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Excimer laser coronary angioplasty combined with drug-coated balloon in the treatment of in-stent restenosis 准分子激光冠状动脉血管成形术联合药物涂层球囊治疗支架内再狭窄。
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-05-13 DOI: 10.1002/lsm.23794
Pan He, Haiwei Chen, Junjie Yang, Lei Gao, Jun Guo, Yundai Chen, Qi Wang

Objectives

The aim of this study is to investigate the safety and efficacy of excimer laser coronary angioplasty (ELCA) combined with drug-coated balloons (DCBs) in the treatment of in-stent restenosis (ISR), and to explore whether the contrast injection technique would improve the neointimal tissue ablation of ELCA.

Methods

We studied patients diagnosed with ISR between January 2019 and October 2022 at two medical centers. These patients underwent DCB angioplasty guided by optical coherence tomography (OCT). Based on whether ELCA was performed before DCB treatment, patients were categorized into two groups: the ELCA + DCB group and the DCB group. All patients underwent clinical follow-up 1 year after the procedure. The primary endpoint was the 1-year rate of target lesion revascularization (TLR), which was defined as any repeat percutaneous intervention or bypass surgery on the target vessel conducted to address restenosis or other complications related to the target lesion. The secondary endpoints including immediate luminal gain (ΔMLA, defined as the difference in minimum lumen area before and after the intervention).

Results

A total of 85 lesions in 75 patients were included. The mean age of the study population was 64.2 ± 12.0 years, with 81.3% male. Baseline clinical characteristics were well-balanced, and procedural success was 100% in both groups. The ELCA + DCB group (n = 24) exhibited a greater ΔMLA compared to the DCB group (n = 61) (3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm², [95% confidence interval, CI: 0.57–1.69], p < 0.001), The reduction in 1-year TLR was more frequently observed in patients from the ELCA + DCB group compared to the DCB group (hazard ratio 0.33 [95% CI: 0.11–0.99]; log-rank p = 0.048). The exploratory analysis showed that ELCA with contrast infusion is associated with greater acute lumen gain compared to ELCA with saline infusion (p < 0.001).

Conclusions

The combination of ELCA and DCB is a safe and effective treatment strategy for in-stent stenosis. Additionally, compared with saline injection, ELCA with contrast injection is associated with greater acute lumen gain. However, the optimal contrast agent concentration and long-term outcome of the contrast injection technique need confirmation through larger sample sizes and prospective studies.

研究目的本研究旨在探讨准分子激光冠状动脉成形术(ELCA)联合药物涂层球囊(DCB)治疗支架内再狭窄(ISR)的安全性和有效性,并探讨造影剂注射技术是否能改善ELCA的新生内膜组织消融:我们对两家医疗中心在2019年1月至2022年10月期间诊断为ISR的患者进行了研究。这些患者在光学相干断层扫描(OCT)的引导下接受了 DCB 血管成形术。根据 DCB 治疗前是否进行了 ELCA,患者被分为两组:ELCA + DCB 组和 DCB 组。所有患者都在术后一年接受了临床随访。主要终点是靶病变血运重建(TLR)的1年率,TLR的定义是为解决再狭窄或与靶病变相关的其他并发症而对靶血管进行的任何重复经皮介入治疗或搭桥手术。次要终点包括即时管腔增大(ΔMLA,定义为介入治疗前后最小管腔面积的差异):结果:共纳入了 75 名患者的 85 个病灶。研究对象的平均年龄为(64.2 ± 12.0)岁,81.3%为男性。两组患者的基线临床特征均衡,手术成功率均为100%。与 DCB 组(n = 61)相比,ELCA + DCB 组(n = 24)的ΔMLA 更大(3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm²,[95% 置信区间,CI:0.57-1.69],p 结论:ELCA + DCB 组的ΔMLA 更小:ELCA和DCB联合治疗支架内狭窄是一种安全有效的治疗策略。此外,与生理盐水注射相比,注射造影剂的 ELCA 与急性管腔增大相关。然而,造影剂的最佳浓度和造影剂注射技术的长期效果还需要通过更大样本量的前瞻性研究来证实。
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引用次数: 0
Histological analysis of laser-enabled tissue coring with a novel 2910 nm erbium-doped fluoride glass fiber laser 利用新型 2910 纳米掺铒氟化玻璃光纤激光器对激光辅助组织取芯进行组织学分析。
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-05-08 DOI: 10.1002/lsm.23792
Taryn N. Murray MD, Hasina Maredia MD, Paul M. Friedman MD

Objectives

There remains an unmet need for a laser-enabled tissue coring device that can effectively improve face and neck skin laxity and rhytides. We investigate a novel 2910 nm erbium-doped fluoride glass fiber laser (2910 nm fiber laser) (UltraClear; Acclaro Medical) for laser-coring of submental tissue.

Methods

Five subjects, Glogau scale III−IV, were treated with a single pulse of the laser-coring mode of the 2910 nm fiber laser in the submentum. A 4 mm punch biopsy was immediately performed. Biopsy specimens were sectioned and stained with hematoxylin and eosin and placed on glass slides. All sections were reviewed, and sections containing the center of the transected core were analyzed for depth and diameter of the ablative microchannel and width of the surrounding zone of coagulation.

Results

A total of 15 intact micro-cores were analyzed. Histological analysis revealed an average ± standard deviation microchannel diameter of 242.5 ± 65.2 µm, an average ablative depth of 980 ± 318.8 µm, and an average zone of coagulation of 104 ± 32 µm.

Conclusions

Laser-enabled tissue coring with a novel 2910 nm fiber laser can safely achieve a wider microchannel diameter with ablative depth extending to the mid and deep dermis, which has the potential for collagen contraction and tissue tightening. Laser-coring to this ablation diameter and depth and with the surrounding zone of coagulation was found to be safe without adverse effects of post-inflammatory erythema or scarring in our study.

目标:目前仍未满足对可有效改善面颈部皮肤松弛和皱纹的激光组织切削设备的需求。我们研究了一种新型 2910 nm 掺铒氟化玻璃光纤激光器(2910 nm 光纤激光器)(UltraClear;Acclaro Medical),用于对下颌组织进行激光切削:方法:对五名格洛高分级 III-IV 级的受试者进行了治疗,采用 2910 nm 光纤激光器的单脉冲激光凿毛模式对其进行治疗。随即进行 4 毫米打孔活检。活检样本经切片、苏木精和伊红染色后置于玻璃载玻片上。对所有切片进行复查,并对包含横切核心中心的切片进行分析,以确定烧蚀微通道的深度和直径以及周围凝固区的宽度:结果:共分析了 15 个完整的微芯。组织学分析显示,微通道的平均直径为 242.5 ± 65.2 µm,平均烧蚀深度为 980 ± 318.8 µm,平均凝固区为 104 ± 32 µm:结论:使用新型 2910 nm 光纤激光器进行激光组织抽芯,可以安全地获得更宽的微通道直径,烧蚀深度可延伸至真皮中层和深层,具有收缩胶原和紧致组织的潜力。在我们的研究中发现,按照这种烧蚀直径和深度以及周围的凝固区进行激光切削是安全的,不会产生炎症后红斑或瘢痕等不良影响。
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引用次数: 0
Picosecond alexandrite laser treatment of nevus of Ota in children 皮秒紫翠宝石激光治疗儿童太田痣。
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-05-06 DOI: 10.1002/lsm.23795
Wenwen Zhao BSN, Ying Yang MD, Hualing Shi BSN, Lifang Guo MD, Hui Ding MD, Huiying Zhen MD, Tong Lin MD, Yiping Ge MD

Background

The picosecond alexandrite laser has been safely and effectively used to treat the nevus of Ota in adults. However, limited data are available for children.

Objective

To investigate the efficacy, safety, and correlative influencing factors of a 755nm picosecond alexandrite laser in the treatment of nevus of Ota in children.

Methods

We retrospectively analyzed Chinese children with nevus of Ota who received a 755nm picosecond alexandrite laser treatment in a tertiary dermatological hospital.

Result

A total of 305 pediatric patients received an average of two treatments achieving an average of 79% pigment clearance. After the first treatment, 22 patients achieved complete clearance (95%–100%), and 72 patients achieved excellent response (75%–94%), with an average initial efficacy of 63% lesion clearance. Treatment at an early age achieved better initial efficacy (0- to 12-month group >1- to 6-year group, 6- to 12-year group). And 0- to 12-month group achieved better final efficacy. More treatment sessions also increased the final efficacy. Both initial efficacy and final efficacy were better when treating a darker lesion. The incidence of complications was 12.1%, with 10.8% being post-inflammatory hyperpigmentation and 1.3% being hypopigmentation. The rate of recurrence was 6.6%.

Limitation

Retrospective study.

Conclusion

A 755nm picosecond alexandrite laser is safe and effective in treating nevus of Ota in children. Younger to initiate treatment, darker lesions, and more treatments are positively associated with better pigmentation clearance.

背景介绍皮秒紫翠宝石激光已被安全有效地用于治疗成人太田痣。然而,用于儿童的数据有限:研究 755nm 皮秒紫翠宝石激光治疗儿童太田痣的疗效、安全性及相关影响因素:我们回顾性分析了在一家三级皮肤病医院接受 755nm 皮秒紫翠宝石激光治疗的中国太田痣患儿:共有 305 名儿童患者接受了平均两次治疗,色素清除率平均达到 79%。第一次治疗后,22 名患者达到完全清除(95%-100%),72 名患者达到极佳反应(75%-94%),平均初始疗效为病灶清除率 63%。早期治疗取得了更好的初始疗效(0至12个月组>1至6年组,6至12年组)。0至12个月组的最终疗效更好。治疗次数越多,最终疗效越好。治疗颜色较深的病灶时,初始疗效和最终疗效都更好。并发症发生率为12.1%,其中10.8%为炎症后色素沉着,1.3%为色素减退。复发率为 6.6%:局限性:回顾性研究:755nm皮秒紫翠宝石激光治疗儿童太田痣安全有效。开始治疗的年龄越小、皮损颜色越深、治疗次数越多,色素清除率越高。
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引用次数: 0
Effective treatment of corticosteroid-induced facial erythema using fractional radiofrequency microneedling 使用点阵射频微针有效治疗皮质类固醇引起的面部红斑
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.1002/lsm.23787
Xiaowen Huang PhD, Siqi Zheng MBBS, Pingjiao Chen PhD, Menghua Zhu MD, Jia Guo MD, Qian Li PhD, Kang Zeng PhD, Sijin He MD

Objectives

To investigate the efficacy of Fractional Radiofrequency Microneedling (FRM) in treating corticosteroid-induced facial erythema.

Methods

A retrospective study was conducted involving eight patients diagnosed as corticosteroid-induced facial erythema. Each patient underwent a single session of FRM. Evaluative measures included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), assessment of telangiectasia severity, procedure-associated pain (10-point scale), patient satisfaction (3-point scale) and secondary outcomes.

Results

The study found a 75% success rate and 100% effectiveness rate in alleviating erythema symptoms. CEA and PSA scores decreased by 67.7% and 78.1%, respectively. No cases of erythema rebound were recorded during the 3-month follow-up period.

Conclusions

FRM demonstrated effectiveness and safety in treating facial erythema, offering promising advancement in dermatologic therapeutics.

目的 探讨点阵射频微针疗法(FRM)在治疗皮质类固醇引起的面部红斑方面的疗效。方法 对 8 名确诊为皮质类固醇引起的面部红斑患者进行回顾性研究。每位患者都接受了一次 FRM 治疗。评估指标包括临床医师红斑评估(CEA)、患者自我评估(PSA)、毛细血管扩张严重程度评估、手术相关疼痛(10 分制)、患者满意度(3 分制)和次要结果。CEA和PSA评分分别下降了67.7%和78.1%。结论FRM 在治疗面部红斑方面表现出了有效性和安全性,是皮肤病治疗领域的一大进步。
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引用次数: 0
Cover Image: Volume 56 Issue S36 封面图片:第 56 卷第 S36 期
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-04-30 DOI: 10.1002/lsm.23791

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引用次数: 0
In vivo assessment of bladder cancer with diffuse reflectance and fluorescence spectroscopy: A comparative study 利用漫反射和荧光光谱对膀胱癌进行活体评估:比较研究。
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-04-22 DOI: 10.1002/lsm.23788
Nadezhda V. Zlobina MSc, Gleb S. Budylin PhD, Polina S. Tseregorodtseva BSc, Viktoria A. Andreeva MSc, Nikolay I. Sorokin PhD, David M. Kamalov PhD, Andrey A. Strigunov MSc, Artashes G. Armaganov MSc, Armais A. Kamalov PhD, Evgeny A. Shirshin PhD

Objectives

The aim of this work is to assess the performance of multimodal spectroscopic approach combined with single core optical fiber for detection of bladder cancer during surgery in vivo.

Methods

Multimodal approach combines diffuse reflectance spectroscopy (DRS), fluorescence spectroscopy in the visible (405 nm excitation) and near-infrared (NIR) (690 nm excitation) ranges, and high-wavenumber Raman spectroscopy. All four spectroscopic methods were combined in a single setup. For 21 patients with suspected bladder cancer or during control cystoscopy optical spectra of bladder cancer, healthy bladder wall tissue and/or scars were measured. Classification of cancerous and healthy bladder tissue was performed using machine learning methods.

Results

Statistically significant differences in relative total haemoglobin content, oxygenation, scattering, and visible fluorescence intensity were found between tumor and normal tissues. The combination of DRS and visible fluorescence spectroscopy allowed detecting cancerous tissue with sensitivity and specificity of 78% and 91%, respectively. The addition of features extracted from NIR fluorescence and Raman spectra did not improve the quality of classification.

Conclusions

This study demonstrates that multimodal spectroscopic approach allows increasing sensitivity and specificity of bladder cancer detection in vivo. The developed approach does not require special probes and can be used with single-core optical fibers applied for laser surgery.

方法多模态方法结合了漫反射光谱(DRS)、可见光(405 nm 激发)和近红外(NIR)(690 nm 激发)范围内的荧光光谱以及高波长拉曼光谱。所有四种光谱方法都结合在一个装置中。对 21 名疑似膀胱癌患者或在对照膀胱镜检查期间的膀胱癌、健康膀胱壁组织和/或疤痕的光学光谱进行了测量。结果发现肿瘤组织和正常组织之间在相对总血红蛋白含量、氧饱和度、散射和可见荧光强度方面存在显著统计学差异。结合 DRS 和可见荧光光谱检测癌症组织的灵敏度和特异度分别为 78% 和 91%。本研究表明,多模态光谱方法可以提高体内膀胱癌检测的灵敏度和特异性。所开发的方法不需要特殊探针,可与用于激光手术的单芯光纤一起使用。
{"title":"In vivo assessment of bladder cancer with diffuse reflectance and fluorescence spectroscopy: A comparative study","authors":"Nadezhda V. Zlobina MSc,&nbsp;Gleb S. Budylin PhD,&nbsp;Polina S. Tseregorodtseva BSc,&nbsp;Viktoria A. Andreeva MSc,&nbsp;Nikolay I. Sorokin PhD,&nbsp;David M. Kamalov PhD,&nbsp;Andrey A. Strigunov MSc,&nbsp;Artashes G. Armaganov MSc,&nbsp;Armais A. Kamalov PhD,&nbsp;Evgeny A. Shirshin PhD","doi":"10.1002/lsm.23788","DOIUrl":"10.1002/lsm.23788","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this work is to assess the performance of multimodal spectroscopic approach combined with single core optical fiber for detection of bladder cancer during surgery in vivo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multimodal approach combines diffuse reflectance spectroscopy (DRS), fluorescence spectroscopy in the visible (405 nm excitation) and near-infrared (NIR) (690 nm excitation) ranges, and high-wavenumber Raman spectroscopy. All four spectroscopic methods were combined in a single setup. For 21 patients with suspected bladder cancer or during control cystoscopy optical spectra of bladder cancer, healthy bladder wall tissue and/or scars were measured. Classification of cancerous and healthy bladder tissue was performed using machine learning methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Statistically significant differences in relative total haemoglobin content, oxygenation, scattering, and visible fluorescence intensity were found between tumor and normal tissues. The combination of DRS and visible fluorescence spectroscopy allowed detecting cancerous tissue with sensitivity and specificity of 78% and 91%, respectively. The addition of features extracted from NIR fluorescence and Raman spectra did not improve the quality of classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates that multimodal spectroscopic approach allows increasing sensitivity and specificity of bladder cancer detection in vivo. The developed approach does not require special probes and can be used with single-core optical fibers applied for laser surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of vitamins and food on the fluorescence spectrum of human urine 维生素和食物对人体尿液荧光光谱的影响
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-04-11 DOI: 10.1002/lsm.23785
Praveen Chalissery, Christian Homann PhD, Herbert Stepp PhD, Maximilian Eisel PhD, Maximilian Aumiller PhD, Adrian Rühm PhD, Alexander Buchner MD, Ronald Sroka PhD

Objectives

Fluorescence spectroscopy of human urine is a method with the potential to gain importance as a diagnostic tool in the medical field, e.g., for measuring Coproporphyrin III (CPIII) as an indicator of cancer and acute types of porphyria. Food can change human urine's color, which could influence the urine fluorescence spectrum and the detection of CPIII in urine. To determine if there is a noticeable influence on the urine fluorescence spectrum or on the detection of CPIII in urine, 16 vitamin supplements, and three food items were tested. Such investigation may also prevent false interpretation of measured data.

Methods

Urine samples were collected before and after (overnight, ca. 8 h) intake of each test substance. Samples were investigated by fluorescence spectrum analysis. At excitation wavelengths from 300 to 500 nm and emission wavelengths from 400 to 700 nm excitation-emission-matrices were measured. Data obtained from urine before intake were compared to the data from overnight urine. Furthermore, the investigation of any interference with the CPIII concentration was performed at an excitation wavelength of 407 ± 3 nm and emission wavelengths of 490−800 nm.

Results

Only vitamin B2, but none of the other tested substances, showed noticeable influence on the urine fluorescence spectrum. None of the tested substances showed noticeable interference with the recovery rate of CPIII.

Conclusions

The correct interpretation of measured data by fluorescence spectroscopy is possible with the exception if vitamin B2 supplementation was performed; thus, the consumption of vitamin B2 supplements before fluorescence testing of the patient's urine should be avoided and/or must be requested. CPIII concentrations could reliably be measured in all cases.

目的人体尿液荧光光谱法是一种有可能在医学领域作为重要诊断工具的方法,例如用于测量作为癌症和急性卟啉症指标的铜卟啉 III(CPIII)。食物会改变人体尿液的颜色,从而影响尿液荧光光谱和尿液中 CPIII 的检测。为了确定对尿液荧光光谱或尿液中 CPIII 的检测是否有明显影响,我们对 16 种维生素补充剂和 3 种食物进行了检测。方法在摄入每种测试物质前后(过夜,约 8 小时)收集尿液样本。通过荧光光谱分析对样本进行调查。激发波长为 300 至 500 nm,发射波长为 400 至 700 nm。将摄入前尿液的数据与隔夜尿液的数据进行比较。此外,在激发波长为 407 ± 3 nm 和发射波长为 490-800 nm 时,对 CPIII 浓度的干扰进行了调查。结论通过荧光光谱法可以正确解释所测得的数据,但补充维生素 B2 的情况除外;因此,在对患者的尿液进行荧光检测之前,应避免服用维生素 B2 补充剂,并且/或者必须要求服用维生素 B2 补充剂。在所有情况下都能可靠地测量出 CPIII 的浓度。
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引用次数: 0
Percutaneous delivery of liquid tetracycline using a thermal resurfacing drug delivery system for the treatment of festoons 利用热重塑给药系统经皮给药液态四环素以治疗静脉曲张
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-04-11 DOI: 10.1002/lsm.23786
Margarita Safir MD, Inbar Waizer MD, Ari Safir MD, Morris E. Hartstein MD, Ofir Artzi MD

Objectives

To examine the effects of percutaneous tetracycline delivery to the malar area using a thermomechanical device (Tixel) in patients suffering from festoons.

Methods

This retrospective study included patients who underwent combination treatment with a thermomechanical device (Tixel) followed by application of topical tetracycline 1% at two private clinics between 2019 and 2023. Demographic and medical data, treatment parameters along with before and after treatment photographs were retrieved retrospectively. All patients were asked to answer a questionnaire, assessing self-reported pre and posttreatment disturbance, patient global impression of change (PGIC) score, overall satisfaction with treatment, and the onset and duration of treatment effect. Finally, three masked reviewers evaluated and graded the severity of before and after treatment photographs.

Results

Twenty healthy patients received the combination treatment. The mean age was 59.4 ± 8.2 years (range: 45–72 years), and 90.0% (n = 18) were female. The number of treatment sessions per patient ranged from 2 to 8, mean of 5.0 ± 1.9, performed at 5.4 ± 1.2-week intervals. The masked reviewers' grading scores demonstrated a significant improvement (2.81 ± 1.3 before vs. 1.6 ± 1.1 after, p < 0.001). The self-reported disturbance caused by the festoons improved significantly as well (4.7 ± 0.98 vs. 1.7 ± 1.1, p < 0.001). On the PGIC score, 85% (17/20) reported moderate (grade 5) to significant (grade 7) improvement of symptoms and life quality after treatment. Improvement onset was reported to occur 11.2 ± 6.6 days after the first treatment (range 2−30 days), and 90% (18/20) of the patients reported improvement lasting at least 4 months after completion of the second treatment.

Conclusions

Topical tetracycline application following Tixel treatment induced significant improvement in patient with festoons.

方法这项回顾性研究纳入了2019年至2023年期间在两家私人诊所接受热机械装置(Tixel)联合治疗,然后外敷1%四环素的患者。研究人员回顾性地检索了患者的人口统计学数据、医疗数据、治疗参数以及治疗前后的照片。所有患者都被要求回答一份问卷,评估自我报告的治疗前和治疗后干扰、患者总体变化印象(PGIC)评分、对治疗的总体满意度以及治疗效果的开始和持续时间。最后,三名蒙面评审员对治疗前后照片的严重程度进行了评估和分级。平均年龄为 59.4 ± 8.2 岁(范围:45-72 岁),90.0%(n = 18)为女性。每位患者的治疗次数为 2 至 8 次不等,平均为 5.0 ± 1.9 次,治疗间隔为 5.4 ± 1.2 周。蒙面评审员的评分结果显示,患者的病情有了明显改善(治疗前为 2.81 ± 1.3,治疗后为 1.6 ± 1.1,p <0.001)。患者自我报告的褶皱造成的干扰也有明显改善(4.7 ± 0.98 vs. 1.7 ± 1.1,p < 0.001)。在 PGIC 评分中,85%(17/20)的患者表示治疗后症状和生活质量得到了中度(5 级)到明显(7 级)的改善。据报告,第一次治疗后 11.2 ± 6.6 天(2-30 天不等)病情开始好转,90%(18/20)的患者报告在第二次治疗后病情好转持续了至少 4 个月。
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引用次数: 0
Modeling pulsed dye laser treatment of psoriatic plaques by combining numerical methods and image-derived lesion morphologies 结合数值方法和图像衍生皮损形态,建立脉冲染料激光治疗银屑病斑块的模型
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-04-05 DOI: 10.1002/lsm.23781
Leah S. Wilk PhD, Meagan Doppegieter MSc, Nick van der Beek MSc, Ton G. van Leeuwen PhD, Maurice C. G. Aalders PhD

Objectives

Knowledge of the physical effects of pulsed dye laser (PDL) treatment of psoriatic lesions is essential in unraveling the remedial mechanisms of this treatment and hence also in maximizing in its disease-modifying potential. Therefore, the main objective of this study was to provide estimates of these physical effects (for laser wavelengths of 585 and 595 nm), with the aim of identifying pathogenic processes that may be affected by these conditions.

Methods

We modeled the laser light propagation and subsequent photothermal heating by numerically solving the transient diffusion and heat equations simultaneously. To this end, we used the finite element method in conjunction with an image-derived psoriatic lesion morphology (which was defined by segmenting blood vessels from a confocal microscopy image of a fluorescently labeled section of a 3 mm punch biopsy of a psoriatic lesion). The resulting predictions of the generated temperature field within the lesion were then used to assess the possibility of stalling or arresting some suspected pathogenic processes.

Results

According to our results, it is conceivable that perivascular nerves are thermally denatured, as almost all locations that reach 60°C were found to be within 18 µm (at 585 nm) and 11 µm (at 595 nm) of a blood vessel wall. Furthermore, activation of TRPV1 and TRPV2 channels in perivascular neuronal and immune cells is highly likely, since a critical temperature of 43°C is generated at locations within up to 350 µm of a vessel wall (at both wavelengths) and sustained for up to 700 ms (at 585 nm) and 40 ms (at 595 nm), while a critical temperature of 52°C is reached by locations within 80 µm (at 585 nm) and 30 µm (at 595 nm) of a vessel wall and sustained for up to 100  ms (at 585 nm) and 30 ms (at 595 nm). Finally, we found that the blood vessel coagulation-inducing temperature of 70°C is sustained in the vascular epithelium for up to 19 and 5 ms at 585 and 595 nm, respectively, rendering partial or total loss of vascular functionality a distinct possibility.

Conclusions

The presented approach constitutes a useful tool to provide realistic estimates of the photothermal effects of PDL treatment of psoriatic plaques (as well as other selective photothermolysis-based treatments), yielding information that is essential in guiding future experimental studies toward unraveling the remedial mechanisms of these treatments.

目的了解脉冲染料激光(PDL)治疗银屑病皮损的物理效应,对于揭示这种治疗方法的补救机制,从而最大限度地发挥其改变疾病的潜力至关重要。因此,本研究的主要目的是对这些物理效应(波长为 585 和 595 nm 的激光)进行估算,以确定可能受这些条件影响的致病过程。为此,我们将有限元法与图像衍生的银屑病皮损形态(通过共聚焦显微镜对银屑病皮损 3 毫米冲孔活检荧光标记切片的图像进行血管分割来定义)结合使用。结果根据我们的研究结果,血管周围神经可能发生热变性,因为几乎所有达到 60°C 的位置都在血管壁 18 微米(585 纳米)和 11 微米(595 纳米)范围内。此外,血管周围神经细胞和免疫细胞中的 TRPV1 和 TRPV2 通道极有可能被激活,因为在距离血管壁 350 微米以内的位置(在两种波长下)会产生 43°C 的临界温度,并可维持长达 700 毫秒(在 585 纳米波长下)和 40 毫秒(在 595 纳米波长下)、而血管壁 80 微米(585 纳米波长)和 30 微米(595 纳米波长)范围内的位置会达到 52°C 的临界温度,并持续 100 毫秒(585 纳米波长)和 30 毫秒(595 纳米波长)。最后,我们发现,在 585 纳米和 595 纳米波长下,血管上皮细胞内 70°C 的血管凝固诱导温度可分别持续长达 19 毫秒和 5 毫秒,从而使血管功能部分或完全丧失成为可能。结论所介绍的方法是一种有用的工具,可用于对银屑病斑块的 PDL 治疗(以及其他基于选择性光热解的治疗)的光热效应进行切合实际的估计,所产生的信息对于指导未来的实验研究以揭示这些治疗的补救机制至关重要。
{"title":"Modeling pulsed dye laser treatment of psoriatic plaques by combining numerical methods and image-derived lesion morphologies","authors":"Leah S. Wilk PhD,&nbsp;Meagan Doppegieter MSc,&nbsp;Nick van der Beek MSc,&nbsp;Ton G. van Leeuwen PhD,&nbsp;Maurice C. G. Aalders PhD","doi":"10.1002/lsm.23781","DOIUrl":"10.1002/lsm.23781","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Knowledge of the physical effects of pulsed dye laser (PDL) treatment of psoriatic lesions is essential in unraveling the remedial mechanisms of this treatment and hence also in maximizing in its disease-modifying potential. Therefore, the main objective of this study was to provide estimates of these physical effects (for laser wavelengths of 585 and 595 nm), with the aim of identifying pathogenic processes that may be affected by these conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We modeled the laser light propagation and subsequent photothermal heating by numerically solving the transient diffusion and heat equations simultaneously. To this end, we used the finite element method in conjunction with an image-derived psoriatic lesion morphology (which was defined by segmenting blood vessels from a confocal microscopy image of a fluorescently labeled section of a 3 mm punch biopsy of a psoriatic lesion). The resulting predictions of the generated temperature field within the lesion were then used to assess the possibility of stalling or arresting some suspected pathogenic processes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>According to our results, it is conceivable that perivascular nerves are thermally denatured, as almost all locations that reach 60°C were found to be within 18 µm (at 585 nm) and 11 µm (at 595 nm) of a blood vessel wall. Furthermore, activation of TRPV1 and TRPV2 channels in perivascular neuronal and immune cells is highly likely, since a critical temperature of 43°C is generated at locations within up to 350 µm of a vessel wall (at both wavelengths) and sustained for up to 700 ms (at 585 nm) and 40 ms (at 595 nm), while a critical temperature of 52°C is reached by locations within 80 µm (at 585 nm) and 30 µm (at 595 nm) of a vessel wall and sustained for up to 100  ms (at 585 nm) and 30 ms (at 595 nm). Finally, we found that the blood vessel coagulation-inducing temperature of 70°C is sustained in the vascular epithelium for up to 19 and 5 ms at 585 and 595 nm, respectively, rendering partial or total loss of vascular functionality a distinct possibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presented approach constitutes a useful tool to provide realistic estimates of the photothermal effects of PDL treatment of psoriatic plaques (as well as other selective photothermolysis-based treatments), yielding information that is essential in guiding future experimental studies toward unraveling the remedial mechanisms of these treatments.</p>\u0000 </s","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140568672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating the effect of pulse energy on femtosecond laser trabeculotomy (FLT) outflow channels for glaucoma treatment in human cadaver eyes 评估脉冲能量对飞秒激光小梁切开术(FLT)流出通道的影响,在人体尸体眼睛中治疗青光眼
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-04-03 DOI: 10.1002/lsm.23783
Shangbang Luo PhD, Eric R. Mikula PhD, Reza Khazaeinezhad PhD, Samantha M. Bradford PhD, Fengyi Zhang MSc, James V. Jester PhD, Tibor Juhasz PhD

Background and Objectives

Femtosecond laser trabeculotomy (FLT) creates aqueous humor outflow channels through the trabecular meshwork (TM) and is an emerging noninvasive treatment for open-angle glaucoma. The purpose of this study is to investigate the effect of pulse energy on outflow channel creation during FLT.

Materials and Methods

An FLT laser (ViaLase Inc.) was used to create outflow channels through the TM (500 μm wide by 200 μm high) in human cadaver eyes using pulse energies of 10, 15, and 20 μJ. Following treatment, tissues were fixed in 4% paraformaldehyde. The channels were imaged using optical coherence tomography (OCT) and assessed as full thickness, partial thickness, or not observable.

Results

Pulse energies of 15 and 20 μJ had a 100% success rate in creating full-thickness FLT channels as imaged by OCT. A pulse energy of 10 μJ resulted in no channels (n = 6), a partial-thickness channel (n = 2), and a full-thickness FLT channel (n = 2). There was a statistically significant difference in cutting widths between the 10 and 15 μJ groups (p < 0.0001), as well as between the 10 and 20 μJ groups (p < 0.0001). However, there was no statistically significant difference between the 15 and 20 μJ groups (p = 0.416).

Conclusions

Fifteen microjoules is an adequate pulse energy to reliably create aqueous humor outflow channels during FLT in human cadaver eyes. OCT is a valuable tool when evaluating FLT.

背景和目的 飞秒激光小梁切开术(FLT)可通过小梁网(TM)形成房水外流通道,是治疗开角型青光眼的一种新兴无创疗法。本研究的目的是探讨 FLT 过程中脉冲能量对流出通道形成的影响。 材料和方法 使用 FLT 激光器(ViaLase 公司)在人体尸体眼球中创建流出通道(宽 500 μm,高 200 μm),脉冲能量分别为 10、15 和 20 μJ。处理后,将组织固定在 4% 多聚甲醛中。使用光学相干断层扫描(OCT)对通道进行成像,并评估为全厚度、部分厚度或不可观察。 结果 15 和 20 μJ 的脉冲能量在通过 OCT 成像创建全厚 FLT 通道方面的成功率为 100%。10 μJ 脉冲能量导致无通道(n = 6)、部分厚度通道(n = 2)和全厚度 FLT 通道(n = 2)。10 μJ 组和 15 μJ 组之间以及 10 μJ 组和 20 μJ 组之间的切割宽度差异有统计学意义(p < 0.0001)。然而,15 和 20 μJ 组之间的差异没有统计学意义(p = 0.416)。 结论 15 微焦耳的脉冲能量足以在人体尸体眼睛的 FLT 过程中可靠地创建房水流出通道。OCT 是评估 FLT 的重要工具。
{"title":"Evaluating the effect of pulse energy on femtosecond laser trabeculotomy (FLT) outflow channels for glaucoma treatment in human cadaver eyes","authors":"Shangbang Luo PhD,&nbsp;Eric R. Mikula PhD,&nbsp;Reza Khazaeinezhad PhD,&nbsp;Samantha M. Bradford PhD,&nbsp;Fengyi Zhang MSc,&nbsp;James V. Jester PhD,&nbsp;Tibor Juhasz PhD","doi":"10.1002/lsm.23783","DOIUrl":"https://doi.org/10.1002/lsm.23783","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Femtosecond laser trabeculotomy (FLT) creates aqueous humor outflow channels through the trabecular meshwork (TM) and is an emerging noninvasive treatment for open-angle glaucoma. The purpose of this study is to investigate the effect of pulse energy on outflow channel creation during FLT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>An FLT laser (ViaLase Inc.) was used to create outflow channels through the TM (500 μm wide by 200 μm high) in human cadaver eyes using pulse energies of 10, 15, and 20 μJ. Following treatment, tissues were fixed in 4% paraformaldehyde. The channels were imaged using optical coherence tomography (OCT) and assessed as full thickness, partial thickness, or not observable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pulse energies of 15 and 20 μJ had a 100% success rate in creating full-thickness FLT channels as imaged by OCT. A pulse energy of 10 μJ resulted in no channels (<i>n</i> = 6), a partial-thickness channel (<i>n</i> = 2), and a full-thickness FLT channel (<i>n</i> = 2). There was a statistically significant difference in cutting widths between the 10 and 15 μJ groups (<i>p</i> &lt; 0.0001), as well as between the 10 and 20 μJ groups (<i>p</i> &lt; 0.0001). However, there was no statistically significant difference between the 15 and 20 μJ groups (<i>p</i> = 0.416).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fifteen microjoules is an adequate pulse energy to reliably create aqueous humor outflow channels during FLT in human cadaver eyes. OCT is a valuable tool when evaluating FLT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140546755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Lasers in Surgery and Medicine
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