Revision 439311543 of "Zerona" on enwiki

{{cleanup|date=April 2011}}{{More footnotes|article|date=July 2011}}
'''Zerona''' is a low-level laser device applied for non-invasive body slimming of the waist, hips, and thighs.  It has been shown to disrupt [[adipocyte]], or fat cell, membranes causing the release of stored [[lipids]] and fatty material, in turn, promoting adipocyte collapse.  The device was first introduced to the market in 2008 as an [[off-label use]] device for slimming, but later was granted 510k market clearance by the [[Food and Drug Administration]] in 2010 indicated for use as a non-invasive dermatological aesthetic treatment for the reduction of circumference of hips, waist, and thighs.  The Zerona was the first aesthetic device to receive this indication by the FDA following the completion of a [[placebo-controlled]], randomized, [[double-blind]], multi-centered [[clinical trial]].  Clinical study participants randomly assigned to receive “active” or real treatment displayed an average loss of {{Convert|3.5|in|cm|abbr=on}} across the waist, hips, and thighs in two weeks.  This was compared to study participants randomly assigned to the “sham” or [[placebo]] group who exhibited a reduction of {{Convert|0.68|in|cm|abbr=on}} after two weeks.<ref name=pmid20014253>{{cite journal |pmid=20014253 |first1=Robert F. |last1=Jackson |first2=Doug D. |last2=Dedo |first3=Greg C. |last3=Roche |first4=David I. |last4=Turok |first5=Ryan J. |last5=Maloney |year=2009 |url=http://www.erchonia.com/files/uploads/1/file/Jackson_3LT%20Non-Invasive%20Approach%20for%20Body%20Contouring%20Randomized%20Controlled%20Study_LISM_12_09.pdf |title=Low-Level Laser Therapy as a Non-Invasive Approach for Body Contouring: A Randomized, Controlled Study |journal=Lasers in Surgery and Medicine |volume=41 |issue=10 |pages=799–809 |doi=10.1002/lsm.20855}}</ref>

== Device ==
Zerona is a class IIIB low-level laser which under 21 CFR 801.109 is subject to prescription use only. [[Low level laser therapy]](LLLT) represents a division of [[photomedicine]] utilizing defined parameters of laser light for the treatment of a specific medical ailment.  The efficacy and safety of this subtle therapeutic approach is dependent on the [[wavelength]], [[dosage]], pulsation, and [[intensity]] being applied.  For instance, laser therapy has exhibited a biphasic dose response revealing that too much applied energy could hamper or prevent the desired clinical outcome from transpiring.<ref name=pmc2790317>{{cite journal |pages=358–83 |doi=10.2203/dose-response.09-027.Hamblin |pmc=2790317 |title=Biphasic Dose Response in Low Level Lightherapy |year=2009 |last1=Hamblin |first1=Michael R. |last2=Carroll |first2=James D. |last3=Chen |first3=Aaron C.-H. |last4=Huang |first4=Ying-Ying |journal=Dose-Response |volume=7 |issue=4 |pmid=20011653}}</ref> The development of Zerona required significant clinical investigation to determine the ideal output parameters to ensure optimal efficacy and safety.  Studies evaluated Zerona’s interaction with individual to several million fat cells in order to determine the precise slimming setting.  Zerona is a [[monochromatic]] semiconductor diode laser that emits 5 independent 635&nbsp;nm divergent beams.

The four adjustable arms along with the center non-adjustable laser enables the Zerona to concurrently treat the waist, hips, and thighs for complete slimming of the mid-section.

== History ==
Initial trials for the Zerona began back in late 1998 in Cali, Colombia by Dr. Rodrigo Neira and his wife Dr. Clara Neira at the Universidad Nacional de Colombia.  They first applied the device as an adjunct to [[liposuction]] to reduce pain and inflammation commonly experienced after the invasive surgical procedure.  In hopes of achieving better pain reduction they began applying LLLT prior to aspiration and surprisingly found that the subcutaneous fat appeared softer and easier to extract.  Fascinated with this finding, Dr. Neira and his wife started performing histological investigations to determine why laser had this unique biological influence on fat tissue.  Utilizing [[scanning electron microscopy]] and [[transmission electron microscopy]], they observed the formation of transitory pores or openings in the protective membranes of adipocytes which enabled stored intracellular lipids to be released from enlarged fat cells. The term emulsification was applied to describe the laser-induced liberation of the stored lipids. The initial findings were later confirmed by three individual sites including the University of Singapore, University of Mexico, and the University of Chicago.  These findings prompted the development of a device, the EML Laser, to assist in the surgical procedure, liposuction, with the intent to emulsify the fat thereby softening the area prior to aspiration.  A placebo-controlled, randomized, double-blind, multi-centered clinical study was performed to evaluate the clinical utility of this application as an adjunct to liposuction and found that laser therapy decreased operating room times, increased the volume of fat extracted, less force was required by the physician to breakup fat, and the recovery for patients was significantly improved.<ref name=pmc2790317/>  Based on the findings of this study the FDA cleared the EML device in 2001 for use as an adjunctive therapy to liposuction.

The next logical transition was to evaluate the body’s capacity to remove the liberated fatty material, in turn, positioning this technology as a non-invasive body slimming application.{{Citation needed|date=July 2011}}

== Mechanism of action ==
The exact mechanism of action for the Zerona is not fully-understood.  As a low-level laser device the theory of action is defined as bioorganic [[photochemistry]], a discipline that explores the interaction between [[photons]] and biochemical pathways within cells.  Like many other science principles, bioorganic photochemistry is defined by laws, and the first law of [[photochemistry]] states that a photoabsorbing structure must be present to yield a clinical outcome. [[Cytochrome c oxidase]] , a terminal enzyme found within the [[electron transport chain]] of the [[mitochondria]] , has been reported to function as a photoabsorbing complex within eukaryotic cells ([[eukaryote]]).  This enzyme is responsible for facilitating the transport of electrons across the [[inner mitochondrial membrane]] to reduce oxygen and generate a proton [[electrochemical gradient]].  Cytochrome c oxidase serves an important role in the metabolic process known as [[oxidative phosphorylation]], which is the production of the high energy molecule [[adenosine triphosphate]] (ATP).<ref>{{cite book |first1=Reginald |last1=Garrett |first2=Charles M. |last2=Grisham |title=Biochemistry |edition=3rd |year=2010 |isbn=978-0-495-10935-8 |url=http://books.google.com/books?id=iGPsen3fSOIC}}{{Page needed|date=July 2011}}</ref><ref name=pmid6479342>{{cite journal |pages=95–9 |doi=10.1016/0014-5793(84)80577-3 |title=Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by helium-neon laser |year=1984 |last1=Passarella |first1=S. |last2=Casamassima |first2=E. |last3=Molinari |first3=S. |last4=Pastore |first4=D. |last5=Quagliariello |first5=E. |last6=Catalano |first6=I.M. |last7=Cingolani |first7=A. |journal=FEBS Letters |volume=175 |pmid=6479342 |issue=1}}</ref><ref name=pmid2476986>{{cite journal |pages=1428–34 |doi=10.1016/0006-291X(89)91138-8 |title=Increase in RNA and protein synthesis by mitochondria irradiated with Helium-Neon laser |year=1989 |last1=Greco |first1=M |journal=Biochemical and Biophysical Research Communications |volume=163 |issue=3 |pmid=2476986 |last2=Guida |first2=G |last3=Perlino |first3=E |last4=Marra |first4=E |last5=Quagliariello |first5=E}}</ref> Stimulation of cytochrome c oxidase with a well-defined monochromatic low-level laser instrument modulates cellular metabolism and secondary biological cascades which can affect cell function and behavior giving rise to the positive clinical outcomes that have been reported.<ref name=pmc2790317/>  Subsequent to laser stimulation the mitochondrial membrane potential and proton gradient increases, prompting changes in mitochondria optical properties and increasing the rate of ADP/ATP exchange.<ref>{{cite journal |pages=355–61 |doi=10.1089/pho.2005.23.355 |title=Exact Action Spectra for Cellular Responses Relevant to Phototherapy |year=2005 |last1=Karu |first1=T.I. |last2=Kolyakov |first2=S.F. |journal=Photomedicine and Laser Surgery |volume=23 |issue=4 |pmid=16144476}}</ref><ref>{{cite book |first1=Aleksandr Nikolaevich |last1=Terenin |year=1954 |title=Photochemistry of dyes and related organic compounds |oclc=32060439}}{{Page needed|date=July 2011}}</ref><ref>{{cite journal |pages=265–322 |doi=10.1016/0304-4173(85)90014-X |title=Electron transfers in chemistry and biology |year=1985 |last1=Marcus |first1=R |journal=Biochimica et Biophysica Acta |volume=811 |issue=3}}</ref> It is suggested that laser irradiation increases the rate at which cytochrome c oxidase transfers electrons from cytochrome c to dioxygen.<ref name="pmid6479342" /><ref>{{cite journal |pmid=10379650 |year=1998 |last1=Konev |first1=SV |last2=Beljanovich |first2=LM |last3=Rudenok |first3=AN |title=Photoreactivation of the cytochrome oxidase complex with cyanide: the reaction of heme a3 photoreduction |volume=12 |issue=5 |pages=743–54 |journal=Membrane & cell biology}}</ref><ref name="pmid2476986" /> Moreover, it has been proposed that laser irradiation reduces the catalytic center of cytochrome c oxidase, making more electrons available for the reduction of dioxygen.<ref>{{cite journal |pages=324–36 |doi=10.1016/j.jinorgbio.2004.10.011 |title=Cytochrome  oxidase, ligands and electrons |year=2005 |last1=Brunori |first1=M |last2=Giuffre |first2=A |last3=Sarti |first3=P |journal=Journal of Inorganic Biochemistry |volume=99 |pmid=15598510 |issue=1}}</ref><ref>{{cite journal |pages=46–54 |doi=10.1002/lsm.20589 |title=Low-energy laser irradiation increases endothelial cell proliferation, migration, and eNOS gene expression possibly via PI3K signal pathway |year=2008 |last1=Chen |first1=Chung-Huang |last2=Hung |first2=Huey-Shan |last3=Hsu |first3=Shan-hui |journal=Lasers in Surgery and Medicine |volume=40 |pmid=18220263 |issue=1}}</ref><ref>{{cite journal |pmid=1053185 |year=1975 |last1=Mester |first1=E |last2=Korényi-Both |first2=A |last3=Spiry |first3=T |last4=Tisza |first4=S |title=The effect of laser irradiation on the regeneration of muscle fibers (preliminary report) |volume=8 |issue=4 |pages=258–62 |journal=Zeitschrift fur experimentelle Chirurgie}}</ref> In turn, an increase in electron and proton transfer increases the quantity of ATP that is synthesized which can directly affect numerous intracellular proteins.

The upregulation of ATP induced by laser therapy is also responsible for the increased production of a natural byproduct known as [[reactive oxygen species]](ROS).<ref name=pmid16248161>{{cite journal |pmid=16248161 |year=2005 |last1=Klebanov |first1=GI |last2=Chichuk |first2=TV |last3=Osipov |first3=AN |last4=Vladimirov |first4=IuA |title=The role of lipid peroxidation products in the effect of He-Ne laser on human blood leukocytes |volume=50 |issue=5 |pages=862–6 |journal=Biofizika}}</ref><ref>{{cite journal |pmid=15129632 |year=2004 |last1=Vladimirov |first1=IuA |last2=Klebanov |first2=GI |last3=Borisenko |first3=GG |last4=Osipov |first4=AN |title=Molecular and cellular mechanisms of the low intensity laser radiation effect |volume=49 |issue=2 |pages=339–50 |journal=Biofizika}}</ref><ref name=pmid8570716>{{cite journal |pmid=8570716 |year=1995 |last1=Geiger |first1=PG |last2=Korytowski |first2=W |last3=Girotti |first3=AW |title=Photodynamically generated 3-beta-hydroxy-5 alpha-cholest-6-ene-5- hydroperoxide: toxic reactivity in membranes and susceptibility to enzymatic detoxification |volume=62 |issue=3 |pages=580–7 |journal=Photochemistry and photobiology |doi=10.1111/j.1751-1097.1995.tb02388.x}}</ref> This highly reactive oxygen molecule participates in numerous pathways within a cell. However, as the concentration of ROS elevates a process known as [[lipid peroxidation]] can occur where ROS reacts with lipids found within cell membranes temporarily damaging them.<ref name=pmid16248161/><ref name=pmid8570716/> It has been hypothesized that the Zerona, as a low-level laser device, modulates cell metabolism resulting in a transient rise of ROS which temporarily degrades the membrane creating transitory pores or openings. Presently, studies are on-going to fully elucidate the underlying mechanism of action.{{Citation needed|date=July 2011}}

== Clinical trial ==
In 2008, the clinical trial to investigate the efficacy of Zerona commenced.  The trial enrolled 67 subjects, 35 of which were randomly assigned to receive “active” or “real” treatment with 32 randomly assigned to the “sham” or inactive group.  Both groups were asked to sign an affidavit stating that during the clinical trial they would make no changes to their lifestyle and would not participate in any other program or consume any supplements that would promote slimming.  Furthermore, patients were asked to track their daily activities and caloric intake through the entire duration of the trial.  This daily journal ensured that patients were not making any changes that could impact the outcome.
Patients received treatment every-other day for two weeks receiving a total of 6 treatments.  Patients’ waist, hips, and thighs were treated concurrently for 40 total minutes each treatment, including 20 minutes of anterior or front treatment and 20 minutes of posterior or back treatment.   Measurements were taken at baseline, weeks one and two, and a two-week post-procedure follow-up measurement.  After two weeks the “active” treatment group averaged a cumulative reduction of 3.54&nbsp;inches compared to the “sham” group which averaged a cumulative reduction of just 0.68&nbsp;inches.  At the two-week post-procedure follow-up, “active” group participants did not exhibit a significant gain in their measurements. If the circumference reduction in the study is re-calculated to a radius measure (i.e. a more just measure of fat layer thickness) the actual fat layers on waist, hips and thighs were reduced on average 2.8% or 0.05 inches (0.13 cm) for the "active" group two weeks after the last treatment.<ref name=pmid20014253/> This should be compared to [[cryolipolysis]] which on average results in a 25.5% reduction of fat layer thickness.<ref>{{cite journal |doi=10.1007/s00266-008-9286-8 |title=Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves |year=2009 |last1=Coleman |first1=Sydney R. |last2=Sachdeva |first2=Kulveen |last3=Egbert |first3=Barbara M. |last4=Preciado |first4=Jessica |last5=Allison |first5=John |journal=Aesthetic Plastic Surgery |volume=33 |issue=4 |pages=482–488 |pmid=19296153}}</ref> No adverse events or side-effects were reported during the clinical trial.<ref name=pmid20014253/>

The clinical trial for Zerona was published in the peer-reviewed journal Laser’s in Surgery and Medicine in 2009.<ref name=pmid20014253/>

== Future applications ==
The adipocyte or fat cell is described as an endocrine organ cell responsible for the synthesis of bioactive peptides which participate in autocrine, paracrine, and endocrine pathways.  The physical adaptability of the adipocyte is extraordinary, enabling it to expand nearly 1,000 fold in volume and 10 fold in diameter in order to store excessive fuel as triglycerides.<ref>{{cite journal |pmid=9843879 |year=1998 |last1=Marques |first1=BG |last2=Hausman |first2=DB |last3=Martin |first3=RJ |title=Association of fat cell size and paracrine growth factors in development of hyperplastic obesity |volume=275 |issue=6 Pt 2 |pages=R1898–908 |journal=The American journal of physiology}}</ref> During periods of limited food intake fat tissue rapidly transitions to an abundant provider of non-esterfied free fatty acids which upon their release into the circulatory system can undergo beta-oxidation to supply energy.  The storage capacity of adipocytes remains a key component of its function but has been shown to modulate the synthesis of bioactive peptides, specifically adipose-derived hormones.{{Citation needed|date=July 2011}}

Studies have revealed a correlation between deregulated adipose tissue function and excessive fat mass having deleterious effects on the endocrine and immune systems.<ref name=pmid19948207>{{cite journal |pages=69–78 |doi=10.1016/j.mce.2009.11.011 |title=The autocrine and paracrine roles of adipokines |year=2010 |last1=Karastergiou |first1=Kalypso |last2=Mohamed-Ali |first2=Vidya |journal=Molecular and Cellular Endocrinology |volume=318 |pmid=19948207 |issue=1–2}}</ref><ref name=pmid18334583>{{cite journal |pages=2255–62 |doi=10.1210/jc.2007-2188 |title=Adipokine Protein Expression Pattern in Growth Hormone Deficiency Predisposes to the Increased Fat Cell Size and the Whole Body Metabolic Derangements |year=2008 |last1=Ukropec |first1=J. |last2=Penesova |first2=A. |last3=Skopkova |first3=M. |last4=Pura |first4=M. |last5=Vlcek |first5=M. |last6=Radikova |first6=Z. |last7=Imrich |first7=R. |last8=Ukropcova |first8=B. |last9=Tajtakova |first9=M. |journal=Journal of Clinical Endocrinology & Metabolism |volume=93 |issue=6}}</ref><ref name=pmid18037457>{{cite journal |pages=206–18 |doi=10.1016/j.physbeh.2007.10.010 |title=The role of adipose tissue dysfunction in the pathogenesis of obesity-related insulin resistance |year=2008 |last1=Goossens |first1=Gijs H. |journal=Physiology & Behavior |volume=94 |issue=2}}</ref><ref name=pmid20107860>{{cite journal |pages=1277–92 |doi=10.1007/s00018-010-0263-4 |title=Adipocyte extracellular matrix composition, dynamics and role in obesity |year=2010 |last1=Mariman |first1=Edwin C. M. |last2=Wang |first2=Ping |journal=Cellular and Molecular Life Sciences |volume=67 |issue=8 |pmid=20107860 |pmc=2839497}}</ref><ref name=pmid19192421>{{cite journal |pmid=19192421 |year=2009 |last1=Gutierrez |first1=DA |last2=Puglisi |first2=MJ |last3=Hasty |first3=AH |title=Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia |volume=9 |issue=1 |pages=26–32 |pmc=2735041 |journal=Current diabetes reports |doi=10.1007/s11892-009-0006-9}}</ref> Excessive body fat results in adipocyte hypertrophy or acquired [[lipodystrophy]].  Significant adipocyte expansion is believed to interrupt the interplay of transcriptional factors and other intracellular components yielding pathological consequences.<ref name=pmid19948207/><ref name=pmid18334583/><ref name=pmid18037457/><ref name=pmid20107860/><ref name=pmid19192421/>

Adipocyte [[hypertrophy]] has been shown to directly disrupt [[angiogenesis]], [[adipogenesis]], extracellular matrix dissolution and reformation, lipogenesis, growth factor production, glucose metabolism, lipid metabolism, enzyme production, immune response, and hormone production.<ref name=pmid17021375>{{cite journal |pmid=17021375 |year=2006 |last1=Ahima |first1=RS |title=Adipose tissue as an endocrine organ |volume=14 Suppl 5 |pages=242S–249S |doi=10.1038/oby.2006.317 |journal=Obesity (Silver Spring, Md.)}}</ref> Furthermore, studies have illustrated an alteration in [[gene expression]] recording an upregulation in [[proinflammatory]] factors including classic [[cytokines]] and [[complement factors]].<ref name=pmid17021375/><ref name=pmid18473870>{{cite journal |pmid=18473870 |year=2008 |last1=Heilbronn |first1=LK |last2=Campbell |first2=LV |title=Adipose tissue macrophages, low grade inflammation and insulin resistance in human obesity |volume=14 |issue=12 |pages=1225–30 |journal=Current pharmaceutical design}}</ref><ref name=pmid17505154>{{cite journal |pmid=17505154 |year=2007 |last1=Bahceci |first1=M |last2=Gokalp |first2=D |last3=Bahceci |first3=S |last4=Tuzcu |first4=A |last5=Atmaca |first5=S |last6=Arikan |first6=S |title=The correlation between adiposity and adiponectin, tumor necrosis factor alpha, interleukin-6 and high sensitivity C-reactive protein levels. Is adipocyte size associated with inflammation in adults? |volume=30 |issue=3 |pages=210–4 |journal=Journal of endocrinological investigation}}</ref> A rise in pro-inflammatory [[adipokines]] coupled with cytokine production may promote the onset of metabolic disorders like [[atherosclerosis]].{{Citation needed|date=July 2011}}

Positively correlated with increased adipose tissue size are pro-inflammatory factors: [[tumor necrosis factor-α]] (TNF-α), [[interleukin-6]] (IL-6), and [[C-reactive protein]]. Participating in [[paracrine]] and [[autocrine]] signaling, adipocyte impairment may account for metabolic dysfunction as adipose tissue communicates with multiple body systems including nervous, immune, skeletal, cardiovascular, and gastrointestinal.<ref name=pmid17021375/> Positive caloric intake can result in adipocyte [[hypertrophy]] modulating adipose tissue function and increasing a patient’s risk of developing serious metabolic disorders.{{Citation needed|date=July 2011}}

Directly associated with enlarged fat mass is the chronic disease [[diabetes]]. [[Adiponectin]], a hormone solely produced by adipocytes, has demonstrated insulin sensitive effects promoting anti-diabetic characteristics.<ref name=pmid16642957>{{cite journal |pmid=16642957 |year=2006 |last1=Ahima |first1=RS |title=Metabolic actions of adipocyte hormones: focus on adiponectin |volume=14 Suppl 1 |pages=9S–15S |doi=10.1038/oby.2006.276 |journal=Obesity (Silver Spring, Md.) |issue=2S}}</ref> As a plasma protein, adiponectin has been reported to regulate insulin sensitivity via the activation of AMPK and reduction of mTOR/S6 kinase activity consequentially reducing insulin receptor substrate 1 inhibitory serine phosphorylation in several tissues.<ref name=pmid17021375/><ref name=pmid16642957/> The synthesis of adiponectin is tightly coupled with adipose tissue fat mass, demonstrating a negative relationship with larger masses. Individuals who are classified as obese display a lower plasma adiponectin concentration when compared to non-obese groups. Furthermore, a direct correlation between low adiponectin levels and the onset of type-2 diabetes has been reported. Adiponectin modulation is reflective of the deleterious outcome that manifests when the adipocyte accumulates tremendous volume.{{Citation needed|date=July 2011}}

Studies have demonstrated the physiological importance of adipocytes.  [[Lipoatrophy]], a condition in which the total number of adipocytes are reduced, reveals an association with [[insulin resistance]], [[hyperglycemia]], and liver [[steatosis]].<ref>{{cite journal |pmid=10675352 |year=2000 |last1=Gavrilova |first1=O |last2=Marcus-Samuels |first2=B |last3=Graham |first3=D |last4=Kim |first4=JK |last5=Shulman |first5=GI |last6=Castle |first6=AL |last7=Vinson |first7=C |last8=Eckhaus |first8=M |last9=Reitman |first9=ML |title=Surgical implantation of adipose tissue reverses diabetes in lipoatrophic mice |volume=105 |issue=3 |pages=271–8 |doi=10.1172/JCI7901 |pmc=377444 |journal=The Journal of clinical investigation}}</ref> Therefore, preserving cell viability while restoring a lean state is an important strategy as adipocytes exert a protective action by releasing beneficial endocrine hormones. Zerona has been proven to restore a lean state adipocytes without inducing cell apoptosis. It is hypothesized that Zerona could serve as an adjunct to other dietary therapies to promote insulin sensitivity and reduce the risk of diabetes.  The Zerona, based on histological evidence, has proven to reduce adipose tissue fat mass of the waist, hips, and thighs while preventing fat cell death.  The formation of the transitory pore within the adipocyte membrane results in adipocyte cell collapse and its return to a lean state.  Reduced fat mass is associated with the synthesis of beneficial hormones like adiponectin which promotes insulin sensitivity within numerous tissues. On-going clinical trials are evaluating the Zerona for potential acute and long-term medical benefits.{{Citation needed|date=July 2011}}

An article published in the American Journal of Cosmetic Surgery in 2010 demonstrated a statistically significant reduction in both serum triglyceride and total cholesterol levels following a standard two-week, six treatment Zerona administration.<ref>{{cite journal |first1=Robert F. |last1=Jackson |first2=Greg C. |last2=Roche |first3=Kevin |last3=Wisler |year=2010 |title=Reduction in Cholesterol and Triglyceride Serum Levels Following Low-Level Laser Irradiation: A Noncontrolled, Nonrandomized Pilot Study |journal=The American Journal of Cosmetic Surgery |volume=27 |issue=4 |pages=177–84 |url=http://www.erchonia.com/files/uploads/1/file/Jackson_Reduction%20in%20Cholesterol%20and%20Triglyceride%20Serum%20Levels%20Following%203LT_AJCS_2010.pdf}}</ref> Presently, clinical studies are on-going to elucidate the potential utility of this application.{{Citation needed|date=July 2011}}

== References ==
{{reflist}}

[[Category:Laser medicine]]