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Erschienen in: Lasers in Medical Science 6/2014

01.11.2014 | Original Article

Phototherapy in skeletal muscle performance and recovery after exercise: effect of combination of super-pulsed laser and light-emitting diodes

verfasst von: Fernanda Colella Antonialli, Thiago De Marchi, Shaiane Silva Tomazoni, Adriane Aver Vanin, Vanessa dos Santos Grandinetti, Paulo Roberto Vicente de Paiva, Henrique Dantas Pinto, Eduardo Foschini Miranda, Paulo de Tarso Camillo de Carvalho, Ernesto Cesar Pinto Leal-Junior

Erschienen in: Lasers in Medical Science | Ausgabe 6/2014

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Abstract

Recent studies with phototherapy have shown positive results in enhancement of performance and improvement of recovery when applied before exercise. However, several factors still remain unknown such as therapeutic windows, optimal treatment parameters, and effects of combination of different light sources (laser and LEDs). The aim of this study was to evaluate the effects of phototherapy with the combination of different light sources on skeletal muscle performance and post-exercise recovery, and to establish the optimal energy dose. A randomized, double-blinded, placebo-controlled trial with participation of 40 male healthy untrained volunteers was performed. A single phototherapy intervention was performed immediately after pre-exercise (baseline) maximum voluntary contraction (MVC) with a cluster of 12 diodes (4 of 905 nm lasers—0.3125 mW each, 4 of 875 nm LEDs—17.5 mW each, and 4 of 670 nm LEDs—15 mW each- manufactured by Multi Radiance Medical™) and dose of 10, 30, and 50 J or placebo in six sites of quadriceps. MVC, delayed onset muscle soreness (DOMS), and creatine kinase (CK) activity were analyzed. Assessments were performed before, 1 min, 1, 24, 48, 72, and 96 h after eccentric exercise protocol employed to induce fatigue. Phototherapy increased (p < 0.05) MVC was compared to placebo from immediately after to 96 h after exercise with 10 or 30 J doses (better results with 30 J dose). DOMS was significantly decreased compared to placebo (p < 0.05) with 30 J dose from 24 to 96 h after exercise, and with 50 J dose from immediately after to 96 h after exercise. CK activity was significantly decreased (p < 0.05) compared to placebo with all phototherapy doses from 1 to 96 h after exercise (except for 50 J dose at 96 h). Pre-exercise phototherapy with combination of low-level laser and LEDs, mainly with 30 J dose, significantly increases performance, decreases DOMS, and improves biochemical marker related to skeletal muscle damage.
Literatur
1.
Zurück zum Zitat Goldman JA, Chiapella J, Casey H, Bass N, Graham J, McClatchey W, Dronavalli RV, Brown R, Bennett WJ, Miller SB, Wilson CH, Pearson B, Haun C, Persinski L, Huey H, Muckerheide M (1980) Laser therapy of rheumatoid arthritis. Lasers Surg Med 1:93–101PubMedCrossRef Goldman JA, Chiapella J, Casey H, Bass N, Graham J, McClatchey W, Dronavalli RV, Brown R, Bennett WJ, Miller SB, Wilson CH, Pearson B, Haun C, Persinski L, Huey H, Muckerheide M (1980) Laser therapy of rheumatoid arthritis. Lasers Surg Med 1:93–101PubMedCrossRef
2.
Zurück zum Zitat Hegedus B, Viharos L, Gervain M, Gálfi M (2009) The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg 27:577–584PubMedCrossRefPubMedCentral Hegedus B, Viharos L, Gervain M, Gálfi M (2009) The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg 27:577–584PubMedCrossRefPubMedCentral
3.
Zurück zum Zitat Bjordal JM, Lopes-Martins RA, Iversen VV (2006) A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med 40:76–80PubMedCrossRefPubMedCentral Bjordal JM, Lopes-Martins RA, Iversen VV (2006) A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med 40:76–80PubMedCrossRefPubMedCentral
4.
Zurück zum Zitat Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM (2008) Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. Am J Sports Med 36:881–887PubMedCrossRef Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM (2008) Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. Am J Sports Med 36:881–887PubMedCrossRef
5.
Zurück zum Zitat Basford JR, Sheffield CG, Harmsen WS (1999) Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil 80:647–652PubMedCrossRef Basford JR, Sheffield CG, Harmsen WS (1999) Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil 80:647–652PubMedCrossRef
6.
Zurück zum Zitat Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND (2010) Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study. Photomed Laser Surg 28:553–560PubMedCrossRef Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND (2010) Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study. Photomed Laser Surg 28:553–560PubMedCrossRef
7.
Zurück zum Zitat Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S (2004) Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med 35:229–235PubMedCrossRef Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S (2004) Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med 35:229–235PubMedCrossRef
8.
Zurück zum Zitat Chow RT, Heller GZ, Barnsley L (2006) The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study. Pain 124:201–210PubMedCrossRef Chow RT, Heller GZ, Barnsley L (2006) The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study. Pain 124:201–210PubMedCrossRef
9.
Zurück zum Zitat Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009) Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 374:1897–1908PubMedCrossRef Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009) Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 374:1897–1908PubMedCrossRef
10.
Zurück zum Zitat Leal Junior EC, Lopes-Martins RA, Dalan F, Ferrari M, Sbabo FM, Generosi RA, Baroni BM, Penna SC, Iversen VV, Bjordal JM (2008) Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans. Photomed Laser Surg 26:419–424PubMedCrossRef Leal Junior EC, Lopes-Martins RA, Dalan F, Ferrari M, Sbabo FM, Generosi RA, Baroni BM, Penna SC, Iversen VV, Bjordal JM (2008) Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans. Photomed Laser Surg 26:419–424PubMedCrossRef
11.
Zurück zum Zitat de Almeida P, Lopes-Martins RA, De Marchi T, Tomazoni SS, Albertini R, Corrêa JC, Rossi RP, Machado GP, da Silva DP, Bjordal JM, Leal Junior EC (2012) Red (660 nm) and infrared (830 nm) low-level laser therapy in skeletal muscle fatigue in humans: what is better? Lasers Med Sci 27:453–458PubMedCrossRefPubMedCentral de Almeida P, Lopes-Martins RA, De Marchi T, Tomazoni SS, Albertini R, Corrêa JC, Rossi RP, Machado GP, da Silva DP, Bjordal JM, Leal Junior EC (2012) Red (660 nm) and infrared (830 nm) low-level laser therapy in skeletal muscle fatigue in humans: what is better? Lasers Med Sci 27:453–458PubMedCrossRefPubMedCentral
12.
Zurück zum Zitat Leal Junior EC, Lopes-Martins RA, Vanin AA, Baroni BM, Grosselli D, De Marchi T, Iversen VV, Bjordal JM (2009) Effect of 830 nm low-level laser therapy in exercise-induced skeletal muscle fatigue in humans. Lasers Med Sci 24:425–431PubMedCrossRef Leal Junior EC, Lopes-Martins RA, Vanin AA, Baroni BM, Grosselli D, De Marchi T, Iversen VV, Bjordal JM (2009) Effect of 830 nm low-level laser therapy in exercise-induced skeletal muscle fatigue in humans. Lasers Med Sci 24:425–431PubMedCrossRef
13.
Zurück zum Zitat Leal Junior EC, Lopes-Martins RA, Frigo L, De Marchi T, Rossi RP, de Godoi V, Tomazoni SS, da Silva DP, Basso M, Lotti Filho P, Corsetti FV, Iversen VV, Bjordal JM (2010) Effects of low-level laser therapy (LLLT) in the development of exercise-induced skeletal muscle fatigue and changes in biochemical markers related to post-exercise recovery. J Orthop Sports Phys Ther 40:524–532PubMedCrossRef Leal Junior EC, Lopes-Martins RA, Frigo L, De Marchi T, Rossi RP, de Godoi V, Tomazoni SS, da Silva DP, Basso M, Lotti Filho P, Corsetti FV, Iversen VV, Bjordal JM (2010) Effects of low-level laser therapy (LLLT) in the development of exercise-induced skeletal muscle fatigue and changes in biochemical markers related to post-exercise recovery. J Orthop Sports Phys Ther 40:524–532PubMedCrossRef
14.
Zurück zum Zitat De Marchi T, Leal Junior EC, Bortoli C, Tomazoni SS, Lopes-Martins RA, Salvador M (2012) Low-level laser therapy (LLLT) in human progressive-intensity running: effects on exercise performance, skeletal muscle status, and oxidative stress. Lasers Med Sci 27:231–236PubMedCrossRef De Marchi T, Leal Junior EC, Bortoli C, Tomazoni SS, Lopes-Martins RA, Salvador M (2012) Low-level laser therapy (LLLT) in human progressive-intensity running: effects on exercise performance, skeletal muscle status, and oxidative stress. Lasers Med Sci 27:231–236PubMedCrossRef
15.
Zurück zum Zitat Dos Santos Maciel T, Muñoz IS, Nicolau RA, Nogueira DV, Hauck LA, Osório RA, de Paula Júnior AR (2013) Phototherapy effect on the muscular activity of regular physical activity practitioners. Lasers Med Sci 29:1145–1152PubMedCrossRef Dos Santos Maciel T, Muñoz IS, Nicolau RA, Nogueira DV, Hauck LA, Osório RA, de Paula Júnior AR (2013) Phototherapy effect on the muscular activity of regular physical activity practitioners. Lasers Med Sci 29:1145–1152PubMedCrossRef
16.
Zurück zum Zitat Leal Junior EC, Lopes-Martins RA, Baroni BM, De Marchi T, Rossi RP, Grosselli D, Generosi RA, de Godoi V, Basso M, Mancalossi JL, Bjordal JM (2009) Comparison between single-diode low-level laser therapy (LLLT) and LED multi-diode (cluster) therapy (LEDT) applications before high-intensity exercise. Photomed Laser Surg 27:617–623PubMedCrossRef Leal Junior EC, Lopes-Martins RA, Baroni BM, De Marchi T, Rossi RP, Grosselli D, Generosi RA, de Godoi V, Basso M, Mancalossi JL, Bjordal JM (2009) Comparison between single-diode low-level laser therapy (LLLT) and LED multi-diode (cluster) therapy (LEDT) applications before high-intensity exercise. Photomed Laser Surg 27:617–623PubMedCrossRef
17.
Zurück zum Zitat Leal Junior EC, Lopes-Martins RA, Rossi RP, De Marchi T, Baroni BM, de Godoi V, Marcos RL, Ramos L, Bjordal JM (2009) Effect of cluster multi-diode light emitting diode therapy (LEDT) on exercise-induced skeletal muscle fatigue and skeletal muscle recovery in humans. Lasers Surg Med 41:572–577PubMedCrossRef Leal Junior EC, Lopes-Martins RA, Rossi RP, De Marchi T, Baroni BM, de Godoi V, Marcos RL, Ramos L, Bjordal JM (2009) Effect of cluster multi-diode light emitting diode therapy (LEDT) on exercise-induced skeletal muscle fatigue and skeletal muscle recovery in humans. Lasers Surg Med 41:572–577PubMedCrossRef
18.
Zurück zum Zitat Borges LS, Cerqueira MS, Dos Santos Rocha JA, Conrado LA, Machado M, Pereira R, Neto OP (2013) Light-emitting diode phototherapy improves muscle recovery after a damaging exercise. Lasers Med Sci 29:1139–1144PubMed Borges LS, Cerqueira MS, Dos Santos Rocha JA, Conrado LA, Machado M, Pereira R, Neto OP (2013) Light-emitting diode phototherapy improves muscle recovery after a damaging exercise. Lasers Med Sci 29:1139–1144PubMed
19.
Zurück zum Zitat Miranda EF, Leal Junior EC, Marchetti PH, Dal Corso S (2014) Acute effects of light emitting diodes therapy (LEDT) in muscle function during isometric exercise in patients with chronic obstructive pulmonary disease: preliminary results of a randomized controlled trial. Lasers Med Sci 29:359–365PubMedCrossRef Miranda EF, Leal Junior EC, Marchetti PH, Dal Corso S (2014) Acute effects of light emitting diodes therapy (LEDT) in muscle function during isometric exercise in patients with chronic obstructive pulmonary disease: preliminary results of a randomized controlled trial. Lasers Med Sci 29:359–365PubMedCrossRef
20.
Zurück zum Zitat Borsa PA, Larkin KA, True JM (2013) Does phototherapy enhance skeletal muscle contractile function and postexercise recovery? A systematic review. J Athl Train 48:57–67PubMedPubMedCentral Borsa PA, Larkin KA, True JM (2013) Does phototherapy enhance skeletal muscle contractile function and postexercise recovery? A systematic review. J Athl Train 48:57–67PubMedPubMedCentral
21.
Zurück zum Zitat Leal Junior EC, Vanin AA, Miranda EF, de Carvalho PT, Dal Corso S, Bjordal JM (2013) Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis. Lasers Med Sci. doi:10.1007/s10103-013-1465-4 Leal Junior EC, Vanin AA, Miranda EF, de Carvalho PT, Dal Corso S, Bjordal JM (2013) Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis. Lasers Med Sci. doi:10.​1007/​s10103-013-1465-4
22.
Zurück zum Zitat Joensen J, Demmink JH, Johnson MI, Iversen VV, Lopes-Martins RÁ, Bjordal JM (2011) The thermal effects of therapeutic lasers with 810 and 904 nm wavelengths on human skin. Photomed Laser Surg 29:145–153PubMedCrossRef Joensen J, Demmink JH, Johnson MI, Iversen VV, Lopes-Martins RÁ, Bjordal JM (2011) The thermal effects of therapeutic lasers with 810 and 904 nm wavelengths on human skin. Photomed Laser Surg 29:145–153PubMedCrossRef
23.
Zurück zum Zitat de Oliveira AR, Vanin AA, De Marchi T, Antonialli FC, Grandinetti VD, de Paiva PR, Albuquerque Pontes GM, Santos LA, Aleixo ID Jr, de Carvalho PD, Bjordal JM, Leal Junior EC (2014) What is the ideal dose and power output of low-level laser therapy (810 nm) on muscle performance and post-exercise recovery? Study protocol for a double-blind, randomized, placebo-controlled trial. Trials 15:69PubMedCrossRefPubMedCentral de Oliveira AR, Vanin AA, De Marchi T, Antonialli FC, Grandinetti VD, de Paiva PR, Albuquerque Pontes GM, Santos LA, Aleixo ID Jr, de Carvalho PD, Bjordal JM, Leal Junior EC (2014) What is the ideal dose and power output of low-level laser therapy (810 nm) on muscle performance and post-exercise recovery? Study protocol for a double-blind, randomized, placebo-controlled trial. Trials 15:69PubMedCrossRefPubMedCentral
24.
Zurück zum Zitat Baroni BM, Leal Junior EC, De Marchi T, Lopes AL, Salvador M, Vaz MA (2010) Low level laser therapy before eccentric exercise reduces muscle damage markers in humans. Eur J Appl Physiol 110:789–796PubMedCrossRef Baroni BM, Leal Junior EC, De Marchi T, Lopes AL, Salvador M, Vaz MA (2010) Low level laser therapy before eccentric exercise reduces muscle damage markers in humans. Eur J Appl Physiol 110:789–796PubMedCrossRef
26.
Zurück zum Zitat Leal Junior EC, Lopes-Martins RA, de Almeida P, Ramos L, Iversen VV, Bjordal JM (2010) Effect of low-level laser therapy (GaAs 904 nm) in skeletal muscle fatigue and biochemical markers of muscle damage in rats. Eur J Appl Physiol 108:1083–1088PubMedCrossRef Leal Junior EC, Lopes-Martins RA, de Almeida P, Ramos L, Iversen VV, Bjordal JM (2010) Effect of low-level laser therapy (GaAs 904 nm) in skeletal muscle fatigue and biochemical markers of muscle damage in rats. Eur J Appl Physiol 108:1083–1088PubMedCrossRef
27.
Zurück zum Zitat de Almeida P, Lopes-Martins RÁ, Tomazoni SS, Silva JA Jr, de Carvalho PT, Bjordal JM, Leal Junior EC (2011) Low-level laser therapy improves skeletal muscle performance, decreases skeletal muscle damage and modulates mRNA expression of COX-1 and COX-2 in a dose-dependent manner. Photochem Photobiol 87:1159–1163PubMedCrossRef de Almeida P, Lopes-Martins RÁ, Tomazoni SS, Silva JA Jr, de Carvalho PT, Bjordal JM, Leal Junior EC (2011) Low-level laser therapy improves skeletal muscle performance, decreases skeletal muscle damage and modulates mRNA expression of COX-1 and COX-2 in a dose-dependent manner. Photochem Photobiol 87:1159–1163PubMedCrossRef
28.
Zurück zum Zitat Santos LA, Marcos RL, Tomazoni SS, Vanin AA, Antonialli FC, Grandinetti VS, Albuquerque-Pontes GM, Paiva PR, Lopes-Martins RA, de Carvalho PT, Bjordal JM, Leal Junior EC (2014) Effects of pre-irradiation of low-level laser therapy with different doses and wavelengths in skeletal muscle performance, fatigue and skeletal muscle damage induced by tetanic contractions in rats. Lasers Med Sci. doi:10.1007/s10103-014-1560-1 Santos LA, Marcos RL, Tomazoni SS, Vanin AA, Antonialli FC, Grandinetti VS, Albuquerque-Pontes GM, Paiva PR, Lopes-Martins RA, de Carvalho PT, Bjordal JM, Leal Junior EC (2014) Effects of pre-irradiation of low-level laser therapy with different doses and wavelengths in skeletal muscle performance, fatigue and skeletal muscle damage induced by tetanic contractions in rats. Lasers Med Sci. doi:10.​1007/​s10103-014-1560-1
29.
Zurück zum Zitat Tullberg M, Alstergren PJ, Ernberg MM (2003) Effects of low-power laser exposure on masseter muscle pain and microcirculation. Pain 105:89–96PubMedCrossRef Tullberg M, Alstergren PJ, Ernberg MM (2003) Effects of low-power laser exposure on masseter muscle pain and microcirculation. Pain 105:89–96PubMedCrossRef
30.
Zurück zum Zitat Silveira PC, Silva LA, Fraga DB, Freitas TP, Streck EL, Pinho R (2009) Evaluation of mitochondrial respiratory chain activity in muscle healing by low-level laser therapy. J Photochem Photobiol B 95:89–92PubMedCrossRef Silveira PC, Silva LA, Fraga DB, Freitas TP, Streck EL, Pinho R (2009) Evaluation of mitochondrial respiratory chain activity in muscle healing by low-level laser therapy. J Photochem Photobiol B 95:89–92PubMedCrossRef
31.
Zurück zum Zitat Xu X, Zhao X, Liu TC, Pan H (2008) Low-intensity laser irradiation improves the mitochondrial dysfunction of C2C12 induced by electrical stimulation. Photomed Laser Surg 26:197–202PubMedCrossRef Xu X, Zhao X, Liu TC, Pan H (2008) Low-intensity laser irradiation improves the mitochondrial dysfunction of C2C12 induced by electrical stimulation. Photomed Laser Surg 26:197–202PubMedCrossRef
32.
Zurück zum Zitat Avni D, Levkovitz S, Maltz L, Oron U (2005) Protection of skeletal muscles from ischemic injury: low-level laser therapy increases antioxidant activity. Photomed Laser Surg 23:273–277PubMedCrossRef Avni D, Levkovitz S, Maltz L, Oron U (2005) Protection of skeletal muscles from ischemic injury: low-level laser therapy increases antioxidant activity. Photomed Laser Surg 23:273–277PubMedCrossRef
33.
Zurück zum Zitat Rizzi CF, Mauriz JL, Freitas Correa DS, Moreira AJ, Zettler CG, Filippin LI, Marroni NP, González-Gallego J (2006) Effects of low-level laser therapy (LLLT) on the nuclear factor (NF)-kappaB signaling pathway in traumatized muscle. Lasers Surg Med 38:704–713PubMedCrossRef Rizzi CF, Mauriz JL, Freitas Correa DS, Moreira AJ, Zettler CG, Filippin LI, Marroni NP, González-Gallego J (2006) Effects of low-level laser therapy (LLLT) on the nuclear factor (NF)-kappaB signaling pathway in traumatized muscle. Lasers Surg Med 38:704–713PubMedCrossRef
34.
Zurück zum Zitat Hayworth CR, Rojas JC, Padilla E, Holmes GM, Sheridan EC, Gonzalez-Lima F (2010) In vivo low-level light therapy increases cytochrome oxidase in skeletal muscle. Photochem Photobiol 86:673–680PubMedCrossRef Hayworth CR, Rojas JC, Padilla E, Holmes GM, Sheridan EC, Gonzalez-Lima F (2010) In vivo low-level light therapy increases cytochrome oxidase in skeletal muscle. Photochem Photobiol 86:673–680PubMedCrossRef
Metadaten
Titel
Phototherapy in skeletal muscle performance and recovery after exercise: effect of combination of super-pulsed laser and light-emitting diodes
verfasst von
Fernanda Colella Antonialli
Thiago De Marchi
Shaiane Silva Tomazoni
Adriane Aver Vanin
Vanessa dos Santos Grandinetti
Paulo Roberto Vicente de Paiva
Henrique Dantas Pinto
Eduardo Foschini Miranda
Paulo de Tarso Camillo de Carvalho
Ernesto Cesar Pinto Leal-Junior
Publikationsdatum
01.11.2014
Verlag
Springer London
Erschienen in
Lasers in Medical Science / Ausgabe 6/2014
Print ISSN: 0268-8921
Elektronische ISSN: 1435-604X
DOI
https://doi.org/10.1007/s10103-014-1611-7

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