Lasers in Surgery and Medicine最新文献

Background: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition predominantly affecting postmenopausal women, often leading to significant discomfort and impaired quality of life. Current treatments, such as topical corticosteroids, have limitations in efficacy and long-term safety. Fractional CO₂ laser therapy has emerged as a promising modality for managing VLS, but its combination with topical estrogen remains underexplored.

Objective: This study aimed to evaluate the efficacy and safety of combined fractional CO₂ laser and topical estrogen therapy in managing VLS in postmenopausal women.

Methods: A randomized controlled trial was conducted involving 60 postmenopausal women diagnosed with VLS. Participants were divided into two groups: the intervention group received fractional CO₂ laser therapy combined with topical estrogen ointment, while the control group received topical estrogen alone. Efficacy was defined as a significant reduction in vulvar lichen sclerosus symptom score (VLSSS), assessed at baseline, 3 months, and 6 months. Secondary outcomes included histopathological changes and patient-reported quality of life measures.

Results: At both 3 months and 1 year after treatment, the intervention group showed a significant reduction in VLSSS compared to the control group (p < 0.001). Histopathological analysis demonstrated reduced inflammation and fibrosis. Patient-reported outcomes revealed significant improvements in sexual function (FSFI) and quality of life (CECA10) in the combined therapy group. Additionally, the recurrence rate at 1 year was significantly lower in the intervention group (17.14%) than in the control group (31.43%, p < 0.001). No severe adverse events were reported.

Limitations: The study's sample size was relatively small, and the follow-up period was limited to 6 months, which may not capture long-term outcomes. Additionally, the single-center design may limit generalizability.

Conclusion: Combined fractional CO₂ laser and topical estrogen therapy is a safe and effective approach for managing VLS in postmenopausal women, offering significant symptom relief and improved quality of life. Further studies with larger cohorts and longer follow-up are warranted to confirm these findings.

Objectives: To develop an optical feedback system compatible with a commercial surgical laser for automatically distinguishing between urinary stones and soft tissues during laser lithotripsy, thereby enhancing procedural safety.

Methods: The system, based on diffuse reflectance spectroscopy (DRS), was implemented in an engineered clinical theranostic platform. In vivo experiments were conducted to collect and analyze DRS spectra of tissues during laser lithotripsy. Illumination was performed via the endoscope, and detection was performed via the treatment fiber. Classification of urinary stones and soft tissues was performed using machine learning methods, i.e., Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA).

Results: The system demonstrated high diagnostic performance, with 93% sensitivity for soft tissue identification and 93% specificity for stone detection evaluated by the LDA method. This real-time differentiation effectively minimized unintended laser exposure to non-target tissues.

Conclusions: The developed optical guidance system provides real-time feedback during laser lithotripsy, improving safety and precision by reducing the risk of accidental tissue damage. The proposed technology is expected to enhance outcomes in minimally invasive urological laser procedures.

Objectives: To assess the efficacy of antimicrobial blue light (aBL) in managing Candida albicans keratitis in rabbit corneas ex vivo and safety to retinal cells in vitro.

Methods: C. albicans (strain CEC-749) suspensions were exposed to aBL with different light irradiance to assess the susceptibility of C. albicans to aBL. An ex vivo C. albicans keratitis model using rabbit corneas infected with a bioluminescent strain CEC-749 was developed. aBL was delivered topically to the infected corneas after fungal inoculation at varying irradiances. Bioluminescent imaging was used to track corneal infection progression in real-time. To evaluate the toxicity of aBL to the retinal cells, photoreceptors (661W) and retinal pigment epithelium cells (ARPE-19) were exposed to aBL in vitro, with cell viability and apoptosis assessed. The viability change of 661W cells under intermittent irradiation of aBL is determined.

Results: At varying irradiances of 25, 50, and 100 mW/cm² and a constant 405 nm blue light exposure of 216 J/cm², 3.39-, 3.67-, and 2.83-log10 CFU of C. albicans were inactivated in suspensions, respectively. Bioluminescence imaging revealed that C. albicans keratitis was fully developed in ex vivo rabbit corneas 24 h following fungal inoculation. After exposure to 288 J/cm² aBL, the fungal burden in the 6, 18, and 24 h-infected rabbit corneas was reduced by approximately 1.57-, 2.18-, and 1.47-log10, as determined by bioluminescence imaging. The viability and apoptosis of both 661W and ARPE-19 cells were significantly affected by continuous aBL delivery at 32.43 J/cm². Intermittent irradiation with a total exposure of 37.50 J/cm², administered as 12.50 J/cm² per irradiation session with 2 h intervals for three sessions, did not affect the viability of 661W cells.

Conclusions: aBL is a potential treatment for C. albicans keratitis. The intermittent irradiation approach using aBL to treat fungal keratitis could be a safety modality for clinical application.

Objectives: Informed consent is vital in dermatologic procedures, particularly in cosmetic dermatology, where shared decision-making improves outcomes and patient satisfaction. However, drafting detailed consent forms for every type of procedure is time-consuming and tedious. Recent advances in artificial intelligence, including language models like ChatGPT, offer potential for efficiently generating readable consent documents. This study evaluated the quality of ChatGPT-generated informed consent forms for commonly used lasers and energy-based devices.

Methods: A cross-sectional study was conducted using ChatGPT-4 (January 2025) to generate consent forms for eight laser and energy-based dermatologic devices via standardized prompts. Five board-certified dermatologists independently rated each form using a four-point rubric assessing the accuracy and completeness of procedure descriptions, benefits, risks, alternatives, and overall impression. Mean scores were calculated across all domains and devices.

Results: ChatGPT-generated consent forms showed variability in quality. Radiofrequency microneedling consents consistently scored highest (average 2.75/3.0), with 9 of 10 domains rated ≥ 2.5. Monopolar radiofrequency devices scored lowest (1.85), with six domains ≤ 2. Expected pain (2.68) and restrictions (2.5) were most consistently well-documented, while general descriptions (2.16) and overall impression (2.05) were least complete. Benefits and risks varied widely across devices. Some forms included incomplete or inaccurate content.

Conclusion: ChatGPT shows promise in generating informed consent documents efficiently, particularly for procedures like radiofrequency microneedling. However, variability in completeness and occasional inaccuracies limit its standalone clinical utility. Dermatologist oversight remains essential. Broader studies are needed to assess the impact of AI-generated forms on patient comprehension and satisfaction in diverse clinical settings.

Objectives: Cellular senescence contributes to skin aging. Lasers and energy-based devices (EBDs) are used to treat age-related skin changes. Given the clinical improvement seen with these devices, we sought to systematically review whether current evidence supports an impact on cellular senescence.

Methods: A systematic literature review was conducted according to PRISMA guidelines. PubMed, EBSCO, and Web of Science databases were searched for relevant articles examining the effects of lasers and EBDs on cellular senescence. Devices included lasers, radiofrequency, ultrasound, photobiomodulation, photodynamic therapy, and intense pulsed light.

Results: A total of 23 articles presented original work, relevant to dermatology, evaluating the impact of these treatments at a cellular level. These comprised laser (n = 6), light-based (n = 11), and other EBDs (n = 6). Overall, these technologies demonstrated a positive effect on cellular senescence and clinically minimized neocarcinogenesis and improved age-related skin changes.

Conclusions: Literature evaluating the impact of lasers and EBDs on cellular senescence is scarce. This review suggests that these modalities may reduce cellular senescence, thereby restoring cellular signaling and rejuvenating the skin. We propose that these effects represent a converging fundamental mechanism of hormesis promoting skin anti-fragility and longevity.