A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: A pilot study

Objective: to evaluate the effects of low-level laser therapy for perineal pain and healing after episiotomy. Design: a double-blind, randomised, controlled clinical trial comparing perineal pain scores and episiotomy healing in women treated with low-level laser therapy (LLLT) and with the simulation of the treatment. Setting: the study was conducted in the Birth Centre and rooming-in units of Amparo Maternal, a maternity service located in the city of Sao Paulo, Brazil. Participants: fifty-two postpartum women who had had mediolateral episiotomies during their first normal delivery were randomly divided into two groups of 26: an experimental group and a control group. Intervention: in the experimental group, the women were treated with LLLT. Irradiation was applied at three points directly on the episiotomy after the suture and in three postpartum sessions: up to 2 hrs postpartum, between 20 and 24 hrs postpartum and between 40 and 48 hrs postpartum. The LLLT was performed with diode laser, with a wavelength of 660 nm (red light), spot size of 0.04 cm(2), energy density of 3.8 J/cm(2), radiant power of 15 mW and 10 s per point, which resulted in an energy of 0.15 J per point and a total energy of 0.45 J per session. The control group participants also underwent three treatment sessions, but without the emission of radiation (simulation group), to assess the possible effects of placebo treatment. Main outcomes: perineal pain scores, rated on a scale from 0 to 10, were evaluated before and immediately after the irradiation in the three sessions. The healing process was assessed using the REEDA scale (Redness, Edema, Echymosis, Discharge Aproximation) before each laser therapy session and 15 and 20 days after the women's discharge. Findings: comparing the pain scores before and after the LLLT sessions, the experimental group presented a significant within-group reduction in mean pain scores after the second and third sessions (p=0.003 and p<0.001, respectively), and the control group showed a significant reduction after the first treatment simulation (p=0.043). However, the comparison of the perineal pain scores between the experimental and control groups indicated no statistical difference at any of the evaluated time points. There was no significant difference in perineal healing scores between the groups. All postpartum women approved of the low-level laser therapy. Conclusions: this pilot study showed that LLLT did not accelerate episiotomy healing. Although there was a reduction in perineal pain mean scores in the experimental group, we cannot conclude that the laser relieved perineal pain. This study led to the suggestion of a new research proposal involving another irradiation protocol to evaluate LLLT's effect on perineal pain relief. (C) 2011 Elsevier Ltd. All rights reserved.

Laser therapy and pain-related behavior after injury of the inferior alveolar nerve: possible involvement of neurotrophins

Nerve-related complications have been frequently reported in dental procedures, and a very frequent type of occurrence involves the inferior alveolar nerve (IAN). The nerve injury in humans often results in persistent pain accompanied by allodynia and hyperalgesia. In this investigation, we used an experimental IAN injury in rats, which was induced by a Crile hemostatic clamp, to evaluate the effects of laser therapy on nerve repair. We also studied the nociceptive behavior (von Frey hair test) before and after the injury and the behavioral effects of treatment with laser therapy (emitting a wavelength of 904 nm, output power of 70 Wpk, a spot area of *0.1 cm2, frequency of 9500 Hz, pulse time 60 ns and an energy density of 6 J/cm2). As neurotrophins are essential for the process of nerve regeneration, we used immunoblotting techniques to preliminarily examine the effects of laser therapy on the expression of nerve growth factor (NGF) and brainderived neurotrophic factor (BDNF). The injured animals treated with laser exhibited an improved nociceptive behavior. In irradiated animals, there was an enhanced expression of NGF (53%) and a decreased BDNF expression (40%) after laser therapy. These results indicate that BDNF plays a locally crucial role in pain-related behavior development after IAN injury, increasing after lesions (in parallel to the installation of pain behavior) and decreasing with laser therapy (in parallel to the improvement of pain behavior). On the other hand, NGF probably contributes to the repair of nerve tissue, in addition to improving the pain-related behavior.

A 12-month follow-up of hypopigmentation after laser hair removal

Introduction: Laser hair removal is becoming an increasingly popular alternative to traditional methods such as shaving, waxing, among other methods. Semiconductor diode lasers are considered the most efficient light sources available and are especially well suited for clinical applications including hair reduction. The effectiveness of laser hair reduction depends on many variables, including the skin type of the patient. Material and Methods: A patient with Fitzpatrick Skin Type IV was submitted to laser hair removal of the arms with a high-power diode laser system with long pulses with a wavelength of 800 nm, a fluence of 40 J/cm2 and a pulse width of 20 ms. A 12-month follow-up assessment was performed and included photography and questionnaire. Results: Hypopigmentation was observed after a single laser hair removal section. After 6 months with the area totally covered, a gradual suntan with a sun screen lotion with an SPF of 15 was prescribed by the dermatologist. After 12 months of the initial treatment, a complete recovery of the hypopigmentation was achieved. Conclusion: Although a safe procedure, lasers for hair removal may be associated with adverse side effects including undesired pigment alterations. Before starting a laser hair removal treatment, patients seeking the eradication of hair should be informed that temporary, and possibly permanent, pigmentary changes may occur.

Design, synthesis and photochemical studies of stilbenoid dendrimers

Stilbenoid dendrimers with stilbene in the periphery and stilbene in periphery as well as core were synthesized by convergent approach except 2nd generation dendrimer with stilbene in the periphery as well as in core (D-5). All dendrimers were characterized by standard techniques such as 1H NMR, 13C NMR, MS and IR spectroscopy. The MALDI-TOF technique proved to be very helpful in the identification of the 2nd generation dendrimer (D-5) with a mass of 3231 a.m.u. The dendrimers were designed in such a way that an intramolecular photochemical CC bond formation was favored. As two stilbene units of the same molecule were close enough so they preferred an intramolecular cyclic process except for zero generation dendrimers. Apart from the cycloaddition, some E/Z isomerization and oligomer formation was also observed on irradiation. These processes were observed by 1H NMR and MALDI-TOF MS. The photochemical behavior was also studied by UV absorption spectroscopy. Irradiating by monochromatic light led to an initial E/Z isomerization and by prolonged irradiation, an irreversible cyclic structure was formed. The choice of the wavelength of incident light is very important as irradiation at 320 nm leads to a reversible E/Z isomerization and a non-reversible cyclobutane formation, but irradiation at 340 nm favors the one-way process E Z. The [2+2] cycloaddition of molecule Tm2De was also studied by irradiating thin films on a quartz surface. An AFM image was taken before irradiation, after 3 sec irradiation and after long irradiation (1 hour). AFM studies show that a short irradiation leads to a cyclic structure as formation of hills of about 20-30 nm on the surface. A prolonged irradiation leads to a CC cross linking which can be monitored on AFM images as disappearance of hills. The roughness goes back to an almost smooth surface. These results prove a very complex material transport, which accompanies the reaction in the surface region.

Optical resonances of sphere-on-plane geometries

The optical resonances of metallic nanoparticles placed at nanometer distances from a metal plane were investigated. At certain wavelengths, these “sphere-on-plane” systems become resonant with the incident electromagnetic field and huge enhancements of the field are predicted localized in the small gaps created between the nanoparticle and the plane. An experimental architecture to fabricate sphere-on-plane systems was successfully achieved in which in addition to the commonly used alkanethiols, polyphenylene dendrimers were used as molecular spacers to separate the metallic nanoparticles from the metal planes. They allow for a defined nanoparticle-plane separation and some often are functionalized with a chromophore core which is therefore positioned exactly in the gap. The metal planes used in the system architecture consisted of evaporated thin films of gold or silver. Evaporated gold or silver films have a smooth interface with their substrate and a rougher top surface. To investigate the influence of surface roughness on the optical response of such a film, two gold films were prepared with a smooth and a rough side which were as similar as possible. Surface plasmons were excited in Kretschmann configuration both on the rough and on the smooth side. Their reflectivity could be well modeled by a single gold film for each individual measurement. The film has to be modeled as two layers with significantly different optical constants. The smooth side, although polycrystalline, had an optical response that was very similar to a monocrystalline surface while for the rough side the standard response of evaporated gold is retrieved. For investigations on thin non-absorbing dielectric films though, this heterogeneity introduces only a negligible error. To determine the resonant wavelength of the sphere-on-plane systems a strategy was developed which is based on multi-wavelength surface plasmon spectroscopy experiments in Kretschmann-configuration. The resonant behavior of the system lead to characteristic changes in the surface plasmon dispersion. A quantitative analysis was performed by calculating the polarisability per unit area /A treating the sphere-on-plane systems as an effective layer. This approach completely avoids the ambiguity in the determination of thickness and optical response of thin films in surface plasmon spectroscopy. Equal area densities of polarisable units yielded identical response irrespective of the thickness of the layer they are distributed in. The parameter range where the evaluation of surface plasmon data in terms of /A is applicable was determined for a typical experimental situation. It was shown that this analysis yields reasonable quantitative agreement with a simple theoretical model of the sphere-on-plane resonators and reproduces the results from standard extinction experiments having a higher information content and significantly increased signal-to-noise ratio. With the objective to acquire a better quantitative understanding of the dependence of the resonance wavelength on the geometry of the sphere-on-plane systems, different systems were fabricated in which the gold nanoparticle size, type of spacer and ambient medium were varied and the resonance wavelength of the system was determined. The gold nanoparticle radius was varied in the range from 10 nm to 80 nm. It could be shown that the polyphenylene dendrimers can be used as molecular spacers to fabricate systems which support gap resonances. The resonance wavelength of the systems could be tuned in the optical region between 550 nm and 800 nm. Based on a simple analytical model, a quantitative analysis was developed to relate the systems’ geometry with the resonant wavelength and surprisingly good agreement of this simple model with the experiment without any adjustable parameters was found. The key feature ascribed to sphere-on-plane systems is a very large electromagnetic field localized in volumes in the nanometer range. Experiments towards a quantitative understanding of the field enhancements taking place in the gap of the sphere-on-plane systems were done by monitoring the increase in fluorescence of a metal-supported monolayer of a dye-loaded dendrimer upon decoration of the surface with nanoparticles. The metal used (gold and silver), the colloid mean size and the surface roughness were varied. Large silver crystallites on evaporated silver surfaces lead to the most pronounced fluorescence enhancements in the order of 104. They constitute a very promising sample architecture for the study of field enhancements.

Nanomechanical and phononic properties of structured soft materials

Significant interest in nanotechnology, is stimulated by the fact that materials exhibit qualitative changes of properties when their dimensions approach ”finite-sizes”. Quantization of electronic, optical and acoustic energies at the nanoscale provides novel functions, with interests spanning from electronics and photonics to biology. The present dissertation involves the application of Brillouin light scattering (BLS) to quantify and utilize material displacementsrnfor probing phononics and elastic properties of structured systems with dimensions comparable to the wavelength of visible light. The interplay of wave propagation with materials exhibiting spatial inhomogeneities at sub-micron length scales provides information not only about elastic properties but also about structural organization at those length scales. In addition the vector nature of q allows, for addressing the directional dependence of thermomechanical properties. To meet this goal, one-dimensional confined nanostructures and a biological system possessing high hierarchical organization were investigated. These applications extend the capabilities of BLS from a characterization tool for thin films to a method for unravelingrnintriguing phononic properties in more complex systems.

Fluctuation spectroscopy of single plasmonic nanostructures

Plasmonic nanoparticles are great candidates for sensing applications with optical read-out. Plasmon sensing is based on the interaction of the nanoparticle with electromagnetic waves where the particle scatters light at its resonance wavelength. This wavelength depends on several intrinsic factors like material, shape and size of the nanoparticle as well as extrinsic factors like the refractive index of the surrounding medium. The latter allows the nanoparticle to be used as a sensor; changes in the proximate environment can be directly monitored by the wavelength of the emitted light. Due to their minuscule size and high sensitivity this allows individual nanoparticles to report on changes in particle coverage.rnrnTo use this single particle plasmon sensor for future sensing applications it has to meet the demand for detection of incidents on the single molecule level, such as single molecule sensing or even the detection of conformational changes of a single molecule. Therefore, time resolution and sensitivity have to be enhanced as today’s measurement methods for signal read-out are too slow and not sensitive enough to resolve these processes. This thesis presents a new experimental setup, the 'Plasmon Fluctuation Setup', that leads to tremendous improvements in time resolution and sensitivity. This is achieved by implementation of a stronger light source and a more sensitive detector. The new setup has a time resolution in the microsecond regime, an advancement of 4-6 orders of magnitude to previous setups. Its resonance wavelength stability of 0.03 nm, measured with an exposure time of 10 ms, is an improvement of a factor of 20 even though the exposure time is 3000 times shorter than in previous reports. Thus, previously unresolvable wavelength changes of the plasmon sensor induced by minor local environmental alteration can be monitored with extremely high temporal resolution.rnrnUsing the 'Plasmon Fluctuation Setup', I can resolve adsorption events of single unlabeled proteins on an individual nanorod. Additionally, I monitored the dynamic evolution of a single protein binding event on a millisecond time scale. This feasibility is of high interest as the role of certain domains in the protein can be probed by a study of modified analytes without the need for labels possibly introducing conformational or characteristic changes to the target. The technique also resolves equilibrium fluctuations in the coverage, opening a window into observing Brownian dynamics of unlabeled macromolecules. rnrnA further topic addressed in this thesis is the usability of the nanoruler, two nanospheres connected with a spacer molecule, as a stiffness sensor for the interparticle linker under strong illumination. Here, I discover a light induced collapse of the nanoruler. Furthermore, I exploit the sensing volume of a fixed nanorod to study unlabeled analytes diffusing around the nanorod at concentrations that are too high for fluorescence correlation spectroscopy but realistic for biological systems. Additionally, local pH sensing with nanoparticles is achieved.

Spins, moments and radii of cd isotopes

The complex nature of the nucleon-nucleon interaction and the wide range of systems covered by the roughly 3000 known nuclides leads to a multitude of effects observed in nuclear structure. Among the most prominent ones is the occurence of shell closures at so-called ”magic numbers”, which are explained by the nuclear shell model. Although the shell model already is on duty for several decades, it is still constantly extended and improved. For this process of extension, fine adjustment and verification, it is important to have experimental data of nuclear properties, especially at crucial points like in the vicinity of shell closures. This is the motivation for the work performed in this thesis: the measurement and analysis of nuclear ground state properties of the isotopic chain of 100−130Cd by collinear laser spectroscopy.rnrnThe experiment was conducted at ISOLDE/CERN using the collinear laser spectroscopy apparatus COLLAPS. This experiment is the continuation of a run on neutral atomic cadmium from A = 106 to A = 126 and extends the measured isotopes to even more exotic species. The required gain in sensitivity is mainly achieved by using a radiofrequency cooler and buncher for background reduction and by using the strong 5s 2S1/2 → 5p 2P3/2 transition in singly ionized Cd. The latter requires a continuous wave laser system with a wavelength of 214.6 nm, which has been developed during this thesis. Fourth harmonic generation of an infrared titanium sapphire laser is achieved by two subsequent cavity-enhanced second harmonic generations, leading to the production of deep-UV laser light up to about 100 mW.rnrnThe acquired data of the Z = 48 Cd isotopes, having one proton pair less than the Z = 50 shell closure at tin, covers the isotopes from N = 52 up to N = 82 and therefore almost the complete region between the neutron shell closures N = 50 and N = 82. The isotope shifts and the hyperfine structures of these isotopes have been recorded and the magnetic dipole moments, the electric quadrupole moments, spins and changes in mean square charge radii are extracted. The obtained data reveal among other features an extremely linear behaviour of the quadrupole moments of the I = 11/2− isomeric states and a parabolic development in differences in mean square nuclear charge radii between ground and isomeric state. The development of charge radii between the shell closures is smooth, exposes a regular odd-even staggering and can be described and interpreted in the model of Zamick and Thalmi.

Fingering instability down the outside of a vertical cylinder

We present an experimental and numerical study examining the dynamics of a gravity-driven contact line of a thin viscous film traveling down the outside of a vertical cylinder of radius R. Experiments on cylinders with radii ranging between 0.159 and 3.81 cm show that the contact line is unstable to a fingering pattern for two fluids with differing viscosities, surface tensions, and wetting properties. The dynamics of the contact line is studied and results are compared to previous studies of inclined plane experiments in order to understand the influence substrate curvature plays on the fingering pattern. A lubrication model is derived for the film height in the limit that ε = H/R≪1, where H is the upstream film thickness, and in terms of a Bond number ρgR3/(γH), and the linear stability of the contact line is analyzed using traveling wave solutions. Curvature controls the capillary ridge height of the traveling wave and the range of unstable wavelength when ε = O(10-1), whereas the shape and stability of the contact line converge to the behavior one observes on a vertical plane when ε ≤ O(10-2). The most unstable wave mode, cutoff wave mode for neutral stability, and maximum growth rate scale as 0.45 where = ρgR2/γ ≥ 1.3, and the contact line is unstable to fingering when ≥ 0.56. Using the experimental data to extrapolate outside the range of validity of the thin film model, we estimate the contact line is stable when <0.56. Agreement is excellent between the model and the experimental data for the wave number (i.e., number of fingers) and wavelength of the fingering pattern that forms along the contact line.

Favorable effect of priming with granulocyte colony-stimulating factor in remission induction of acute myeloid leukemia restricted to dose-escalation of cytarabine

The clinical value of chemotherapy sensitization of acute myeloid leukemia (AML) with G-CSF priming has remained controversial. Cytarabine is a key constituent of remission induction chemotherapy. The effect of G-CSF priming has not been investigated in relationship with variable dose levels of cytarabine. We randomized 917 AML patients to receive G-CSF (456 patients) or no G-CSF (461 patients) at the days of chemotherapy. In the initial part of the study, 406 patients were also randomized between 2 cytarabine regimens comparing conventional-dose (199 patients) versus escalated-dose (207 patients) cytarabine in cycles 1 and 2. We found that patients after induction chemotherapy plus G-CSF had similar overall survival (43% vs 40%, P = .88), event-free survival (37% vs 31%, P = .29), and relapse rates (34% vs 36%, P = .77) at 5 years as those not receiving G-CSF. However, patients treated with the escalated-dose cytarabine regimen benefited from G-CSF priming, with improved event-free survival (P = .01) and overall survival (P = .003), compared with patients without G-CSF undergoing escalated-dose cytarabine treatment. A significant survival advantage of sensitizing AML for chemotherapy with G-CSF was not apparent in the entire study group, but it was seen in patients treated with escalated-dose cytarabine during remission induction. The HOVON-42 study is registered under The Netherlands Trial Registry (www.trialregister.nl) as #NTR230.

Generation of custom modes in a Nd:YAG laser with a semipassive bimorph adaptive mirror

Custom modes at a wavelength of 1064 nm were generated with a deformable mirror. The required surface deformations of the adaptive mirror were calculated with the Collins integral written in a matrix formalism. The appropriate size and shape of the actuators as well as the needed stroke were determined to ensure that the surface of the controllable mirror matches the phase front of the custom modes. A semipassive bimorph adaptive mirror with five concentric ring-shaped actuators and one defocus actuator was manufactured and characterised. The surface deformation was modelled with the response functions of the adaptive mirror in terms of an expansion with Zernike polynomials. In the experiments the Nd:YAG laser crystal was quasi-CW pumped to avoid thermally induced distortions of the phase front. The adaptive mirror allows to switch between a super-Gaussian mode, a doughnut mode, a Hermite-Gaussian fundamental beam, multi-mode operation or no oscillation in real time during laser operation.

Detection of approximal caries with a new laser fluorescence device

The laser device DIAGNOdent developed for the detection of occlusal caries has limited value on approximal surfaces. The aim of this study was to develop and to test a new laser fluorescence (LF) device for the detection of approximal caries. Light with a wavelength of 655 nm was transported to the approximal surface using two different sapphire fibre tips. Seventy-five teeth were selected from a pool of extracted permanent human molars, frozen at -20 degrees C until use. Before being measured, they were defrosted, cleaned and calculus was removed with a scaler. The molars were set in blocks simulating the contact area of adults. Bitewing radiographs were obtained using Kodak Insight films. After two independent assessments with the new LF device, the teeth were histologically prepared, and assessed for caries extension. Using the laser, specificity values for D1 threshold (outer half of enamel), D2 threshold (inner half of enamel), D3 threshold (dentine) ranged between 0.81 and 0.93, sensitivity between 0.84 and 0.92 with no difference between the two tips. Bitewing radiography showed an inferior performance compared to LF (p<0.05). Intraex aminer reproducibility was high (kappa>.74). The new LF system might be a useful additional tool in detecting approximal caries. Because of its good reproducibility, it could be used to monitor caries regression or progression on approximal surfaces.

A genetically explicit model of speciation by sensory drive within a continuous population in aquatic environments

BACKGROUND: The sensory drive hypothesis predicts that divergent sensory adaptation in different habitats may lead to premating isolation upon secondary contact of populations. Speciation by sensory drive has traditionally been treated as a special case of speciation as a byproduct of adaptation to divergent environments in geographically isolated populations. However, if habitats are heterogeneous, local adaptation in the sensory systems may cause the emergence of reproductively isolated species from a single unstructured population. In polychromatic fishes, visual sensitivity might become adapted to local ambient light regimes and the sensitivity might influence female preferences for male nuptial color. In this paper, we investigate the possibility of speciation by sensory drive as a byproduct of divergent visual adaptation within a single initially unstructured population. We use models based on explicit genetic mechanisms for color vision and nuptial coloration. RESULTS: We show that in simulations in which the adaptive evolution of visual pigments and color perception are explicitly modeled, sensory drive can promote speciation along a short selection gradient within a continuous habitat and population. We assumed that color perception evolves to adapt to the modal light environment that individuals experience and that females prefer to mate with males whose nuptial color they are most sensitive to. In our simulations color perception depends on the absorption spectra of an individual's visual pigments. Speciation occurred most frequently when the steepness of the environmental light gradient was intermediate and dispersal distance of offspring was relatively small. In addition, our results predict that mutations that cause large shifts in the wavelength of peak absorption promote speciation, whereas we did not observe speciation when peak absorption evolved by stepwise mutations with small effect. CONCLUSION: The results suggest that speciation can occur where environmental gradients create divergent selection on sensory modalities that are used in mate choice. Evidence for such gradients exists from several animal groups, and from freshwater and marine fishes in particular. The probability of speciation in a continuous population under such conditions may then critically depend on the genetic architecture of perceptual adaptation and female mate choice.

Measuring the bending of asymmetric planar EAP structures

The geometric characterization of low-voltage dielectric electro-active polymer (EAP) structures, comprised of nanometer thickness but areas of square centimeters, for applications such as artificial sphincters requires methods with nanometer precision. Direct optical detection is usually restricted to sub-micrometer resolution because of the wavelength of the light applied. Therefore, we propose to take advantage of the cantilever bending system with optical readout revealing a sub-micrometer resolution at the deflection of the free end. It is demonstrated that this approach allows us to detect bending of rather conventional planar asymmetric, dielectric EAP-structures applying voltages well below 10 V. For this purpose, we built 100 μm-thin silicone films between 50 nm-thin silver layers on a 25 μm-thin polyetheretherketone (PEEK) substrate. The increase of the applied voltage in steps of 50 V until 1 kV resulted in a cantilever bending that exhibits only in restricted ranges the expected square dependence. The mean laser beam displacement on the detector corresponded to 6 nm per volt. The apparatus will therefore become a powerful mean to analyze and thereby improve low-voltage dielectric EAP-structures to realize nanometer-thin layers for stack actuators to be incorporated into artificial sphincter systems for treating severe urinary and fecal incontinence.

A technique for continuous detection of drill liquid in ice cores

When drilling ice cores deeper than ∼100 m, drill liquid is required to maintain ice-core quality and to limit borehole closure. Due to high-pressure air bubbles in the ice, the ice core can crack during drilling and core retrieval, typically at 600–1200 m depth in Greenland. Ice from this 'brittle zone' can be contaminated by drill liquid as it seeps through cracks into the core. Continuous flow analysis (CFA) systems are routinely used to analyse ice for chemical impurities, so the detection of drill liquid is important for validating accurate measurements and avoiding potential instrument damage. An optical detector was constructed to identify drill liquid in CFA tubing by ultraviolet absorption spectroscopy at a wavelength of 290 nm. The set-up was successfully field-tested in the frame of the NEEM ice-core drilling project in Greenland. A total of 27 cases of drill liquid contamination were identified during the analysis of 175 m of brittle zone ice. The analyses most strongly affected by drill liquid contamination include insoluble dust particles, electrolytic conductivity, ammonium, hydrogen peroxide and sulphate. This method may also be applied to other types of drill liquid used at other drill sites.