This is a presentation at CAM, Indian Center for Spinal Injuries, on integrative clinical treatments based on laser acupuncture, acupressure and sports massage. This is an attempt to bring together documents that provide scientific basics. It is at stages untidy and duplicated from online content that does not require permissions

1. SEMINAR ON ACUPRESSURE AND
LASER ACUPUNCTURE AS A CAM
THERAPY
AT INDIAN SPINAL INJURIES CENTER.
CAM DEPARTMENT
1

2. LASER ACUPUNCTURE
THERAPY AS CAM
MALINI CHAUDHRI.
Ph.D. Dr.Ac
WALT, ISLSM
ISLA, EMLA
NAALT, LASER
ANNALS,
Swedish Medical Laser
Society.
Has worked with Photomedicine
since 1994 with Alma Ata (Hong
Kong, Colombo,) Japan, USA,
Czech Republic, and Sweden.
Sponsored to USA in 2003.
Based in R&D from India.
Published scientific papers and
developed a course, edited by
Jan Tuner, Editor of Laser Annals.
Specializes in Laser Acupuncture
and Physio, technical training ,
therapy and research.
Delete text and
place photo here.
2

3. INTEGRATIVE MEDICINE. SUPPORT
WITHOUT DRUGS
TOPICS OF
DISCUSSION
LLLT AND LAP
WOUND HEALING
LYMPHEDEMA
PAIN MANAGEMENT
MYOFASIAL DYSFUNCTION
DERMATONE/SCLEROTOME
PATHWAYS
STROKE
SPINAL CORD INJURY
MANUAL THERAPIES:
ACUPRESSURE.
TRIGGER POINT RELEASE
PNF STRETCHES. SPORTS
MASSAGE/ ORTHOPEDIC
Delete text and place
photo here.
3

4. MECHANISMS
OF LLLT. LAWS OF
PHOTOCHEMISTRY
.
Delete text and
place photo here.
ABSORPTION SPECTRA. For a photo
reaction to take place there must be a
photoacceptor. This is mainly cytochrome
c oxidase in the mitochondria.
Chromophores receiving light molecules
that are active in photochemistry are
melanin and haemoglobin.
ACTION SPECTRA
Depends on the nature of the
photostimulation. Wavelengths from
600nm to 950 nm are considered
therapeutic.
Coherent laser light involves photo
excitation in the mitochondria that is
conveyed to the nucleus. Increased ATP
and DNA synthesis provides scope for
reversing disease and targeting gene
therapy.
All cells having mitochondria respond to
LLLT.
Recent research has shown the infinite
possibilities of the mitochondria to expand
and generate photo pathways for added
photo chemistry
Photo of Malini Chaudhri giving laser to Dr Naidoo from
S.Africa
4

5. Different light treatments
Therapeutic wavelengths and effects

6. LASER EFFECTS AND
SAFETY
• Photo thermal effects. Involve significant increase of
temperature in tissue (5 -10 C),and remodelling. CO2, ND
Yag. Hair removal lasers, surgical lasers etc. Class 4
laser
• Photo mechanical effects. This develops a steeper
gradient during exposure. Q switch. Removing tattoos.
Class 4 laser
Photochemistry. No significant thermal effects. LLLT.
Class 3 laser
6

7. PHOTOCHEMISTRY
photo absorption -
photo action -
I I
I
Wound healing Relief of inflammation
neurogenic pain
Tissue repair pain,edema, acute
injuries, acupuncture
Prevention of tissue chronic diseases
death
Cellular
photoacceptor
in
mitochondria
Low level laser wavelength
600nm- 950nm
IIIIIIII
7

8. NOTES ON EFFECTS OF LLLT
• Photoacceptors (Cytochrome c oxidase) can absorb low
level lasers irradiation and transfer it inside mitochondria
in order to provide cell energy (ATP) which is the product
cytochrome c oxidase in the respiratory chain of the
mitochondria. The stimulation of ATP synthesis results
in increased cell activity. These changes influences
macrophages, fibroblasts, endothelial cells, mast cells,
bradykinin and nerve conduction speed.
• Biomodulatory effects of LLLT comprise the following:
• Macrophages, lymphocytes, fibroblasts, endothelial cells
and keratinocytes proliferation; increase ATP synthesis
and cell respiration, growth factors and
• other cytokines release, change of fibroblasts to
myofibroblasts; change in inflammatory mediators level
(histamine and prostaglandins); increase in oxygen
transport and improve in glucose consumption; changes
in cell membrane potential and permeability,
• sodium/potassium pump excitation and more calcium
removal; vasodilation and angiogenesis (improve in
tissue nutrition); collagen synthesis.
8

9. Multiple tissue
structures treated with
LLLT
9

10. What are the progressed
physiological effects of laser light?
• - Proliferation on immune cells leads to the combat of
inflammations and an accelerated healing of wound as well as
an increased endorphin disbursement, increase of the ATP
production and increased nervous cell potential.
• - Increased leukocyte phagocytosis, boosted neovascularisation,
increased collagen formation and protein biosynthesis. It also
leads to an improved cell respiration and stabilization of the
membrane potential.
• - Enhancement of the proton gradient via the mitochondria
membrane, generation of an increased potential difference with
increased phosphorisation of ATP (increase of 150%).
• - No modification of intact cells.
• - Energetic build-up of sick cells.
• - Energy is to a large extent (more than 40%) used for ATP
synthesis, in order to increase the pump activity for maintaining
the membrane potential.
• - Membrane stabilization leads to blocking of impulses, reducing
the transmissions of pain sensations.
• - The cell’s calcium content is regulated (diminished ATP
synthesis leads to a an overflow of the cell with calcium and
activation of proteinasis, resulting in the death of the cell, the
necrosis).
• - In the pre-necrotic state, cells suffer from acute lack of energy
with sodium and calcium streaming in, which can only be
removed with the utmost pump activity. This pump activity can
only be enhanced by radiant energy.
10

11. 11

12. MULTIPLE WAVELENGTH SYSTEMS FOR
COMREHENSIVE TREATMENTS
12

13. • LASER DOSE SELECTIONS ARE
BASED ON THE ARNDT SCHULTZ
LAW
• LOWER DOSES ARE
BIOSTIMULATORY
• HIGHER DOSES ARE INHIBITORY
• LEDS ARE IN WIDESPREAD USE.
HOWEVER THEY ARE NOT BASED ON
COHERENT LIGHT AND GENERATE
• SUPERFICIAL EFFECTS SUITABLE FOR
HEALING WOUNDS
• IN LASERS Areas of high difference in light
intensity levels form
• SPECKLES. Local differences in intensity
create temperature and pressure gradients
across cell membranes which enhances
permeability of the membrane so that photons
may be active deeper.
•
13

14. WOUND HEALING
Lasers in the visible red
spectrum are preferred for
wound healing(or LEDS)
Helium Neon 634.8nm,
670nm, 780nm in
Continuous wave. LEDS.
PDT
Supports dramatic healing
of Bedsores
Open wounds
Allergic or contact
dermatitis
Infectious and ulcerating
wounds
Diabetic ulcers
Surgical wounds
Acne
Burns
Delete text and
place photo here.
Delete text and
place photo here.
14

15. Mechanisms of wound
healing
• LLLT is beneficial for wounds of various etiologies and
affects every molecule involved. This includes
• Increased ATP levels
• Promotion and proliferation of migration of keratinocytes,
endothelial cell and fibroblasts.
• Secretion of growth factor from macrophages
• Increasing collagen synthesis
• Increasing phagocytic and bactericidal activities of
inflammatory cells.
• Modulation and regulation of secretion of chemokines and
cytokines
• These support the 3 stages of wound healing,
• 1) Inflammation (immune cells migrate to the wound and close it
to promote healing)
• 2) Proliferation(new granulation tissue is produced to fill in the
gaps with more collagen production and increased epithelialization
• 3) maturation( with wound closure keratins undergo stratification
and differentiation to restore the barrier without which wounds
become chronic)
15

16. Oral Mucositis. Patients
undergoing chemotherapy
need LLLT
Photo: R-J Bensadoun,
Nice

17. A Stye. The
following day
after HE NE
laser
Photos courtesy Jan
Tuner

18. TECHNIQUES
FOR WOUND
HEALING
Apply a probe to points
in contact mode along
the periphery of the
wound to stimulate
contraction. Incase of
scanner apply over the
wound at .5 cm distance
from skin
Along the open area use the
techniques drawn on the left
or apply along the surface of
the wound as a grid as below.
Dose. 2-6J/sq cm
::::::::::::
::::::::::::
::::::::::::
Delete text and
place photo here.
Delete text and
place photo here.
These
applications
improve the
effects of laser
therapy on wound
healing with
lasers in the
visible spectrum
Recommendation
s are from Tuner
Hode
18

19. APPROACHES
Laser
irradiation
/
scanning.
Trigger
point
release
Laser
acupunctu
re
Laser
auricular
acupunctu
re
Interstitial
laser
treatment
Increases
synthesis
of
endorphins
and
bradykinin,
decreased
activity of
C fibers,
reduction
of
serotonin
and
nociceptors
. Increased
pain
threshold
Relaxes
muscles
bands and
reduces
referred
pain
based on
treatment
of hyper-
irritable
points
located in
muscles
that are
shortened
This is an
approach
through the
CNS to
activate
acupunctur
e pathways
and create
homeostasi
s
This is a
photo
pathway
through the
auricular
nerves to
stimulate a
somatotopi
c
representat
ion of the
human
fetus in the
ear, with
respect to
embryonic
tissue
This is an
invasive
procedure
in which a
5 mw laser
fiber
needle
penetrates
deep into
the skin to
deliver
photons in
a injured
musculosk
etal
condition
19

20. Laser treatment
systems
20

21. LASER EFFECTS
21

22. FURTHER SCOPE
ORTHOPEDIC
CONDITIONS
• TREATMENT OF
SCLEROTOME PATHWAYS
• TREATMENT OF
DERMATONES
• TREATMENT OF DAMAGED
PERIPHERAL NERVES
• LASER AND OM COMBO
for assessment and correction
• THE DIAGRAM SHOWS
DERMATONE PATHWAYS
22

23. 23
SCLEROTOME PAIN PATHWAYS REFLECT ON
CONNECTIVE TISSUE INNERVATED BY THE
SAME SPINAL NERVE. ANATOMICAL
APPROACHES TO TREATMENT

24. Trigger Points in muscles and
pathways for referring pain
• Approach
Palpate for pain.
• Manage to identify all trigger points, primary
and secondary
• Trace referred pain zones. Determine dose
• Reexamine after treatment for changes in
tissue
• Example of Splenius capitis
24

25. MYOFASCIAL RELEASE WITH
MANUAL AND LASER THERAPY
• Myofascial dysfunction is specifically a muscle
dysfunction. Painful points correspond with sensory
motor and nerve ending located in the belly and
insertion of the muscles. They cause pain and
reduce functional ROM.
• A single part/full body laser session can enable
assessment and correction
25

26. ACUPUNCTURE
PATHWAYS
EXAMPLE OF LARGE INTESTINE MERIDIAN
26

27. ACUPUNCTURE
APPROACH
27

28. PAIN MANAGEMENT WITH
LLLT AND LAP
• A possible stabilization of nerve cell membranes, probably due to
the more stable conformation of the lipid bilayers induced by
LPT, and the associated integral proteins of the nerve cell
membrane, the enhanced redox systems of the cell and an
increase in ATP production have also been shown to restore
neuronal membranes and decrease pain transmission.
• - Reduction of Inflammation and edema (-releasing of
inflammatory cytokines like prostaglandin E2 and plasminogen
activator could be reduced- less inflammatory cells were present
in irradiated samples-
• - Reduction of inflammatory cell migration,
• - Reduction of edema and inflammatory cytokines like TNF-α,
interleukins 1 and 6
• - The laser acts by inhibiting cyclooxygenase,
• - Interrupting the conversion of arachido prostaglandin and also
increases the production of B-endorphin.
• .
• In addition to these, analgesic effects of lasers can be explained
by the increase synthesis of endorphin and bradykinin which
results in decreased activity of C fibers and change in pain
threshold, and also in reduction of serotonin and suppression of
nociceptors
28

29. PAIN MANAGEMENT
• Evidence exists on the treatments effects of low
level lasers on the synthesis, release and
metabolism of various chemical nervous mediators
like serotonin and acetylcholine in central nervous
system, and histamine and prostaglandin in
peripheral nerves. The increase in production of
endorphin, the reduction of C fibers activity, the
decrease of bradykinin and the change in pain
threshold can also explain the effects of low level
lasers on pain
• The anti inflammatory effects of LLLT can be
due to the augmentation of phagocytosis and
increase of number and diameter of lymphatic
vessels, decrease in permeability of blood
vessels, repair of capillary flow and reduction
of edema
29

30. 30
LYMPHEDEMA
LLLT has been noticed to reduce histamine
release and accumulated lymph edema even
at Stage 3.
This application is useful for lymphedema of
patients who have surgically removed nodes,
or after chemotherapy
-It is not proven in conditions that are genetic.
- In treatment of wounds and sports injuries,
the lymph pathways have to be cleared
through laser application techniques that are
specific. This involves irradiating nodes,
applying a technique called ‘woodpecker, and
managing a dose that regenerates lymph
vessels if needed. As with injured skin, injured
lymph vessels may also be repaired with laser.

31. 31

32. 32
4th stage lymphedema treated with
laser reduced by 1 inch in a single
session of 1 hour

33. TREATING PAIN
THROUGH TRIGGER
POINTS IN
ORTHOPEDIC
CONDITIONS
Sports injuries, surgeries,
visceral organ diseases and
orthopedic conditions
including spinal curvature,
Spondylosis, lumbago etc,
will require an approach with
laser to treat trigger points.
Pontinens Principle should be
applied to maximize the dose
till the painful trigger point is
removed. The therapist may
palpate the tender point to
assess pain score, and
determine effects before and
after lllt.
Also manage referred pain
33

34. Trigger Point therapy is an
essential technique used in
Physical therapy to manage
pain.
There is a large database of
research from World
Association of Laser therapy
on precise dosimetry for each
condition and muscle or
tendon group.
The therapist must be
acquainted with
1) the laser wavelength,
2) anatomy of muscle and
3) location of trigger point
4) Recommended dosimetry
in joules
Photo shows trigger pints and areas
of referred pain
34

35. CHUKUKA
ENWEMEKA.
WALT EDITOR
Manual on WALT
doses and trigger
points is published
online based on
meta-analysis of
scientific data
Emphasis on
tendonitis
And osteo-arthritis
http://se-led-
belt.com/wp-
content/uploads/201
2/10/Light_Therapy
_by_Chukuka_Enw
emeka_PhD.pdf.
35

36. muscle or area no of
joules
points
Biceps humeri 1-2 8
Supraspinatus 2-3 10
• Minimum 5 Joules per point
Infraspinatus 2-3 10
Minimum 5 Joules per point
Cervical spine 2-4 15
• Minimum 6 Joules per point
Lumbar spine 2-4 40
• Minimum 8 Joules per point
Hip 2-4 40
• Minimum 8 Joules per point
Knee medial 3-6 20
• Minimum 5 Joules per point
RECOMMEND
ED DOSES
FROM WALT
Using 780nm to
830nm single lllt
probes
in Physical
therapy
Chronic and acute
conditions must be
differentiated
Stages of healing
must be
differentiated
Local and referred
pain musat be
differentiated
36

37. 37
CORRESPONDENCE TO SPINAL
THERAPY DUE TO LUMBOPELVIC
IMBALANCE AND CURVATURE

38. 38
TESTIMONIALS
Senior Orthopedic surgeon
DR Goel, took LLLT and LAP
for plantarfascitis. Editor of my
OM course.
“I have gone through your
sports massage manual ,I
found it very good , relevant
and I think
This will be very useful in
india fo training
physiotherapist to handle
sports massage.”
DR X, nuclear medicine from
KingsCollege,London
received TP release and
dermatone therapy for pain
following trochanter surgery
“Malini I wanted to thank you
for the laser therapy that had
a most calming effect on my
bilateral trochanteric bursitis.
Many thanks for this insight
into a new and very helfpul
therapy”

39. LASER ACUPUNCTURE
• Influential points: can be used as
an adjunct treatmentLaser is less painful than
needles
39

40. MIND BODY
CORRELATED
The energy
released in
acupuncture is
from the Jing or
Kidney reservoir.
It is a latent
storehouse of
energy available
for healing.
The Jing is
suggested to
belong to the Dna
or genetic
potential of the
life cycle
It is also used by
martial arts and Qi
gong masters to
acquire greater
physical powers.
40

41. 41

42. 42
2. Body acupuncture with laserneedles:
Orthopaedics Neurology/Psychology
Internal medicine Dermatology
Spinal column syndromes Residual paresis after
apoplexia
Gastro-intestinal diseases Eczema
Herniated discs Migraine and other
headache syndromes
Circulatory disorders Neurodermatitis
Knee arthrosis Trigeminal neuralgia Bronchial asthma
Psoriasis
Hip arthrosis Tinnitus Allergic diseases Chronic wounds
Thumb arthrosis Depressions Hypertension Acne
Scapulohumeral
periarthritis
Psychovegetative fatigue Diabetes mellitus Herpes
Lateral epicondylitis Drug addictions
(Smoking, drugs)
General fatigue Herpes zoster
Tendinitis MS and other
neurovegetative diseases
Gingivitis
Fibromyalgia and PCP Morbus Parkinson

43. 43
-LAP must be differentiated from
needle acupuncture.
-LAP treats single command points,
wheras acupuncture approaches a yin
and yang points related to 5 element
disorders.
-LAP must be differentiated from
Trigger points which treat the fascia
and PNS. LAP treats the CNS and
may speed up treatment effects.
-LAP includes AH SHI points which
are closely co-related to TP’s
-Refer to Laser acupuncture trial on
women golfers, published in Laser
World.

44. LASER AURICULAR
ACUPUNCTURE.
LASER
FREQUENCIES.
44

45. NOGIER FREQUENCIES
AND CORRESPONDENCES
• Frequencies Body Ear (external
face)
• A Orifices: mouth, eyes, nostrils,
navel, anus and genitals Internal
face of tragus, auricular meatus
• B Trunk: face and back Concha
• C Limbs: arms and legs
Anthelix andhelix root
• D Median line front and back, trunk
and head Pre-tragus area
• E Skull, neck and vertebral column
Descending part of helix
• F Face except nose and forehead
Isthmus
• G Forehead (projection of frontal
lobes) Lobule
45

46. Frequencies and
Value (Hz)
• A 292 E 4672
• B 584 F 73
• C 1168 G 146
• D 2336
• Definition of frequencies by Drs Paul and Raphaël Nogier:
Extract from "The man in the ear", Maisonneuve, 1979, 255 p.
• The "A" frequency is associated, in the animal kingdom, with non-
organized, embryonic structures. It is the frequency of the primitive
living being; it is in sympathy with the cell in the crude, undifferentiated
state. This frequency, the most archaic, can also be considered to be
the most anarchic.
• The more elaborate "B" frequency is specific to the nutritional visceral
system and is related to the primitive gastrointestinal apparatus.
• The "C" frequency indicates motor elements of the body. It reflects
movement, the limbs, the renal system, the genital tract.
• The "D" frequency leads us to a higher level of organization, as it
introduces the concept of symmetry, by selectively affecting certain
unpaired organs, presenting the characteristic of being solitary, but
anatomically symmetrical; for example the corpus callosum or the white
commissure, two symmetrical cerebral structures, situated between the
right hemisphere and the left hemisphere [...]
• The "E" frequency is that of the spinal cord and central nervous
system, which perceives and communicates between functional units
situated at different levels.
• The "F" frequency represents subcortical cerebral regions. These
structures are found in the brain of higher animals, dogs, for example.
• The "G" frequency resonates with the most elaborate structures of the
body, those of the cerebral cortex, the typically human part of the brain,
which gives man the capacity to think, create and imagine.
•
46

47. RUBACH. MECHANISMS OF
PAIN CONTROL OF
ACUPUNCTURE
47

48. RUBACH. EMBRYONIC ORIGIN
AND POINT DETECTION
48

49. 49
RUBACH

50. 50
AXEL RUBACH. PRINCIPLES OF EAR
ACUPUNCTURE

51. RUBACH
51

52. 52
RUBACH

53. Embryonic and hormonal
potential of auricular nerves
for LAP
• Specific properties of the vagus
nerve as that some hormonal
mechanisms are active through
this pathway.
• Eg LEPTIN, master fat burning
hormone.
• Leptin also regulates other
hormones as Insulin, thyroid and
leptin others
• This explains why LAP of the
auricular is a famous clinical
treatment for obseity 53

54. • ENSURE THAT YOU ARE
CERTIFIED OR TRAINED
TO APPLY LASER FOR A
SPECIFIC PROTOCOL
• MANAGE APPLICATIONs
THAT ARE DIAGNOSIS
SPECIFIC : WHERE THE
PROTOCOL IS DESIGNED
• ENSURE THAT YOU
BELONG TO A LEGITIMATE
AUTHORITY FOR
INSTRUCTION
• DO NOT MAKE CLAIMS OR
PROMISE TO CURE
• DOCUMENT ALL
PROCEDURES AND
RECORDS
• MANAGE
ORGANIZATIONAL SKILLS
• MANAGE
COMMUNICATION SKILLS
TO INFORM THE CLIENT
• STAY UPDATED IN
RESEARCH AND
SCIENTIFIC LITERATURE
FDA.
APPROVAL
FOR
PRACTISE
54

55. RECENT
CONCERNS
In a recent editorial published
by Tina Karu in
Photomedicine and Laser
surgery, she has
communicated that the time
has come to consider LLLT a
drug based equivalent.
She has been accountable in
presenting the large and
specific database of scientific
achievements in all fields in
40 years.
55

56. LAP IS INDICATED FOR
STROKES. CAM
• NAESSER.Ph. L.AC
• WEBER. Germany
56

57. 57

58. 58

59. TESTIMONIAL OF A
CARE GIVER
59
Malini s has helped my grandmother who is 85
plus recover her movements in her legs and
arms after a major stroke made her to weak to
move. We have
seen great results of her therapy without any
discomfort or pain. The therapy has
helped in strengthening the muscles in knee and
spine
. Before this we had a physio therapist but there
was almost no improvement after 5 months and
so we looked for alternatives to physio
ADITYA BAJAJ
FOUNDER: MIND MY APPS
W 6 Greater Kailash 1
9141414169
Aditya.bajaj@mindmyweb.com

60. 60
WEBER: Injured nerves in infants
treated with laserneedles
THE INTERNATIONAL JOURNAL OF MEDICAL
LASER APPLICATION
VOLUME 1 JULY 2011
Conclusions
The high efficacy rate in the regeneration of
peripheral nerve injuries triggered by LLLT,
especially in newborns and infants, clearly
indicates the validity of this new treatment
technique. More considerations could be offered
regarding the future

61. LLLT FOR SPINAL
CORD INJURY.
Naessers report. NIH
61

62. 62

63. EFFECT OF LLLT ON
MICROCIRCULATION
Ihsan et al. could show a noticeable
increase of the microcirculation as well as
a boost of
adenosin, STH and FGF (Fibroblasts-
Growth-Factor) after infrared laser
irradiation of rabbit tissue
63

64. Laser blood irradiation in biological cancer
therapy
EXTRA
WEBER

65. 65
MANUAL THERAPIES ARE A SUPPORT
. Acupressure, TP’s , Orthopedic massage

66. Some Manual Strokes
• Acupressure
• Techniques
require
assessment of
pulse or
dantian.
• Accordingly a
stimulatory or
inhibitory
treatment is
planned
• Orthopedic/sports
:massage
• Strokes require
soft tissue
release, trigger
point release and
CR MET of
injured muscle
and/or reciprocal
muscles, PNF
stretches
66

67. Manual support.
Contract-relac muscle
energy technique
67

68. 68
Prevents
injuries
Improves
performance
Improves
recovery, range of
movement,
healing
Relieves pain
Reduces
muscle spasm
BENEFITS OF SPORTs MASSAGE
Maintain Rom
Increase
strength
Increase
flexibility
Promote
endurance

69. 69
Philosophy of PNF care is
applied to the whole body
–The technique
stimulates basic
movement patterns
–Has a neurodevelopmental
origin and may be used for
functional activities i.e.
swimming, climbing, throwing
etc
– Manages resisted
movement in multiple
planes simultaneously

70. 70
Perform a
skills self
checklist.
as a
therapist
during
-Consultation
-Treatment
plan
-Treatment
-Treatment
response

71. 71
How do you recognize change
By collecting data:
◦…..Vital signs, cognition, skin
integrity/condition, patient safety while
using assistive devices, gait, balance, MMT,
muscle tone, administer standardized pain
questionnaires, assessment of posture,
ROM, recognizes cyanosis & activities that
aggravate or relieve edema, pain, dyspnea
THEEREFORE MANAGE CLIENT
INTAKE FFORMS
ACCURATELY……

72. 72

73. 73

74. 74
LINKS
www.laserannals.com
www.walt.nu
www.laser.nu
www.centerforwellnes
s.net
With
European
medical
Laser Assoc.
EMLA
parliament