***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Various studies have shown biostimulation effects of laser irradiation by producing metabolic changes within the cells . Little is known about the biological effect of laser irradiation on the oral tissues . Among the many physiological effects , it is important to recognize that low-level laser therapy ( LLLT ) may affect release of growth factors from fibroblasts . Therefore , the aim of the present study was to determine whether the laser irradiation can enhance the release of basic fibroblast growth factor ( bFGF ) , insulin-like growth factor-1 ( IGF-1 ) , and receptor of IGF-1 ( IGFBP3 ) from human gingival fibroblasts ( HGF ) . The number of all sample s in the study were 30 , and the sample s were r and omly divided into three equal groups ; In the first group ( single dose group ) , HGF were irradiated with laser energy of 685 nm , for 140 s , 2 J/cm2 for one time , and in the second group , energy at the same dose was applied for two consecutive days ( double dose group ) . The third group served as nonirradiated control group . Proliferation , viability , and bFGF , IGF-1 , IGFBP3 analysis of control and irradiated cultures were compared with each other . Both of the irradiated groups revealed higher proliferation and viability in comparison to the control group . Comparison of the single-dose group with the control group revealed statistically significant increases in bFGF ( p < 0.01 ) and IGF-1 ( p < 0.01 ) , but IGFBP3 increased insignificantly ( p > 0.05 ) . When the double dose group was compared with the control group , significant increases were determined in all of the parameters ( p < 0.01 ) . In the comparison of the differences between the two irradiated groups ( one dose and two doses ) , none of the parameters displayed any statistically significant difference ( p > 0.05 ) . In both of the laser groups , LLLT increased the cell proliferation and cell viability . The results of this study showed that LLLT increased the proliferation of HGF cells and release of bFGF , IGF-1 , and IGFBP3 from these cells . LLLT may play an important role in periodontal wound healing and regeneration by enhancing the production of the growth factors Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Objective : To compare the long-term efficacy of pneumatic compression and low-level laser therapies in the management of postmastectomy lymphoedema . Design : R and omized controlled trial . Setting : Department of Physical Medicine and Rehabilitation of Cukurova University , Turkey . Subjects : Forty-seven patients with postmastectomy lymphoedema were enrolled in the study . Interventions : Patients were r and omly allocated to pneumatic compression ( group I , n=24 ) and low-level laser ( group II , n=23 ) groups . Group I received 2 hours of compression therapy and group II received 20 minutes of laser therapy for four weeks . All patients were advised to perform daily limb exercises . Main measures : Demographic features , difference between sum of the circumferences of affected and unaffected limbs ( ▵ C ) , pain with visual analogue scale and grip strength were recorded . Results : Mean age of the patients was 48.3 ( 10.4 ) years . ▵ C decreased significantly at one , three and six months within both groups , and the decrease was still significant at month 12 only in group II ( P = 0.004 ) . Improvement of group II was greater than that of group I post treatment ( P = 0.04 ) and at month 12 after 12 months ( P = 0.02 ) . Pain was significantly reduced in group I only at posttreatment evaluation , whereas in group II it was significant post treatment and at follow-up visits . No significant difference was detected in pain scores between the two groups . Grip strength was improved in both groups , but the differences between groups were not significant . Conclusions : Patients in both groups improved after the interventions . Group II had better long-term results than group I. Low-level laser might be a useful modality in the treatment of postmastectomy lymphoedema The current study describes the results of a double blind , placebo‐controlled , r and omized , single crossover trial of the treatment of patients with postmastectomy lymphedema ( PML )  with low‐level laser therapy ( LLLT ) Abstract Background and Objective : As Light Emitting Diode ( LED ) devices are commercially introduced as an alternative for Low Level Laser ( LLL ) Therapy , the ability of LED in influencing wound healing processes at cellular level was examined . Study Design / Material s and Methods : Cultured fibroblasts were treated in a controlled , r and omized manner , during three consecutive days , either with an infrared LLL or with a LED light source emitting several wavelengths ( 950 nm , 660 nm and 570 nm ) and respective power outputs . Treatment duration varied in relation to varying surface energy densities ( radiant exposures ) . Results : Statistical analysis revealed a higher rate of proliferation ( p ≤ 0.001 ) in all irradiated cultures in comparison with the controls . Green light yielded a significantly higher number of cells , than red ( p ≤ 0.001 ) and infrared LED light ( p ≤ 0.001 ) and than the cultures irradiated with the LLL ( p ≤ 0.001 ) ; the red probe provided a higher increase ( p ≤ 0.001 ) than the infrared LED probe and than the LLL source . Conclusion : LED and LLL irradiation result ed in an increased fibroblast proliferation in vitro . This study therefore postulates possible stimulatory effects on wound healing in vivo at the applied dosimetric parameters The aim of this paper was to study the effects of low-level laser therapy ( LLLT ) in the treatment of postmastectomy lymphedema . Eleven women with unilateral postmastectomy lymphedema were enrolled in a double-blind controlled trial . Patients were r and omly assigned to laser and sham groups and received laser or placebo irradiation ( Ga – As laser device with a wavelength of 890 nm and fluence of 1.5 J/cm2 ) over the arm and axillary areas . Changes in patients ’ limb circumference , pain score , range of motion , heaviness of the affected limb , and desire to continue the treatment were measured before the treatment and at follow-up sessions ( weeks 3 , 9 , 12 , 18 , and 22 ) and were compared to pretreatment values . Results showed that of the 11 enrolled patients , eight completed the treatment sessions . Reduction in limb circumference was detected in both groups , although it was more pronounced in the laser group up to the end of 22nd week . Desire to continue treatment at each session and baseline score in the laser group was greater than in the sham group in all sessions . Pain reduction in the laser group was more than in the sham group except for the weeks 3 and 9 . No substantial differences were seen in other two parameters between the two treatment groups . In conclusion , despite our encouraging results , further studies of the effects of LLLT in management of postmastectomy lymphedema should be undertaken to determine the optimal physiological and physical parameters to obtain the most effective clinical response Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists PURPOSE / OBJECTIVES To examine the impact of advanced practice nurse (APN)-administered low-level laser therapy ( LLLT ) as both a st and -alone and complementary treatment for arm volume , symptoms , and quality of life ( QOL ) in women with breast cancer-related lymphedema . DESIGN A three-group , pilot , r and omized clinical trial . SETTING A private rehabilitation practice in the southeastern United States . SAMPLE 46 breast cancer survivors with treatment-related lymphedema . METHODS Patients were screened for eligibility and then r and omized to either manual lymphatic drainage ( MLD ) for 40 minutes , LLLT for 20 minutes , or 20 minutes of MLD followed by 20 minutes of LLLT . Compression b and aging was applied after each treatment . Data were collected pretreatment , daily , weekly , and at the end of treatment . MAIN RESEARCH VARIABLES Independent variables consisted of three types of APN-administered lymphedema treatment . Outcome variables included limb volume , extracellular fluid , psychological and physical symptoms , and QOL . FINDINGS No statistically significant between-group differences were found in volume reduction ; however , all groups had clinical ly and statistically significant reduction in volume . No group differences were noted in psychological and physical symptoms or QOL ; however , treatment-related improvements were noted in symptom burden within all groups . Skin improvement was noted in each group that received LLLT . CONCLUSIONS LLLT with b and aging may offer a time-saving therapeutic option to conventional MLD . Alternatively , compression b and aging alone could account for the demonstrated volume reduction . IMPLICATION S FOR NURSING APNs can effectively treat lymphedema . APNs in private healthcare practice s can serve as valuable research collaborators . KNOWLEDGE TRANSLATION Lasers may provide effective , less burdensome treatment for lymphedema . APNs with lymphedema certification can effectively treat this patient population with the use of LLLT . In addition , bioelectrical impedance and tape measurements can be used to assess lymphedema Muscle regeneration is a complex phenomenon , involving replacement of damaged fibers by new muscle fibers . During this process , there is a tendency to form scar tissue or fibrosis by deposition of collagen that could be detrimental to muscle function . New therapies that could regulate fibrosis and favor muscle regeneration would be important for physical therapy . Low-level laser therapy ( LLLT ) has been studied for clinical treatment of skeletal muscle injuries and disorders , even though the molecular and cellular mechanisms have not yet been clarified . The aim of this study was to evaluate the effects of LLLT on molecular markers involved in muscle fibrosis and regeneration after cryolesion of the tibialis anterior ( TA ) muscle in rats . Sixty Wistar rats were r and omly divided into three groups : control , injured TA muscle without LLLT , injured TA muscle treated with LLLT . The injured region was irradiated daily for four consecutive days , starting immediately after the lesion using an AlGaAs laser ( 808 nm , 30 mW , 180 J/cm2 ; 3.8 W/cm2 , 1.4 J ) . The animals were sacrificed on the fourth day after injury . LLLT significantly reduced the lesion percentage area in the injured muscle ( p < 0.05 ) , increased mRNA levels of the transcription factors MyoD and myogenin ( p < 0.01 ) and the pro-angiogenic vascular endothelial growth factor ( p < 0.01 ) . Moreover , LLLT decreased the expression of the profibrotic transforming growth factor TGF-β mRNA ( p < 0.01 ) and reduced type I collagen deposition ( p < 0.01 ) . These results suggest that LLLT could be an effective therapeutic approach for promoting skeletal muscle regeneration while preventing tissue fibrosis after muscle injury Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer . Breast cancer treatment sequelae , such as lymphedema , may occur early or late and often negatively affect function . Secondary prevention through prospect i ve physical therapy surveillance aids in early identification and treatment of breast cancer – related lymphedema ( BCRL ) . Early intervention may reduce the need for intensive rehabilitation and may be cost saving . This perspective article compares a prospect i ve surveillance model with a traditional model of impairment-based care and exam 
    Output:
    
Conclusions Based upon the current systematic review , LLLT ( PBM ) may be considered an effective treatment approach for women with BCRL .