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TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja.

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Presentation on theme: "TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja."— Presentation transcript:

1 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on:

2 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT: CLINICAL APPLICATIONS

3 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: INTRODUCTION TO LIGHT THERAPY CHARACTERISTICS OF EMITTED LIGHT TARGET AREAS THERAPEUTIC EFFECTS CLINICAL APPLICATIONS LIGHT THERAPY SYSTEM CONTENTS

4 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: INTRODUCTION TO LIGHT THERAPY

5 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WHAT IS LIGHT? Energy Wavelength Visible light Ultraviolet radiation Infra-red radiation MicrowavesX-raysGamma-raysRadio waves Electromagnetic spectrum Light is a form of energy Light has wave-like properties Light is part of the electromagnetic spectrum This is a range of types of radiation from low energy radio waves to high energy gamma rays

6 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: LIGHT THERAPY: HISTORY Light has been used to treat various medical conditions since ancient times Modern light therapy was pioneered by Niels Ryberg Finsen*, a Danish physician Recent developments in light therapy have used low-power lasers & other sources of polarized light * Nobel Prize winner (Medicine) 1903

7 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: CHARACTERISTICS OF EMITED LIGHT

8 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: CHARACTERISTICS OF EMITTED LIGHT The light emitted by this light therapy system has specific characteristics Light emitted from visible & part of infra-red regions of the spectrum Polarized Polychromatic Incoherent Low energy Light waves move in parallel Light waves are out-of-phase Optimal tissue penetration with minimal heat effects

9 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Non-polarized light waves move (oscillate) in all directions (planes) Polarized light waves are restricted to oscillate in parallel planes Highly efficient polarization process used (degree of polarization ~95%) Achieved using a system of multi-layered mirrors Non-polarized Polarized POLARIZED LIGHT

10 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: POLYCHROMATIC LIGHT Light emitted contains a range of wavelengths (480nm 3400nm) This includes visible light & part of the infra-red region No ultraviolet radiation is emitted safety BIOPTRON light480nm3400nm

11 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: INCOHERENT LIGHT Light waves emitted by this system are not synchronized, i.e. they are out-of-phase Unlike laser light in which all the light waves are synchronized BIOPTRON Light Laser light

12 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: LOW ENERGY LIGHT Light waves emitted have low energy density* This provides optimal tissue penetration with minimal heating effect *Energy density ~ 2.4 Joules/cm 2 per minute *Power density ~ 40 mW/cm 2 High energyLow energy HEAT MINIMAL HEAT

13 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: LIGHT CHARACTERISTICS: BENEFITS This combination of light characteristics confers several benefits; Optimal tissue penetration Minimal heating effects No damage to the skin or underlying tissue No known side effects

14 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: TARGET AREA

15 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: LIGHT PENETRATION INTO TISSUES When the light therapy device is held over the skin, energy from emitted light penetrates the underlying tissues This produces a biological response (called photo-biostimulation) Different wavelengths of light can affect different tissues Both visible light & infra-red radiation have been reported to stimulate changes at the cellular level

16 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: ~ ~ Subcutaneous tissue Epidermis Dermis Cross-section of human skin & underlying tissues 0 Penetration depth mm (approx.) >1350 UV 1.0 BIOPTRON Light 3.0 VisibleInfra-red LIGHT PENETRATION INTO TISSUES Wavelength λ [nm]

17 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: POSSIBLE CELULAR TARGETS The exact mechanism of action of photo- biostimulation is still under investigation Proposed targets within the cell include Cell membrane Acting on polar heads of phospholipid bi-layer 1 Acting on calcium channels 2 Mitochondria 3 Changes to the local peripheral blood supply may also be involved 4 1 Karu T. Health Physics 1989; 56: Smith KC. Laser Therapy 1991; 3: Kertesz I. Optics & Laser Technology 1982; 16: Medenica L. J. Wound Care 2003;12: Basic science 1

18 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: POSSIBLE CELULAR TARGETS OF LIGHT THERAPY Mitochondrion Cell membrane Human cell

19 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: The bodys organs (e.g. heart, liver, skin) are made up from different types of tissue A tissue is a collection of cells that are similar in structure & function (e.g. muscle, nerve, bone) A cell is the basic structural unit of the body & each person is made of billions of cells Each cell has an outer layer (cell membrane) & contains specialized structures (organelles) A mitochondrion is one type of organelle; mitochondria are the cells powerhouses & release energy to power the cells activities Basic science - #1

20 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Light therapy may cause structural changes in the cell membrane & alter lipid-protein interactions 1 This could reduce the activation energy required for certain enzymatic reactions 1 Infra-red radiation has been shown to stimulate the cell membrane, probably via activation of Ca 2+ channels 2 Structural changes in cell membrane Alteration in lipid-protein interactions Decreased activation energy for enzyme reactions 1 Kertesz I. Optics & Laser Technology 1982; 16: Smith KC. Laser Therapy 1991; 3: Lipid bilayer; Head Tail Membrane protein Inside cell Basic science 2 EFFECTS ON CELL MEMBRANE

21 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: The outer layer of the cell is called the cell membrane It is made from a double layer of special fat molecules (phospholipids); sitting in this layer are protein molecules These proteins have various specialized functions; some (called enzymes) act as catalysts for cell reactions Other proteins form channels that allow the controlled entry/exit of salts, sugars & other molecules in & out of the cell; one type of channel is the calcium channel Calcium (Ca 2+ ) plays an vital role in passing messages within & between cells Basic science - #2

22 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Absorption of visible light energy by the mitochondria is postulated to activate a chain of molecular events 1 This results in an increase in available cell energy & the activation of nucleic acid synthesis (DNA & RNA) This is essential for repairing tissue damage Respiratory chain reactions ADPATP ATP synthase Nucleic acid synthesis, etc. 1 Karu T. Health Physics 1989; 56: Cell energy Outer membrane Inner membrane Basic science EFFECTS ON MITOCHONDRIA

23 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: There are numerous sausage-shaped mitochondria within each cell Inside each mitochondrion, various molecular reactions are carried out that release energy This energy is stored in chemical packets called ATP molecules Energy released from ATP is required for cellular functions & all cells require a constant supply of ATP Copying the cells genetic material (nucleic acids; DNA, RNA) is one process that requires large amounts of ATP Basic science - #3

24 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: OTHER TARGETS Light therapy also causes dilatation of blood vessels in the area treated 1 This has several beneficial effects; 1 Lievens P. Laser 1988; 1: 6-12 Promotion of healing Increased delivery of nutrients Increased delivery of oxygen Improved local blood flow

25 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Light therapy may also improve the drainage of extra-cellular fluid into lymphatic vessels This reduces edema (tissue swelling) Reduction of edema helps to decrease pain & improve mobility of the affected area (e.g. a swollen joint) OTHER TARGETS

26 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Click on box to launch animation TARGET PROCESS

27 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: THERAPEUTIC EFFECTS

28 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: THERAPEUTIC EFFECTS The main therapeutic effects of polarized light therapy are Stimulation of tissue repair Stimulation of body defense mechanisms Reduction of pain sensation

29 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: STIMULATION OF TISSUE REPAIR Light therapy has a stimulatory effect on healing Stimulation of cell proliferation Enhanced collagen synthesis Release of growth factors Acceleration of wound closure Improved quality of scar tissue Demonstrated by in vitro & in vivo data1-4 Findings confirmed by clinical studies5-8 1 Mester E. Lasers Surg. Med. 1985; 5: Kertesz I. Optics & Laser Technology 1982; 16: Kubasova T. Photochem. Photobiol. 1988; 48: Bolton P. Laser Therapy 1992; 4: Depuyt K. Abstract 10 th Annual EURAPS Meeting, Medenica L. J. Wound Care 2003;12: Monstrey S. Br. J. Plastic Surg. 2002; 55: Iordanou P. Int. J. Nurs. Pract. 2002; 8: Basic science 4 Clinical data

30 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: STIMULATION OF TISSUE REPAIR WITH LIGHT THERAPY

31 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Connective tissue provides a structural framework that supports blood vessels, nerves & other tissues/organs Connective tissue is made from different types of cells plus a mix of protein fibers & complex sugars Collagen is one such type of protein fiber; it is found in several places including the lower layers of the skin (dermis) Collagen is important in repairing damage involving the skin (i.e. from cuts, ulcers, surgical incisions) & is the main component of scar tissue Collagen is made by special cells called fibroblasts Basic science - #4

32 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: USE OF POLARIZED LIGHT THERAPY IN THE MANAGEMENT OF VENOUS ULCERS: A PILOT STUDY Aims To assess the efficacy of polarized light in the treatment of venous leg ulcers Treatment regimen All 25 patients given light therapy x8 minutes daily for 4 weeks Concomitant treatment = saline bath & dry dressing Assessment Ulcer size post-therapy (performed weekly) Medenica L & Lens M. J. Wound Care 2003; 12: 37-40

33 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Medenica L & Lens M. J. Wound Care 2003; 12: Results 99% ulcers showed positive improvement in healing area by end of week 4 Decrease in wound surface area at end of study statistically significant (mean decrease 57%; SD 32%; p<0.01) Mean overall healing rate of 3.5cm 2 per week (SD 4.1; range to +19.3) Total number of 73 leg ulcers at beginning of study was reduced to 51 after end of week 4 (p<0.01) No adverse effects observed Conclusions Polarized light therapy used as monotherapy was associated with positive healing rates in patients with venous leg ulcers USE OF POLARIZED LIGHT THERAPY IN THE MANAGEMENT OF VENOUS ULCERS: A PILOT STUDY

34 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Medenica L & Lens M. J. Wound Care 2003; 12: After 4 weeks of treatment Immediately before treatment USE OF POLARIZED LIGHT THERAPY IN THE MANAGEMENT OF VENOUS ULCERS: A PILOT STUDY

35 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: STIMULATION OF BODY DEFENSE MECHANISMS Light therapy may promote non-specific cellular immune responses1 Activation of neutrophil granulocytes Activation of monocytes / macrophages Stimulation of natural killer cells These activities have general bactericidal & anti- tumor effects 1 Samoilova KA. Proc. Low-Power Light Biol. Syst. 1998; IV: Basic science 5

36 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: STIMULATION OF NON-SPECIFIC IMMUNE REACTIONS WITH LIGHT THERAPY Red blood cell White blood cells Neutrophil granulocyte Natural killer cell Monocyte / macrophage

37 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Basic science #5 White blood cells (leukocytes) protect the body against infection from viruses & bacteria or infestation from parasites; they are sub-divided into several types - Neutrophil granulocytes attack bacteria Monocytes are large cells that digest foreign material & dead matter; they can leave the bloodstream & enter the tissues, where they are then called macrophages Natural killer cells* eliminate virus-infected cells & tumor cells (*exact origin of these cells is not yet known) [Lymphocytes are a further type of leukocyte involved in immune function; they recognize specific foreign particles (antigens). Lymphocytes are divided into B-cells (produce antibodies) & T-cells (help B-cells, kill infected cells, etc.)]

38 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: REDUCTION OF PAIN SENSATION Light therapy may influence pain sensation in several ways 1-4 Improved local blood flow Reduction in muscle spasm Reduction of inflammation Induction of natural pain-killing chemicals Reduction of pain transmission by direct action on peripheral nerves 1 Konstantinovic L. Vojnosanit Pregl 1989; 46: Sakurai Y. Eur. J. Oral Science 2000; 108: Walker JB. Neurosci. Lett. 1983; 4: Tam G. J. Clin. Laser Med. Surg. 1999; 17: Basic science 6 Clinical data

39 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: REDUCTION OF PAIN SENSATION WITH LIGHT THERAPY Release of pain & inflammatory mediators Stimulation of pain receptors & nerve pathways Sensation of pain Muscle spasm Light therapy: potential effects Cell damageTissue ischemia

40 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Basic science #6 Pain is an unpleasant sensation that serves to limit or reduce injury to the body Pain is caused by the stimulation of special free nerve endings (pain receptors) that occurs when certain chemicals (mediators) are released following an injury Pain impulses travel up the spinal cord and into the brain, where they are interpreted as the sensation of pain

41 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: USE OF POLARIZED LIGHT THERAPY IN THE TREATMENT OF CHRONIC MUSCULOSKELETAL PAIN Aims To assess the efficacy of polarized light in the treatment of chronic musculoskeletal pain in the neck/shoulders Treatment regimen Patients given light therapy or placebo* x10 minutes daily for 3 days (60 patients in each group) (*Fake light therapy with inactive device) Assessment Self-reported degree of pain (VAS 100mm scale) Linear range of motion Ballyzek MF & Ruscuklic G. Manuscript in preparation 2004

42 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: USE OF POLARIZED LIGHT THERAPY IN THE TREATMENT OF CHRONIC MUSCULOSKELETAL PAIN Results Statistically significant improvement in degree of pain (VAS) in active therapy group (83% versus 12% for placebo) Mean improvement in pain score was four times higher in active therapy group (31 versus 8 for placebo; p<0.001) For all locations of pain, improvement in range of motion after study period was greater in active therapy group Light therapy was safe & well-tolerated with no side effects Conclusion Polarized light therapy used as monotherapy was associated with improvements in degree of pain & range of movement in patients with chronic neck/shoulder pain Ballyzek MF & Ruscuklic G. Manuscript in preparation 2004

43 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: CLINICAL APPLICATIONS OF LIGHT THERAPY

44 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: CLINICAL APPLICATIONS WOUND HEALING Treatment of burns Treatment of skin ulcers (ulcus cruris, decubitus) Treatment of post-operative wounds Treatment of traumatic injuries PAIN THERAPY Treatment of musculoskeletal pain in rheumatology, physiotherapy and sports medicine

45 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Light therapy can be used in many clinical fields Surgery Dermatology Rheumatology Sports medicine Physical therapy Care of the elderly Occupational therapy Pain management Light therapy CLINICAL APPLICATIONS

46 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: in rheumatology:osteoarthritis, rheumatoid arthritis (chronic), arthroses in physiotherapy:low back pain, shoulder and neck pain, carpal tunnel syndrome, scar tissue, musculoskeletal injuries in sports medicine: soft tissue injuries of muscles, tendons & ligaments like muscle spasm, sprains, strains, tendonitis, ligament and muscle tears, dislocations, contusions, tennis elbow PAIN THERAPY

47 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAIN MANAGEMENT: MUSCULOSKELETAL PAIN Example: Lower back pain Treatment with BIOPTRON 2

48 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAIN MANAGEMENT: REHABILITATION Light therapy can be applied to various parts of the body BIOPTRON Pro 1 BIOPTRON Compact IIIBIOPTRON 2

49 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Rheumatology: Arthritis –Arthritis is the inflammation of a joint –Main symptoms include – Pain, swelling, stiffness & loss of function in the affected joint(s) –Huge costs to society – Major cause of disability & poor quality of life Treatment costs + loss of earnings (time off work &/or unemployment; billions per year) –There are many different types of arthritis, including – Osteoarthritis Rheumatoid arthritis PAIN THERAPY

50 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Basic anatomy #1: A joint LigamentBone Articular cartilageSynovial membrane Synovial fluid Articular cartilage – acts as a shock absorber, protects bone Synovial membrane – lines joint & secretes lubricant (synovial fluid)

51 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Osteoarthritis Commonest joint disorder worldwide Frequency increases with age Present in most all people aged >60 years Degenerative joint disease Caused by wearing away of protective cartilage lining the joints Risk factors: excess weight, injury to bone/joint, manual occupations, sports Affects hip, knee, elbow, joints in hand/foot PAIN THERAPY

52 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Osteoarthritis Disease affecting synovial joints Characterised by loss of articular cartilage with accompanying periarticular bone response Diagnosis based upon symptoms + x-ray appearance + pathological joint changes Main signs: microfractures, bone cysts, osteophyte formation & narrowing of joint space Variable rate of disease progression; symptoms flare up & remit PAIN THERAPY

53 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Rheumatoid arthritis Occurs in 0.5-3% of population Usual age of onset years old, although can occur at any age Immune disorder affecting joints (& other parts of the body) Caused by inflammation of the synovial membrane lining the joints Risk factors: female gender, family history, certain immunological/genetic characteristics Affects small joints in hands/feet, knee, elbow, shoulder, neck PAIN THERAPY

54 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Rheumatoid arthritis Chronic, progressive, systemic inflammatory disorder of unknown cause Characterised by inflammatory synovitis; pannus blocks nutrient supply to underlying articular cartilage Diagnosis based upon history + x-ray changes + blood tests Rheumatoid factor present in ~70% cases; associated with greater disease severity Non-articular disease affects lungs, blood vessels & heart, nerves, eyes, kidneys, etc. PAIN THERAPY

55 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON Light Therapy may help to reduce the symptoms of arthritis PAIN THERAPY

56 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Basic anatomy: Soft tissues Tendon – connects a muscle to a bone Ligament – connects a bone to another bone muscle ligaments tendons (bone*) subcutaneous tissue skin (*not a soft tissue)

57 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Sports medicine: Sprains & strains Strain: injury to a muscle or tendon Sprain: injury to a ligament Both are caused by overstretching or tearing Symptoms: pain, swelling, loss of movement, bruising Sprains commonly involve ankle, knee & wrist Strains commonly affect upper arm, elbow, thigh, ankle, groin & abdomen Risk factors: playing sports, gardening, lifting heavy objects, etc PAIN THERAPY

58 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Sports medicine: Dislocations Dislocation: Displacement of bones at a joint Caused by forces pulling a bone into an abnormal position, or by violent muscle contractions Symptoms: pain, swelling, loss of movement, fracture, joint damage Commonly affects shoulder, thumb/finger, jaw Risk factors: any violent collision (car crash, falling, contact sport), electrocution PAIN THERAPY

59 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Sports medicine: Contusions Contusion: Bleeding into the tissue beneath the skin surface (bruise) Caused by blunt trauma to the body Pressure of impact ruptures small blood vessels, causing blood to pool around the injured area Symptoms: swelling, pain Risk factors: playing contact sports (martial arts, football, boxing, etc.) PAIN THERAPY

60 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Sports medicine: Tendinitis & tenosynovitis Tendinitis: Inflammation around a tendon Tenosynovitis: Inflammation around a tendon sheath Caused by overuse or overloading of the tendon (e.g. tennis elbow) Symptoms: pain, stiffness, weakness, loss of movement Risk factors: playing sports (patellar tendon, Achilles tendon), repetitive hand movements - typing, packing, sewing (tendons in wrist/hand) PAIN THERAPY

61 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON Light Therapy may help to reduce the symptoms of sports injuries PAIN THERAPY

62 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Physiotherapy: Lower back pain –Occurs in >75% of people at some point in their lives –Recurrent or persistent lower back pain is a major cause of disability –90% of low back pain is caused by injury to tissues in the back and spine –Other (less common) causes include spinal infection/inflammation, bone disease and tumours –Symptoms: pain, stiffness, difficulty walking/bending, scoliosis –Risk factors: lifting, bad posture, obesity, pregnancy, old age, etc PAIN THERAPY

63 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Physiotherapy: Carpal tunnel syndrome –Swelling of tissues in the carpal tunnel causes compression of the median nerve loss of sensation & loss of movement in the hand –Occurs in 1-3% of the population, more common in women than men (smaller carpal tunnels) –Symptoms: numbness or aching in the hand (often worse at night) weakness/muscle wasting in the thumb –Risk factors: prolonged use of hands (typing, sewing, etc), injury or infection in wrist/hand; also seen in pregnancy, diabetes, obesity, arthritis & hypothyroidism Carpal tunnel is a narrow anatomical passage in the wrist Median nerve passes through it to supply part of the palm, thumb & certain fingers PAIN THERAPY

64 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Physiotherapy: Neck & shoulder pain –Common problem for many people –Often due to minor injury, poor sleep position or prolonged work over a computer keyboard –Injury to the soft tissues in the shoulder/neck include muscle strain/tear, tendonitis, and whiplash injury –Neck/shoulder pain may also occur with arthritis, bone disease (ankylosing spondylitis), disc prolapse and tumours –Symptoms: pain, stiffness, difficulty moving head or upper arm, headache PAIN THERAPY

65 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON Light Therapy may help as a treatment in physiotherapy PAIN THERAPY

66 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WOUND HEALING Burns therapy:partial thickness burns – superficial & deep Skin ulcers:venous leg ulcers diabetic foot ulcers pressure sores Traumatic wounds:surgical wounds – incisions non-surgical injuries – minor cuts & bruises

67 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Source: Dept. Plastic Surgery, University Hospital Ghent, Belgium Example: Burns to face & neck WOUND HEALING: BURNS Immediately before treatment After 12 days of treatment After 9 months of treatment

68 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Source: Dept. Plastic Surgery, University Hospital Ghent, Belgium Example: Pressure sore to sacrum WOUND HEALING: PRESSURE SORES Immediately before treatment After 18 days of treatment After 4 weeks of treatment

69 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WOUND HEALING: POST-OPERATIVE Example: Cardiothoracic surgery Source: First Surgical Hospital, University of Belgrade, Serbia & Montenegro Immediately before treatmentAfter 25 days of treatment

70 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Burns Burns are common injuries Young children & elderly people are particularly vulnerable Burns often occur in the home Examples: spilling hot coffee, steam from cooking, flames/hot coals from a fire, excessively hot bath water, etc. Severity of a burn is classified by the depth of injury Partial thickness burn; superficial or deep Full thickness burn

71 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BASIC HISTOLOGY: NORMAL SKIN & UNDERLYING TISSUES Epidermis Dermis Subcutaneous tissue Cornified layer Basal layer Granular layer Loose connective tissue, blood vessels & sensory cells

72 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: TYPES OF BURN Partial thickness - superficial Full thicknessPartial thickness - deep

73 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Tissues affected Outer skin layer (epidermis) only Common causes Sunburn (mild) Any sudden & brief burst of heat Signs & symptoms Burn is red & painful – no blisters Medical treatment Basic first aid – cold compress pain relief; dressing not required Complications None Burn usually heals within a few days PARTIAL THICKNESS BURNS: SUPERFICIAL

74 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PARTIAL THICKNESS BURNS: DEEP Tissues affected Outer skin layer (epidermis) + part of underlying layer (dermis) Common causes Scalds from hot liquids Flames from fire Contact with hot objects Signs & symptoms Burn is deeply red*, painful, swollen + blistered [*may also appear white or wet] Medical treatment Hospital treatment – if area affected >10-15% total skin area; burns to face/hands/feet/genital area Outpatient treatment for smaller burns – wound is cleaned & protected with a dressing; pain relief Complications Infection of wound; scarring Burn usually heals within 3-4 weeks

75 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: FULL THICKNESS BURNS Tissues affected Outer skin layer (epidermis) + all of underlying layer (dermis) muscle bone Common causes Severe scalds from hot liquids Prolonged contact with flames or hot objects Electrical or chemical sources Signs & symptoms Wound is white, dry & swollen; skin may be blackened; wound is painless (nerve endings destroyed) Medical treatment Hospital treatment (burns unit) – cleaning of wound (surgery); skin graft may be needed Complications Infection; scarring; loss of function Burn may take many weeks to heal completely

76 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON Light Therapy may help to stimulate wound healing following a burn injury (& may also help to reduce pain from the wound) WOUND HEALING: BURNS

77 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: SKIN ULCERS A skin ulcer is an erosion in the surface layer of skin (epidermis) that exposes the underlying tissue (dermis, subdermal tissue) Skin ulcers are often difficult to treat & may take many months to heal Common types of skin ulcer include; Venous ulcer (lower leg) Diabetic ulcer (foot) Pressure sore (lower spine, pelvis, back of head, etc.)

78 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: VENOUS LEG ULCERS 1 person in 50 will develop a venous leg ulcer during their life Commonly occur in elderly people More common in women than men Caused by pooling of blood in the veins in the lower leg Treatment includes Regular wound dressing to keep wound clean Compression bandages Elevation of leg when at rest Regular exercise To reduce pooling of blood

79 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Valves in veins become damaged allows blood to flow downhill towards the feet (due to gravity) Increased pressure from the blood causes fluid to build up in the tissues around the lower leg/ankle Prevents normal flow of oxygen & nutrients to the tissues begin to die Venous ulcer forms VENOUS LEG ULCERS: DEVELOPMENT Venous blood flow: normal Venous blood flow: abnormal x normal valve: closes when leg muscles contract, preventing backflow of blood damaged valve: opens when leg muscles contract, allowing backflow of blood

80 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: VENOUS LEG ULCERS: DEVELOPMENT The precise mechanism for the pathogenesis of venous ulcer formation remains unclear: various theories have been reported Venous stasis and tissue hypoxia were cited as the main etiological factors Later studies recorded elevated oxygen levels in venous blood samples from patients with chronic venous insufficiency and ulcerations, which led to the development of the theory of tissue hypoxia associated with arteriovenous fistulas More recent publications have included reports of the blockade of capillary exchange of gases/nutrients by pre-capillary accumulation of fibrin (subsequently leading to cell death and formation of venous ulceration), and the role of leucocytes in venous ulcer pathogenesis Detail slide

81 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Venous pooling prevents nutrients/oxygen reaching epidermis & the epidermal cells start to die, areas of dead tissue fall off & expose the dermal tissue underneath [zone A]: this is an ulcer Tissue around the ulcer becomes discoloured & eczematous (i.e. itching, flaking skin) [zone B]: it is very vulnerable to injury VENOUS LEG ULCER: PATHOLOGY A B

82 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WOUND HEALING: VENOUS LEG ULCERS BIOPTRON Light Therapy may help to stimulate wound healing in a venous leg ulcer

83 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DIABETIC FOOT ULCERS Diabetes is becoming more common in many populations People with long-term diabetes often develop foot injuries caused by ulceration Lifetime risk of diabetic foot ulcer is 1 in 10 (10%) Diabetic foot ulcers can become so severe that amputation of the lower leg is required Risk of amputation x15-46 higher for a diabetic Diabetic foot ulcers account for ~25% of all hospital admissions for diabetes (USA & UK) Treatment options; Prevention via patient education, good foot hygiene, etc. Wound care, infection control, surgery Information from : Armstrong DG & Lavery LA. Am Fam Physician (online) 1998; 57(6)

84 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DIABETIC FOOT ULCERS: DEVELOPMENT There are several reasons why diabetic people develop foot ulcers – Diabetes damages nerves supplying sensory information to the legs & feet Diabetic person may not notice when he/she injures his/her foot (e.g. cuts, blisters, etc.); consequently, an injury may worsen before it is detected Diabetes damages blood vessels (arteries) supplying the legs & feet Cells may be damaged by not receiving sufficient nutrients & oxygen; if this is prolonged & severe, the cells will die Diabetes causes other changes that may contribute to foot ulceration Decreased sweating resulting in dry, broken skin Impaired wound healing Foot joint deformity causing areas of increased pressure

85 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DIABETIC FOOT ULCERS: DEVELOPMENT Factors contributing to diabetic foot ulcer formation – Detail slide Peripheral neuropathy (loss of protective sensation) Peripheral arterial occlusive disease Autonomic neuropathy (decreased sweating & dry skin) Structural foot deformity (increased focal pressure & movement limitation) Impaired wound healing (poor glucose control)

86 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DIABETIC FOOT ULCERS: LOCATION Diabetic ulcers commonly develop in the weight-bearing areas on the sole of the foot Diabetic ulcers also develop at other pressure points, such as on the toes (which are often deformed in diabetes due to joint damage)

87 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WOUND HEALING: DIABETIC FOOT ULCERS BIOPTRON Light Therapy may help to stimulate wound healing in a diabetic foot ulcer

88 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PRESSURE SORES Pressure sores can occur in anyone who is unable to move part of their body Sedation (general anesthetic), severe illness (coma, stroke), splinting (broken limb), severe pain, etc. Pressure sores can develop in a matter of hours Pressure sores are ulcers caused by downward pressure of the bodys weight + friction forces Pressure sores can take many weeks to heal & can become infected

89 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Pressure sores: development Downward force of the bodys weight squashes the underlying tissue & prevents normal blood flow Tissues are starved of nutrients & oxygen, cells being to die & an ulcer (or sore) begins to form Severe sores can extend down into muscle, bone & even joints Bony parts of body are more vulnerable to development of pressure sores Wet skin is more susceptible to damage (e.g. incontinence) Early stage – skin intact Sore (ulcer) formation Deep sore – into muscle/bone e d s b m

90 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Pressure sores: location Pressure sores develop in bony, weight-bearing parts of the body Pressure sores: location

91 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WOUND HEALING: PRESSURE SORES BIOPTRON Light Therapy may help to stimulate wound healing in a pressure sore

92 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: TRAUMATIC WOUNDS: SURGICAL INCISIONS A surgical incision is a wound made during surgery by a cutting instrument, such as a scalpel There are many different types of surgical incision Chosen by the surgeon depending on the procedure being carried out Example: Abdominal surgical incisions 5 Pararectus 6 Low transverse abdominal 7 Pfannenstiel Midline 2 Paramedian 3 Subcostal 4 McBurney

93 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: SURGICAL INCISIONS Incision Incision with sutures epidermis dermis blood vessel (cut) The edges of a surgical incision are sewn or stapled together to close the wound & promote healing Complications include wound infection, delayed healing, & scarring

94 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: TRAUMATIC WOUNDS: NON-SURGICAL INJURIES Non-surgical traumatic injuries include incisions + lacerations & contusions Incisions Clean cut from a sharp object (e.g. knife or broken glass) Wound edges are straight May bleed profusely as blood vessels cut Lacerations Rough tear caused by crushing or ripping forces Tissue damage & increased risk of infection Less bleeding Contusions Rupturing of blood vessels beneath skin (bruising) caused by blunt force or punch Fracture to bone or other internal injury may be present

95 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Incision: Clean edges Profuse bleeding Contusion: Bleeding from small blood vessels under the skin Laceration: Rough tear Tissue damage NON-SURGICAL INJURIES

96 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: WOUND HEALING: TRAUMATIC WOUNDS BIOPTRON Light Therapy may help to stimulate wound healing following a traumatic wound

97 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: NEW INDICATIONS FOR THE USE OF BIOPTRON LIGHT THERAPY In addition to the existing clinical applications of BIOPTRON Light Therapy, four new sets of indications have been added - Dermatological conditions Paediatric indications Indications in the newborn baby Seasonal affective disorder

98 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGICAL CONDITIONS Acne Atopic dermatitis Psoriasis Herpes infections Superficial bacterial infections Oral mucosal lesions

99 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: NORMAL SKIN STRUCTURE Cornified layer Basal layer Granular layer Epidermis Dermis Subcutaneous fat Hair follicle Sebaceous gland Sweat gland Blood vessels

100 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGY: ACNE Acne vulgaris Common rash occurring on the face, back & chest Mainly affects teenagers & young adults More common in males (testosterone dependent) Caused by blockage & inflammation of the sebaceous glands Blackheads & inflammatory pustules Often heals with scarring Can cause adverse psychosocial effects Poor self-image, low self-confidence, depression Treatment Topical then systemic - antibiotics, retinoids

101 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: ACNE: COMEDONE LESIONS Blackhead (open comedone) Whitehead (closed comedone) Hair follicle Sebaceous gland duct blocked by plug Sebum oxidized & darkened Bacteria

102 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & ACNE BIOPTRON Light Therapy may help to treat acne by reducing skin inflammation & promoting healing

103 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Patient details 60 juvenile patients with acne & other skin disorders (atopic dermatitis, herpes simplex, boils) BLT regimen Duration: 2-4 minutes per treatment area Frequency: 3 to 12 exposures in total per day (depending upon number of treatment areas) Results Good therapeutic response observed in 91% patients Reduced skin healing time No damage to skin following treatment Conclusions Clinical observations confirm marked benefits & healing effects of BLT Patient tolerance was good Device was easy to use BLT STUDY DATA: ACNE MA Khan, Russian Scientific Center of Reconstructive Medicine & Balneotherapy, Moscow,2001

104 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & ACNE Click on box to launch animation

105 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGY: ATOPIC DERMATITIS Atopic dermatitis (eczema) Common condition Occurs in >5% population More common in children (up to 15%) Also called endogenous eczema Occurs in people with allergies (hay fever, asthma) Exacerbating factors = detergents, animal fur, some foods, (house dust mites??) Main clinical features Skin reddens & tiny vesicles may form itching Surface thickens & cracks bleeding painful Secondary infection may occur

106 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: ATOPIC DERMATITIS (CONTINUED) Quality of life issues with atopic dermatitis Constant itching/soreness, loss of sleep (child & parents) Embarrassment at skin lesions Treatment of atopic dermatitis General treatment Avoid known irritants Topical therapy Topical steroid cream + barrier cream + bath soap substitute 2 nd line agents (severe disease) UV therapy, oral steroids, immunosuppressants Prognosis Children commonly grow out of the condition Older children & adults often have chronic disease

107 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: ATOPIC DERMATITIS: PATHOLOGY Normal skinFully developed atopic dermatitis lesion Spongiosis (vesicles) Hyperkeratosis & parakeratosis (skin scales)

108 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: ATOPIC DERMATITIS: COMMON AREAS AFFECTED adult

109 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & ATOPIC DERMATITIS BIOPTRON Light Therapy may help to treat atopic dermatitis by reducing skin inflammation & promoting healing

110 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: ATOPIC DERMATITIS Patient details 36 patients with atopic dermatitis; Males & females aged years IgE levels IU/mL BLT regimen Duration: 10 minutes per session Frequency: 1 session per day Course: 10 sessions Results & conclusions 21/36 (58%) patients showed immediate improvement, 6/36 (17%) patients improved with co-application of skin ointment Complete remission observed in several patients Erythema & skin fissuring decreased Itching & excoriation eliminated BLT shows good therapeutic effects in this disease

111 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGY: PSORIASIS Psoriasis is an incurable, chronic skin disorder Affects up to 3% of the population Men & women affected equally 25% patients have clinically severe disease 10-15% patients also have destructive arthropathy Aetiology not fully understood Genetic component + environmental factors T-cell disorder Clinical features Well defined, red, scaly patches Commonly on extensor surfaces (knees, elbows) Associated with reduced quality of life issues Low self-confidence/ self-esteem, employment, etc.

112 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PSORIASIS Treatment of psoriasis Concerned with control of disease not cure Topical therapies (mild/moderate disease) Emollients, steroids, retinoid, coal tar extracts Phototherapy Psoralen UV-A, UV-B Systemic therapies (severe/resistant disease) Methotrexate, ciclosporin, acitretin Careful monitoring for toxic side effects Prognosis Relapsing-remitting pattern is common Many patients have the disease for life Disease severity cannot be predicted

113 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PSORIASIS: PATHOLOGY Normal skinFully developed psoriatic lesion Hyperkeratosis & parakeratosis (skin scales) Sterile pustule Dilated blood vessels Inflammatory cells Rete ridges accentuated

114 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & PSORIASIS BIOPTRON Light Therapy may help to treat psoriasis by reducing skin inflammation & promoting healing

115 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGY: HERPES SKIN INFECTIONS Herpes viruses Cause a wide range of human disease Characterized by their ability to become latent (silent) & persist within an individual for life Two main types of herpes virus considered here; Herpes simplex virus HSV type 1 – cold sores (HSV type 2 – genital herpes) Varicella zoster virus Chickenpox – children Shingles – older adults

116 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: HERPES SKIN INFECTIONS Treatment Complications Symptoms Entry into body Chickenpox: Aciclovir (adults) Shingles: Aciclovir, valaciclovir, faciclovir Prophylaxis – Zoster immunoglobulin Chickenpox: Pneumonia, CNS involvement (rare) Shingles: Eye complications, persistent pain Chickenpox: days after initial exposure malaise, fever & rapid development of vesicles Shingles: Reactivation of latent VZV from spinal/cranial nerve severe dermatomal pain & skin lesions Via upper respiratory tract mucosa Aciclovir – oral, cream Corneal ulceration, acute encephalitis, erythema multiforme (all rare) Primary infection is usually subclinical. Viral reactivation causes cold sore around mouth/lips. Recurrence occurs in ~ 1 / 3 rd of people. Via the mouth (or skin) Herpes simplex 1Varicella zoster

117 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & HERPES SKIN INFECTIONS BIOPTRON Light Therapy may help to treat herpes skin infections by reducing skin inflammation, stimulating the immune system & promoting healing

118 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Patient details 20 patients with Herpes simplex (HS) lesions 12 patients with Herpes zoster (HZ) lesions (Male & female, aged 15 – 60 years) BLT regimen Duration: 3-4 minutes per session Frequency: 2 sessions per day Results Good therapeutic response observed in 85% patients Pain & itching disappeared after 1-2 days HS group & after 1-3 days HZ group No permanent skin changes after treatment Neurological pain reduced by 50% in HZ patients Conclusions Clinical observations confirm analgesic, anti-inflammatory & healing effects of BLT Device was easy for patients to use at home BLT STUDY DATA: HERPES SKIN INFECTIONS

119 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGY: SUPERFICIAL BACTERIAL INFECTIONS Infection usually prevented by skins normal friendly bacterial flora Damage to epidermis can allow penetration by pathogens & subsequent skin infection Common pathogens include staphylococcus & streptococcus Bacterial skin infections considered here; Impetigo Boils Erysipelas

120 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: SUPERFICIAL BACTERIAL INFECTIONS: IMPERTIGO Impetigo Staphylococcal skin infection (90% cases) Bacteria penetrate the outer layers of epidermis Pus collects beneath cornified layer Commonly seen in younger children Spread by direct contact highly infectious! Clinical features Yellow-orange pustules + crusting Pustules rupture easily Treatment Topical antibiotic cream Add oral antibiotics if severe

121 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: SUPERFICIAL BACTERIAL INFECTIONS: BOILS Boils (furuncles) Caused by staphylococcus infection Entry via hair follicle Commonly seen in young adults Associated with local trauma, illness, poor nutrition Clinical features Painful, red swellings with central core Often recurrent Large boils = caruncle Treatment Oral antibiotics incision & drainage

122 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: SUPERFICIAL BACTERIAL INFECTIONS: ERYSIPELAS Erysipelas Superficial infection of dermis Usually caused by streptococcus Entry via trauma site or leg ulcer Commonly affects lower leg or face Clinical features Hot, red area on the skin Well-demarcated edges Overlaps clinically with cellulitis Treatment Antibiotics – oral; iv (severe disease)

123 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & SUPERFICIAL BACTERIAL INFECTIONS BIOPTRON Light Therapy may help to treat superficial bacterial skin infections by reducing skin inflammation, stimulating the immune system & promoting healing

124 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: DERMATOLOGY: ORAL MUCOSAL LESIONS The oral mucosa is affected by various conditions; Stomatitis Inflammation of the lining of the mouth Multiple causes (infection, allergy, illness) Chelitis Fissuring of the corners of the mouth Caused by dentures, infection, deficiency states Aphthous ulcers Small, painful ulcers on tongue or cheeks Occur in ~20% population Normally heal without scarring

125 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & ORAL MUCOSAL LESIONS BIOPTRON Light Therapy may help to treat oral mucosal lesions by reducing inflammation, stimulating the immune system & promoting healing

126 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: ORAL MUCOSAL LESIONS Patient details Patients with various types of oral mucosal disease were divided into 2 groups; Test group = conventional medical treatment + BLT Control group = conventional therapy only BLT regimen Details not available Results & conclusions Test group results: Re-epithelialization of the lesions x1.6 faster Superior condition of the mouth & teeth Good improvement in patients with sialosis / gingivitis BLT provides an effective therapy in oral diseases

127 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC INDICATIONS BIOPTRON Light Therapy can be used to treat the following types of condition in children; Paediatric dermatological conditions Allergic eczema, skin infections Paediatric respiratory conditions Upper respiratory tract infections Paediatric musculoskeletal conditions Arthritis, congenital conditions, bone fractures, etc. Paediatric neurological disorders Polio, degenerative conditions, etc.

128 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC INDICATIONS: DERMATOLOGY Allergic eczema Background Affects >15% of children; onset between 2-18 months Often a family history of allergy ~70% cases resolve by age 11 years Clinical features Inflamed, red skin patches weeping Itching, scratching, loss of sleep Secondary infection common Treatment Topical steroid cream + barrier cream + bath soap substitute Prevent of scratching, cotton underclothes Mild night sedation Antibiotics for secondary infection

129 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC ALLERGIC ECZEMA: COMMON AREAS AFFECTED

130 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC INDICATIONS: DERMATOLOGY Erysipelas Streptococcal infection of dermis, commonly affects leg or face; affected skin area is hot, red & swollen Varicella zoster Causes chickenpox – malaise, fever & vesicular rash on trunk/head; lesions resolve spontaneously, usually with complete healing Impetigo Contagious staphlococcal skin infection; small pustules with honey-coloured crusts; topical antibiotic cream Herpes simplex Eruption of painful blisters around the mouth & nose; oral aciclovir for severe infections only Bacterial infectionsViral infections Paediatric skin infections Molluscum contagiosum Caused by a pox virus; multiple small lesions at any site on body, spread by direct contact, crops may continue for 6-12 months; resolves spontaneously

131 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC INDICATIONS: RESPIRATORY Upper respiratory tract infections in children treated with BIOPTRON Light Therapy Commonly caused by viral infections Children <5 years have up to 8 episodes per year Coryza (common cold) Rhinovirus (multiple strains) Nasal discharge, blockage, sneezing, malaise Symptomatic treatment Sinusitis Infection (bacterial) of paranasal sinuses Headache, facial pain, nasal discharge Antibiotic therapy Tonsillitis Adenovirus (50% cases) Sore throat, malaise Symptomatic treatment

132 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY CASE: RESPIRATORY DISEASES (CHILDREN) Patient details 331 children with various respiratory diseases; Susceptible to frequent illnesses 148 Bronchial asthma 46 Sinusitis 52 Acute respiratory viral infection 85 BLT regimen Duration: 4-6 minutes per treatment area [+ conventional treatment] (Face, submandibular & cervical lymph nodes, pharynx, immune organs & reflexogenous zones) Frequency: 2 sessions per day Course: sessions (bronchial asthma 2-3 courses per year) Results & conclusions Pharynx pain disappeared by Day 2 Reduction of tissue swelling & restored nasal breathing by Day 3 Complete clinical recovery around Day 4 Asthma remission after 2 nd treatment course in 58% children Clinical observations support use of BLT in children

133 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: EFFECTS OF RADIATION Patient details Children & adolescents exposed to acute & chronic radiation from the Chernobyl catastrophe BLT regimen Treatment applied to sacrum & sternum; BLT-1 device x6 areas irradiated (30 min exposure) BLT-2 device x2 areas irradiated (20 min exposure) Results Respiratory system; Increased permeability of small/medium bronchi Recovery of bronchial epithelial function Hematology; Increased number of leukocytes, T- & B-lymphocytes Conclusions Both types of BLT devices provided similar efficacy

134 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC INDICATIONS: MUSCULOSKELETAL Musculoskeletal conditions in children treated with BIOPTRON Light Therapy Juvenile chronic arthritis Stills disease, ankylosing spondilitis, rheumatoid arthritis, etc. Chronic pain & swelling of the joints systemic symptoms Congenital orthopaedic conditions Deformity of spine, leg/foot Traumatic conditions Bone fractures, post-surgical wounds, injury

135 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: CHRONIC MUSCULOSKELETAL DISORDERS Patient details 98 children (<1 year to 18 years old) Various musculoskeletal disorders; juvenile rheumatoid arthritis, flaccid paralysis, torticolis, muscular contractures & scoliosis BLT regimen Details not provided Results BLT was effective in; Alleviation of pain Healing of wounds (caused by immobility) Decrease of muscle hypertonia Conclusions BLT was a useful in the treatment & rehabilitation of children with these types of medical problems

136 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: MUSCULOSKELETAL INJURIES (CHILDREN) Patient details 78 children with musculoskeletal injuries; Test group (n=48) = conventional medical treatment + BLT Control group (n=30) = conventional therapy only BLT regimen Duration: 4-6 minutes Frequency: 2 sessions per day Results Children receiving BLT (test group) demonstrated - Faster reduction in pain levels Faster recovery time Conclusions Good therapeutic effect with BLT & no side effects observed Children had no negative emotions regarding BLT

137 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: PAEDIATRIC INDICATIONS: NEUROLOGY Neurological conditions in children treated with BIOPTRON Light Therapy Poliomyelitis Peripheral nerve palsies Traumatic injuries to nerves Inflammatory neurological disorders Degenerative neurological disorders Neuromuscular disorders

138 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Patient details 315 patients with various neurological diseases (affecting PN, CNS, spinal cord, brain) BLT regimen Duration: 10 minutes per session Frequency: 3-4 sessions per day Results & conclusions BLT provided good therapeutic effect BLT had several advantages over other types of treatment; BLT reduced pain levels effectively BLT allowed faster recovery time in some patients BLT could easily be combined with other treatments BLT was simple to use, clean, painless & inexpensive BLT was easy to use in patients who had limited mobility BLT STUDY DATA: NEUROLOGICAL DISORDERS

139 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & PAEDIATRIC INDICATIONS BIOPTRON Light Therapy may help to treat various conditions in children by reducing pain & inflammation, stimulating the immune system & promoting healing

140 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: INDICATIONS IN THE NEW BORN BABY BIOPTRON Light Therapy can be used to treat the following types of condition in newborn babies Traumatic injuries Lacerations, abrasions, bruises, etc. Nappy / diaper / napkin rash (intertrigo) Caused by Candida infection Phlebitis Caused by intravenous lines/injections Pressure sores In babies that are unable to move normally

141 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & INDICATIONS IN THE NEW BORN BABY BIOPTRON Light Therapy may help to treat various conditions in newborn babies by reducing pain/inflammation, stimulating the immune system & promoting healing

142 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: CONDITIONS IN NEWBORN INFANTS Patient details Newborn babies (requiring Life Support & ICU therapy) Various illnesses; phlebitis, skin necrosis, pressure sores & skin infections, etc BLT regimen Duration: 10 minutes per session Frequency: 3-4 sessions per day Results Babies all responded well Best results obtained for treatment of phlebitis Pain reduced within 24 hours Skin problems improved within 2-3 days Conclusions BLT was an effective treatment in newborn babies Parents were very happy with BLT BLT also suitable for low birth weight infants

143 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: SEASONAL AFFECTIVE DISORDER (SAD) SAD & bright light therapy BIOPTRON Pro 1 10,000 to 20,000 lux BIOPTRON Compact III 10,000 to 22,000 lux BIOPTRON 2 13,000 to 14,000 lux Indoor light <500 lux Outdoor (cloudy) <5000 lux Midday summer sun >50,000 lux

144 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON LIGHT THERAPY & SEASONAL AFFECTIVE DISORDER BIOPTRON Light Therapy may help to treat seasonal affective disorder by providing a source of bright light therapy

145 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BLT STUDY DATA: LIGHT THERAPY & SAD >60 studies carried out worldwide Response rates 60% - 90% Light therapy = 1 st line treatment for SAD Mild side effects reported after light therapy Eye strain/visual disturbance 19-27% Headache 13-21% Agitation 6-13% No damage to eye or retina Finland study (Lönnqvist) Office workers received light therapy November - February Improvement in mood, energy levels, alertness & productivity Positive effects occurred in people without SAD

146 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON Compact III BIOPTRON Pro 1 BIOPTRON 2 LIGHT THERAPY SYSTEM

147 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON AG: THE COMPANY BIOPTRON AG Swiss manufacturing company Founded in 1988 Holder of patents for the BIOPTRON Light Therapy System Integrated into Zepter International in 1996 Distribution Using synergies enables us today to distribute the products to more than 50 countries worldwide More than 2,000,000 satisfied users

148 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: QUALITY ASSURANCE CERTIFICATION ISO /42/EEC with annex ISO Declaration of Conformity

149 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: MEDICAL DEVICES: TYPE COMPARISON Identical: Technical characteristics Polarization up to 95% Polychromacy nm Low energy density ~2.4 J/cm2 Incoherency Different: Treatment areas Approximate filter diameters 4 cmBIOPTRON Compact III 11 cmBIOPTRON Pro 1 15 cmBIOPTRON 2 BC BPro B2B2 Proportional representation of the filter diameters

150 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: The convenient solution for clinical use The convenient solution for medical use MEDICAL DEVICES: BIOPTRON 2 Domestic Stand Professional Stand

151 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: free adjustable head inclination 360° rotation of the head adjustable stand hight 10 cm distance holder Table Stand Floor Stand The versatile, ergonomic and elegant solution for professional and home use MEDICAL DEVICES: BIOPTRON Pro 1 Available with ergonomic table stand or floor stand

152 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: MEDICAL DEVICES: BIOPTRON Pro 1 Click on box to launch animation

153 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: Storage and transport case The versatile, ergonomic and elegant solution for professional and home use MEDICAL DEVICES: BIOPTRON Compact III Optional available stand

154 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: BIOPTRON Light Therapy is safe & effective Swiss quality Developed & manufactured by BIOPTRON AG, Switzerland Conclusive therapeutic results Clinically proven efficacy & visible results, that encourage patient compliance Versatile Units are mobile, easy to use & maintenance-free Multifunctional Therapy can be applied in medical practice & in the patients home Cost-effective Potential shortening of hospitalization No side effects any negative side effects are not known Wide application area from traumatology to surgery, from rheumatology to sports medicine, from geriatrics to home care and more. LIGHT THERAPY SYSTEM – SOME ADVANTAGES AT A GLANCE

155 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: CONVINCING MEDICAL RESULTS … … THE INNOVATIVE SOLUTION FOR YOUR PATIENTS BIOPTRON Compact III BIOPTRON Pro 1 BIOPTRON 2 ONE TECHNOLOGY THREE MODELS

156 TARGETSTHERAPEUTICCLINICALCHARACTERISTICSINTROSYSTEM BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on:


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