tissue perfusion, expedite healing, and impede wound progression, reducing the need for invasive interventions.
Conclusion: PBT and APG emerge as valuable tools to augment wound healing, mitigate inflammation, and avert amputation, representing compelling therapeutic options for DFUs.

Exploring the Efficacy of Fractional Carbon Dioxide Laser as an Add-on Combination to Conventional Therapies for Treatment-Resistant Vitiligo (A Review Article)

Parvin Mansouri, Mohammadreza Rahbar, Mohammad Ali Nilforouszadeh, Mohsen Shati

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e51

Introduction: Vitiligo, a dermatological disorder that leads to depigmented skin patches, presents a significant challenge, particularly in resistant areas such as acral regions. Fractional CO2 laser therapy holds promise as an adjunct to conventional treatment, enhancing repigmentation. This review comprehensively explores its efficacy and safety in resistant-to-treatment vitiligo.
Methods: We conducted extensive database searches in PubMed, Embase, and Cochrane, focusing on English-language literature published between 2012 and 2023. We included comparative studies that met the following criteria: (1) Participants had non-segmental vitiligo, with resistant-to-treatment localization engagement; (2) The treatment involved the use of fractional CO2 laser in combination with conventional therapies; and (3) Outcomes were assessed based on the repigmentation ratio or significant difference. We excluded studies from which data from published results could not be extracted.
Results: After extensive screening of 52 articles, we finally selected five studies. The results showed that fractional CO2 laser therapy, when combined with other treatments, often shows promise in vitiligo treatment in refractory cases. Although individual responses varied, overall efficacy and safety were promising, with minimal adverse effects and no severe complications.
Conclusion: The fractional CO2 laser, when used in conjunction with conventional therapies, emerges as a promising option for treating refractory vitiligo. Large-scale randomized trials and a deeper understanding of the underlying mechanisms are vital for future progress in optimizing treatment protocols, case selection, and safety.

A Brief Review of Low-Level Light Therapy in Depression Disorder

Afshan Shirkavand, Maryam AkhavanTavakoli, Zeinab Ebrahimpour

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e55

Introduction: Low-level laser therapy (LLLT), also called Photobiomodulation, has gained widespread acceptance as a mainstream modality, particularly in the form of photobiostimulation (PBM). Here in our review, we aim to present the application of LLLT to help with depression, explore potential action mechanisms and pathways, discuss existing limitations, and address the challenges associated with its clinical implementation.
Methods: In biological systems, visible light with a wavelength range of 400–700 nm activates photoreceptors involved in vision and circadian rhythm regulation. The near-infrared (NIR) light with a wavelength range of 800-1100 nm exhibits superior tissue penetration capabilities compared to visible light, which enables the non-invasive application of LLLT to various tissues.
Results: By enhancing adenosine triphosphate (ATP) production using the respiratory chain, LLLT is able to enhance blood flow, reduce inflammation, support repair and healing, and enhance stem cell growth and proliferation. Preclinical studies using animal models have shown promising neuroprotective effects of the LLLT method on central nervous system (CNS) diseases, suggesting potential improvements in brain function for patients suffering from Alzheimer’s disease. In addition, it helps Parkinson’s patients with their movement problems and ameliorates mental disorders in individuals with depression.
Conclusion: patients’ quality of life can be significantly enhanced. A comprehensive understanding of the protective effects and underlying mechanisms of LLLT will facilitate its therapeutic application in the future.

Original Article

Exploring Intercellular Dynamics: Ultra-Weak Biophoton Emission as a Novel Indicator of Altered Cell Functions and Disease in Oligospermia Mice

Arefeh Aryan, Fakhroddin Aghajanpour, Masoomeh Dashtdar, Fatemeh Hejazi, Maryam Salimi, Azar Afshar, Reza Soltani, Ahad Hasan Seyed Hasani, Abbas Aliaghaei, Hojjat-Allah Abbaszadeh, Hasan Mahmoodi, Leila Zahedi, Mohammad Amin Abdollahifard, Fatemeh Fadaei Fathabadi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e65

Introduction: Biophoton emission, the spontaneous release of photons from living cells, has emerged as an attractive field of research in the study of biological systems. Scientists have recently discovered that changes in biophoton emission could serve as potential indicators of pathological conditions. This intriguing phenomenon suggests that cells might communicate and interact with each other through the exchange of these faint but significant light signals. Therefore, the present study introduces intercellular relationships with biophoton release to detect normal and abnormal cell functions to further achieve cellular interactions by focusing on cell and cell arrangement in disease conditions.
Methods: Twenty male mice were assigned to control and busulfan groups. Five weeks after the injection of busulfan, the testis was removed, and then the stereological techniques and TUNEL assay were applied to estimate the histopathology of the testis tissue sections.
Results: The findings revealed that the ultra-weak biophoton emission in the control group was significantly lower than in the busulfan group. The oligospermia mice model showed that it significantly changed the spatial arrangement of testicular cells and notably decreased the testis volume, length of seminiferous tubules, and the number of testicular cells. The results of the TUNEL assay showed that the percentage of apoptotic cells significantly increased in the busulfan group.
Conclusion: The ultra-weak biophoton emission from testis tissue was reduced in oligospermia mice. As a result, the decline of ultra-weak biophoton can indicate a change in cell arrangement, a decrease in intercellular interaction, and eventually disease.

Blue Laser-Activated Silver Nanoparticles from Grape Seed Extract for Photodynamic Antimicrobial Therapy Against Escherichia coli and Staphylococcus aureus

Ahmad Khalil Yaqubi, Suryani Dyah Astuti, Andi Hamim Zaidan, Dezy Zahrotul Istiqomah Nurdin

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e69

Introduction: Living organisms, particularly humans, frequently encounter microorganisms like bacteria, fungi, and viruses in their surroundings. Silver nanoparticles are widely used in biomedical devices due to their antibacterial, antifungal, and antiviral properties. The study evaluates the efficacy of blue laser and silver nanoparticles from grape seed extract (AgNPs-GSE) in reducing gram-negative Escherichia coli and gram-positive Staphylococcus aureus bacteria causing infections.
Methods: The sample consisted of four groups: a control without laser irradiation (T0), E. coli samples (A1 and A2) irradiated with a 405 nm diode laser at different times and concentrations of silver nanoparticles, and S. aureus samples (A3 and A4) irradiated with a 405 nm diode laser at different times and concentrations. Bacteria in groups A2 and A4 were treated with a photosensitizer (PS) made from grape seed extracts, incubated for 10 minutes, and then irradiated for 90, 120, 150, and 180 seconds. The samples were cultured on Tryptic Soy Agar
(TSA) media, incubated at 37 °C, counted by using a Quebec colony counter, and analyzed using ANOVA and Tukey tests with a significance level of P<0.05.
Results: The study found that 10 µl of AgNPs-GSE, when combined with exposure to a blue laser at 405 nm and a dose of 3.44 J/cm², can effectively photoinactivate E. coli and S. aureus bacteria. The addition of AgNPs-GSE to E. coli bacteria led to a significant reduction in their viability, with a reduction of 73.93%, 80.96%, and 83.80%, respectively. Similarly, when S. aureus bacteria were irradiated for 180 seconds by adding 1 mM, 1.5 mM, and 2 mM AgNPsGSE, bacterial viability was reduced by 70.87%, 78.04%, and 87.01%, respectively.
Conclusion: The findings from the present study indicate that at an energy density of 3.44 J/cm², it was possible to inactivate E. coli by 83.80% and S. aureus by 87.01%.

The Effect of Non-thermal Plasma Therapy on Pushout Bond Strength of Epoxy Resin and Tricalcium SilicateBased Endodontic Sealers

Saeede Zadsirjan, Mohammad Asnaashari, Tina Estarami, Soolmaz Heidari, Babak Shokri, Atoosa Yazdani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e70

Introduction: The current study aimed to assess the effect of non-thermal plasma (NTP) on the pushout bond strength (PBS) of epoxy resin and tricalcium silicate-based endodontic sealers.
Methods: Forty single-canal extracted teeth were decoronated at the coronal region, underwent root canal preparation, and were assigned to four groups (n=10) for the application of AH26 sealer, NTP+AH26 (P-AH26), Endoseal TCS sealer, and NTP+Endoseal TCS sealer (P-TCS). The root canals were sectioned into 1 mm slices, and the PBS value was measured in a universal testing machine. Data were analyzed by the Friedman, Kruskal-Wallis, and Dunn tests (P<0.05).
Results: The PBS of TCS and P-TCS groups was not significantly different (P>0.05). The PBS of the P-AH26 group was significantly lower than that of the AH26 group in the middle third (P<0.05). The PBS of the AH26 group was higher than the other groups in all sections. The PBS in the apical third was lower than other sections in all groups (P<0.05).
Conclusion: NTP had no significant effect on the PBS of Endoseal TCS. NTP significantly decreased the PBS of AH26 sealer in the middle third but had no significant effect on its bond strength in other sections.

Effect of Low-Level Laser Irradiation (810 nm) on the Proliferation and Differentiation of Osteoblast-Like Cells Cultured on SLA Titanium Discs Exposed to a Peri-implantitis Environment

Evangelia P. Zampa, Kyriaki Kyriakidou, Joseph Papaparaskevas, Eudoxie Pepelassi, Ioannis K. Karoussis

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e57

Introduction: Elimination of inflammation and re-osseointegration are the major objectives of peri-implantitis therapy. Existing data, however, do not support any decontamination approach. Thus, the present in vitro study aims to assess whether the air-debriding decontamination method with erythritol powder restores the biocompatibility of infected titanium discs and to investigate the potent biomodulatory ability of diode laser (810 nm) irradiation to promote cell proliferation and differentiation of premature osteoblast-like cells (MG63) towards osteocytes.
Methods: The experimental groups consisted of cells seeded on titanium discs exposed or not in a peri-implantitis environment with or without biomodulation. Infected discs were cleaned with airflow with erythritol powder. Cell cultures seeded on tricalcium phosphate (TCP) surfaces with or without biomodulation with a laser (810 nm) were used as controls. The study evaluated cell viability, proliferation, adhesion (SEM) at 24, 48 and 72 hours, and surface roughness changes (profilometry), as well as the effects of low-level laser therapy (LLLT) on ALP, OSC, TGF-b1, Runx2, and BMP-7 expression in MG63 cells’ genetic profile on days 7, 14, and 21.
Results: The MTT assay as well as the FDA/PI method revealed that cell proliferation did not show significant differences between sterile and decontaminated discs at any time point. SEM photographs on day 7 showed that osteoblast-like cells adhered to both sterile and disinfected surfaces, while surface roughness did not change based on amplitude parameters. The combination of airflow and LLLT revealed a biomodulated effect on the differentiation of osteoblast-like cells about the impact of laser irradiation on the genetic profile of the MG63 cells.
Conclusion: In all groups tested, osteoblast-like cells were able to colonize, proliferate, and differentiate, suggesting a restoration of biocompatibility of infected discs using airflow. Furthermore, photomodulation may promote the differentiation of osteoblast-like cells cultured on both sterile and disinfected titanium surfaces.

Comparison of the Diode Laser Wavelengths 445 nm and 810 nm in Gingival Depigmentation – A Clinical Evaluation

Seyed Masoud Mojahedi Nasab, Matthias Frentzen, Andreas Mayr, Somayeh Rahmani, Fahimeh Anbari, Jörg Meister, Saranaz Azari, Deniz Mojahedi Nasab

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e63

Introduction: Nowadays, esthetic appearance plays an important role in the field of dentistry. Discolorations and pigmentations of the gingiva reduce the appearance of a healthy-looking smile. On this occasion, the use of lasers shows a promising approach for a fast and non-aggressive treatment in this field. Different laser wavelengths are being used for gingival depigmentation this clinical study aimed to investigate the effect of the novel laser wavelength (445 nm) in this field and compare it with an 810 nm diode laser.
Methods: Two diode laser wavelengths (445 nm and 810 nm) were used for depigmentation. The laser output power chosen was 1 W. An optical fiber with a diameter of 400 µm was used. 21 patients with pigmented gingiva were selected. Depigmentation was carried out in a split-mouth design for a direct comparison of the clinical effect. Outcomes were documented by photograph after one month and six months of follow-up.
Results: For each wavelength, 21 volunteers evaluated 21 clinical cases of depigmentation, which means that 441 comparisons were carried out in total regarding the color change from brownish to pinkish. A 100% clarification was achieved for 445 nm. In the 810 nm group, the color change in 44 of 441 cases (10%) could not be identified. No statistically significant difference in pain experience was reported for both laser treatments.
Conclusion: The clinical evaluation showed that within the limitations of this study, most of the clinical outcome parameters were highly acceptable by the patients due to mild pain and discomfort for both laser systems.

Histologic Evaluation of Effect of Three Wavelengths of Diode Laser on Human Gingival Margins

Pilar Blanco Flórez, Helida Helena Avendaño Maz, Josep Arnabat Domínguez, Antonio Jesús España Tost, Jennifer Orozco Páez

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e61

Introduction: Available evidence suggests that the response of the intervened tissue is directly linked to the effects generated by the cutting instrument used. To determine the histological findings in gingival tissue margins excised through gingivectomies performed using 450 nm, 940 nm, and 980 nm diode lasers. The present study aimed to determine the histological findings in gingival tissue margins excised through gingivectomies performed using 450 nm, 940 nm, and 980 nm diode lasers.
Methods: Gingival tissue samples were collected from 30 patients who had undergone gingivectomy procedures. Each study group comprised 10 patients who willingly provided their samples after providing informed consent. The visualization of histological findings was facilitated through Hematoxylin-Eosin staining. Additionally, variables related to pain and hemostasis were assessed during the intraoperative period.
Results: The incision quality was categorized as irregular across all three wavelengths. Histological examination of the epithelial tissue revealed the absence of carbonization and the preservation of cell morphology in over 50% of the resection margin in samples obtained with the 450 nm and 940 nm wavelengths. In the connective tissue, observations included carbonization, collagen coagulation, and basophilia, with the 980 nm wavelength demonstrating the highest percentage of samples displaying collagen coagulation in more than 50% of the resection margin. Conversely, the 450 nm wavelength exhibited the highest degree of preservation of the fibroblast structure.
Conclusion: Based on a comprehensive analysis of the study results, it can be inferred that the 450nm and 940nm wavelength lasers tend to produce less thermal damage and better cell preservation when compared to the 980nm wavelength.

Assessment of Human Umbilical Vein Endothelial Cells Response to Dynamic Therapy

Mona Zamanian Azodi, Babak Arjmand, Maryam Hamzeloo Moghadam, Mostafa Rezaei-Tavirani, Zahra Razzaghi, Alireza Ahmadzadeh, Reza M Robati, Majid Rezaei-Tavirani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e59

Introduction: Photodynamic therapy (PDT) is a method based on application of a photo sensitive agent and administration of light irradiation on the treated samples. PDT is applied as an effective tool with minimal side effect against tumor tissues. Aim of this study is assessment of critical genes targets by PDT in the cellular level of cancer to provide new prospective of its molecular mechanism.

Methods: To assess effect of PDT the differentially expressed genes (DEGs) are extracted from gene expression profiles of human umbilical vein endothelial (HUVEC) Cells treated with PDT from gene expression omnibus (GEO) databases. The queried DEGs were evaluated via regulatory network and gene ontology enrichment to find the critical targets.

Results: Among 76 queried significant DEGs, 27 individuals were interacted by activation, inhibition, and co-expression actions. Number of 30 DEGs were related to the 5 classes of biological terms. IL-17 signaling pathway and PTGS2, CXCL8, FOS, JUN, CXCL1, ZFP36, and FOSB were identified as the crucial targets of PDT.

Conclusion: PDT as a stimulator of gene expression and activator of gene activity overexpressed and hyper-activated many genes. It seems that PST introduces number of genes and pathways that can be regulate by anticancer drugs to fight against cancers.

Topographical Analysis of Human Enamel after Phosphoric Acid Etching and Er,Cr:YSGG Laser Irradiation

Saja Q Salman, Basima Mohammed Ali Hussein

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e68

Introduction: Dental hard and soft tissues have been successfully removed by using the Er,Cr:YSGG laser, but there is a controversy about using lasers over conventional tooth surface preparation for bonding aesthetic restoration. Surface roughness and wettability in response to Er,Cr:YSGG laser irradiation are essential properties for restoration longevity.
Methods: Fifty-one intact human premolars removed in orthodontic treatment were included in this study and divided into three groups (n=17). The first group (G1) was the control without surface treatment, (G2) was treated with 37% phosphoric acid for 15 seconds, and (G3) was treated with the Er,Cr:YSGG laser using the following parameters: 2 W or 3 W at 20 Hz, 10% air and water ratio using the MZ6 laser tip. The standardization of laser irradiation was accomplished by a computerized numerical control unit. The surface of the samples was evaluated by using a light microscope, profilometer, atomic force microscopy (AFM), SEM, and wettability tests.
Results: The SEM examination revealed that the lased enamel surface was clean, irregular, and devoid of a smear layer, while the acid etch surface was relatively smooth and covered with a smear layer. The surface roughness of the lased enamel surface was significantly higher than that of other groups, according to the results of the profilometer as well as the AFM tests. The wettability test showed that the lased enamel surface recorded a significant reduction in the contact angle in comparison to the other groups.
Conclusion: It can be concluded that the Er,Cr:YSGG laser can be used as an alternative and safe method to the acid-etching technique for surface treatment.

Doppler Finding, Cardiovascular Function Assessment, and Fetuses’ Survival Following the Fetoscopic Laser in Twin-to-Twin Transfusion Syndrome

Tahmineh Ezazi Bojnordi, Laleh Eslamian, Vajiheh Marsoosi, Alireza Golbabaei, Mehrdad Sheikh Vatan, Alireza A. Shamshirsaz, Nasim Eshraghi, Marjan Ghaemi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e64

Introduction: This study aimed to evaluate the effectiveness of selective laser photocoagulation of communicating vessels (SLPCV) on cardiac function in twins with twin-to-twin transfusion syndrome (TTTS).
Methods: This retrospective cohort study evaluated 178 women with twin pregnancies complicated with TTTS and scheduled for SLPCV between 16 and 26 weeks of gestation. The severity of TTTS was determined by Quintero staging and the severity of cardiovascular disorders by the CHOP (Children’s Hospital of Philadelphia) score. Patient survival was evaluated through a one-monthafter-birth follow-up of fetuses.
Results: The study revealed significant improvements in Doppler indices in both donors and recipients after SLPCV. The CHOP score also significantly decreased after the intervention. Onemonth after-birth survival rates were 55.1% in donors and 56.7% in recipients. Some Doppler indexes of fetuses before SLPCV could predict survival until one month after birth.
Conclusion: The study suggests that SLPCV can improve cardiac function in fetuses with TTTS and that some Doppler indexes can predict survival outcomes. Additionally, the severity of TTTS can be a powerful indicator of the severity of cardiovascular complications.

Evaluation of the Effect of Phosphoric Acid or Er: YAG Laser on the Shear Bond Strength of Orthodontic Brackets to Enamel Surfaces Followed by 980-Laser Assisted Bleaching: An In Vitro Study

Mohammad Oladzad, Nasim Chiniforush, Rashin Bahrami, Amirhossein Mirhashemi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e62

Introduction: The residual oxygen remaining on the tooth surface after bleaching may interfere with the adhesion of brackets to the enamel surface. This study aimed to evaluate the influence of phosphoric acid and Er: YAG laser as an etching technique on the shear bond strength (SBS) of orthodontic brackets to enamel surfaces after 980-laser-assisted bleaching.
Method: A total of 84 human premolars were recruited in the present study. Samples were divided into 6 groups including conventional bleaching with conventional etching, conventional bleaching with Er: YAG laser etching, laser-assisted bleaching with conventional etching, and Laser-assisted bleaching with Er: YAG laser etching, without bleaching with traditional etching, and without bleaching+Er: YAG laser etching. Following thermocycling, the debonding of brackets was conducted using a universal testing machine. Scanning electron microscope (SEM) microscope evaluation and adhesive remnant index (ARI) scores were assessed. The comparison of SBS values between groups was carried out through a one-way analysis of variance, followed by post hoc tests.
Results: The non-bleaching with conventional etching group showed the highest SBS mean value (23.45±5.16 MPa), whereas the conventional bleaching with conventional etching group represented the lowest SBS mean value (8.8±3.83 MPa). In all groups, the most common type of failure was classified as either score 1 or score 2. No significant difference was observed in terms of SBS mean between the groups (P=0.165); however, the average SBS of bleached teeth was significantly lower, compared to the non-bleached group (P=0.000). Honeycomb structure and porosity were observed following Er: YAG laser etching on the tooth surface.
Conclusion: Increased bond strength of brackets was observed in bleached teeth following Er: YAG laser etching. Therefore, if necessary, bonding the brackets on the same day of bleaching will be done, and the application of Er: YAG laser as an etching technique will be recommended.

Evaluation of the Effect of NovaMin and Er,Cr:YSGG Laser on Remineralization of Erosive Lesions of Primary Enamel Teeth: An In Vitro Study

Yoones Sadabadi, Majid Mehran, Mohammad Bagher Rezvani, Mohammad Asnaashari, Roza Haghgoo

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e56

Introduction: The purpose of this in vitro study is to ascertain how NovaMin and Er, Cr: YSGG laser radiation affects the remineralization of primary tooth enamel lesions.
Methods: 40 main teeth served as the study’s sample size. These teeth were allocated into five groups at random. The first group served as a negative control (artificial saliva); the second group served as a positive control (APF gel 1.23%); the third group NovaMin, the fourth group Er, Cr: YSGG laser, the fifth group Er, Cr: YSGG laser and finally, the application of NovaMin. For the purpose of measuring microhardness, all samples were submitted to the dental materials laboratory three times.
Results: The collected data were compared using the SPSS 28 program between the baseline measurement, after demineralization, and after remineralization. The data were analyzed using ANCOVA and Bonferroni tests. All groups demonstrated a considerable increase in microhardness as compared to the negative control group (P<0.05). With the exception of the third and fourth groups, there was no discernible difference in the rise in microhardness between the other groups. The third and fourth groups were compared, and the results revealed that NovaMin had a greater impact than laser therapy alone (P=0.023). Scanning electron microscopy (SEM) analysis backed up the findings.
Conclusion: In comparison to using the Er, Cr: YSGG laser alone, using NovaMin alone can speed up the remineralization of erosion lesions on the surface of primary teeth.

Efficacy Evaluation of Human Skin Treatment with Photodynamic Therapy in Actinic Keratoses Patients

Zahra Razzaghi, Babak Arjmand, Maryam Hamzeloo Moghadam, Mostafa Rezaei-Tavirani, Mona Zamanian Azodi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e60

Introduction: Photodynamic therapy (PDT) is a combined method of light and light-activated chemicals that are called photosensitizers (PSs). PDT is recommended as a high cure rate method with fewer side effects and a noninvasive tool to treat cancer. This study aimed to evaluate PDT efficacy as a therapeutic method against actinic keratoses in patients via protein-protein interaction (PPI) network analysis by using the gene expression profiles of Gene Expression Omnibus (GEO).
Methods: Twenty-one gene expression profiles were extracted from GEO and analyzed by GEO2R to determine the significant differentially expressed genes (DEGs). The significant DEGs were included in PPI networks via Cytoscape software. The networks were analyzed by the “Network Analyzer”, and the elements of the main connected components were assessed.
Results: There were three main connected components for the compared sets of the gene expression profiles including the lesional region of skin before (Before set) and after (After set) PDT versus healthy (healthy set) skin and before versus after. The before-health comparison showed a partial similarity with the After-Healthy assessment. The before-after evaluation indicated that there were not considerable differences between the gene expression profile of the lesional region before and after PDT.
Conclusion: In conclusion, PDT was unable to return the gene expression pattern of the actinic keratoses skin to a healthy condition completely.


The Efficacy of Long-Pulsed, 1064-nm Nd:YAG Laser Versus Aluminum Chloride 20% Solution in the Treatment of Axillary Hyperhidrosis

Mehdi Gheisari, Reza M Robati, Zahra Hasanzadeh Tabatabai, Tara Barat

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e71

Introduction: Hyperhidrosis (HH) refers to uncontrollable excessive sweating that has a significant negative impact on the quality of life. The aim of this study was to compare the efficacy and safety of the long-pulsed, 1064-nm Nd: YAG laser and aluminum chloride (ALCL3) 20% solution in axillary HH treatment.
Methods: In this single-center, within-patient comparison clinical trial, 12 patients with axillary HH were treated monthly for 3 to 4 consecutive sessions with the long-pulsed, 1064-nm Nd:YAG laser system on one axilla, while the contralateral axilla was treated with ALCL3 20 % by the patient. Treatment response was evaluated by comparing the area of sweating at the end of each session and 6 months after treatment termination using the iodine starch test.
Results: Both treatments led to the reduction of HH from baseline with the mean area of sweating reduced from 109.3±36.6 to 38.3±19.8 and from 92.5±31.6 to 35.6±17.1 in laser- and ALCL3-treated axilla respectively (Both P<0.001). In the 6-month follow-up, the area of sweating was 60.6±29.2 in the laser-treated armpit and 78.3±23.6 in the ALCL3-treated side, which were 45% and 14.4% lower compared to the baseline respectively. Adverse events were temporary, and none caused each of the treatments to be discontinued.
Conclusion: The long-pulsed, 1064-nm Nd: YAG laser with hair reduction setting can stand as a potential therapeutic option for axillary HH since it is as effective as ALCL3. The therapeutic effect is superior in the long term for the laser; nevertheless, the beneficial effect of both treatments may lessen the following treatment cessation.

Assessing Radiosensitivity: Effects of Acute Ionizing Radiation on Inflammation and Apoptosis in Macrophage Cell Line (RAW 264.7)

Zahra Bagheri-Hosseinabadi, Jaber Zafari, Fatemeh Javani Jouni, Hanieh Sadeghi, Mitra Abbasifard

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e40

Introduction: The responses of biological systems to various types of radiation have multifaceted dimensions. In the field of ionizing radiation, in vitro external gamma radiation therapy has primarily been studied as a model to elucidate the challenges that biological systems face from radiation effects. Exposure of cells/organisms to gamma radiation results in a cascade of ionization events that can cause severe and irreversible biological damage. However, the biological responses and oxidative stress-related mechanisms under acute radiation conditions remain poorly understood in inflammatory systems. The present study aimed to provide a model of the effect of ionizing radiation on macrophages, which play a pivotal role in the mechanisms of inflammation, to assess the impact of radiotherapy as an approach to treating inflammatory diseases.
Methods: A macrophage cell line (RAW 264.7) was cultured and exposed to different doses of gamma radiation (4, 6, 8, 10 Gy). Cell viability, apoptosis, cell cycle, migration, nitric oxide (NO) and prostaglandin E2 (PGE2) production, expression of pro-inflammatory and apoptotic genes, and cytokine secretion of macrophages were also evaluated.
Results: The results showed that gamma radiation at 4 Gy had a low effect on macrophage characteristics and cytokine secretion patterns. In contrast, higher doses (8 and 10 Gy) increased DNA damage, expression of apoptotic genes, and secretion of NO and PGE2 cytokines. 6 Gy radiation, the maximum radiation dose, showed moderate non-destructive effects and inflammation process modulation. In this study, doses higher than 6 Gy of Gamma radiation caused cell mortality.
Conclusion: It appears that 6 Gy of gamma radiation modulates the inflammatory cascade caused by macrophage cells.

Comparison of Wavelength-Dependent Penetration Depth of 532 nm and 660 nm Lasers in Different Tissue Types

Ali A.Aldalawi , Nursakinah Suardi, Naser Mahmoud Ahmed , Mahdi A.S.Al-Farawn, Mohammed Ali Dheyab, Wisam. I.jebur , Faisal J.Kadhim

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e28

Introduction: The depth of laser light penetration into tissue is a critical factor in determining the effectiveness of photodynamic therapy (PDT). However, the optimal laser light penetration depth necessary for achieving maximum therapeutic outcomes in PDT remains unclear. This study aimed to assess the effectiveness of laser light penetration depth at two specific wavelengths, 532 nm and 660 mm.
Methods: Chicken and beef of different thicknesses (1, 3, 5, 10, and 20 mm±0.2 mm) were used as in vitro tissue models. The samples were subjected to irradiation by a low-level laser diode of 532 and 660 nm in continuous mode for 10 minutes. with power densities of 167 and 142 J/cm2, respectively. Laser light transmission through the tissue was measured using a power meter.
Results: For beef samples, the 660 nm wavelength achieved a maximum transmission intensity of 30.7% at 1 cm thickness, while the 532 nm laser had a transmission intensity of 6.5%. Similarly, in chicken breast samples, the maximum transmission occurred at 1 cm thickness with 68.1% for the 660 nm wavelength and 18.2% for the 532 nm laser.
Conclusion: Results consistently demonstrated a significant correlation (P<0.05) between tissue thickness and laser light penetration. Thicker tissues exhibited faster declines in light transmission intensity compared to thinner tissues within 10 minutes. These findings highlight the importance of further research to enhance light delivery in thicker tissues and improve the efficacy of PDT in various medical conditions.

In Vitro Comparative Evaluation of the Efficacy of Antimicrobial Photodynamic Therapy, Chlorhexidine, Sodium Fluoride, and Hydrogen Peroxide for Acrylic Resin Disinfection

Farhad Sobouti, Sepideh Dadgar, Aysan Salehi, Nika Rezaei Kalantari, Mehdi Aryana, Hamid Reza Goli, Mohadeseh Heidari

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e52

Introduction: Plaque accumulation on the surface of removable orthodontic appliances could lead to dental caries, periodontitis, and fungal infections. This study evaluated the effectiveness of antimicrobial photodynamic therapy (aPDT), chlorhexidine (CHX), sodium fluoride (NaF), and hydrogen peroxide (H2O2) for the disinfection of acrylic resin.
Methods: In this in vitro experimental study, 100 acrylic resin specimens were randomly divided into five groups (n=20 each): Enterococcus faecalis, Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguinis, and Lactobacillus acidophilus. Each group was immersed separately in 5 mL of microbial suspension. They were then incubated until biofilm formation on their surface. Of each microorganism, one biofilm sample in phosphate-buffered saline was considered as negative control, and other biofilm samples (n=80) were subjected to aPDT with curcumin, 0.12% CHX (positive control), 1% H2O2, and 0.2% NaF. Finally, the number of colonies was counted. Data were analyzed by the Kruskal-Wallis and Mann-Whitney tests, two-way ANOVA, and Bonferroni adjustment at a significance level of 0.05.
Results: The interaction effect of the treatment modality and type of microorganism was significant on the microbial count (effect size: 0.91, P<0.05). Maximum bacterial proliferation was noted in the following combinations: NaF/E. faecalis, H2O2/E. faecalis, and H2O2/S. salivarius. Microorganisms had no or insignificant growth and proliferation in the aPDT and CHX groups.
Conclusion: The results supported the optimal antimicrobial efficacy of PDT which was comparable to that of CHX. aPDT showed superior antimicrobial efficacy to NaF and H2O2 for the disinfection of acrylic resin.

The Effect of Radiofrequency Therapy on Sexual Function in Female Cancer Survivors (Gynecologic and Breast) and Non-cancer Menopausal Women: A SingleArm Trial

Maliheh Arab, Mahshid Vasef, Maryam Talayeh, Maryam Sadat Hosseini, Farah Farzaneh, Tahereh Ashrafganjoei

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e32

Introduction: Up to 90% of postmenopausal women and female cancer survivors may be affected by the genitourinary syndrome of menopause (GSM), with a negative impact on sexual function and quality of life. A novel energy-based device among the treatment options for GSM is radiofrequency therapy (RFT). RFT is a treatment option that uses energy from radio waves to heat the tissue. The objective of this study was to assess the impact of RFT on sexual function in female cancer survivors (gynecologic and breast) and non-cancer menopausal women.
Methods: In a single-arm prospective trial, the efficacy of RFT in both female cancer survivors (gynecologic and breast) and non-cancer menopausal women with sexual dysfunction at a tertiary and referral center (Imam Hossein Medical Center, Tehran, Iran) was evaluated between April 2022 and December 2022. The study protocol consisted of 3 monthly RFT sessions. Examination was performed at baseline (T0) and 3 months after the last RFT session (T1). The primary outcome was sexual function, which was assessed using the Female Sexual Function Index (FSFI). In addition, adverse events were evaluated during treatment and at T1.
Results: A total of 37 female cancer survivors (mean [SD] age: 49.4 [8.9] years) and 37 non-cancer menopausal women (mean [SD] age: 53.8 [5.5] years) were enrolled. Patients exposed to RFT  showed a significant improvement in FSFI scores when compared to baseline scores for both female cancer survivors (13.07, 95% CI: 12.27 - 13.86) and non-cancer menopausal women (13.18, 95% CI: 12.34 -14.03). There was no difference in FSFI total score improvement between the two groups (t(72)=0.06, P=0.951). There were no serious adverse events associated with RFT.
Conclusion: The efficacy of RFT as a treatment for sexual dysfunction has been demonstrated in both non-cancer menopausal women and female cancer survivors. In both groups, a significant improvement was confirmed.

Treatment Modelling of a 3D Tumour in Brain by Laser-Induced Interstitial Thermotherapy

Sadegh Amini, Hossein Ahmadikia

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e26

Introduction: There are some ways to examine heat transfer in tumour tissue, which is an important issue in bioengineering. One of these ways uses the bioheat equation, proposed by Pennes, in a continuous medium. Another one uses a porous medium to model heat transfer in living tissues. The objective of this paper was to study an approach to modelling the temperature distribution and tumour ablation in brain tissue and compare results to Pennes’ approach.
Methods: This approach presents and uses a porous medium as the tissue instead of a continuous medium. In addition, the two approaches (simulation in continuous and porous medium) are compared in terms of temperature simulation and amount of cell ablation. The density, heat conduction factor, and blood perfusion rate are considered functions of temperature.
Results: In these approaches, after an 85-second treatment, the temperature increases to about 90°C. The temperature increase of the porous medium is relatively the same as that of the continuous medium and for this reason, the amount of cancerous cells that are ablated in a porous medium is approximately the same as that in a continuous medium. The volume of cell ablation is about 6500 mm3 for the two ideas. In addition, the degree of damage, computed from the Arrhenius integral method, and the ablated volume of the tumour endorse equality at the end of treatment. According to the results, similar to the continuous approach, the porous approach predicts the temperature and amount of volume of damaged cells.
Conclusion: Therefore, it is possible to use the porous approach instead of the Pennes approach for tumour treatment.

Different Effects of Low-Level Laser Therapy on the Proliferation of HT29 Cells in Culture and Xenograft Models

Najmeh Malekzadeh Gonabadi, Mehdi Shamsara, Dor Mohammad Kordi Tamandani, Sahar Shojaei, Seyed Mehdi Alavi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e31

Introduction: Different kinds of treatments have been developed to fight cancers. Low-level laser therapy (LLLT), also known as photobiomodulation therapy (PBMT), is a low-power monochromatic and coherent light that has been used successfully for healing injuries and combating malignancies. However, there are concerns about the application of LLLT to cancers due to the increased proliferation of some cancer cells after LLLT.
Methods: This study investigated the effects of 650 nm and 870 nm lasers on the proliferation of HT29 colorectal cancer cell lines in vitro and in vivo.
Results: The results showed that the laser with a wavelength of 870 nm did not meaningfully alter the proliferation of cultured cells. However, cell proliferation was promoted when the laser was applied within a wavelength of 650 nm. Treatment of HT29-derived tumors in nude mice with the 650 nm laser resulted in the decline of the tumor progression rate compared to controls. This result was inconsistent with the proliferative effects of the laser on the cultured cells.
Conclusion: Cell behavior in response to LLLT might be different between cell culture and xenograft models.

Evaluation of the Cellular Resistance Process in Treated Cells Via Extracorporeal Photopheresis

Babak Arjmand, Mostafa Rezaei-Tavirani, Somayeh Jahani Sherafat, Mitra Rezaei, Masoumeh Farahani, Majid Rezaei-Tavirani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e46

Introduction: Extracorporeal photopheresis (ECP) is a therapeutic method applied against some diseases such as cancers. Using 8-methoxypsoralen (8-MOP) and UVA radiation in ECP is associated with achievement in the treatment of patients with leukemic cutaneous T-cell lymphoma (CTCL). Evaluation of cellular resistance versus ECP is the aim of this study.
Methods: Data were downloaded from the Gene Expression Omnibus (GEO) database and were analyzed via the GEO2R program. The significant DEGs were assessed via protein-protein interaction (PPI) network analysis by using the STRING database and Cytoscape software. The critical genes were evaluated via gene ontology by using the ClueGO application of Cytoscape software. The identified biological processes were determined and analyzed.
Results: Fifty-seven significant DEGs were determined. The main connected component of the PPI network including 32 queried significant DEGs plus 50 first neighbors was constructed. Nineteen histones as critical nodes were assessed via gene ontology, and “nucleosome organization” was pointed out as a crucial biological process. Finally, 15 histones from H2A, H2B, and H3 histone families were identified as the key genes that are involved in the resistance property of the treated cells.
Conclusion: In conclusion, 15 members of H2A, H2B, and H3 families (especially H2A family) were considered as the origin of resistance versus ECP treatment. It is concluded that sensitivity to ECP treatment depends on gross molecular events which are involved in the functions of histones.

Comparative Effects of Er:YAG Laser, Sodium Hypochlorite, and QMix on Root Canals Infected With Enterococcus faecalis and Candida albicans

Agime Dragidella, Ariana Kameri

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e43

Introduction: During endodontic treatment, the smear layer can reduce disinfectant efficacy. The aim of this study was to evaluate the antimicrobial efficacy of Er: YAG laser radiation and its combination with NaOCl and QMix against Enterococcus faecalis and Candida albicans and their comparison with conventional irrigation with only NaOCl and QMix.

Methods: Two hundred extracted single-rooted teeth after root canal preparation were divided into two groups and inoculated with E. faecalis and C. albicans. According to the treatment method, all samples were divided into five treatment groups: (1) Er: YAG laser, (2) NaOCl, (3) QMix, (4) Er: YAG laser plus NaOCl, and (5) Er:YAG laser plus QMix. After 24 hours of agar plate cultivation, cell viability was recorded with a flow cytometer.

Results: All treatment modalities showed efficiency in the reduction of microbial cells. For laser treatment alone after exposure for 90 seconds, significantly fewer non-death cells were seen, compared to 30-second treatment. For both timings (30 and 90 seconds), irrigation with NaOCl or QMix after laser application resulted in significantly fewer vital cells of E. faecalis and C. albicans, compared with laser treatment alone (P<0.001). The samples treated with only NaOCl showed a significantly higher percentage of vital E. faecalis and Candida albicans cells, compared to the samples treated with only QMix (P<0.001).

Conclusion: Higher Er: YAG laser exposure time (90 seconds) after its combination with QMix and NaOCl improves the efficacy in the reduction of E. faecalis and C. albicans from the root canal, compared to 30-second laser exposure time and conventional irrigation methods with NaOCl and QMix.

Collagen Synthesis as a Prominent Process During the Interval between Two Laser Sessions

Vahid Mansouri, Babak Arjmand, Maryam Hamzeloo Moghadam, Mostafa Rezaei-Tavirani, Zahra Razzaghi, Alireza Ahmadzadeh, Mitra Rezaei, Reza Mohamoud Robati

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e50

Introduction: Many people suffer from skin photodamage, especially photoaging. The application of a laser to repair damages is a common therapeutic method that is used widely. In the present study, the effectiveness and molecular mechanism of an Er: Glass non-ablative fractional laser on the human skin was assessed via bioinformatics and network analysis.
Methods: The gene expression profiles of 17 white female forearm skins which received an Er: Glass non-ablative fractional laser before and after laser treatment in two sessions were extracted from Gene Expression Omnibus (GEO). Data were evaluated via GEO2R and the significant differentially expressed genes (DEGs) were assessed via protein-protein interaction (PPI) network analysis. The central nodes were identified and discussed for the compared set of samples.
Results: Five classes of samples were clustered in two categories: first, baseline, 7 and 14 days after the first session of laser treatment, and second, one day after the first laser session, 29 days after the first laser session, and 1 day after the second laser session. The gross cell functions such as cell division cell cycle and immune response were highlighted as the early affected targets of the laser. Collagen synthesis resulted after the first laser session.
Conclusion: In conclusion, the time interval between laser sessions plays a critical role in the effectiveness of laser therapy. Findings indicate that the gross effect of laser application appears in a short time, and important processes such as collagen synthesis happen later.

Effect of Photodynamic Therapy on the Pushout Bond Strength of Resin-Based and Calcium Silicate-Based Endodontic Sealers

Saeede Zadsirjan, Mohammad Asnaashari, Atoosa Yazdani, Soolmaz Heidari, Tina Estarami

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e33

Introduction: This study aimed to assess the effect of photodynamic therapy (PDT) on the pushout bond strength (PBS) of resin-based and calcium silicate-based endodontic sealers.
Methods: Forty single-canal teeth were assigned to four groups. After root canal preparation by the crown-down technique and smear layer removal, groups 1 and 2 served as the control group, and groups 3 and 4 underwent PDT by using a low-level diode laser as the light source and methylene blue as the photosensitizer (MB). The root canals in groups 1 and 3 were filled with AH26 sealer while the root canals in groups 2 and 4 were filled with Endoseal TCS. The samples were sectioned at 4, 8, and 12 mm from the apex tip (1mm thick slices). The PBS test was performed, and the mode of failure was determined in the coronal, middle, and apical thirds. The data were analyzed by the Kruskal-Wallis, Friedman, and Dunn tests.
Results: No significant difference was noted in the PBS of resin-based and calcium silicate-based sealers in the apical, middle, or coronal thirds in the application of PDT (P>0.05). The PBS of AH26 was significantly higher than that of Endoseal TCS (P<0.05). Cohesive failure was the dominant mode of failure in the AH26 groups, while mixed failure was the dominant failure mode in the Endoseal TCS groups.
Conclusion: PDT had no significant effect on the PBS of resin-based and calcium silicate-based sealers.

Analysis of the Temperature Elevation of the DualWavelength Diode Laser and the Er, Cr: YSGG Laser in Oral Soft Tissue Incisions

Alaa Jamal Al-Ani, Ammar Saleh Al-Alawi, Hanan Jafar Taher

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e37

Introduction: Lasers are one of the most advantageous tools that have been used in a variety of medical fields. Soft tissue management is an important part of oral and maxillofacial surgery. There are different surgical procedures for management; one of them is laser surgery. The purpose of this study was to compare the dual-wavelength diode laser and the Er, Cr: YSGG laser to choose the most effective laser for a soft tissue incision in oral and maxillofacial surgery regarding temperature elevation.
Methods: A dual-wavelength diode laser (810 and 980 nm) with 1.5 W and 2.5 W power outputs and an Er, Cr: YSGG (2780 nm) with 2.5 W and 3.5 W power outputs were used to make 50 incisions in six freshly dissected sheep tongues. The temperature means were measured at initial, and maximum temperatures, as well as the temperature rise (difference between initial and maximum), and all were compared between the groups of soft tissue.
Results: The lowest mean temperature rise was observed with a 2.5 W Er, Cr: YSGG laser, and the highest mean temperature rise was observed with a 2.5 W diode laser, and all samples from the two lasers showed a statistically significant difference (P<0.05) in the temperature rise except for the 1.5 W diode, which is higher but not statistically significantly different from the 3.5 W Er, Cr: YSGG laser (P=0.100).
Conclusion: The power output of 2.5 W of an Er, Cr: YSGG laser produced low levels of temperature rise compared to a diode laser and produced surgical incisions with a lower probability of heat damage to surrounding tissues.

Long and Short-terms Effects of Ablative Fractional Laser Therapy on Human Skin: A Network Analysis

Zahra Razzaghi, Babak Arjmand, Mostafa Rezaei-Tavirani, Maryam Hamzeloo Moghadam, Mohammad Rostami-Nejad, Reza Mohamoud Robati

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e27

Introduction: The time-dependent effects of laser radiation have been investigated by researchers. An understanding of the molecular mechanism of the time course effect of the laser needs molecular assessment and function evaluation of the related genes. In the present study, the importance of repetition of treatment after 4 weeks and gene expression alteration after 7 days of laser radiation versus one day on the human skin was evaluated via protein-protein interaction (PPI) network analysis and gene ontology enrichment.
Methods: The differentially expressed genes (DEGs) were extracted from Gene Expression Omnibus (GEO) and assessed via PPI network analysis. The critical DEGs were enriched via gene ontology. The related biological processes and biochemical pathways were retrieved from “GO-Biological process” and “Kyoto Encyclopedia of Genes and Genomes” (KEGG) respectively.
Results: The repetition of laser therapy after 4 weeks of the first treatment did not have a significant effect on treatment efficacy. Sixty-three significant DEGs and six classes of biological terms discriminated the samples seven days after the treatment from individuals one day after the treatment. The studied DEGs were organized into two clusters with certain functions.
Conclusion: Based on the findings after laser therapy, several days are required to complete the critical processes such as DNA biosynthesis and skin cornification.

Anti-inflammatory, Antioxidant, and Wound-Healing Effects of Photobiomodulation on Type-2 Diabetic Rats

Atefeh Moheghi, Seyed Mohammadhossein Noori Mougehi, Abdollah Amini, Atarodalsadat Mostafavinia, Fatemehalsadat Rezaei, Fatemeh Bagheri Tadi, Sufan Chien, Mohammad Bayat

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e45

Introduction: In the current study, the effects of photobiomodulation (PBM) treatments were
examined based on biomechanical and histological criteria and mRNA levels of catalase (CAT),
superoxide dismutase (SOD), and NADPH oxidase (NOX) 1 and 4 in a postponed, ischemic, and
infected wound repair model (DIIWHM) in rats with type 2 diabetes (DM2) during the inflammation
(day 4) and proliferation (day 8) stages.
Methods: To study ischemic wound repair in a diabetic rat model (DIIWHM), 24 rats with type-2 diabetes were randomly divided into four groups and infected with methicillin-resistant Staphylococcus aureus (MRSA). The control groups consisted of CG4 (control group on day 4) and CG8 (control group on day 8), while the PBM groups comprised PBM4 (PBM treatment group on day 4) and PBM8
(PBM treatment group on day 8). These group assignments allowed for comparisons between the control groups and the PBM-treated groups at their respective time points during the study.
Results: On days 4 and 8 of wound restoration, the PBM4 and PBM8 groups showed substantially modulated inflammatory responses and improved formation of fibroblast tissue compared with the CG groups (P<0.05). Concurrently, the effects of PBM8 were significantly superior to those of PBM4
(P<0.05). The antioxidant results on days 4 and 8 revealed substantial increases in CAT and SOD in the PBM groups compared with the CGs (P<0.05). Substantial decreases were observed in the antioxidant agents NOX1 and NOX4 of the PBM4 and PBM8 groups compared with both CGgroups
Conclusion: PBM treatments significantly sped up the inflammatory and proliferating processes in a DHIIWM in DM2 animals by modifying the inflammatory reaction and boosting fibroblast proliferation. Overall, the current findings indicated substantially better results in the PBM groups than in the CG groups.

Effect of Erbium:YAG Laser Recycling on Mechanical Characteristics of Retrieved Orthodontic Mini-screws

Soghra Yassaei, Hossein Aghili, Atie Behrouzirad

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e42

Introduction: This study aimed to evaluate the influence of two recycling methods on the mechanical and surface characteristics of orthodontic mini-screws.

Methods: Thirty-six retrieved mini-screws were randomly classified into two equal groups. In the first group (laser recycled group (LG)), the Er:YAG laser (2940 nm, 5.5 W, 275 mJ, perpendicular to the mini-screws at a distance of 7-10 mm, 25 s) was used to recycle mini-screws. In the second group (phosphoric acid and sodium hypochlorite recycled group (ASG)), the mini-screws were kept in 37% phosphoric acid gel (10 minutes) and then placed in 5.25% sodium hypochlorite for 30 minutes. Eighteen new mini-screws were selected as the control group (CG). Maximum insertion torque (MIT), maximum removal torque (MRT), and fracture torque (FT) of all mini-screws were measured. A sample from each group was examined for the surface changes of the mini-screw and tissue remnants under a scanning electron microscope (SEM).

Results: The mean MIT was significantly higher in both LG and ASG groups than the CG (P<0.001 and P=0.002, respectively). However, no significant difference was shown between the LG and ASG groups. The mean values of MRT and FT showed no significant difference between the groups. The amount of tissue remnants in the ASG group was significantly higher than that in the LG group. The evidence of porosity and corrosion was observed on the ASG mini-screw surface, and there was an increase in roughness on the LG mini-screw surface.

Conclusion: The Er: YAG laser recycling of mini-screws is a proper method causing minimum damage to the screw surface.

Effect of the 1064 nm Nd: YAG Laser on the MICs of Antifungals Used in Clinical Practice for the Treatment of Fungal Nail Infections

Taraneh Razavyoon, Seyed-Jamal Hashemi, Parvin Mansouri, Roshanak Daie Ghazvini, Sadegh Khodavaisy, Heydar Bakhshi, Saham Ansari, Zahra Rafat, Nahid Nikkhah, Bahram Mohajer, Shayesteh Razavyoon, Davoud Roostaei

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e35

Introduction: The fungal nail infection (onychomycosis) involves 18%-40% of all nail disorders, which, although not fatal, can cause mechanical, aesthetic, occupational, and economic problems. Drug treatments due to prolonged treatment periods, drug interactions, adverse effects, and slow progression may be associated with numerous negative outcomes. This study aimed to evaluate the long-pulsed 1064-nm Nd: YAG laser effect on fungal colonies and subsequently possible change in the minimum inhibitory concentrations (MICs) of common antifungals compared with the same non-lasered colonies as a novel way to investigate laser and antifungal interaction.
Methods: Sixty onychomycosis samples consisting of saprophyte (n=20), dermatophyte (n=20), and yeast (n=20) duplicate colonies were isolated. A series was treated by a long-pulsed 1064-nm Nd: YAG laser. Afterward, the MIC (CLSI-M38-A2 and CLSI-M27-A3) of two series against common antifungals were compared.
Results: After 1064-nm Nd: YAG laser irradiation in all 20 tested saprophytes, the MICs of terbinafine (P value<0.035) were changed, and in all 20 tested dermatophytes, the MICs of voriconazole (P value<0.021) were changed. Also, in all 20 tested yeasts, the MICs of caspofungin (P value<0.037) were changed. Moreover, in saprophytes, dermatophytes, and yeasts, significant changes in the MICs of itraconazole (P value<0.032), terbinafine (P value<0.025), and caspofungin (P value<0.037) were detected. Our result showed the GM MICs of the 1064-nm Nd: YAG laser in all saprophyte, dermatophyte, and yeast groups were lower than in the control group.
Conclusion: The present study indicated that the long-pulsed 1064-nm Nd: YAG laser significantly changes the MICs of antifungals in onychomycosis clinical samples.

Impact of Er,Cr:YSGG Laser, Sandblast, and Acid Etching Surface Modification on Surface Topography of Biodental Titanium Implants

Mohammed A Abdulla, Radhwan H Hasan , Osama Hazim Al-Hyani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e38

Introduction: Several techniques have been used to modify the surface of commercially pure titanium (CPTi) implants to improve osseointegration using lasers, sandblasts, sandblasts with acid etching, and other modalities. For implant-osseointegration, surface features like the chemical composition of a surface, topography, and surface energy are essential. The present comparative study aimed to compare the impact of Er, Cr: YSGG laser, sandblasting, and acid etching implant surface modifications on the surface topography, roughness, and element chemical composition of the Ti dental implant.
Methods: Thirty CPTi dental implants were divided into three groups according to the surface modification (n=10 for each group): Group A: Sandblasting with acid etching (SLActive), group B: Sandblasting, and Group C: Er,Cr: YSGG laser surface modifications. The modified surfaces were analyzed using scanning electron microscopy (SEM), profilometer, and energy dispersive x-ray spectrometry (EDS).
Results: One-way analysis of variance (ANOVA) showed that there were significant differences in the mean values of average roughness (Ra) of the three groups (P<0.05). Tukey’s post hoc test showed that the average roughness (Ra) of laser-surface modification (group C) of the implant had the highest mean value (2.30 µm) among the different groups, while sandblasted surface modification (group B) of the implant had the lowest mean value (1.39 µm). The SLActive (group A) sandblast with acid etching had a mean value of 1.63 µm. SEM analysis showed that significantly modified surface topographies and different element concentrations were found within all modified groups.
Conclusion: The Er, Cr: YSGG laser irradiation increased the implant surface roughness value after implant surface modification, compared to sandblasts and sandblasts with acid etching application. The observations for the SEM-EDS analysis revealed several elements with different concentrations, which were affected by the physical–chemical characteristics of the surface modification techniques. The SEM analysis showed a significant modification in implant surface topographies of the tested groups.

Assessment of Photosensitizer Concentration Effects on the Efficacy of Photodynamic Therapy

Reza Vafaee, Babak Arjmand, Maryam Hamzeloo Moghadam, Mostafa Rezaei-Tavirani, Zahra Razzaghi, Reza M Robati, Mitra Rezaei, Fatemeh Montazer

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e53

Introduction: Photodynamic therapy (PDT) is an attractive approach in medicine. Due to its noninvasive nature and low side effects, PDT has been developed quickly. In the present study, the gene expression profiles of the human cell line that was treated via PDT in the sub-lethal concentration (LC50) and super-lethal concentration (LC90) of a photosensitizer (PS) from Gene Expression Omnibus (GEO) were extracted and the common differentially expressed genes (DEGs) were investigated.
Methods: The gene expression profiles of the treated cells were compared with a control, and the common DEGs were determined. The common DEGs were assessed via protein-protein interaction (PPI) network analysis and gene ontology enrichment were evaluated. The related biological terms for the common genes were identified.
Results: Ninety-four common DEGs were selected to be analyzed. It appeared that the activation and increment of gene expression were prominent processes. Jun, Dusp1, Atf4, and Atf3 as four critical genes were highlighted. “Chromosomal and microsatellite instability in colorectal cancer” was identified as the main class of biological terms related to the assessed DEGs.
Conclusion: The major molecular events that happened in both analyses indicated that PDT, independent from the concentration of PS, induced gross molecular changes such as the upregulation of Jun and Dusp1.

Evaluation of the Effects of Photodynamic Therapy With Methylene Blue on Different Candida Species In Vitro

Faezeh Khozeimeh , Atefeh Tavangar, Mehdi Razzaghi-Abyaneh , Milad Amini, Marzieh Ghayoor

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e34

Introduction: Oral candidiasis is the most prevalent opportunistic infection of the oral cavity. The most common cause of this infection is Candida albicans. Considering the side effects of conventional antifungal therapies, this study aimed to evaluate the efficacy of photodynamic therapy with new methylene blue (a photosensitizer) in inhibiting the growth of C. albicans, C. tropicalis, C. glabrata, and C. krusei in vitro.
Methods: In this experimental study, 200 samples of standard suspension (0.5 McFarland) were prepared from C. albicans, C. tropicalis, C. glabrata, and C. krusei (50 samples from each species). The samples of each species were divided into five groups (n=10), including photodynamic therapy with a photosensitizer, with or without laser irradiation, nystatin treatment, laser therapy, and control. Next, cultivation of samples was performed on Sabouraud dextrose agar, and the colonyforming units were determined after 24 hours of incubation at 37 °C. Data were analyzed in SPSS version 22 by means of the Kruskal-Wallis test (P<0.05).
Results: The most sensitive and resistant species to nystatin therapy were C. glabrata and C. krusei, respectively. On the other hand, C. krusei was the most sensitive species to photodynamic therapy, and C. glabrata was the most resistant type to this treatment. The highest therapeutic effectiveness was attributed to nystatin therapy, although photodynamic therapy was also effective. Laser therapy was recognized as the least effective method.
Conclusion: Photodynamic therapy with new methylene blue, as a suitable adjunct therapy, can be effective in the management of candidiasis. It may also be a potential novel treatment for immunocompromised patients with oral candidiasis.

A Comparative Histological Study of Gingival Depigmentation by 808 and 445 nm Diode Lasers

Seyed Masoud Mojahedi Nasab, Matthias Frentzen, Somayeh Rahmani, Fahimeh Anbari, Saranaz Azari-Marhabi, Jörg Meister, Deniz Mojahedi Nasab

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e48

Introduction: Using lasers in melanin depigmentation is one of the main fields of interest for dental practitioners and patients. However, it is important to know what would happen inside the tissue and how the cells would interact inside the tissue with a laser.
Methods: In this study, we used both wavelengths of 445 nm and 808 nm on sheep gingiva to find out the effects and side effects of these diode lasers while using them for gingival depigmentation.
Results: After microscopic evaluation, we concluded that 808 nm and 445 nm lasers with a power of 1 W are safe enough to use in the depigmentation of gingiva, and both lasers are highly effective in melanin pigments which are located in the basal membrane.
Conclusion: The 445 nm blue laser produced a less thermal effect, which means it is safer to be used in gingival hyperpigmentation than a diode laser

A Good Craftsperson Knows Their Tools: Understanding of Laser and Ureter Mechanics in Training Urologists

Sorcha O'Meara, Stefanie Croghan, Fergal J. O'Brien, Niall F. Davis

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e29

Introduction: Recent decades have seen a move to minimally invasive techniques to manage urolithiasis. Trainees are expected to develop competency in common endourology procedures. Knowledge of ureter mechanics and the theory behind new technologies is important to ensure safe and efficient techniques. We aim to evaluate the exposure to endourology, self-reported competency in common techniques, and knowledge of basic ureter biomechanics and technology in training urologists.
Methods: An online survey was circulated to all training urologists in the Republic of Ireland. Questions focused on self-reported competency, clinical knowledge, ureter mechanical properties, and laser technology.
Results: Thirty responses were received with a range of 1-8 years of urology experience (mean=4 years). The respondents reported high levels of exposure to endourology with the majority reporting competency in flexible ureterorenoscopy (FURS) (n=18, 60%) and semi-rigid ureteroscopy (URS) (n=21, 70%). The respondents demonstrated good clinical knowledge but variable knowledge of laser settings, laser thermodynamics, and ureter mechanics. Half of the respondents (n=15, 50%) correctly described fragmentation laser settings, with 10 trainees (n=33%) accurately identifying both factors that increase ureteral access sheath (UAS) insertion force. Most of the respondents (n=20, 67%) described the proximal ureter as the site with the greatest compliance, while the site of the greatest force during ureteroscope insertion was correctly identified by 17% (n=5).
Conclusion: To our knowledge, this represents the first study evaluating urologist understanding of laser technology and the mechanical properties of the human ureter. Despite trainees reporting high levels of experience in endourology, there is a variable understanding of the principles of laser technology and ureter mechanics. Further research and education are needed with a focus on laser safety, suitable laser settings and the safe limit of insertion forces.

Non-thermal CO2 Laser Therapy (NTCLT): A Novel Photobiomodulative Approach for Immediate Pain Relief of Patchy Oral Mucositis Due to Chemotherapy of Solid Tumors

Nasrin Zand, Safa Najafi, Mohsen Fateh, Jila Sadighi, Parvin Mansouri, Mohammad Farhadi, Leila Ataie-Fashtami, Alireza Nikoofar, Hoda Mahdavi, Afshan Shirkavand

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e54

Introduction: Chemotherapy-induced oral mucositis (COM) is a prominent complication of chemotherapy (CT). Non-thermal CO2 laser therapy (NTCLT) has been demonstrated as an innovative and safe photobiomodulative approach in some kinds of painful oral lesions. The purpose of this study was to evaluate the palliative effects of one session of NTCLT on COM lesions.
Methods: Patients with painful COM (WHO grade:≥2) were included in this before-after clinical trial based on the eligibility criteria. The oral lesions were irradiated with a CO2 laser (power: 1 W, scanning the lesions with the rapid circular motion of the defocused handpiece) through a thick layer (3-4 mm) of a transparent gel containing a high water content. The severity of pain in the lesions was self-assessed using a 0-to-10 visual analog scale (VAS) for 7 consecutive days. The evaluating physician visited the patients on the 3rd and 7th days in search of any kind of complications.
Results: Seventeen adult patients with 35 patches of OM due to chemotherapy of solid tumors completed the trial. Immediately after NTCLT, the mean for non-contact VAS pain scores of the lesions significantly declined from 4.91±2.356 to 0.29±0.622 (P<0.001) and the mean for contact VAS pain scores from 7.77±1.57 to 1.31±1.18 (P<0.001). The mean VAS pain scores of the lesions showed statistically significant differences between the follow-up periods compared to the baseline (P<0.001). The process was completely pain-free and required no anesthesia. After NTCLT, no kind of thermal adverse effects such as irritation, destruction, aggravation, and even erythema were observed.
Conclusion: Based on the results of this before-after clinical trial, NTCLT has the potential to be considered a non-invasive and safe palliative option for the pain management of patchy OM due to chemotherapy of solid tumors

Experimental Analysis of Vaginal Laxity in Rats Treated With a Combination of Er:YAG Fractional Lasers and AMSC-MP

Trisniartami Setyaningrum, Muhammad Yulianto Listiawan Listiawan, Budi Santoso, Cita Rosita Sigid Prakoeswa, Widjiati Widjiati, Brahmana Askandar Tjokroprawiro

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e2

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.

Diode Laser Irradiation Effects on Miniscrew Stability and IL-1β and TGF-β1 Levels: A Split-Mouth Randomized Controlled Clinical Trial

Soghra Yassaei, Somayeh Kordi, Hosseinagha Aghili, Javad Zavar reza, Zahra Ebrahiminik

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e3

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

Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction

Aliasghar Jamehbozorgi, Bahman Norozian, Samaneh Arabi, Seyedeh Mahta Marashipour, Khosro Khademi Kalantari, Alireza Akbarzadeh Baghban, Seyyed Morteza Kazemi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e6

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.

Keloid Treatment Using Plasma Exeresis: A Pilot Trial Study

Shohreh Delavar, Setareh Tehrani, Hournaz Hassanzadeh, Sepideh Tehrani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e7

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.

Antimicrobial Photodynamic Therapy as a Technique for Decontamination of Acrylic Resin Devices Provided by Different Dental Laboratories

Bruna Marjorie Dias Frota de Carvalho, Bruna Albuquerque Garcia, Aghata Kelma Palacio Gomes, Danielle Dourado Alcântara, Karina Matthes de Freitas Pontes

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e8

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.

Effect of Er: YAG Laser Irradiation on Bone Metabolism-Related Factors Using Cultured Human Osteoblasts

Tsuka Yuji, Ryo Kunimatsu, Hidemi Gunji, Shuzo Sakata, Ayaka Nakatani, Sho Oshima, Kodai Rikitake, Purtranti Nurul Aisyah, Isamu Kado, Kotaro Tanimoto

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e9

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.

Gene Ontology Assessment of Indirect Cold Physical Plasma and UV-Radiation Molecular Mechanism at the Cellular Level

Zahra Razzaghi, Babak Arjmand, Maryam Hamzeloo Moghadam, Mostafa Rezaei-Tavirani

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e10

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.

Microleakage and Marginal Integrity of Surface-Coated and Laser-Pretreated Class V Composite Restorations in Primary Teeth

Niloofar Azimi, Najmeh Mohammadi, Zahra Parsaie, Kiarash Fereidouni

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e11

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.

Effect of Low-Level Laser Therapy on Patients With Class II Mandibular Deficiency Treated with Farmand Functional Appliance

Hossein Agha Aghili, Soghra Yassaei, Mohadeseh Sharifi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e12

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.

The Efficacy of Intense Pulsed Light in the Treatment of Keloids and Hypertrophic Scars

Le Thai Van Thanh, Tran So Quan, Le Vi Anh, Ta Quoc Hung, Nguyen Lam Vuong

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e13

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.

The Clinical Effects of Laser Acupuncture on Hospitalized Patients With Severe COVID-19: A Randomized Clinical Trial

Arista Shojaeddin, Alireza Fatemi, Zahra Razzaghi, Mehdi Pishgahi, Somayeh Jahani Sherafat, Mohammad Reza Razzaghi, Mohamad Karim Shahrzad, Nafiseh Anaraki, Chiman Salehi, Aslan Amiri

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e14

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.

Photobiomodulation Therapy Improves Inflammatory Responses by Modifying Stereological Parameters, microRNA-21 and FGF2 Expression

Abdollah Amini, Fahimeh Ghasemi Moravej, Atarodalsadat Mostafavinia, Hossein Ahmadi, Sufan Chien, Mohammad Bayat

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e16

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.

Combined Use of Photobiomodulation and CurcuminLoaded Iron Oxide Nanoparticles Significantly Improved Wound Healing in Diabetic Rats Compared to Either Treatment Alone

Manouchehr Hekmat, Houssein Ahmadi, Farzad Baniasadi, Behnaz Ashtari, Parvaneh Naserzadeh, Mansooreh Mirzaei, Hamidreza Omidi, Atarodalsadat Mostafavinia, Abdollah Amini, Michael R Hamblin, Sufan Chien, Mohammad Bayat

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e18

Introduction: Here, we assess the therapeutic effects of photobiomodulation (PBM) and curcumin (CUR)-loaded superparamagnetic iron oxide nanoparticles (SPIONs), alone or together, on the maturation step of a type 1 diabetes (DM1) rat wound model.
Methods: Full-thickness wounds were inflicted in 36 rats with diabetes mellitus (DM) induced by the administration of streptozotocin (STZ). The rats were randomly allocated to four groups. Group one was untreated (control); group two received CUR; group 3 received PBM (890 nm, 80 Hz, 0.2 J/cm2 ); group 4 received a combination of PBM plus CUR. On days 0, 4, 7, and 15, we measured microbial flora, wound closure fraction, tensile strength, and stereological analysis.
Results: All treatment groups showed a substantial escalation in the wound closure rate, a substantial reduction in the count of methicillin-resistant Staphylococcus aureus (MRSA), a substantial improvement in wound strength, a substantial improvement in stereological parameters compared to the control group, however, the PBM+CUR group was superior to the other treatment groups (all, P≤0.05).
Conclusion: All treatment groups showed significantly improved wound healing in the DM1 rat model. However, the PBM+CUR group was superior to the other treatment groups and the control group in terms of wound strength and stereological parameters.

Effect of Photobiomodulation Therapy With an 810-nm Diode Laser on Pain Perception Associated With Dental Injections in Children: A Double-Blind Randomized Controlled Clinical Trial

Bahman Seraj, Anise Bavaghar, Neda Hakimiha, Zahra Hosseini, Mohammad Javad Kharazifard, Sara Ghadimi

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e19

Introduction: This study investigated the photobiomodulation effect of an 810-nm diode laser in adjunction with topical anesthesia on pain perception during infiltration anesthesia of primary maxillary molars in children.
Methods: This double-blind randomized controlled clinical trial was conducted on 64 children (aged 5-9 years) requiring extraction or stainless steel crown for their primary maxillary molars. The patients were randomly allocated into two groups (n=32) of laser and control. In the laser group, the injection site (buccal and palatal mucosa) was irradiated with an 810-nm laser (200 mW, 5.2 J/cm2) after 20% benzocaine topical anesthetic application, while the control group received a placebo laser following topical anesthesia. The pain intensity experienced by children during needle insertion into the buccal and palatal mucosa was determined using a visual analog scale (VAS) and modified behavioral pain scale (MBPS).
Results: According to the results of the VAS and MBPS, no significant difference was detected in pain scores between the laser and control groups neither in the buccal nor in the palatal mucosa (P>0.05).
Conclusions: Photobiomodulation therapy with an 810-nm laser with the current setting adjunct to topical anesthesia did not promote significant additional effects on the pain intensity.

Effects of Photobiomodulation With Two Wavelengths of 630 and 810 nm on Diabetic Neuropathy

Seyed Alireza Ebadi, Faraj Tabeie, Sahar Tavakoli, Shayesteh Khalili

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e22

Introduction: Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes patients. Among different therapeutic approaches for treating DPN, low-level laser therapy (LLLT) or photobiomodulation (PBM) is a new promising non-invasive technique. This study aims to evaluate the effect of visible and infrared LLLT on DPN.
Methods: Sixty DPN patients enrolled in a randomized-controlled study. The patients were randomly divided into the same population of control and laser groups. The patients in the laser group received LLLT with two wavelengths of 630 and 819 nm and conventional therapy, and those in the control group received conventional therapy alone. Irradiation of the patients lasted 15 minutes per session, and it was performed over the surface of each foot three times a week for 12 sessions. The patients were evaluated at baseline and at the end of the study with the Michigan Neuropathy Screening Instrument (MNSI) and microfilament test.
Results: Patients’ sensation in the right foot in the monofilament test had increased from 22 (84.6%) to 26 (86.7%) (P=0.000), and in the left foot it had increased from 20 (80%) to 25 (86.2%) (P=0.001). The mean and standard deviation of the scores of section A of the Michigan questionnaire showed a statistically significant difference between the two groups (P<0.05), but the B part scores of the Michigan test did not show a significant difference.
Conclusion: This study showed that the visible and infra-red LLLT significantly improved the symptoms of diabetic neuropathy without any side effects.

Extracellular Vesicle-Derived Cord Blood Plasma and Photobiomodulation Therapy Down-Regulated Caspase 3, LC3 and Beclin 1 Markers in the PCOS Oocyte: An In Vitro Study

Samira Sahraeian, Hojjat-allah Abbaszadeh, Robabeh Taheripanah, Mohammad Amin Edalatmanesh

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e23

Introduction: Polycystic ovary syndrome (PCOS) is the communal endocrine illness in women and the most common cause of infertility due to lack of ovulation. The exact cause of PCOS is still unknown. Affected women may have difficulty getting pregnant due to ovulation problems. Various methods have not been effective in the treatment of PCOS due to the positive role of photobiomodulation therapy (PBMT) and extracellular vesicles (ECV) obtained from cord blood plasma in the treatment of various diseases. The aim of this study was to study the role of ECV and PBMT in the maturation and improvement of infertility in women with PCOS.
Methods: In this research, a number of oocytes were obtained after ovarian stimulation from women who had been referred to the hospital for infertility treatment after obtaining personal consent, and they were divided into three groups: control, ECV, and PBMT. Subsequently, in vitro maturation (IVM) was assessed, then some oocytes were cultured with a routine medium and others were treated with ECV and PBMT. Real-time PCR was used to evaluate BCL-2, BAX, caspase-3, and autophagy gene (ATG5, LC3, Beclin 1). Oocyte glutathione (GSH), oxidised gluathione (GSSG), and reactive oxygen species (ROS) were measured.
Results: The metaphase II (MII) oocyte ratio formation significantly increased in the ECV and PBMT groups (P<0.05). The expression of the BCL-2 gene was significantly up-regulated in the ECV and PBMT groups, but the expression of BAX and caspase-3 significantly decreased (P<0.05). The expression of the ATG5, LC3, BECLIN-2 genes significantly decreased in the ECV and PBMT groups (P<0.05). ROS, GSSG decreased in ECV and PBMT groups but GSH increased (P<0.05).
Conclusion: The use of ECV and PBMT can increase the rate of fertilization and maturation of an oocyte and cause a decrease in apoptosis, autophagy, and ROS in a PCOS oocyte.

Introducing Critical Genes in Response to Photodynamic Therapy: A Network Analysis

Vahid Mansouri, Babak Arjmand, Maryam Hamzeloo Moghadam, Mostafa rezaei-tavirani, Zahra Razzaghi, Alireza Ahmadzadeh, Mohammad Rostami-Nejad, Reza Mohamoud Robati

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e25

Introduction: Photodynamic therapy (PDT) is applied as an efficient method for preventing the progress of cancers. Light and a photosensitive compound which is known as photosensitizer (PS) are the main parts of PDT. In the present study, molecular events after using PDT in the presence of a super lethal dose of a PS were assessed via protein-protein interaction (PPI) analysis.
Methods: Data were extracted from Gene Expression Omnibus (GEO). The gene expression profiles of the treated human Sk-Cha1 cells via PDT were compared with the control cells. Expressed change analysis and PPI network analysis were administrated via Cytoscape software v 3.7.2 to find the critical differentially expressed genes (DEGs). Regulatory relationships between the central DEGs were evaluated and the highlighted genes were identified.
Results: The significant amounts of gene expression values were grouped and a few DEGs characterized by tremendously expressed values were identified. EGFR, CANX, HSPA5, MYC, JUN, ITGB1, APP, and CDH1 were highlighted as hub-bottleneck DEGs. EGFR, CDH1, and JUN appeared as a set of SEGs, which play a crucial role in response to PDT in the treated Sk-Cha1 cells.
Conclusion: In conclusion, regulatory relationships between EGFR, CDH1, and JUN, which have an effect on the regulation of cellular survival, differentiation, and proliferation, were highlighted in the present investigation.

Case Report

Use of Phototherapy and Er-YAG Laser in the Management of Mandible Osteoradionecrosis: A Case Report

Larissa Couto de Freitas, Elenice Lika Kawamoto, Ana Maria Aparecida Souza, Paulo Yataro Kawasakami, Alyne Gonçalves Simões

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e58

Introduction: Osteoradionecrosis (ORN) is a secondary complication from radiotherapy, which is difficult to manage and significantly reduces the life quality of the affected patients.
Case Report: A 59-year-old female patient, diagnosed with infiltration by squamous cell carcinoma in the left cervical region, underwent adjuvant cervical-facial radiotherapy with a total dose of 66.6 Gy of radiation. Eight years after the diagnosis, the patient underwent multiple extractions and, subsequently, the installation of osseointegrated implants, evolving to extensive intraoral bone exposure associated with oral cutaneous fistula. The patient was initially exposed to photobiomodulation therapy (PBMT), with a low-power laser at wavelengths of 660 nm and 808 nm, and thereafter to antimicrobial photodynamic therapy (aPDT). After an improvement in the clinical condition and resolution of the oral cutaneous fistula, a surgical procedure with the Er: YAG laser was performed to remove the remaining necrotic bone. Once the ORN condition was completely treated, the patient’s oral rehabilitation was implemented by the installation of an upper mucous-supported total prosthesis and a lower implant-supported prosthesis.
Conclusion: The patient is in a clinical follow-up and has no signs of bone necrosis recurrence, suggesting that low and high-power laser treatment can be an effective therapeutic alternative to resolve this condition

Photobiomodulation Therapy for Managing Motor and Sensory Dysfunctions Following Temporomandibular Joint Surgery: A Case Report

Luiz Felipe Palma, Thales dos Santos Porfírio, Rafael Verardi Serrano, Luana Campos, Luís Otávio Carvalho de Moraes

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e67

Introduction: Surgical procedures involving the temporomandibular joint (TMJ) are frequently associated with nerve injuries and subsequent dysfunctions. Considering that traumatic peripheral nerve injuries may resolve slowly and their prognosis is generally unpredictable, the current study aimed to report a clinical case in which both motor (affecting the temporal and zygomatic branches of the facial nerve) and sensory dysfunctions (affecting the auriculotemporal nerve of the trigeminal nerve) following TMJ surgery were effectively treated by using photobiomodulation therapy (PBMT).
Case Report: PBMT sessions, involving a total of 30 facial points, were administered twice a week for 10 weeks. The following parameters were utilized: wavelength of 808 nm, energy density of 75 J/cm², power output of 100 mW, total energy of 3 J, and duration of 30 seconds per point. A considerable improvement in both facial asymmetry and muscle function was achieved within 5 weeks, along with a total restoration of cutaneous sensitivity. By the 10th week of PBMT, the facial movement dysfunction was completely resolved.
Conclusion: According to the current case, PMBT seems to be an effective intervention to manage motor and sensory nerve dysfunctions following TMJ surgery.

Photobiomodulation Therapy as an Adjuvant Treatment of Cervicofacial Liposuction Complications

Leticia Boaro, Angelica Pimentel, Daniela Muknicka , Sumaya Bordalo, Luana Campos

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e1

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.

Photobiomodulation Therapy for Multiple Painful Fixed Drug Eruptions: The First Case Report

Luiz Felipe Palma, Luana Campos, Sandro Francisco de Oliveira, Ludmila Penido, Susana Morimoto, Luís Otávio Carvalho de Moraes

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e4

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.

Photobiomodulation With a Continuous Wave Red Laser (660 nm) as Monotherapy for Adult Alopecia Areata: A Case Presentation

Luiz Felipe Palma, Luana Campos, Cristina Maria Arvate Álvares, Rafael Verardi Serrano, Luís Otávio Carvalho de Moraes

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e21

Introduction: Alopecia areata (AA) is an autoimmune, inflammatory, non-scarring hair loss in which T-cells target hair follicles. Given that the available therapeutic options generally do not induce and sustain remission of AA effectively and many adverse effects may occur, monochromatic light sources have been recently gaining attention from clinicians. Therefore, the present paper aimed to report the first case in which photobiomodulation therapy (PBMT) with a continuous wave red laser (660 nm) was used as monotherapy for AA.
Case Presentation: An isolated round area of complete hair loss was subjected to daily PBMT sessions, resulting in significant regrowth (hair of normal coloration and thickness) within 7 days. On the 21st day, the patient’s aesthetic concern was completely resolved.
Conclusion: PBMT with a continuous wave red laser seems to be a promising therapeutic option for the treatment of AA; however, additional studies are necessary to obtain more robust evidence.

Combination of Fractional Er:YAG Laser, Pulsed Dye Laser, and Intralesional Triamcinolone With 5-Fluorouracil for Keloid Treatment

Bonnie Anggawirya, Putri Hendria Wardhani, Diah Mira Indramaya, Muhammad Yulianto Listiawan

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e30

Introduction: Benign fibroproliferative scars that are larger than the initial lesion are called keloids. Keloid treatment in clinical practice is still difficult. Although there are various therapy choices, none is embraced by everyone or is relapse-free. Various treatment modalities such as intralesional corticosteroid injection with 5-fluorouracil (5-FU), fractional Er: YAG laser, pulsed dye laser (PDL), and others can be used either as monotherapies or combined therapies. Therefore, efforts should be made to select the treatment that will provide the best results.
Case Presentation: A 6-year-old boy with keloids on the lower lips extending to the chin was successfully treated with a 2940-nm fractional Er: YAG laser alternated with a 595-nm long-PDL followed by the combined intralesional injection of corticosteroid and 5-FU. The patient was followed up for 1 year with no lesion recurrence.
Conclusion: Our case supports a combined therapy to successfully treat a patient with a keloid on the chin. Therapy using a combination of these four modalities seems safe and effective and may have a synergistic effect with minimal downtime.

Capillary Hemangioma Managed With Laser Ablation: A Case Report

Aravind Warrier S, Vaishnavi Muthukumaran, Aparna Venkatramakrishnan, Divyambika CV, Thamizhchelvan H, Muthukumar Santhanakrishnan

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e39

Introduction: Hemangiomas are hamartomatous benign tumours of the vascular tissue, which are common among infants and adolescents and are found in the head and neck region. Oral hemangiomas are infrequently encountered in the palate. Baseline soft tissue imaging must be considered for an appropriate diagnosis and treatment approach.
Case Report: A 68-year-old female presented with a painless growth in the roof of her mouth that gradually increased in size. She was subjected to intraoral ultrasonography and was diagnosed with capillary hemangioma. In this instance, laser ablation was chosen as the preferred treatment due to the complications associated with conventional surgery.
Conclusion: This case report enlightens the systematic diagnostic approach and treatment plan.

Case Series

Successful Treatment of Sebaceous Nevus With Copper Vapor Laser

IGOR Vladimirovich PONOMAREV, Sergey B. Topchiy, Yuri N. Andrusenko, Ludmila D. Shakina

Journal of Lasers in Medical Sciences, Vol. 14 (2023), 29 January 2023, Page e20

Introduction: Sebaceous nevus (SN) is a benign skin hamartoma with a potent transformation into benign or malignant tumors in adolescents or adults. Due to the most common location in the esthetic zone, an SN makes patients seek a dermatologist for cosmetic concerns on the face or neck. The surgical excision of a large-sized SN in the esthetic zone may require reconstruction with a skin flap and be associated with recurrences and scar formation.
Case Report: We describe the successful treatment of the large-sized neck SN with copper vapor laser (CVL) for the first time. A left-sided neck SN (linear size of 27 mm) in the 24-year-old Caucasian female completely resolved after eight CVL sessions. The settings were as follows: average power accounted for 0.8-1.0 W, with a ratio at green (511 nm) and yellow (578 nm) wavelengths of 3:2. The pulse duration was set as 20 nanoseconds, the repetition rate 16.6 kHz, the exposure time 200 ms, the light spot diameter of 1 mm. The CVL treatment resulted in the complete disappearance of the SN without remote side effects such as hyperpigmentation, scarring, or recurrences 24 months after the treatment. The patient was satisfied with the excellent cosmetic results.
Conclusion: The CVL treatment of the SN provides the most relevant result due to the complete elimination of SN cells and the remodeling of the vascular bed supplying the involved areas.