Device-based physical therapies in chronic pruritus: A narrative review.

Chronic pruritus is a highly prevalent disease associated with high psychosocial and economic burdens. In addition to pharmacological treatments, device-based physical therapies also offer antipruritic effects. Phototherapy, laser, electrical neurostimulation technologies, acupuncture, cryotherapy, and cold atmospheric plasma are, in part, still experimental but emerging treatment options that augment our repertoire to treat patients with chronic pruritus. In this narrative review, we provided an overview of these physical modalities and their role in itch management.

Detection sensitivity of fluorescence lifetime imaging ophthalmoscopy for laser-induced selective damage of retinal pigment epithelium.

PURPOSE: To investigate the sensitivity of fluorescence lifetime imaging ophthalmoscopy (FLIO) to detect retinal laser spots by comparative analysis with other imaging modalities. METHODS: A diode laser with a wavelength of 514 nm was applied with pulse durations of 5.2, 12, 20, and 50 µs. The laser pulse energy was increased so that the visibility of the laser spot by slit-lamp fundus examination (SL) under the irradiator's observation covers from the subvisible to visible range immediately after irradiation. The irradiated areas were then examined by fundus color photography (FC), optical coherence tomography (OCT), fundus autofluorescence (AF), FLIO, and fluorescein angiography (FA). The visibility of a total of over 2200 laser spots was evaluated by two independent researchers, and effective dose (ED) 50 laser pulse energy values were calculated for each imaging modality and compared. RESULTS: Among examined modalities, FA showed the lowest mean of ED50 energy value and SL the highest, that is, they had the highest and lowest sensitivity to detect retinal pigment epithalium (RPE)-selective laser spots, respectively. FLIO also detected spots significantly more sensitively than SL at most laser pulse durations and was not significantly inferior to FA. AF was also often more sensitive than SL, but the difference was slightly less significant than FLIO. CONCLUSION: Considering its high sensitivity in detecting laser spots and previously reported potential of indicating local wound healing and metabolic changes around laser spots, FLIO may be useful as a non-invasive monitoring tool during and after minimally invasive retinal laser treatment.

Case report: Topical pilocarpine ameliorated the accommodation loss and pupillary dilation after micropulse transscleral laser treatment.

BACKGROUND: The present study elucidates a common significant postoperative complication of micropulse transscleral laser treatment (mTLT) and explores its potential management strategies for younger patients with good central vision. CASE PRESENTATION: Three younger Chinese glaucoma patients with good central vision maintained high intraocular pressures (IOPs) (36, 25, and 30 mmHg) on maximally tolerated topical anti-glaucoma medications. All patients were treated with mTLT because of a higher risk of complications with filtering surgery. After the procedure, their best-corrected visual acuities were not significantly changed, IOPs were significantly decreased, and the number of topical anti-glaucoma medicines was gradually decreased. However, all patients complained about reduced near visual acuity (NVA) for 1-5 months. Slit-lamp examination revealed pupillary dilation, and binocular accommodative function examination indicated accommodation loss. After treatment with 2% topical pilocarpine, all patients reported an improvement in NVA. Among them, we could observe pupillary constriction, recovery of accommodation function, and improved NVA, even discontinuation of pilocarpine in Patient 2. CONCLUSION: In younger patients with good central vision, topical pilocarpine might ameliorate accommodation loss and pupillary dilation after mTLT.

Hybrid fractional laser facial resurfacing: A comparison between a single treatment at high settings versus multiple treatments at low to moderate settings.

OBJECTIVES: Fractional laser treatments for facial skin rejuvenation is an evolving field with the increase of innovative technologies. Typically, better results are achieved by using more aggressive approaches although this is accompanied by an increased risk. The demand for a modality that combines efficacy with minimal downtime and risk of adverse events led to the development of a hybrid laser, which delivers a fractional treatment of ablative CO2 and nonablative 1570 nm lasers, simultaneously. This study compares the clinical results, side effects, and downtime profile of the hybrid laser in multiple low-to-moderate-setting treatments versus a single high-setting treatment in the facial area. MATERIALS AND METHODS: This retrospective single-center study included 44 patients who underwent 1-3 treatments with the hybrid laser for facial rejuvenation between the years 2020-2022. The patients were divided into two groups based on the number of treatments they had received (Group A; single high-setting treatment, Group B; 2-3 low-to-moderate setting treatments). Three independent nontreating physicians evaluated the objective improvement by assessing the patients' standardized clinical photographs before and after the treatments, using three different scales. Treatment data, adverse events, and patients' satisfaction in each group were also reviewed. RESULTS: A superiority to 2-3 low-to-moderate setting treatments (Group B) was found in most of the evaluated scales. Patients' satisfaction was significantly higher in Group B, and the average downtime was significantly lower: 4.3 ± 1.6 days versus 7.3 ± 2.3 days in Group A. The expected treatment effects were significantly milder in severity in Group B as graded by the patients, and no adverse events were reported in this group. An average overall improvement of 51%-75% according to Global Esthetic Improvement Scale (GAIS) was found in both groups. CONCLUSIONS: The new hybrid laser generates remarkable clinical outcomes in facial rejuvenation. Performing several treatments at mild to moderate settings can lead to a safer and more favorable procedure while maintaining high efficacy and achieving higher patients' satisfaction.

Fractional ablative CO2 laser and oral isotretinoin-A prospective randomized controlled split-face trial comparing concurrent versus delayed laser treatment for acne scars.

BACKGROUND: Therapeutic dogma has been to treat acne scars with ablative fractional laser no less than 6 months after isotretinoin (ITN) cessation. OBJECTIVE: To evaluate the safety and efficacy of fractional ablative CO2 laser (FACL) in patients treated concurrently with ITN. METHODS: We conducted a prospective split-face randomized control trial in patients treated with FACL concurrently with ITN versus patients treated with FACL 6 months post-ITN treatment. Patients received 3 monthly sessions of FACL with concurrent ITN treatment on half of the face; the other side of the face received the same FACL treatment regimen 6 months post-ITN cessation. Patients were followed for adverse effects up to 6 months post-FACL treatment. Final cosmesis was scored using the Quantitative Global Acne Scarring Grading System (GASGS) by three independent dermatologists. RESULTS: The GASGS of the concurrent ITN-FACL treated side of the face was significantly lower than the side treated with delayed laser therapy (4.7 ± 2.5 vs. 7.7 ± 2.9, respectively, p < 0.001). LIMITATIONS: The laser's settings were standardized, and not adjusted per patient skin type. CONCLUSION: Per our prospective trial, concurrent treatment of FACL -ITN is superior to delayed FACL treatment 6 months post-ITN cessation. Fractional ablative laser treatment is effective in improving acne scars, which persist despite isotretinoin therapy.

Modeling pulsed dye laser treatment of psoriatic plaques by combining numerical methods and image-derived lesion morphologies.

OBJECTIVES: Knowledge of the physical effects of pulsed dye laser (PDL) treatment of psoriatic lesions is essential in unraveling the remedial mechanisms of this treatment and hence also in maximizing in its disease-modifying potential. Therefore, the main objective of this study was to provide estimates of these physical effects (for laser wavelengths of 585 and 595 nm), with the aim of identifying pathogenic processes that may be affected by these conditions. METHODS: We modeled the laser light propagation and subsequent photothermal heating by numerically solving the transient diffusion and heat equations simultaneously. To this end, we used the finite element method in conjunction with an image-derived psoriatic lesion morphology (which was defined by segmenting blood vessels from a confocal microscopy image of a fluorescently labeled section of a 3 mm punch biopsy of a psoriatic lesion). The resulting predictions of the generated temperature field within the lesion were then used to assess the possibility of stalling or arresting some suspected pathogenic processes. RESULTS: According to our results, it is conceivable that perivascular nerves are thermally denatured, as almost all locations that reach 60°C were found to be within 18 µm (at 585 nm) and 11 µm (at 595 nm) of a blood vessel wall. Furthermore, activation of TRPV1 and TRPV2 channels in perivascular neuronal and immune cells is highly likely, since a critical temperature of 43°C is generated at locations within up to 350 µm of a vessel wall (at both wavelengths) and sustained for up to 700 ms (at 585 nm) and 40 ms (at 595 nm), while a critical temperature of 52°C is reached by locations within 80 µm (at 585 nm) and 30 µm (at 595 nm) of a vessel wall and sustained for up to 100 ms (at 585 nm) and 30 ms (at 595 nm). Finally, we found that the blood vessel coagulation-inducing temperature of 70°C is sustained in the vascular epithelium for up to 19 and 5 ms at 585 and 595 nm, respectively, rendering partial or total loss of vascular functionality a distinct possibility. CONCLUSIONS: The presented approach constitutes a useful tool to provide realistic estimates of the photothermal effects of PDL treatment of psoriatic plaques (as well as other selective photothermolysis-based treatments), yielding information that is essential in guiding future experimental studies toward unraveling the remedial mechanisms of these treatments.

Fetoscopic laser coagulation for twin-to-twin transfusion syndrome: a comparison of flexible 1.0/1.2 mm fetoscopes with curved sheaths of 2.7/3.3 mm2 vs. 2 mm fetoscopic lens technique with sheaths of 6.6/11.3 mm2.

OBJECTIVES: Fetoscopic laser coagulation of placental anastomoses is usually performed for a treatment of twin-to-twin transfusion syndrome (TTTS). A common complication of fetoscopic laser coagulation for TTTS is preterm preliminary rupture of fetal membranes (PPROM) aggravating the neonatal outcome significantly. However, use of an flexible 1 mm fetoscope with an curved sheath could reduce iatrogenic damage of the amniotic membrane and improve neonatal outcomes after laser treatment. The aim of this study was to compare neonatal outcomes using this flexible fetoscope with curved sheath vs. use of a standard lens technique. METHODS: Outcomes were retrospective analyzed after use of a standard lens fetoscope of 2 mm (sheath 6.63 mm2 or 11.27 mm2 for anterior placenta) and a flexible fetoscope of 1 mm or 1.2 mm (sheath 2.65 mm2 or 3.34 mm2) in two German centers of fetal surgery, performed during 2006-2019. RESULTS: Neonatal outcome of 247 TTTS patients were analyzed including the rates of double and single fetal survival. The survival of at least one fetus was 97.2 % in the group with the ultrathin technique (n=154) compared to 88.3 % (n=93) in the group with the standard lens fetoscope (p=0.008). Survival of both fetuses was not different between groups (81.0 vs. 75.3 %). The procedure to delivery interval was significantly increased using the ultrathin fetoscope (89.1±35.0 d vs. 71.4±35.4 d, p=0.001) resulting in an increased gestational age at delivery by 11 days on average (231.9±28.1 d vs. 221.1±32.7 d, p=0.012). CONCLUSIONS: Fetal survival can be significantly increased following TTTS using flexible fetoscope of 1 mm or 1.2 mm (sheath 2.65 mm2 or 3.34 mm2).

In vitro studies the influence of Nd: YAG laser on dental enamels.

The present work aimed at assessing chemical, topographical, and morphological changes induced by Nd : YAG laser treatment of dental enamels by means of energy dispersive X-ray spectroscopy (EDS), atomic force microscopy (AFM), and scanning electron microscopy (SEM). Fifteen human enamel specimens were obtained, three of samples were kept untreated as a control while the others twelve samples were equally divided into four groups where each group have a three samples according to treating approach as: G1:(untreated);G2: (treated with Nd:YAG laser, 100 mJ/pulse,10 Hz/1064nm); G3(treated with Nd:YAG laser, 500 mJ/pulse, 10 Hz/1064nm); G4(treated with Nd:YAG laser 1000 mJ/pulse, 10 Hz/1064nm), and finally G5(treated with Nd:YAG laser, 1000 mJ/pulse, 10 Hz/532nm) respectively. Beside many craters and cracks, the AFM results showed fractures with depths of 19.23 nm, 174.7 nm, 216.9 nm, 207.4 nm and 156.5 nm and width of 559.2 nm, 833.4 nm, 1115 nm, 695.0 nm, and 5142 nm for all Groups respectively. The highest surface roughness was found in G5 with 111.4 nm while the lowest surface roughness was found in G1 to be 14.3 nm. The inside surface of the fissures was also rough. The SEM micrographs revealed modifications to the morphology. EDS was used to measure the phosphorous (P), calcium (Ca), oxygen (O), and carbon (C) percentages presented in crater areas and their surroundings, Ca, P, O, and C levels were observed to vary significantly at the crater and its rim, a lower percentage of C wt% were realized corresponding to laser treatment of 1000 mJ/Pulse laser energy. However, it was not feasible to recognize a specific chemical arrangement in the craters. It is also concluded that the higher depth and particular edge of ablated part when teeth were irradiated by laser with 1000 mJ/10Hz/1064nm.

1726 nm Lasers for the Treatment of Acne Vulgaris.

The treatment of acne vulgaris traditionally consists of a combination of topical and oral medications. The use of lasers to treat this condition has been an area of increasing research, and several types have previously been used in the treatment of acne. New 1726 nm lasers specifically target the sebaceous gland, which is known to be pivotal in acne pathophysiology. This laser wavelength demonstrates substantial potential as a safe and effective therapeutic option for moderate to severe acne without the risks of systemic therapy. This paper reviews the 1726 nm lasers for acne vulgaris.

Keloid and Hypertrophic Scars Treatment.

BACKGROUND: Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen. OBJECTIVE: To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device. METHODS: Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3-1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded. RESULTS: A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics. CONCLUSIONS: The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Uveoscleral Outflow Routes after MicroPulse Laser Therapy for Refractory Glaucoma: An Optical Coherence Tomography Study of the Sclera.

To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MP-TLT) in refractory glaucoma using anterior segment-optical coherence tomography (AS-OCT). Forty-two candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baseline and after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction by one-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-) intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR; arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP was the secondary outcome. The relations between the baseline-to-six months differences (D) of DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At 6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baseline S-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR were higher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50% increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes (p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, and DT-SR, there were no significant differences between the groups. In the successful procedures, DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05). MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Given the partial correlation between these modifications and post-treatment IOP reduction, our study confirmed that the activation of the uveoscleral AH outflow route could significantly contribute to the IOP lowering after MP-TLT.

[The impact of laser radiation on the effectiveness of therapeutic treatment of dental patients]. / Vliyanie lazernogo izlucheniya na effektivnost' terapevticheskogo lecheniya stomatologicheskikh bol'nykh.

The paper presents an overview of modern scientific data on the study of the effect of laser radiation on biological tissues of the mouth in the therapeutic treatment of dental diseases. The use of lasers in the treatment of dental caries and its complications, non-carious lesions of hard dental tissues, as well as the use of lasers in the treatment of periodontal diseases and aesthetic restoration of teeth is considered.

A highly sensitive and long-term stable wearable patch for continuous analysis of biomarkers in sweat.

Although increasing efforts have been devoted to the development of non-invasive wearable or stretchable electrochemical sweat sensors for monitoring physiological and metabolic information, most of them still suffer from poor stability and specificity over time and fluctuating temperatures. This study reports the design and fabrication of a long-term stable and highly sensitive flexible electrochemical sensor based on nanocomposite-modified porous graphene by simple and facile laser treatment for detecting biomarkers such as glucose in sweat. The laser-reduced and patterned stable conductive nanocomposite on the porous graphene electrode provides the resulting glucose sensor with an excellent sensitivity of 1317.69 µAmM-1cm-2 with an ultra-low limit of detection (LOD) of 0.079 µM. The sensor can also detect pH and exhibit extraordinary stability to maintain more than 91% sensitivity over 21 days in ambient conditions. Taken together with a temperature sensor based on the same material system, the dual glucose and pH sensor integrated with a flexible microfluidic sweat sampling network further results in accurate continuous on-body glucose detection calibrated by the simultaneously measured pH and temperature. The low-cost, highly sensitive, and long-term stable platform could facilitate and pave the way for the early identification and continuous monitoring of different biomarkers for non-invasive disease diagnosis and treatment evaluation.

The efficacy and safety of micropulse transscleral laser treatment in glaucoma: a systematic review and meta-analysis.

OBJECTIVE: Micropulse transscleral laser treatment (mTLT) is the latest alternative intraocular pressure (IOP) lowering approach for glaucoma patients. This meta-analysis aims to evaluate the efficacy and safety of mTLT and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) for the treatment of glaucoma. METHODS: We searched the PubMed, Embase, and Cochrane Library of Systematic Reviews databases from January 2000 to July 2022 to identify studies that, evaluated the efficacy and safety of mTLT in glaucoma. There were no restrictions regarding study type, patient age, or type of glaucoma. We analysed the reduction in IOP and the number of anti-glaucoma medications (NOAM), retreatment rates, and complications between mTLT and CW-TSCPC treatment. Publication bias was conducted for evaluating bias. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2020) reporting guideline. RESULTS: We identified 6 eligible studies of which only 2 RCTs and 386 participants with various types of glaucoma at different stages were ultimately included. The results revealed significant IOP decreases after mTLT up to 12 months and significant NOAM reductions at 1 month (WMD=-0.30, 95% CI -0.54 to 0.06), and 3 months (WMD=-0.39, 95% CI -0.64 to 0.14) in mTLT compared to CW-TSCPC. Moreover, the retreatment rates (Log OR=-1.00, 95% CI -1.71 to -0.28), hypotony (Log OR=-1.21, 95% CI -2.26 to -0.16), prolonged inflammation or uveitis (Log OR=-1.63, 95% CI -2.85 to -0.41), and worsening of visual acuity (Log OR=-1.13, 95% CI -2.19 to 0.06) occurred less frequently after mTLT. CONCLUSION: Our results demonstrated that mTLT could lower the IOP until 12 months after treatment. mTLT seems to have a lower risk of retreatment after the first procedure, and mTLT is superior to CW-TSCPC with respect to safety. Studies with longer follow-up durations and larger sample sizes are necessary in the future. TRIAL REGISTRATION NUMBER: INPLASY202290120.

Efficacy evaluation of endolift laser for treatment of nasolabial folds and marionette lines.

BACKGROUND: The nasolabial folds are the most marked sign of aging. Endolift laser was used for the treatment of nasolabial folds and marionette lines (one of the facial danger zones). METHODS: Ten female subjects were engaged in this study. Patients underwent Endolift laser for nasolabial folds and marionette lines treatment. The efficacy of the Endolift technique on the nasolabial folds and marionette lines was evaluated by biometric assessment with Cutometer, Visioface, and the Skin Ultrasound Imaging system. Also, patient's satisfaction and blinded dermatologists' assessment were assessed. RESULTS: The Visoface results displayed that the Endolift laser treatment significantly declined the depth and area of the nasolabial wrinkles. The skin ultrasonography results reported that the epidermis and dermis density and thickness were significantly increased. Also, the cutometer outcomes showed that the Endolift laser treatment can increase skin elasticity. The results showed that a large number of patients were very satisfied with the technique. CONCLUSION: In conclusion, Endolift laser has an effective technique for decreasing the nasolabial folds, marionette lines, and improve the appearance of the face without any sever side effect. This technique does not need general anesthesia and recovery time.

Endovascular laser treatment. Comparison of lasers and fibers of different generations: study of temperatures and tissue damage produced on a porcine liver model.

The current international guidelines identify tumescent ablative techniques such as laser thermal ablation (EVLA) and radiofrequency (RFA) to be the gold standard in varicose vein surgery. New-generation lasers have been introduced, which have high wavelengths (1940 and 2000 nm) and therefore with a greater affinity for water than the old generation (980- and 1470-nm lasers). The purpose of the study was to evaluate the biological effect and the temperatures produced during the use of lasers with different wavelengths (980, 1470, and 1940 nm) and with optical fibers with different emission (radial diverging at 60° and radial with cylindrical mono-ring) on in vitro model. Porcine liver was used as an in vitro model. The laser control units used had 3 different wavelengths: 980, 1470, and 1940 nm. The optical fibers used were 2: the Corona 360 fiber (mono-ring radial fiber) and the infinite fiber (cylindrical mono-ring fiber). The laser operating parameters used included the delivery of 6 W in continuous wave (CW) mode with a standard 10 s/cm pull-back. Eleven measurements were made for each fiber and for each laser, for a total of 66 measurements. We performed measurements of the maximum transverse diameter produced with laser irradiation to evaluate the biological effectiveness of the treatment. During laser irradiation, we performed measurements of both of the temperatures reached on the external surface of the porcine tissue, near the tip of the laser catheter, and the temperatures reached inside the irradiated tissue by using a digital laser infrared thermometer with apposite probe. The calculation of the statistical significance (p-value) was obtained with the ANOVA method with two between factors. The comparison study of the maximum transverse diameter (DTM) of the lesion produced on the target tissue demonstrated the absence of statistically significant differences between the 1470-nm laser and the 1940-nm laser regardless of the type of fiber used. It was not possible to perform measurements of the maximum transverse diameter produced with the 980-nm laser as this produced no visible effect on the model. The comparison study of the temperatures developed during and immediately after the treatment instead showed higher maximum surface temperatures (TSM) and a higher thermal increase (IT) regardless of the type of fiber used in a statistically significant way (respectively, p 0.002 and 0.012) when using the 980-nm laser versus the 1940-nm laser. Comparing instead the 980-nm laser with 1470 nm, there were no differences in TI recorded during the procedure but a significantly higher VTI (p 0.029). The experiment conducted with the new generation laser, compared with those of the first and second generation, shows how this works overall at lower temperatures with the same effectiveness.

Effects of Er: YAG, Er,Cr: YSGG, and Nd: YAG laser irradiation and adhesive systems on the immediate and long-term bond strength of dentin: a systematic review and meta-analysis.

At present, lasers are increasingly used in the oral clinical field, and research and applications in dental hard tissue treatment are also increasing. The effect of laser etching dentin on the bonding strength of composite resin reported in the literature is still inconclusive. The purpose of this review was to evaluate whether laser etching can improve the immediate and long-term bonding strength of dentin and investigate the effect of different types of adhesives on the bonding strength of dentin. Two reviewers performed a literature search up from January 2012 to November 2021 in four databases: MEDLINE (PubMed), Web of Science, EMBASE, and the Cochrane Library. A total of 25 studies were included in the meta-analysis. The Cochrane Collaboration Bias Risk Assessment tool was used to evaluate the quality of the included literature, and an analysis was carried out using Review Manager Software version 5.3. The aging bond strength of dentin after erbium (Er): yttrium aluminum garnet (YAG) laser treatment was significantly lower than that of dentin in the bur group (P < 0.00001). At the same time, the bond strength of dentin immediately and aging after (Er), chromium-doped (Cr): yttrium scandium gallium garnet (YSGG) laser treatment was lower than that of dentin in the bur group (P < 0.05). There was no significant difference in the immediate and aging bonding strength among samples in the Er: YAG laser, Er, Cr: YSGG laser, and blank control groups (no laser or bur). The aging bond strength of samples after neodymium-doped (Nd): YAG laser treatment was higher than that of samples in the blank control group (P < 0.05); in addition, the performance of self-etching adhesive was slightly better than that of acid etching adhesive. Regardless of the applied surface treatment and the adhesive employed, dentin after aging showed significant bond degradation (P < 0.05). There was high heterogeneity of bond strength between different groups, and the small number of studies and the contradictory results may be the main reasons for this outcome.

Functional outcomes after transoral CO2 laser treatment for posterior glottic stenosis: a bicentric case series.

PURPOSE: The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I-IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers. METHODS: An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires. RESULTS: Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy. CONCLUSION: In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.

Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes.

PURPOSE: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study.

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.