Lasers in Surgery and Medicine最新文献_第10页

Novel 40 µm spot size 3050/3200 nm DFG laser versus CO2 laser for laser-assisted drug delivery 用于激光辅助给药的新型 40 µm 光斑尺寸 3050/3200 nm DFG 激光器与 CO2 激光器的对比。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-01-16 DOI: 10.1002/lsm.23755

Parita T. Suwan MD, Ga Ram Ahn MD, PhD, Roger Sumner MSc, Dilip Paithankar PhD, Ilya V. Yaroslavsky PhD, Gregory Altshuler PhD, Valeriya Arkhipova PhD, Dieter Manstein MD, PhD, Michael Wang-Evers PhD

Background and Objectives

The use of ablative fractional lasers to enhance the delivery of topical drugs through the skin is known as laser-assisted drug delivery. Here, we compare a novel 3050/3200 nm difference frequency generation (DFG) fiber laser (spot size: 40 µm) to a commercially used CO₂ laser (spot size: 120 µm). The objective is to determine whether differences in spot size and coagulation zone (CZ) thickness influence drug uptake.

Materials and Methods

Fractional ablation was performed on ex-vivo human abdominal skin with the DFG (5 mJ) and CO₂ (12 mJ) lasers to generate 680 µm deep lesions. To evaluate drug delivery, 30 kDa encapsulated fluorescent dye was topically applied to the skin and histologically analyzed at skin depths of 100, 140, 200, 400, and 600 µm. Additionally, transcutaneous permeation of encapsulated and 350 Da nonencapsulated dye was assessed using Franz Cells.

Results

The DFG laser generated smaller channels (diameter: 56.5 µm) with thinner CZs (thickness: 22.4 µm) than the CO₂ laser (diameter: 75.9 µm, thickness: 66.8 µm). The DFG laser treated group exhibited significantly higher encapsulated dye total fluorescence intensities after 3 h compared to the CO₂ laser treated group across all skin depths (p < 0.001). Permeation of nonencapsulated dye was also higher in the DFG laser treated group vs the CO₂ laser treated group after 48 h (p < 0.0001), while encapsulated dye was not detected in any group.

Conclusion

The DFG laser treated skin exhibited significantly higher total fluorescence uptake compared to the CO₂ laser. Additionally, the smaller spot size and thinner CZ of the DFG laser could result in faster wound healing and reduced adverse effects while delivering similar or greater amount of topically applied drugs.

背景和目的：使用烧蚀点阵激光来加强局部药物通过皮肤的输送被称为激光辅助给药。在此，我们比较了新型 3050/3200 nm 差分频率生成 (DFG) 光纤激光器（光斑大小：40 µm）和商用 CO2 激光器（光斑大小：120 µm）。目的是确定光斑大小和凝固区（CZ）厚度的不同是否会影响药物吸收：使用 DFG（5 mJ）和 CO2（12 mJ）激光器在体外人体腹部皮肤上进行点阵消融，以产生 680 µm 深的病灶。为了评估药物输送情况，将 30 kDa 封装荧光染料局部涂抹在皮肤上，并在皮肤深度 100、140、200、400 和 600 微米处进行组织学分析。此外，还使用弗朗兹细胞评估了封装染料和 350 Da 非封装染料的透皮渗透情况：与 CO2 激光（直径：75.9 微米，厚度：66.8 微米）相比，DFG 激光产生的通道更小（直径：56.5 微米），CZ 更薄（厚度：22.4 微米）。与二氧化碳激光治疗组相比，DFG 激光治疗组在 3 小时后的所有皮肤深度都显示出明显更高的封装染料总荧光强度（p 2）：与 CO2 激光相比，DFG 激光治疗组皮肤的总荧光吸收率明显更高。此外，DFG 激光的光斑更小，CZ 更薄，因此伤口愈合更快，不良反应更少，同时局部用药量相似或更大。

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引用次数: 0

Treatment of hypopigmented burn hypertrophic scars with short-term topical tacrolimus does not lead to repigmentation 用短期外用他克莫司治疗色素沉着的烧伤增生性疤痕不会导致色素再沉着。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-01-15 DOI: 10.1002/lsm.23754

Esteban A. Molina MS, Taryn E. Travis MD, Lou'ay Hussein BS, Mary A. Oliver BS, John W. Keyloun MD, Lauren T. Moffatt PhD, Jeffrey W. Shupp MD, Bonnie C. Carney PhD

<div> <section> <h3> Objectives</h3> <p>Dyschromia is an understudied aspect of hypertrophic scar (HTS). The use of topical tacrolimus has successfully shown repigmentation in vitiligo patients through promotion of melanogenesis and melanocyte proliferation. It was hypothesized that HTSs treated with topical tacrolimus would have increased repigmentation compared to controls.</p> </section> <section> <h3> Methodology</h3> <p>Full-thickness burns in red Duroc pigs were either treated with excision and meshed split-thickness skin grafting or excision and no grafting, and these wounds formed hypopigmented HTSs (<i>n</i> = 8). Half of the scars had 0.1% tacrolimus ointment applied to the scar twice a day for 21 days, while controls had no treatment. Further, each scar was bisected with half incurring fractional ablative CO<sub>2</sub> laser treatment before topical tacrolimus application to induce laser-assisted drug delivery (LADD). Pigmentation was evaluated using a noninvasive probe to measure melanin index (MI) at Days 0 (pretreatment), 7, 14, and 21. At each timepoint, punch biopsies were obtained and fixed in formalin or were incubated in dispase. The formalin-fixed biopsies were used to evaluate melanin levels by H&E staining. The biopsies incubated in dispase were used to obtain epidermal sheets. The ESs were then flash frozen and RNA was isolated from them and used in quantitative reverse transcription polymerase chain reaction for melanogenesis-related genes: Tyrosinase (TYR), TYR-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Analysis of variance test with Šídák's multiple comparisons test was used to compare groups.</p> </section> <section> <h3> Results</h3> <p>Over time, within the grafted HTS and the NS group, there were no significant changes in MI, except for Week 3 in the −Tacro group. (+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (−Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5). Over time, within the ungrafted HTS and the NS group, there were no significant changes in MI. (+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (−Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3). LADD did not lead to any differential change in pigmentation compared to the non-LADD group. There was no evidence of increased melanogenesis within the tissue punch biopsies at any timepoint. There were no changes in TYR, TYRP1, or DCT gene expression after treatment.</p> </section> <section> <h3> Conclusion</h3> <p>Hypopigmented HTSs treated with 0.1% tacrolimus ointment w

目的：色素沉着症是增生性瘢痕（HTS）中未被充分研究的一个方面。通过促进黑色素生成和黑色素细胞增殖，外用他克莫司已成功地使白癜风患者的皮肤恢复色素。我们假设，与对照组相比，使用局部他克莫司治疗的 HTS 会增加再色素沉着：方法：对红色杜洛克猪的全厚烧伤进行切除和网状分层植皮或切除和不植皮处理，这些伤口形成了色素沉着的HTS（n = 8）。其中一半的疤痕涂上 0.1% 他克莫司软膏，每天两次，持续 21 天，而对照组则不做任何处理。此外，在局部使用他克莫司诱导激光辅助给药（LADD）之前，将每个疤痕一分为二，一半疤痕接受二氧化碳激光点阵消融治疗。在第 0 天（治疗前）、第 7 天、第 14 天和第 21 天，使用无创探针测量黑色素指数（MI），评估色素沉着情况。在每个时间点，取冲孔活检组织，用福尔马林固定或用分散酶培养。福尔马林固定的活检组织用于通过 H&E 染色评估黑色素水平。在分散酶中培养的活组织用于获取表皮片。然后闪速冷冻 ES，从中分离出 RNA，用于黑色素生成相关基因的定量反转录聚合酶链反应：酪氨酸酶（TYR）、TYR 相关蛋白-1（TYRP1）和多巴醌合成酶（DCT）。结果表明，随着时间的推移，嫁接的 H 细胞内的酪氨酸酶和多巴醌同工酶的数量都在增加，而酪氨酸酶和多巴醌同工酶的数量则在减少：结果：随着时间的推移，在移植的 HTS 和 NS 组中，除 -Tacro 组第 3 周外，MI 没有显著变化。(+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (-Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5)。随着时间的推移，未移植 HTS 组和 NS 组的 MI 没有显著变化。(+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (-Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3)。与非 LADD 组相比，LADD 并未导致色素沉着的任何不同变化。在任何时间点，组织打孔活检中都没有黑色素生成增加的证据。治疗后，TYR、TYRP1或DCT基因表达没有变化：结论：使用 0.1% 他克莫司软膏或不使用 LADD 治疗色素减退的 HTS，其再色素沉着并没有明显增加。这项研究的局限性在于，治疗间隔时间比已知的白癜风患者色素恢复所需的时间短。使用非侵入性的局部治疗方法来促进色素恢复，是缓解烧伤疤痕色素沉着症相关发病率的一种有吸引力的策略，需要进一步研究。

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引用次数: 0

Long-term efficacy and safety of nonablative monopolar radiofrequency in the treatment of moderate to severe acne vulgaris 非烧蚀单极射频治疗中重度寻常痤疮的长期疗效和安全性。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-01-14 DOI: 10.1002/lsm.23757

Woraphong Manuskiatti MD, Supisara Wongdama MD, Noldtawat Viriyaskultorn MD, Jayne Bernadeth Li MD, Kanokvalai Kulthanan MD, Thanya Techapichetvanich MD

<div> <section> <h3> Background</h3> <p>Acne vulgaris (AV) is a prevalent skin condition known for its potential to cause scarring and psychological distress, often leading to diminished self-esteem. While topical and oral treatments are commonly prescribed, some patients experience treatment failure, adverse effects, or contraindications to conventional therapies. In response to these challenges, laser and energy-based device therapies have emerged as promising alternatives for individuals who fall into these categories, showing considerable potential in the treatment of AV.</p> </section> <section> <h3> Objective</h3> <p>This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) in treatment of moderate to severe AV.</p> </section> <section> <h3> Methods</h3> <p>Twenty-four patients with moderate to severe AV underwent a series of two NMRF treatment sessions, spaced 4 weeks apart. To evaluate treatment outcomes, live in-person lesion counts and measurements of pore size and volume, and sebum production were quantified using Antera® 3D imaging system, and Sebumeter®, respectively. Patients' self-assessment data regarding degree of improvement and facial oiliness were gathered. Dermatology life quality index (DLQI) questionnaire was utilized to assess the impact of AV on their quality of life. All objective and subjective evaluations were conducted at the baseline, 1 month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment sessions. Adverse effects were also recorded during each visit.</p> </section> <section> <h3> Results</h3> <p>Twenty out of the 24 subjects completed the study protocol. The mean inflammatory lesion counts significantly reduced by 42.86% and 45.71% from the baseline at 3 (<i>p</i> = 0.027) and 6 months (<i>p</i> = 0.032) after the second treatment. Sebum excretion likewise significantly decreased from baseline by 11.62% (<i>p</i> = 0.012), 13.37% (<i>p</i> < 0.001), and 21.51% (<i>p</i> = 0.004), 1 month after the first treatment, 1 and 6 months after the second treatment, respectively. The pore volume continued to decrease by 35% (<i>p</i> = 0.003) and 41.5% (<i>p</i> < 0.001) at 1 and 6 months following the final treatment, respectively. The DLQI significantly decreased from 10.00 (interquartile range [IQR]: 6.50−15.00) to 2.00 (IQR: 1.00−4.75), corresponding to 80% improvement of the index, 1 month after the last treatment and was sustained up to the last follow-up visit. Patients' self-assessments on degree of improvemen

背景：寻常性痤疮（AV）是一种常见的皮肤病，可能会造成疤痕和心理困扰，往往导致自尊心下降。虽然外用药和口服药是常用的治疗方法，但有些患者会出现治疗失败、不良反应或传统疗法禁忌症。为了应对这些挑战，激光和基于能量的设备疗法已成为有前途的替代疗法，显示出治疗反车辆的巨大潜力：本研究旨在评估非烧蚀性单极射频（NMRF）治疗中度至重度房室传导阻滞的长期疗效和安全性：24名中重度房室传导患者接受了两次非剥脱单极射频（NMRF）治疗，每次治疗间隔4周。为了评估治疗效果，使用 Antera® 3D 成像系统和 Sebumeter® 分别对患者的皮损计数、毛孔大小和体积以及皮脂分泌进行了现场量化测量。还收集了患者对改善程度和面部出油情况的自我评估数据。皮肤科生活质量指数（DLQI）问卷用于评估 AV 对患者生活质量的影响。所有客观和主观评估均在基线、首次治疗后 1 个月以及最后一次治疗后 1、3 和 6 个月的随访中进行。每次就诊时还记录了不良反应：结果：24 名受试者中有 20 人完成了研究方案。在第二次治疗后的 3 个月（p = 0.027）和 6 个月（p = 0.032），平均炎症病变计数比基线值分别显著减少了 42.86% 和 45.71%。皮脂排泄量也同样比基线明显减少了 11.62% (p = 0.012)、13.37% (p 结论：NMRF 是一种有效的皮脂治疗方法：NMRF 似乎是治疗炎症性视网膜病变的一种有效而安全的方法，其疗效在两次治疗后可持续 6 个月。

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引用次数: 0

Introduction to the 2024 special dermatology plastic surgery issue 介绍 2024 年皮肤科整形外科特刊。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-01-05 DOI: 10.1002/lsm.23753

Emily Wenande MD, PhD, Merete Haedersdal MD, PhD, DMSc

引用次数: 0

Line-field confocal optical coherence tomography for in vivo visualization of morphological characteristics of squamous cell carcinoma in a murine model 线场共聚焦光学相干断层成像用于在鼠模型中活体观察鳞状细胞癌的形态特征。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2023-12-21 DOI: 10.1002/lsm.23750

Uffe H. Olesen PhD, Camilla Foged MD, Kevin Jacobsen MD, Vinzent K. Ortner PhD, Gabriella Fredman MD, Uwe Paasch PhD, Merete Haedersdal PhD, DMSc

Objectives

Non-invasive imaging with line-field confocal optical coherence tomography (LC-OCT) can support the diagnosis of squamous cell carcinoma (SCC) through visualization of morphological characteristics specific to skin cancer. We aimed to visualize prominent morphological characteristics of SCC using LC-OCT in a well-established murine SCC model.

Materials and Methods

Nine hairless mice were exposed to ultraviolet radiation three times weekly for 9 months to induce SCC development. Visible SCC tumors (n = 9) were imaged with LC-OCT and the presence of 10 well-described morphological characteristics of SCC were evaluated in the scans by two physicians with adjudication by a third.

Results

Overall, murine morphological characteristics resembled corresponding features previously reported in human SCCs. Interrupted dermal-epidermal junction occurred in 100% of tumors. In epidermis, the most frequently observed characteristics were severe epidermal dysplasia (100%) and tumor budding (89%). Common dermal characteristics included broad strands (100%) and collagen alterations (78%).

Conclusion

LC-OCT imaging can be used to non-invasively visualize morphological characteristics specific to SCC in an in vivo preclinical model.

目的：线场共聚焦光学相干断层扫描（LC-OCT）的无创成像可以通过观察皮肤癌特有的形态特征来支持鳞状细胞癌（SCC）的诊断。我们的目的是在一个成熟的小鼠鳞状细胞癌模型中使用 LC-OCT 观察鳞状细胞癌的突出形态特征：九只无毛小鼠每周暴露于紫外线辐射三次，持续 9 个月，以诱导 SCC 的发展。用 LC-OCT 对可见的 SCC 肿瘤（n = 9）进行成像，并由两名医生对扫描结果中是否存在 10 种明确描述的 SCC 形态特征进行评估，由第三名医生进行裁定：结果：总体而言，小鼠的形态特征与之前报道的人类 SCC 的相应特征相似。100%的肿瘤都出现了真皮-表皮交界中断。在表皮中，最常观察到的特征是严重的表皮发育不良（100%）和肿瘤出芽（89%）。常见的真皮特征包括宽股（100%）和胶原改变（78%）：结论：LC-OCT成像可用于在体内临床前模型中非侵入性地观察SCC特有的形态特征。

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引用次数: 0

Corneal wound healing following infrared laser irradiation at the wavelengths of 1.319 and 10.6 μm 波长为 1.319 和 10.6 μm 的红外线激光照射后的角膜伤口愈合情况

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2023-12-17 DOI: 10.1002/lsm.23749

Congling Zhou MSc, Yixue Yin MSc, Jiarui Wang PhD, Ziqi Ren MSc, Luguang Jiao PhD, Li Zhong PhD, Zaifu Yang PhD

Objectives

To investigate the wound healing of rabbit cornea following infrared laser irradiations at the wavelengths of 1.319 and 10.6 μm.

Materials and Methods

Twelve New Zealand rabbits were selected to establish a corneal injury model. The right and left eyes were irradiated with a neodymium-doped yttrium aluminum garnet laser at the wavelength of 1.319 μm (140 J/cm²) for 0.7 s and a CO₂ laser at the wavelength of 10.6 μm (5.94 J/cm²) for 0.14 s, respectively. The incident spot diameter was 3 mm. Optical coherence tomography (OCT) was used to monitor injuries at 0 h, 0.5 h, 1 h, 3 h, 6 h, 12 h, 18 h, 24 h, 30 h, 36 h, 42 h, 48 h, 54 h, 60 h, 66 h, 3 d, 7 d, 14 d, 28 d, 3 m, and 6 m postexposure. Meanwhile, slit-lamp microscopy and histopathology were performed at 6 h, 24 h, 3 d, 7 d, 14 d, 28 d, 3 m, and 6 m postexposure.

Results

After the two types of infrared laser injuries, distinct white circular lesions on the corneal surface were directly observed. Deeper corneal injury, more severe edema, and faster migration of new epithelium were found for the wavelength of 1.319 μm, compared to the wavelength of 10.6 μm.

Conclusions

OCT combined with histopathology and slit-lamp microscopy can clearly observe the dynamic process of corneal wound healing after infrared laser irradiation. The damage characteristics for the two different wavelengths were visibly different, but the whole wound healing process was similar. The obtained results may provide references for the diagnosis, treatment, and evaluation of laser-induced damages.

研究波长为 1.319 和 10.6 μm 的红外线激光照射后兔角膜伤口的愈合情况。

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引用次数: 0

Ultrasonographic elastography, a new era showing the improvement of episiotomy scar treated with Er:YAG laser, a case-series 超声弹性成像，显示用 Er:YAG 激光治疗外阴切开术疤痕改善情况的新时代，病例系列。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2023-12-15 DOI: 10.1002/lsm.23748

Cemal Tamer Erel, Mert Urfalioglu MD, Rauf Hamid MD, Osman Aykan Kargin MD, Ipek Betul Ozcivit Erkan MD, Elif Bayraktar MD, Ibrahim Adaletli, Ozge Askin

引用次数: 0

Cover Image: Volume 55 Issue 10 封面图片：第 55 卷第 10 期

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2023-12-13 DOI: 10.1002/lsm.23751

Arsham Hamidi PhD, Yakub A. Bayhaqi PhD, Sandra Drusová PhD, Alexander A. Navarini MD, PhD, Philippe C. Cattin PhD, Ferda Canbaz PhD, Azhar Zam PhD

Cover micrograph: The cover image is based on the Basic Science Article Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation by Arsham Hamidi et al., https://doi.org/10.1002/lsm.23732.

封面显微照片:封面图像基于Arsham Hamidi等人的基础科学文章《智能激光截骨术的多模态反馈系统:深度控制和组织分化》，https://doi.org/10.1002/lsm.23732。

引用次数: 0

Spectral effects and enhancement quantification in healthy human saliva with surface-enhanced Raman spectroscopy using silver nanopillar substrates 使用银纳米柱基底的表面增强拉曼光谱分析健康人唾液的光谱效应和增强定量

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2023-12-10 DOI: 10.1002/lsm.23746

Esmat Zamani BEng, Nassim Ksantini MSc, Guillaume Sheehy MSc, Katherine J. I. Ember PhD, Bill Baloukas PhD, Oleg Zabeida PhD, Tran Trang BSc, Myriam Mahfoud MEng, Jolanta-Ewa Sapieha PhD, Ludvik Martinu PhD, Frédéric Leblond PhD

Objectives

Raman spectroscopy as a diagnostic tool for biofluid applications is limited by low inelastic scattering contributions compared to the fluorescence background from biomolecules. Surface-enhanced Raman spectroscopy (SERS) can increase Raman scattering signals, thereby offering the potential to reduce imaging times. We aimed to evaluate the enhancement related to the plasmonic effect and quantify the improvements in terms of spectral quality associated with SERS measurements in human saliva.

Methods

Dried human saliva was characterized using spontaneous Raman spectroscopy and SERS. A fabrication protocol was implemented leading to the production of silver (Ag) nanopillar substrates by glancing angle deposition. Two different imaging systems were used to interrogate saliva from 161 healthy donors: a custom single-point macroscopic system and a Raman micro-spectroscopy instrument. Quantitative metrics were established to compare spontaneous RS and SERS measurements: the Raman spectroscopy quality factor (QF), the photonic count rate (PR), the signal-to-background ratio (SBR).

Results

SERS measurements acquired with an excitation energy four times smaller than with spontaneous RS resulted in improved QF, PR values an order of magnitude larger and a SBR twice as large. The SERS enhancement reached 100×, depending on which Raman bands were considered.

Conclusions

Single-point measurement of dried saliva with silver nanopillars substrates led to reproducible SERS measurements, paving the way to real-time tools of diagnosis in human biofluids.

拉曼光谱作为生物流体应用的一种诊断工具，与生物大分子的荧光背景相比，其非弹性散射贡献较低，因而受到限制。表面增强拉曼光谱（SERS）可以增加拉曼散射信号，从而有可能缩短成像时间。我们的目的是评估与质子效应相关的增强效果，并量化与人体唾液中 SERS 测量相关的光谱质量改进。

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引用次数: 0

Analysis of lithotripsy efficiency and stone retropulsion displacement according to pulse characteristics of Ho: YAG laser with Moses effect 基于摩西效应的Ho: YAG激光脉冲特性对碎石效率和碎石反推位移的分析。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2023-11-30 DOI: 10.1002/lsm.23743

Kanghae Kim PhD, Young-Seok Seo PhD, Phil-Sang Chung MD, PhD, Joo Beom Eom PhD

<div> <section> <h3> Background and Objectives</h3> <p>Compared to the conventional Ho: YAG laser, a Ho: YAG laser device has been reported that has a Moses effect to reduce stone retropulsion and increase lithotripsy efficiency. The principle of this equipment is to convert a single laser pulse into two pulses. Most studies on such lasers are limited to lithotripsy efficiency and the prevention of stone retropulsion; studies according to each pulse condition have not been performed. Therefore, the purpose of this study was to quantify the bubble shape, lithotripsy efficiency, and stone retropulsion displacement in a ureteral phantom according to the modulation of the first pulse characteristics of the Moses effect laser under conditions that maintained the total energy and repetition rate.</p> </section> <section> <h3> Material and Methods</h3> <p>In this study, a Ho: YAG laser system (Holinwon Pro, Wontech Inc., Korea) with an emission wavelength of 2.10 μm and a Moses effect was used. To verify the Moses effect based on the changes in the pulse, a water tank was fabricated, and the ureteral phantom was manufactured in a structure that could be easily installed in the water tank. Additionally, a spherical artificial stone in the ureteral phantom was prepared by mixing calcined gypsum (Cacinated Gypsum) and water at a ratio of 3:1. In the ureteral phantom, a high-speed camera (FASTCAM NOVA S12, Photron Inc.) and visible light were used to record pulse-dependent image analysis of bubbles and stone retropulsion.</p> </section> <section> <h3> Result</h3> <p>After mounting the artificial stone in the ureteral phantom, the pulse duration and energy of the first pulse of the Moses effect laser were varied; 30 laser shots for 3 s at a repetition rate of 10 Hz were applied to quantify the lithotripsy efficiency and stone retropulsion displacement, and the experimental values were compared. The fragmentation efficiency was confirmed by measuring the mass before and after the laser pulse application, the original position of the stone retropulsion displacement, and the distance moved. The minimum value of stone retropulsion displacement appeared when the pulse duration of the first pulse was 300 μs, the pulse energy was 100 mJ, and the value was approximately 0.28 mm. The highest fragmentation efficiency was observed under the same conditions, and the mass loss of the artificial stone at that time was approximately 3.7 mg.</p> </section> <section> <h3> Conclusion</h3> <p>Quantitative indices, such as lithotripsy efficiency and stone retropulsion displacement, were confirmed using ultrahigh-speed cameras to determine the effect of the first

背景与目的:与传统的Ho: YAG激光器相比，已经报道了一种Ho: YAG激光装置，它具有摩西效应，可以减少石头的反冲，提高碎石效率。该设备的原理是将一个激光脉冲转换成两个脉冲。大多数关于这种激光器的研究都局限于碎石效率和防止石头的反冲;还没有对每一种脉搏情况进行研究。因此，本研究的目的是在保持总能量和重复率的条件下，通过调制Moses效应激光的第一脉冲特性，量化输尿管幻体中的气泡形状、碎石效率和结石退推位移。材料与方法:本研究采用发射波长为2.10 μm、具有Moses效应的Ho: YAG激光系统(Holinwon Pro, Wontech Inc.， Korea)。为了验证基于脉冲变化的摩西效应，我们制作了一个水箱，并制作了一个易于安装在水箱中的输尿管幻体。此外，将煅烧石膏(Cacinated gypsum)与水按3:1的比例混合，在输尿管幻体内制备球形人工结石。在输尿管幻影中，使用高速摄像机(FASTCAM NOVA S12, Photron Inc.)和可见光记录气泡和结石退推的脉冲依赖图像分析。结果:在输尿管幻体内放置人工结石后，Moses效应激光第一脉冲的脉冲持续时间和能量发生了变化;采用重复频率为10 Hz的30次激光照射，持续3 s，量化碎石效率和石头的推退位移，并对实验值进行比较。通过测量激光脉冲施加前后的质量、石头的原始位置的反推位移和移动的距离来确定破碎效率。当第一次脉冲脉冲持续时间为300 μs，脉冲能量为100 mJ时，石推位移最小，其值约为0.28 mm;在相同的条件下，观察到最高的破碎效率，此时人造石的质量损失约为3.7 mg。结论:利用超高速摄像机确定了具有Moses效应的Ho: YAG激光第一脉冲能量和持续时间对石质去除的影响，确定了碎石效率和石质反推位移等定量指标。结果表明，主脉冲持续时间越长、能量越低，破片效率越高。在本研究中，根据Moses效应激光器的第一脉冲条件，证实了制造具有最佳脱石效果的激光器的可能性。

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