In vitro study of the effects of diode laser on dentin hypersensitivity and evaluation of intra-pulpal temperature variation.

To evaluate the efficacy and safety of different wavelengths of high-power diode lasers for the treatment of dentin hypersensitivity by analyzing morphological changes and temperature variation. Human third molars were irradiated with five different commercially available lasers at wavelengths of 808 nm, 940 nm, 976 nm, and 980 nm, both with and without the use of a photoinitiator (activated charcoal). Temperature variations were monitored using thermocouples, and morphological changes were assessed through scanning electron microscopy. Lasers with wavelengths of 940 nm, 976 nm, and 980 nm, used without a photoinitiator, promoted dentinal tubule obliteration without causing thermal damage. Lasers with wavelengths of 808 nm, 940 nm, 976 nm, and 980 nm, when combined with a photoinitiator, resulted in even lower temperature variation compared to the non-photoinitiator groups, although no regular fused surface was observed. Diode laser parameters, except Group 1(808 nm without photoinitiator), are potentially safe for dentinal tubule obliteration. The use of a photoinitiator continues to be an effective strategy for minimizing temperature variations during irradiation.

Photobiomodulation of gut microbiota with low-level laser therapy: a light for treating neuroinflammation.

The gut microbiota is known to interact with various organs in the body, including the central nervous system, through the gut-brain axis. Intestinal dysbiosis can lead to increased peripheral inflammation and, consequently, affect the brain, resulting in neuroinflammation. Photobiomodulation (PBM) has demonstrated positive regulatory effects on the imbalance of certain body functions, including pain, inflammation, immunity, wound healing, and gut microbiota dysbiosis. Therefore, PBM at the intestinal level could help improve intestinal dysbiosis and reestablish cerebral homeostasis. In this context, this study aimed to conduct a narrative review of the literature on the effects of PBM at the intestinal level on intestinal dysbiosis and neuroinflammation. Overall, the findings highlight that PBM modulates the gut microbiota, suggesting it could serve as a therapy for neurological conditions affecting the gut-brain axis. Future research should focus on further elucidating the molecular mechanisms underlying this therapy.

Effect of selective caries removal and photobiomodulation on postoperative sensitivity in deep cavities: randomized clinical trial.

This randomized clinical trial aimed to evaluate the effect of selective caries removal in deep Class I cavities in posterior teeth followed or not by photobiomodulation (PBM) therapy at two different wavelengths on postoperative sensitivity. Baseline spontaneous and stimulated sensitivity scores of 33 vital permanent molars were determined by the participants using a numeric rating scale. The teeth had their affected dentine preserved and were randomly allocated into three groups (n = 11): selective removal of infected dentine (control), selective removal of infected dentine followed by infrared (IR; 810 nm) or red (R; 660 nm) laser irradiation. The teeth were restored with a two-step self-etch adhesive and nanoparticle composite layers, and followed by laser irradiation only for IR and R groups. Both spontaneous and stimulated sensitivity were recorded after 12 h, 7 days, and 14 days. Data were statistically analyzed by Kruskal-Wallis, Friedman, and Wilcoxon tests (p < 0.05). The pulp of all teeth positively responded to cold a stimulus. The control group presented a significant increase in spontaneous sensitivity at 12 h (p < 0.05), which decreased to the preoperative level after 14 days. In both IR and R groups, the sensitivity levels remained stable over time (p > 0.05). At both 7- and 14-day follow-ups, the spontaneous sensitivity for the IR group was significantly lower than the other groups (p < 0.05). In addition to preserving tooth sensitivity, selective deep caries removal can be associated with R or IR to respectively attenuate or completely resolve postoperative sensitivity within one week.

Effect of photobiomodulation on dentin hypersensitivity: a randomized controlled double-blind clinical trial.

OBJECTIVES: To investigate if photobiomodulation (PBM) can reduce dentin hypersensitivity (DH) through a randomized, controlled, double-blind clinical trial. MATERIALS AND METHODS: One hundred and twelve patients experiencing DH after non-surgical scaling and root planing (SRP) were enrolled and divided into the Experimental Group - SRP + PBM (660 nm, 1.061 J/cm²) and the Control Group - SRP + PBM simulation. The primary outcome was the assessment of DH through tactile and thermal stimulation using the visual analog scale (VAS) after seven days. Additionally, paracetamol was prescribed and quantified as needed. Also, the impact of oral health on participants' quality of life using the Oral Health Impact Profile (OHIP-14) questionnaire was applied. Outcome assessments occurred seven days and one-month post-application. RESULTS: In both 7 and 30 days, pain values were significantly lower in the experimental group compared to the control group (P = 0.001 and < 0.001, respectively). No differences were observed between the groups regarding analgesic usage. The experimental group also showed a significant improvement in the impact of oral health on participants' quality of life (P < 0.001), with lower OHIP-14 scores at all time points (P = 0.008). CONCLUSIONS: These results suggest that photobiomodulation significantly reduces pain at 7- and 30-days following scaling and root planing. Additionally, it is associated with improvements in the oral health-related quality of life in patients with dentin hypersensitivity. CLINICAL TRIAL REGISTRATION: NCT05946265.

Intradermal Incobotulinum Toxin A for Postbreast Cancer Treatment Asymmetry: A Literature Review and Case Report.

BACKGROUND: Botulinum toxin (BTX) is globally the most common aesthetic procedure. Its usage has expanded beyond facial treatments to therapeutic areas, including managing scars and postsurgical deformities. Breast cancer survivors often face significant deformities and asymmetry during recovery. OBJECTIVES: This study systematically reviewed literature from the past 4 years on botulinum toxin applications in breast cancer survivors and presented a case report of a patient treated with Incobotulinum toxin (IncoBonTA; Xeomin, Merz Pharmaceuticals GmbH, Frankfurt, Germany) for left breast deformity postchemotherapy and radiotherapy. METHODS: Following PRISMA guidelines, a systematic search was conducted on PubMed and Scopus using keywords: "botulinum toxin," "breast cancer," and "breast asymmetry," identifying relevant literature from 2020 to 2024. Five full-text articles were included. Additionally, a 2024 case report of a patient with significant breast asymmetry postsurgery and radiotherapy was published. RESULTS: The literature review indicated botulinum toxin's primary uses in breast cancer include pain management, upper limb impairment, postsurgical scars, and capsular contracture. Although some benefits were reported, further research is needed. In the case report, the patient was treated in one session with IncoBonTA at two different dilutions based on contracture severity without complications. CONCLUSION: The review showed promising advances in using botulinum toxin for deformities secondary to oncological treatment in breast cancer patients. The therapy was administered to a 53-year-old patient, resulting in significant aesthetic improvement, especially at the nipple and areola, suggesting that it was a viable option for these patients.

Blue light-emitting diode therapy for recurrent vulvovaginal candidiasis: a Brazilian report.

PURPOSE: RVVC is defined as four or more episodes of candidiasis in a 12-month period. Conventional treatment is complex and often involves long-term medication use or multiple treatments. ABL therapy is a promising treatment option as it is acceptable to women and has only rare side effects. We conducted a prospective study with the objective of assessing the effects of antimicrobial blue light (ABL) therapy for recurrent vulvovaginal candidiasis (RVVC) in drug-resistant women. METHODS: Our study enrolled RVVC drug-resistant women (defined based on clinical non-response to standard azole therapies confirmed through culture or persistence of VVC symptoms (oedema, erythema, pruritus, burning, dysuria and leucorrhea)), who received ABL through 10 sessions for 20 min once a week from January 2023 to January 2024. The symptoms of Recurent VVC were assessed after 10 treatment sections and after 6 months. RESULTS: We included 62 patients. The overall symptoms improvement were 79% immediately after treatment and 58% after 6 months, respectively. There was an improvement in the symptoms of pruritus, burning, oedema, erythema and leucorrhoea. CONCLUSION: ABL was an effective therapy to be employed in drug-resistant women suffering from RVVC.

Endolift® is a non-surgical treatment for skin tissue conditions. Is there evidence for its application?

The Endolift® technique, introduced in 2005, gained popularity among medical and non-medical professionals as a non-surgical approach using subdermal laser devices. However, its widespread adoption lacked a thorough understanding of its physiological interaction, resulting in controversies over its effectiveness and safety. This study aimed to assess the evidence of Endolift® efficacy, parametrization, and safety by analyzing adverse events. A systematic literature review was conducted by searching the following databases: NCBI/PubMed, Medline, Embase, CINAHL, and the Cochrane Central Library. These searches resulted in 111 articles. Seven articles were selected after removing duplicates and screening titles, abstracts, and full texts. These articles exhibited a high risk of bias, a lack of standardization in treatment parameters, and reports of adverse events that did not align with clinical reality, often occurring with off-label use.In conclusion, due to insufficient high-quality research and inconsistent indications and parameter adjustments, asserting the efficacy and safety of Endolift® is challenging. Randomized studies are recommended to curb indiscriminate use, which may compromise patient safety. This analysis underscores the importance of evidence-based clinical practices for patient safety and ethical treatment.

Photobiomodulation in carpal tunnel syndrome with pain, strength, and functionality analysis: a systematic review and meta-analysis.

BACKGROUND: Carpal tunnel syndrome (CTS) is characterized as a compressive neuropathy of the median nerve and has several treatments, including photobiomodulation, which can be performed with low-intensity laser therapy (LLLT) and light-emitting diodes (LEDs). PURPOSE: To carry out a literature review on the effectiveness of low-intensity laser therapy (LLLT) in CTS. METHODS: This study is characterized by being a systematic review with metaanalysis. The databases included were PubMed, Embase, Cochrane, the Physiotherapy Evidence Database (PEDro), Scopus and LILACS. Also, gray literature: Google Scholar, OpenGrey and CAPES Theses and Dissertations Catalog. The search was carried out in all databases on October 11, 2023 and updated on June 06, 2024. The risk of bias was assessed using the Cochrane tool, RoB 2, by two blinded reviewers and conflicts were resolved by consensus. The outcomes of interest were pain intensity (Visual analogue scale), strength (handgrip and pinch) and hand functionality (Boston questionnaire, Levine questionnaire, Purdue Pergboard Test). Statistical analysis was carried out using RevMan 5.4.1. Continuous results were expressed as standard mean differences (95% CI), with p-value of < 0.05 considered statistically significant. The value of the I2 statistical test was calculated to test for heterogeneity between studies. A random effects model was adopted. RESULTS: 13 randomized controlled trials were selected from 1.613 records. In the general bias analysis, two studies (15,4%) were considered to have some relevant problems that could interfere with the quality of the study, and three (23,1%) were identified as having a high risk of bias, eight studies (61,5%) were classified as having a low risk of bias. In the meta-analysis, it was possible to observe that there were no advantages of the laser for pain (p = 0.08), nor for handgrip strength (p = 0.11), but it did produce improvements in functionality. CONCLUSION: It is concluded that LLLT is an effective therapeutic modality in the treatment of CTS, improving functionality; however, despite the studies pointing to advantages for the modality in reducing pain and improving grip strength, the meta-analysis did not show this result. Even so, there is a need for more clinical trials are needed to standardize dosimetry, mainly because the primary studies showed clinical advantages of PBM. REGISTRATION: Open Science Framework (OSF)- https://doi.org/10.17605/OSF.IO/HQCRP .

Effects of photobiomodulation in mitochondrial quantity, biogenesis and mitophagy-associated genes in breast cancer cells.

In this article, we aim to evaluate the effects of photobiomodulation on mitochondria quantity, biogenesis, and mitophagy-associated genes in breast cancer (BC) cells. Both models were irradiated with a low-power infrared laser (880 nm, 150 mW) and amber LED (617 nm, 1500 mW), alone or simultaneously. We evaluated the mRNA expression of PINK1 and PGC-1α genes, and the mitochondrial number was assessed based on the ratio of mitochondrial DNA/genomic DNA (mtDNA/gDNA). No significant difference was observed in the mtDNA/gDNA ratio comparing the low-power infrared laser (LPIL) and LED-irradiated groups to their control counterparts. Similarly, no difference was observed in the mRNA levels of PINK1 and PGC-1α of the irradiated group with an LPIL and LED alone or in combination. In conclusion, PBM with LPIL and LED did not alter the mtDNA/gDNA ratio nor modulate the mRNA levels of the genes related to mitophagy and biogenesis in BC cells.

Influence of an aquatic resistance progressive exercise and low-level laser therapy on musculoskeletal atrophy: an experimental model of knee osteoarthritis.

The aim of this study was to evaluate the effectiveness of an aquatic progressive resistance exercise (APRE) and PBM (associated or not) on morphology of skeletal muscle and biochemical markers using an experimental model of knee osteoarthritis (OA). Fifty male Wistar rats were randomly distributed into 5 groups: control group (CG); OA control (OAC); OA submitted to APRE (OAE); OA submitted to PBM (OAL); OA submitted to APRE and PBM (OAEL). Trained rats performed a water-jumping program carrying a load equivalent to 50-80% of their body mass strapped to their chest. Laser irradiation (808 nm) was performed on 2 points of the knee joint. Treatments (3 days a week, for 8 weeks) started 4 weeks after the OA induction. The results showed that all OA groups presented a significantly increase in the muscle cross-section area (CSA) and a decrease in muscle fiber density compared to CG. Moreover, both trained groups presented a reduced expression of atrogin and an intense myoD immunoexpression in the laser exercised animals. The results demonstrate that APRE was effective in reducing muscle atrophy markers and its association with PBM could be effective in modulating molecules involved in muscle recovery in knee OA.

Effect of photobiomodulation as preventive treatment of diabetic foot ulcer: randomised, controlled, double-blind, clinical trial protocol.

INTRODUCTION: The prevention of diabetic foot ulcer (DFU) involves the classification of risk, systemic care, regular examinations, foot care, therapeutic education and adjunct treatments. Photobiomodulation (PBM) has been successfully administered for the healing of DFU and its preventive effects have drawn the interest of researchers. METHODS AND ANALYSIS: The purpose of the study is to assess the effect of PBM for the prevention of DFU through a randomised, controlled, double-blind, clinical trial. Individuals from 18 to 75 years of age of both sexes with type 2 diabetes mellitus (DM) at moderate to high risk of developing DFU will be randomly allocated to two groups of 32 participants each. The PBM group will wear a boot with 1344 light-emitting diodes (LEDs)-504 with a wavelength of 660 nm located on the sides of the boot (28.5 mW, 10 J per LED), 504 with a wavelength of 850 nm also on the sides of the boot (23 mW, 8 J per LED), 168 with a wavelength of 660 nm on the base of the boot (28.5 mW, 10 J per LED) and 168 with a wavelength of 850 nm also on the base of the boot (23 mW, 8 J per LED). The boot will be worn once a day for 6 min over 60 days and the participants will also receive therapeutic education. The control group will wear a non-therapeutic LED boot (sham) under the same conditions and will also receive therapeutic education. Assessments will be performed at the beginning of the study, after 30 days (clinical examination) and after 60 days (clinical examination, assessment of peripheral neuropathy (PN) and peripheral artery disease (PAD), blood and urine examinations and quality of life). ETHICS AND DISSEMINATION: This protocol received approval from the Human Research Ethics Committee of Nove de Julho University and the Mandaqui Hospital Complex (certificate number: 66098522.0.3001.5511; final approval date: 22 June 2023). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT06353568, ClinicalTrials.gov.

Current availability of radiotherapy devices in Peru and artificial intelligence-based analysis for constructing a nationwide implementation plan.

PURPOSE: We provide for the first time a comprehensive situational diagnosis and propose an artificial intelligence (AI)-assisted nationwide plan of implementation, attending the most urgent needs. METHODS: Baseline information was collected from open-source databases of the Peruvian Government. Data on cancer incidence from the Health Authorities and GLOBOCAN were collected and compared. The existing external-beam radiotherapy (EBRT) devices and brachytherapy (BT) units were identified and information on their obsolescence was additionally collected. The ten most common cancer entities with RT indication were considered for the analysis. Utilizing open-source softwares, population clusters based on density, cancer incidence, geographic distribution, existing facilities able to be implemented with radiotherapy and travel times for patients were defined. A coding for identifying the best possible locations with AI was developed, keeping the allocation of resources to the minimum possible. A projection until 2030 on required resources was additionally elaborated. RESULTS: As of 2023 eight additional EBRT and seven BT devices were needed to cover the existing demand. The artificial-intelligence algorithm yielded the regions where these resources should be primarily allocated. An increase in demand of approximately 22% is expected until 2030, which translates into additional 23 EBRT and 16 BT devices, considering the replacement of obsolete units until then. CONCLUSION: Increased investment pace is required to cover the existing RT demand in Peru. This AI-assisted analysis might help prioritize allocation of resources. The code employed in this work will be made publicly available, so this method could be replicated in other developing economies.

Machine learning prediction model for oral mucositis risk in head and neck radiotherapy: a preliminary study.

PURPOSE: Oral mucositis (OM) reflects a complex interplay of several risk factors. Machine learning (ML) is a promising frontier in science, capable of processing dense information. This study aims to assess the performance of ML in predicting OM risk in patients undergoing head and neck radiotherapy. METHODS: Clinical data were collected from 157 patients with oral and oropharyngeal squamous cell carcinoma submitted to radiotherapy. Grade 2 OM or higher was considered (NCI). Two dataset versions were used; in the first version, all data were considered, and in the second version, a feature selection was added. Age, smoking status, surgery, radiotherapy prescription dose, treatment modality, histopathological differentiation, tumor stage, presence of oral cancer lesion, and tumor location were selected as key features. The training process used a fivefold cross-validation strategy with 10 repetitions. A total of 4 algorithms and 3 scaling methods were trained (12 models), without using data augmentation. RESULTS: A comparative assessment was performed. Accuracy greater than 55% was considered. No relevant results were achieved with the first version, closest performance was Decision Trees with 52% of accuracy, 42% of sensitivity, and 60% of specificity. For the second version, relevant results were achieved, K-Nearest Neighbors outperformed with 64% accuracy, 58% sensitivity, and 68% specificity. CONCLUSION: ML demonstrated promising results in OM risk prediction. Model improvement was observed after feature selection. Best result was achieved with the KNN model. This is the first study to test ML for OM risk prediction using clinical data.

Progression of nutritional impact symptoms in cancer patients undergoing radiotherapy.

OBJECTIVES: To analyze the presence of nutritional impact symptoms (NIS) throughout radiotherapy treatment in the head and neck, thorax, abdomen, and pelvis areas. METHODS: A prospective cohort study was conducted with individuals undergoing radiotherapy for cancer. Three assessments were carried out: at the start of radiotherapy, midway through, and in the last week of treatment. Clinical, anthropometric data, and the Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess symptoms. RESULTS: A total of 254 participants were evaluated at the start, 165 at the midpoint, and 120 at the end of the treatment. More than half of the participants at all stages were elderly. At the start, 51.6% were women, while at the end, 57.5% were men. Pelvic tumors were the most common, followed by tumors in the head and neck and thorax. The prevalence of NIS increased from 58.2% at the beginning to 76.9% at the midpoint (RR 1.32; 95% CI 1.17-1.48; p = < 0.001) and 78.3% at the end of treatment (RR 1.34; 95% CI 1.18-1.52; p = < 0.001). Odynophagia was the most reported symptom among patients with head and neck tumors, increasing from 24.5 to 66.6%, and from 3.0 to 22.2% by the end of treatment in patients with thoracic tumors. Diarrhea was common at the end of treatment among those with abdominal (69.2%) and pelvic (35.8%) tumors. CONCLUSION: NIS increased during radiotherapy. The location of tumors influences symptom prevalence, highlighting the need for continuous nutritional support.

Effects of photobiomodulation and bethanechol chloride treatment on salivary composition and flow rate in head and neck cancer patients undergoing radiotherapy: longitudinal interventional experimental clinical study.

OBJECTIVE: To evaluate the efficacy of photobiomodulation therapy (PBMT) and bethanechol chloride (BC) on the quantity and quality of saliva in patients undergoing radiotherapy (RT) for head and neck cancer. METHODS: Saliva samples were collected from patients before and after RT, who were treated with PBMT or BC. Clinical parameters, including salivary flow rate (SFR), pH, xerostomia, and concentrations of macro and microelements in saliva, were assessed. Data were compared and analyzed using a self-organizing map. RESULTS: No significant changes were observed in SFR, pH, and xerostomia pre- and post-RT in both the PBMT and BC-treated groups. However, there was an increase in Cr levels in the BC group and a reduction in P levels in the PBMT group. CONCLUSION: The results suggest that both PBMT and BC treatments can effectively mitigate the impacts of RT, since quality and quantity of saliva were maintained.

Oral microbiota in head and neck cancer patients during radiotherapy: a systematic review.

PURPOSE: Radiotherapy (RT) in the head and neck (HN) area causes a series of oral complications and the oral microbiota may play an important role in these complications. The aim of this systematic review was to explore alterations in the oral microbiota among individuals undergoing RT in the HN region. METHODS: A comprehensive search across six databases and grey literature was made. No limitations were imposed on language or publication year. Studies meeting the inclusion and exclusion criteria were considered for inclusion. RESULTS: Twenty-six articles met the criteria for inclusion in this systematic review. These studies varied in terms of radiation doses administered (ranging from 40 Gy to 82.60 Gy), microorganisms analyzed, locations within the oral cavity examined, and timing of assessments. Additionally, different methods of analysis were employed by the studies. Regarding oral microbiota changes, post-RT, there was significant increase in Candida species. Bacterial microbiota experienced increases, notably including Streptococcus mutans (S.mutans) and Lactobacillus, with dynamic fluctuations. CONCLUSION: RT in the HN region induces significant changes in oral microbiota, including increases in S. mutans, Lactobacillus and Candida species colonization, and decreases in beneficial bacteria such as Neisseria and Fusobacteria. These microbiota changes may contribute to oral complications post-RT, emphasizing the need for preventive measures and targeted therapies to manage oral health in HN cancer patients undergoing RT.

Efficacy and safety of narrowband ultraviolet B phototherapy for prurigo nodularis: a tertiary center experience.

BACKGROUND: Prurigo nodularis is a chronic pruritic dermatosis and narrowband-UVB (NB-UVB) phototherapy is considered an effective and safe treatment option in patients with multiple comorbidities. OBJECTIVE: In this study, the authors aimed to evaluate the efficacy and safety of NB-UVB phototherapy in the management of prurigo nodularis and to compare response rates according to lesions localization. METHODS: Thirty prurigo nodularis patients who had been treated with NB-UVB phototherapy were included in this study. The data for this study were retrieved retrospectively from patient follow-up forms in the phototherapy unit. RESULTS: NB-UVB phototherapy led to a complete response (CR) in 24 (80%) patients while partial response (PR) was achieved in 6 (20%) patients. Regarding prurigo nodularis localization, the CR rate was statistically higher in those with diffuse and central involvement (p < 0.05). Erythema and/or pruritus were observed in 4 (13.3%) patients with prurigo nodularis. STUDY LIMITATIONS: This study is limited because it is single-centered and has a retrospective design. CONCLUSIONS: NB-UVB phototherapy is an effective and safe treatment option for prurigo nodularis patients especially those with multiple comorbidities and using several medications. Patients with diffuse and central involvement may respond better to phototherapy than those with peripheral involvement.

Quality appraisal of systematic reviews on high-intensity laser therapy for musculoskeletal pain management: an umbrella review.

Musculoskeletal pain (MSP) remains one of the leading causes of disability worldwide. Recent approaches to treating this condition have prompted the development of several systematic reviews investigating the efficacy of high-intensity laser therapy (HILT), whose analgesic mechanisms are based on photobiomodulation neural inhibition, endorphin and serotonin release and anti-inflammatory effects. To assess the methodological quality, reliability, and validity of the systematic reviews (SRs) on HILT in MSP. This study is an overview of SRs (umbrella review) with an observational, retrospective, and secondary design. The search considered PubMed, Scopus, Web of Science, CINAHL, Embase, Cochrane Library, ScienceDirect, and Google Scholar databases (updated October 23, 2024). The primary focus was on the methodological quality of the reviews and their reporting of pain intensity results. The HILT effects on pain intensity were reported using mean differences (MD) or standardized mean differences (SMD). The quality assessment was conducted using the A Measurement Instrument to Assess Systematic Reviews 2 checklist (AMSTAR-2), and the findings were synthesized narratively. The MD and SMD obtained from all reviews were presented using forest plots. The Shapiro-Wilk normality test assessed MD and SMD distributions for pain intensity across meta-analyses. The average MD and SMD, along with their respective confidence intervals (CI), were estimated and presented based on the aggregate study outcomes. Twenty SRs were included, fourteen of which conducted meta-analyses covering diverse musculoskeletal disorders such as knee osteoarthritis, epicondylalgia, myofascial pain, frozen shoulder, plantar fasciitis, neck, and low back pain. The primary databases used were PubMed, Web of Science, and the Cochrane Library. The AMSTAR-2 average score was 12.9 points (± 1.8), indicating varying methodological quality with one or two criteria resulting in low or critically low. HILT's best analgesic effects are observed in frozen shoulder disorder (MD = -2.23 cm; 95% CI:-3.3,-1.2; p < 0.01), knee osteoarthritis (MD = -1.9 cm; 95% CI:-2.0,-1.8;p < 0.01), low back pain (MD = -1.9 cm; 95% CI = -2.9,-1.0; p < 0.01), and myofascial pain (MD = -1.9 cm; 95% CI:-2.6,-1.2; p < 0.01). Largest effect sizes are for neck pain (SMD = 2.1; 95% CI = 1.2,3.0, p < 0.05) and low back pain (SMD = 1.1 (95% CI = 1.4,0.8; p < 0.01). This review underscores the generally low to critically low methodological quality of SRs on HILT, as assessed by AMSTAR-2. Key areas for improvement for future SRs of RCTs include addressing publication bias, disclosing funding sources, and enhancing search strategies and discussions on heterogeneity. The scarcity of RCTs for conditions such as temporomandibular disorders, carpal tunnel syndrome, and myofascial pain highlights the need for further research. SRs on spinal disorders, frozen shoulder, and neck pain demonstrated the most favorable analgesic effects, providing valuable insights for clinical practice and future RCTs.

Pelvic floor muscle training associated with the photobiomodulation therapy for women affected by the genitourinary syndrome of menopause: a study protocol.

Background: Frequently, the women affected by the genitourinary syndrome of menopause experience genitourinary dysfunctions that profoundly influence their overall health. Even though the symptoms do not jeopardize the women's lives, the urinary and sexual dysfunctions significantly impact their quality of life. Isolated treatments focused on the main causes of the dysfunctions, such as pelvic floor muscle training (PFMT) and photobiomodulation have shown significant improvements in genitourinary dysfunctions. So, the association of PFMT with photobiomodulation may generate additional effects in the genitourinary area. This study aims to create a PFMT protocol isolated and associated with photobiomodulation therapy in women affected by the genitourinary syndrome of menopause. Methods: It is a randomized, controlled, double-blind clinical trial protocol study that will include women experiencing genitourinary symptoms related to menopause, sexually active, never practiced pelvic floor muscle exercise or photobiomodulation treatment, and do not use hormone replacement therapy for at least 3 months. The randomization will allocate the women to three groups: PFMT group, PFMT associated with active intracavitary photobiomodulation group, and PFMT associated with sham intracavitary photobiomodulation group. A total of 16 sessions will be conducted twice a week. The assessments will occur before interventions, after the sixteenth session, and 1 month after the sixteenth session (follow-up). The evaluation will include the pelvic floor muscle vaginal manometry as the primary outcome. Also, the international consultation on incontinence questionnaire-short form, the female sexual function index, the Utian Quality of Life scale, the patient global impression of improvement, the modified Oxford scale, and the vaginal health index will be the secondary outcomes. Discussion: Despite there are gold standard treatments such as PFMT, to alleviate genitourinary symptoms, interventions mirroring clinical practice are needed. This study protocol might show a groundbreaking and viable method to potentiate the effects of a gold-standard treatment associated with photobiomodulation. Conclusion: We expect this protocol to demonstrate that the use of PFMT and photobiomodulation strategies is feasible and able to potentiate the recovery of women affected by the genitourinary syndrome of menopause. The Ethics Committee of the Federal University of Rio Grande do Norte approved the study (n° 6.038.283), and the clinical trials platform registered the protocol (n° RBR-5r7zrs2).

Predicting treatment responses using magnetic resonance imaging-based radiomics in hepatocellular carcinoma patients undergoing transarterial radioembolization.

OBJECTIVE: This study evaluates the efficacy of magnetic resonance imaging-based radiomics in predicting treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization. METHODS: Pre-treatment magnetic resonance imaging scans from 65 hepatocellular carcinoma patients were analyzed. Radiomic features were extracted from axial T1-weighted and T2-weighted sequences using a standardized workflow involving image preprocessing, segmentation, and feature extraction. Multivariate logistic regression models combining radiomic and clinical features were developed to predict treatment outcomes. The performance of the models was evaluated using the area under the curve metric. RESULTS: The study included 65 patients with a median age of 64 years; 44.6% showed a complete response, while 55.4% showed a non-complete response. The median radiomics score in the T1-weighted portal phase was -0.49 for non-complete responders and -0.07 for complete responders (p<0.001). In the T2-weighted sequence, the median radiomics score was -0.76 for non-complete responders and 1.1 for complete responders (p<0.001). Tumor size ≥5 cm was a significant predictor of non-complete response in univariate analysis (p=0.027) but not in multivariate analysis after adding radiomics scores. The area under the curve for the radiomics signature in predicting non-complete response was 0.754 for T1-weighted and 0.850 for T2-weighted sequences. CONCLUSION: Magnetic resonance imaging-based radiomics enhances the prediction of treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization. Integrating radiomic features with clinical parameters significantly improves predictive accuracy.