Journal of Lasers in Medical Sciences

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.

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.

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

Introduction: 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: 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.

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.

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.

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.

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.

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.

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

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

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.

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.