Endoscopic Submucosal Dissection (ESD) has been increasingly accepted as a minimally invasive treatment for the patients with early gastrointestinal cancers. However, reliable ESD technique demands high maneuverability, and the success of the operation is dependent on each operator's skill. We have developed a novel laser endoscopic system for ESD to overcome such technique-related difficulties. Compared to conventional ESD using electrosurgical knives, an ESD method using the CO₂ laser offers the advantages of less risk of perforation and the prevention of extensive thermal damage, because the CO₂ laser is strongly absorbed by water. Furthermore, due to the non-contact technique associated with the CO₂ laser and adequate visualization of the treatment area, the laser system may provide every endoscopist with more precise and safer treatment.

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Background and aims: The prevalence of pathogenic Escherichia coli as well as E. coli O157 and antibiotic-resistant bacteria has increased. This study aimed to examine the effect of methylene blue (MB) with sodium bicarbonate (NaHCO₃) against E. coli using photodynamic antimicrobial chemotherapy (PACT).
Materials and methods: MB was basified using NaHCO₃. E. coli and basic MB were smeared on the culture media followed by irradiation using a red light-emitting diode (LED) at 660 nm. Energy densities of 5, 10, 15, and 20 J/cm² were applied to the culture medium.
After 24 h, the bactericidal effect of basic MB with LED irradiation was determined based on the bacterial growth.
Results: The basic effect was observed with 1%–6% of NaHCO₃ at 5 J/cm². This effect increased between 1% and 2% of NaHCO₃ at 10 J/cm² and 15 J/cm², whereas decreased at the NaHCO₃ concentrations of > 2%. Moreover, this effect decreased at an energy density of 20 J/cm². The biphasic basic effect on bactericidal activity was observed between pH 8.6 – 9.0.
Conclusions: Thus, PACT using basic MB may be an effective method for pathogenic E. coli sterilization.

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Background and aims: We have previously reported improvement of clinical symptoms of genitourinary syndrome of menopause (GSM) at 3 and 6 months following three CO₂ laser treatments. The current paper presents the results of long term follow up at 12, 15- and 18-months post laser treatment.
Methods: Twenty subjects (mean age 60.65 ± 6.34 years) who had completed the core study participated in follow-up. Subjects were evaluated at 12, 15, and 18 months following final laser therapy. An optional maintenance treatment was offered during Month 12 and Month 15 to those women who failed to increase their Vaginal Health Index Score (VHIS) by more than 34% from their individual baseline, or if the subject desired an additional treatment. At each study visit, VHIS and vulvovaginal atrophy (VVA) symptom severity were recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI).
Results: Fifteen subjects were eligible for a single maintenance treatment (N = 2, at 12 months, and N = 13 at 15 Months). The mean VHIS (± standard deviation) remained significantly improved at 12 months following their last laser treatment (16.3 ± 4.5 vs. Baseline 12.4 ± 4.0; p < 0.05) and at the 15- and 18-months follow up visits as well (16.9 ± 4.6 and 17.1 ± 4.6, respectively; p < 0.05 compared to Baseline). Almost all VVA symptoms were significantly improved at 12 months following the third treatment compared to Baseline and this improvement was sustained at 15 and 18 months. At the 12 Months visit, the total FSFI score increased significantly (N = 15, 24.4 ± 6.9; p < 0.05), and at the 15- and 18-month follow-up visits, the total FSFI remained significantly higher than Baseline (22.2 ± 6.7, 25.8 ± 6.6).
Conclusions: Fractional CO₂ laser treatments are effective in alleviating symptoms of VVA and sexual dysfunction in post-menopausal women, and that effects are sustained over the long-term.

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Background and aims: Chronic pain is a significant health care problem which is often encountered inmedical institute out-patient clinics . In previous studies we have reported on the benefits of low level laser therapy (LLLT) for chronic musculoskeletal pain patients. The present study is a report on the effects of LLLT in patients with pain in major muscles which govern the motion of two joints (2-joint muscles).
Materials and methods: Over the past 5 years, 19 subjects visited our out-patient clinic with complaints of pain in 2-joint muscles (biceps brachii muscle or gastrocnemius muscle). They were treated with LLLT using a 1000 mW semi-conductor laser device delivering 20.1 J/cm² per point at 830 nm in continuous wave. Four shots were given per session (1 treatment) twice a week for 2 months (total of 16 treatments).
Results: A treatment approach modified from the methods of Shiroto and Ohshiro, was used, and the efficacy of LLLT for pain attenuation in the affected muscle was determined. After the end of the treatment regimen, excellent and good improvement was observed in 16 patients out of 19. Discussions with the patients revealed that it was important for them to learn how to modify their everyday life to avoid posture and activities of daily life that could cause them pain in the 2-joint muscles, in order to enjoy continuous benefits from the treatment.
Conclusions: The present study demonstrated that LLLT was an effective form of treatment for pain in the biceps brachii and gastrocnemius muscles. To maximize and prolong treatment efficacy, advice should be given to patients to avoid adopting any posture and activities of daily living which would cause pain in these specific muscles.

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Aim: The aim of this study was to evaluate and compare caries removal by Er,Cr:YSGG Laser and conventional method using Air-rotor handpiece in primary teeth.
Materials and methods: 25 children with at least two class I carious lesions on primary teeth with Diagnodent readings not differing more than ± 10 for both teeth were included in the study. All 50 teeth in the study received treatment by the same operator. Time taken for caries removal was recorded using a timer. Pain assessment was done using Wong Baker Modified Faces Pain Rating Scale and Visual Analog Scale before and after the procedure. After caries removal, caries detection dye was applied to the prepared cavity to check the efficacy of the procedure. In addition, after completion of treatment, each child was asked to indicate which method of caries removal, Er,Cr:YSGG Laser or Air-rotor hand piece, was more comfortable.
Results: The difference between the mean values for post-procedural Wong Baker Faces Pain Rating Scale scores and Visual Analog Scale scores in Group A and Group B were compared, which showed that children experienced less pain during the caries removal procedure with Er,Cr:YSGG Laser than with Air-rotor handpiece. Time taken for caries removal procedure was more in Group A than in Group B. It was seen that in both the groups caries detection dye was completely removed and both the procedures were equally efficacious for caries removal. Children indicated caries removal procedure with Laser to be more comfortable.
Conclusions: Within the parameters and limitations of the present study, it is suggested that Er,Cr:YSGG Laser seems to be an acceptable tool for caries removal in primary teeth. Children found caries removal with Er,Cr:YSGG Laser to be more comfortable even though time taken was more than the conventional method using Air-rotor handpiece.

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Background: The aim of the study was to compare preservation of pulp vitality by indirect pulp treatment with calcium hydroxide, calcium silicate based cement (Biodentine) and Er,Cr:YSGG laser in permanent molars.
Materials and methods: 30 patients were selected for this study as per the inclusion and exclusion criteria in the age group of 6–14 years and then randomly allocated to three groups A, B & C. In group A, after caries excavation, calcium hydroxide (Dycal) was placed at the floor. In group B, after caries excavation, calcium silicate based cement (Biodentine) was placed at the floor. In group C, after caries excavation, decontamination of the cavity was done with Er,Cr:YSGG laser. This was followed by placement of permanent restorative material in all the groups. Clinical and radiographic success was monitored at 3,6 and months. Data analysis was performed using Statistical Package for the Social Science-21 (SPSS-21).
Results: At the end of 9 months, overall success rate of indirect pulp was 86.6%. There was no significant difference between the three groups. (p > 0.05)
Conclusions: The study showed that the success of indirect pulp treatment is independent of the type of liner used for pulp capping. Moreover, the study also shows that Er,Cr;YSGG laser can be effectively used for indirect pulp capping procedures.

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Background and aims: Nowadays, studies show the effective laser irradiation role on the adhesion of bonding agents to the dentin. Therefore, the present study was set to find an appropriate protocol for the use of Nd:YAG, Er:YAG, and Diode lasers during the application of two steps self-etch adhesives in direct dental restorations in order to achieve higher microtensile strength.
Materials and methods: A total number of 100 extracted healthy teeth were selected. After removing occlusal enamel and exposing dentin, samples randomly divided into ten groups: Group Control (C), two steps self-etch adhesives was applied in accordance with the manufacturer instructions, without using laser systems; Groups Er-YAG, laser (2940 nm, 10 Hz, 0.4w, 40 mJ) irradiated Before applying Primer (Er-BPsubgroup), After applying Primer (Er-AP subgroup), After applying Bonding (Er-AB subgroup); Groups Nd-YAG, laser (1064 nm, 10 Hz, 1.2w, 40 mJ) irradiated Before applying Primer (Nd-BP subgroup), After applying Primer (Nd-AP subgroup), After applying Bonding (Nd-AB subgroup); Groups Diode, laser (940nm, 10 Hz, 0.7w, 70 mJ) irradiated Before applying Primer (D-BP subgroup), After applying Primer (D-AP subgroup), After applying Bonding (D-AB subgroup). After intervention and composite build up, the samples were stored 24 hours in 37°C distilled water. The microtensile strength was measured using the universal testing machine. The data were analyzed by one-way ANOVA test and post hoc Tukey test. (p < 0.05)
Results: The Means and standard deviations of the groups were as follow: C = 30.09 ± 4.21, Er-BP = 18.83± 4.21, Er-AP = 14.43 ± 3.12, Er-AB = 19.67 ± 4.96, Nd-BP = 20.35 ± 5.55, Nd-AP = 39.85 ± 4.13, Nd-AB =18.16 ± 3.36, D-BP = 26.74 ± 5.05, D-AP = 28.11 ± 5.12, D-AB = 37.28 ± 5.61. The mean microtensile strength achieved in groups: Nd-AP and D-AB were significantly higher than control group (p < 0.05).Groups D-BP and D-AP had no significant difference in comparison with control group while the remaining groups had significantly lower values (P < 0.05).
Conclusions: Nd:YAG laser irradiation after applying the primer, and diode laser irradiation after applying the bonding agent, both can improve the microtensile bond strength in two steps self-etch adhesive systems significantly.

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Background and aims: Acupuncture has become a substantial part of medical practice in Switzerland. So far, only few cases of accidental tattoo after acupuncture have been reported, which were all caused by acupuncture needles that had been left in the skin and led to local argyrosis.
Case: We report the case of a 31-year-old female who developed gray-brown macules after acupuncture. Over 5 months, she had received acupuncture on the same spots one to two times per week and the macules had gradually become darker and had increased in size. The needles used were disposable, contained nickel and were not left in the skin for over 30 minutes. The patient was of Fitzpatrick skin phototype II and showed several grayish-brown macules with an average diameter of around 5mm in the region of glabella, nucha and dorsum pedis. We treated the lesions with a quality-switched ruby laser (694nm) with a fluence between 3 and 5.5 J/cm², a spot size of 4 or 6 mm and in intervals of 8 to 23 weeks up to a complete elimination of the hyperpigmentation within 11 laser sessions.
Conclusions: In synopsis with the anamnesis, the clinical aspect and the therapeutic course, we interpreted the hyperpigmentary spots as a combination of iatrogenic tattooing with nickel and deposition of hemosiderin as well as melanin due to repeated mechanical manipulation and UV exposure of the skin. Furthermore, we hereby show the validity of the quality-switched ruby laser in the removal of accidental hyperpigmentation in skin phototype II.

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