Kenneth Thomsen, Raluca Jalaboi, Ole Winther, Hans Bredsted Lomholt, Henrik F. Lorentzen, Trine Høgsberg, Henrik Egekvist, Lene Hedelund, Sofie Jørgensen, Sanne Frost, Trine Bertelsen, Lars Iversen
Objectives
Hirsutism is a widespread condition affecting 5%–15% of females. Laser treatment of hirsutism has the best long-term effect. Patients with nonpigmented or nonterminal hairs are not eligible for laser treatment, and the current patient journey needed to establish eligibility for laser hair removal is problematic in many health-care systems.
Methods
In this study, we compared the ability to assess eligibility for laser hair removal of health-care professionals and convolutional neural network (CNN)-based models.
Results
The CNN ensemble model, synthesized from the outputs of five individual CNN models, reached an eligibility assessment accuracy of 0.52 (95% CI: 0.42–0.60) and a κ of 0.20 (95% CI: 0.13–0.27), taking a consensus expert label as reference. For comparison, board-certified dermatologists achieved a mean accuracy of 0.48 (95% CI: 0.44–0.52) and a mean κ of 0.26 (95% CI: 0.22–0.31). Intra-rater analysis of board-certified dermatologists yielded κ in the 0.32 (95% CI: 0.24–0.40) and 0.65 (95% CI: 0.56–0.74) range.
Conclusion
Current assessment of eligibility for laser hair removal is challenging. Developing a laser hair removal eligibility assessment tool based on deep learning that performs on a par with trained dermatologists is feasible. Such a model may potentially reduce workload, increase quality and effectiveness, and facilitate equal health-care access. However, to achieve true clinical generalizability, prospective randomized clinical intervention studies are needed.
{"title":"Physician Level Assessment of Hirsute Women and of Their Eligibility for Laser Treatment With Deep Learning","authors":"Kenneth Thomsen, Raluca Jalaboi, Ole Winther, Hans Bredsted Lomholt, Henrik F. Lorentzen, Trine Høgsberg, Henrik Egekvist, Lene Hedelund, Sofie Jørgensen, Sanne Frost, Trine Bertelsen, Lars Iversen","doi":"10.1002/lsm.23843","DOIUrl":"10.1002/lsm.23843","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Hirsutism is a widespread condition affecting 5%–15% of females. Laser treatment of hirsutism has the best long-term effect. Patients with nonpigmented or nonterminal hairs are not eligible for laser treatment, and the current patient journey needed to establish eligibility for laser hair removal is problematic in many health-care systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we compared the ability to assess eligibility for laser hair removal of health-care professionals and convolutional neural network (CNN)-based models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CNN ensemble model, synthesized from the outputs of five individual CNN models, reached an eligibility assessment accuracy of 0.52 (95% CI: 0.42–0.60) and a <i>κ</i> of 0.20 (95% CI: 0.13–0.27), taking a consensus expert label as reference. For comparison, board-certified dermatologists achieved a mean accuracy of 0.48 (95% CI: 0.44–0.52) and a mean <i>κ</i> of 0.26 (95% CI: 0.22–0.31). Intra-rater analysis of board-certified dermatologists yielded <i>κ</i> in the 0.32 (95% CI: 0.24–0.40) and 0.65 (95% CI: 0.56–0.74) range.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current assessment of eligibility for laser hair removal is challenging. Developing a laser hair removal eligibility assessment tool based on deep learning that performs on a par with trained dermatologists is feasible. Such a model may potentially reduce workload, increase quality and effectiveness, and facilitate equal health-care access. However, to achieve true clinical generalizability, prospective randomized clinical intervention studies are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 1","pages":"80-87"},"PeriodicalIF":2.2,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290322","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}
Konika Patel Schallen, Madelyn Seder, Michael Jorgenson, Kevin Schomacker, Jag Bhawan
Objectives
Non-ablative fractional lasers (NAFL) have increased in demand compared to ablative laser treatments as they provide lesser down time, fewer side-effects, and are safer to use. Non-ablative fractional treatment with lasers ranging from 1320 to 1927-nm have been shown to be safe and effective for skin resurfacing procedures. The objective of this study is to investigate healing of the 1940-nm NAFL-induced microthermal treatment zones (MTZs) in human skin from a histologic perspective.
Methods
Three subjects received 1940-nm NAFL treatment to test areas on the abdomen at various timepoints during the study. The minimum 5 mJ/MTZ and maximum 20 mJ/MTZ energy settings were used at 20% coverage. Biopsies were taken coinciding with immediately posttreatment, 1, 3, 7 days, and 6 weeks posttreatment. Blinded analysis of hematoxylin and eosin stained slides was performed to measure the width and depth of the MTZs and evaluate the inflammatory and healing response of the skin over time (immediately to 6 weeks posttreatment). Safety was evaluated by assessing local skin responses and adverse events immediately after treatment and at all study visits.
Results
Histological analysis of tissue following NAFL 1940-nm treatments showed mild early inflammatory response (presence of lymphotic infiltrate) in some test areas and zones of necrosis and coagulation having widths and depths (immediately–3 days posttreatment) that scaled with the 1940-nm pulse energy. Signs of healing such as presence of dermal mucin, evidence of fibrosis, and absence of necrosis were observed long-term (7 days to 6 weeks posttreatment). Evidence of the MTZ persisted beyond the 6-week study and was predicted to last for 100 days. All local clinical skin responses healed within 6 weeks and were limited to mild, transient erythema and edema which resolved in less than 12–24 h following treatment. No serious adverse events occurred during the study.
Conclusions
NAFL 1940-nm treatments are safe for inducing small fractional coagulation and necrosis zones in abdominal skin. NAFL 1940-nm laser creates fractional columns of injury with sufficient depth and coverage that suggest effective skin resurfacing, like other non-ablative fractional lasers.
{"title":"In Vivo Histological Study Evaluating Non-Ablative Fractional 1940-nm Laser","authors":"Konika Patel Schallen, Madelyn Seder, Michael Jorgenson, Kevin Schomacker, Jag Bhawan","doi":"10.1002/lsm.23842","DOIUrl":"10.1002/lsm.23842","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Non-ablative fractional lasers (NAFL) have increased in demand compared to ablative laser treatments as they provide lesser down time, fewer side-effects, and are safer to use. Non-ablative fractional treatment with lasers ranging from 1320 to 1927-nm have been shown to be safe and effective for skin resurfacing procedures. The objective of this study is to investigate healing of the 1940-nm NAFL-induced microthermal treatment zones (MTZs) in human skin from a histologic perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three subjects received 1940-nm NAFL treatment to test areas on the abdomen at various timepoints during the study. The minimum 5 mJ/MTZ and maximum 20 mJ/MTZ energy settings were used at 20% coverage. Biopsies were taken coinciding with immediately posttreatment, 1, 3, 7 days, and 6 weeks posttreatment. Blinded analysis of hematoxylin and eosin stained slides was performed to measure the width and depth of the MTZs and evaluate the inflammatory and healing response of the skin over time (immediately to 6 weeks posttreatment). Safety was evaluated by assessing local skin responses and adverse events immediately after treatment and at all study visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Histological analysis of tissue following NAFL 1940-nm treatments showed mild early inflammatory response (presence of lymphotic infiltrate) in some test areas and zones of necrosis and coagulation having widths and depths (immediately–3 days posttreatment) that scaled with the 1940-nm pulse energy. Signs of healing such as presence of dermal mucin, evidence of fibrosis, and absence of necrosis were observed long-term (7 days to 6 weeks posttreatment). Evidence of the MTZ persisted beyond the 6-week study and was predicted to last for 100 days. All local clinical skin responses healed within 6 weeks and were limited to mild, transient erythema and edema which resolved in less than 12–24 h following treatment. No serious adverse events occurred during the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NAFL 1940-nm treatments are safe for inducing small fractional coagulation and necrosis zones in abdominal skin. NAFL 1940-nm laser creates fractional columns of injury with sufficient depth and coverage that suggest effective skin resurfacing, like other non-ablative fractional lasers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 1","pages":"54-62"},"PeriodicalIF":2.2,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290320","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}
<p>Recently, Lasers in Surgery and Medicine published a meta-analysis based on 40 PDL studies and 18 HMME-PDT studies [<span>1</span>]. The authors indicate that “HMME-PDT has emerged as the first choice for PWB treatment, particularly for young children” and at the same time raise many questions regarding the use of HMME-PDT in China. On behalf of the Consensus Development Expert Group of Expert consensus on HMME-PDT, I appreciate American colleagues' interest and concern in HMME-PDT.</p><p>PDT's potential for PWS treatment was suggested in the mid-1980s and PDT protocols were developed for PWS treatment in China in the early 1990s [<span>2, 3</span>]. Two photosensitizing drugs, HiPorfin and Hemoporfin (also known as HMME) are approved for PWS treatment. There is no specific age restriction in HiPorfin production information. Because HMME Phase II and III trials only included patients > 14 years old, “lack of pediatric information in prescribe drug label” is stated in HMME production information. The post-marketing requirements suggest including pediatric patients in Phase IV trials to benefit them more. Clinical trials have been launched for 7−14 years old (NCT03125057, CTR20170189) and 2−7 years old (NCT04106258), respectively. Concerning “young children,” with therapeutic intention and on the premise of obtaining explicit informed consent from the parents, I believe the prescribing of HMME-PDT is regulatory adherence and in compliance with current regulations of rational off-label use of medicines [<span>4-6</span>].</p><p>The authors cite a paper published in 1934 and state that “hematoporphyrin derivatives have been used as antidepressants, indicating potential effects on brain function by this category of compounds. Therefore, the risk of HMME exposure to CNS in neonates, infants, and young children cannot be ignored.” In fact, the paper suggests it requires “intramuscular and oral administration of hematoporphyrin hydrochloride for an average period of 50 to 60 days” to see psychological benefit in depressive psychoses [<span>7</span>]. The remote risk of short-term HMME exposure to CNS in young children is likely small. Neurological and neuropsychiatric adverse reactions similar to that of porphyria have not been reported for HMME-PDT.</p><p>PDT was used before PDL became available in China. Partially due to this historical reason, many patients and parents would consider PDT as the first choice. For PDL resistance cases and large PWS lesions, clinicians might be inclined more toward PDT. But I am not aware that any publication implies “the use of HMME-PDT as the first choice of treatment for young children.” Hence, it is intriguing that the authors suggest that “HMME-PDT has emerged as the first choice for PWB in many major hospitals in China.” When accurate and thoughtfully presented, reporting of comparison of different modalities should be appreciated. In return, the authors who prefer one modality over another should have factua
{"title":"Is HMME-PDT the First Choice of Treatment for Young Children With Port-Wine Stain Birthmarks?","authors":"Jiang Xian","doi":"10.1002/lsm.23831","DOIUrl":"10.1002/lsm.23831","url":null,"abstract":"<p>Recently, Lasers in Surgery and Medicine published a meta-analysis based on 40 PDL studies and 18 HMME-PDT studies [<span>1</span>]. The authors indicate that “HMME-PDT has emerged as the first choice for PWB treatment, particularly for young children” and at the same time raise many questions regarding the use of HMME-PDT in China. On behalf of the Consensus Development Expert Group of Expert consensus on HMME-PDT, I appreciate American colleagues' interest and concern in HMME-PDT.</p><p>PDT's potential for PWS treatment was suggested in the mid-1980s and PDT protocols were developed for PWS treatment in China in the early 1990s [<span>2, 3</span>]. Two photosensitizing drugs, HiPorfin and Hemoporfin (also known as HMME) are approved for PWS treatment. There is no specific age restriction in HiPorfin production information. Because HMME Phase II and III trials only included patients > 14 years old, “lack of pediatric information in prescribe drug label” is stated in HMME production information. The post-marketing requirements suggest including pediatric patients in Phase IV trials to benefit them more. Clinical trials have been launched for 7−14 years old (NCT03125057, CTR20170189) and 2−7 years old (NCT04106258), respectively. Concerning “young children,” with therapeutic intention and on the premise of obtaining explicit informed consent from the parents, I believe the prescribing of HMME-PDT is regulatory adherence and in compliance with current regulations of rational off-label use of medicines [<span>4-6</span>].</p><p>The authors cite a paper published in 1934 and state that “hematoporphyrin derivatives have been used as antidepressants, indicating potential effects on brain function by this category of compounds. Therefore, the risk of HMME exposure to CNS in neonates, infants, and young children cannot be ignored.” In fact, the paper suggests it requires “intramuscular and oral administration of hematoporphyrin hydrochloride for an average period of 50 to 60 days” to see psychological benefit in depressive psychoses [<span>7</span>]. The remote risk of short-term HMME exposure to CNS in young children is likely small. Neurological and neuropsychiatric adverse reactions similar to that of porphyria have not been reported for HMME-PDT.</p><p>PDT was used before PDL became available in China. Partially due to this historical reason, many patients and parents would consider PDT as the first choice. For PDL resistance cases and large PWS lesions, clinicians might be inclined more toward PDT. But I am not aware that any publication implies “the use of HMME-PDT as the first choice of treatment for young children.” Hence, it is intriguing that the authors suggest that “HMME-PDT has emerged as the first choice for PWB in many major hospitals in China.” When accurate and thoughtfully presented, reporting of comparison of different modalities should be appreciated. In return, the authors who prefer one modality over another should have factua","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 8","pages":"691-692"},"PeriodicalIF":2.2,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290321","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}
The aim of our study was to explore the factors influencing cerebral edema and intracranial pressure in glioblastoma multiforme (GBM) patients who undergo photodynamic therapy (PDT) after resection.
Approach
This was a retrospective controlled study of GBM patients treated with PDT-assisted resections of varying scope from May 2021 to August 2023. The baseline clinical data, cerebral edema volumes, intracranial pressure values, and imaging data of the GBM patients were collected for statistical analysis.
Results
A total of 56 GBM patients were included. Thirty of the patients underwent gross total resection (GTR), and the other 26 patients underwent subtotal resection (STR). We found that the cerebral edema volume and the mean intracranial pressure in patients who underwent GTR were lower than those in patients who underwent STR. Moreover, univariate analysis showed that the scope of tumor resection was an independent factor affecting cerebral edema and intracranial pressure after PDT.
Conclusions
Compared with STR, PDT combined with GTR significantly reduced postoperative brain edema volume and intracranial pressure in GBM patients.
{"title":"The Implication of Photodynamic Therapy Applied to the Level of Tumor Resection on Postoperative Cerebral Edema and Intracranial Pressure Changes in Gliomas","authors":"Jingxuan Li, Weijun Sun, Shaoshan Hu, Xiuwei Yan","doi":"10.1002/lsm.23837","DOIUrl":"10.1002/lsm.23837","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of our study was to explore the factors influencing cerebral edema and intracranial pressure in glioblastoma multiforme (GBM) patients who undergo photodynamic therapy (PDT) after resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>This was a retrospective controlled study of GBM patients treated with PDT-assisted resections of varying scope from May 2021 to August 2023. The baseline clinical data, cerebral edema volumes, intracranial pressure values, and imaging data of the GBM patients were collected for statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 56 GBM patients were included. Thirty of the patients underwent gross total resection (GTR), and the other 26 patients underwent subtotal resection (STR). We found that the cerebral edema volume and the mean intracranial pressure in patients who underwent GTR were lower than those in patients who underwent STR. Moreover, univariate analysis showed that the scope of tumor resection was an independent factor affecting cerebral edema and intracranial pressure after PDT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with STR, PDT combined with GTR significantly reduced postoperative brain edema volume and intracranial pressure in GBM patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 8","pages":"709-722"},"PeriodicalIF":2.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217421","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}
Christiane Rodrigues Tofoli Palauro, Patrícia Froes Meyer, Ciro Dantas Soares, Eneida de Morais Carreiro, Flávio de Paiva Dumaresq, Fernando Cesar Camara de Oliveira, Ana Laura Martins de Andrade, Priscila da S. P. S. Daumas
Introduction
Cryolipolysis (CLL) is a widely employed noninvasive procedure for body fat reduction. It operates by inducing cooling, leading to the crystallization of cytoplasmic lipids, loss of cellular integrity, and apoptosis/necrosis of adipocytes, accompanied by local inflammation. Ongoing discussions revolve around CLL's potential to transform white adipocytes into brown adipocytes, potentially yielding more significant effects compared to alternative procedures.
Objective
Thus, this randomized, blinded clinical study aimed to investigate the effects of CLL on adipose tissue and elucidate the mechanisms involved in its application and capacity for adipocyte conversion.
Methodology
Tissue samples from six patients were assessed at intervals of 45, 60, and 90 days following the application of the CLL protocol during abdominoplasty surgeries.
Results
The samples underwent immunohistochemical analyses targeting various markers, revealing higher expression of PPAR-gamma, PPAR-alpha, and UCP-1 markers in CLL-treated samples.
Conclusion
Therefore, the present study suggests that CLL has the ability to intervene in adipocyte conversion.
{"title":"Effects of Cryolipolysis on the Conversion of White Adipose Tissue: Pilot Study","authors":"Christiane Rodrigues Tofoli Palauro, Patrícia Froes Meyer, Ciro Dantas Soares, Eneida de Morais Carreiro, Flávio de Paiva Dumaresq, Fernando Cesar Camara de Oliveira, Ana Laura Martins de Andrade, Priscila da S. P. S. Daumas","doi":"10.1002/lsm.23839","DOIUrl":"10.1002/lsm.23839","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cryolipolysis (CLL) is a widely employed noninvasive procedure for body fat reduction. It operates by inducing cooling, leading to the crystallization of cytoplasmic lipids, loss of cellular integrity, and apoptosis/necrosis of adipocytes, accompanied by local inflammation. Ongoing discussions revolve around CLL's potential to transform white adipocytes into brown adipocytes, potentially yielding more significant effects compared to alternative procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Thus, this randomized, blinded clinical study aimed to investigate the effects of CLL on adipose tissue and elucidate the mechanisms involved in its application and capacity for adipocyte conversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Tissue samples from six patients were assessed at intervals of 45, 60, and 90 days following the application of the CLL protocol during abdominoplasty surgeries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The samples underwent immunohistochemical analyses targeting various markers, revealing higher expression of PPAR-gamma, PPAR-alpha, and UCP-1 markers in CLL-treated samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Therefore, the present study suggests that CLL has the ability to intervene in adipocyte conversion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 1","pages":"88-95"},"PeriodicalIF":2.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217422","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}
Sergio del Río-Sancho, Stephanie Christen-Zaech, David Alvarez Martinez, Jöri Pünchera, Rastine Merat, Hans Joachim Laubach
Background
The advent of ablative fractional photothermolysis has revolutionized laser dermatology by providing a method to produce well-standardized, precise, and repeatable microscopic lesions. These wounds typically heal within 1–3 weeks, depending on the body site, with a minimal risk of permanent scarring. This positions ablative fractional photothermolysis as an exemplary in vivo model for studying the skin's wound healing processes.
Objectives
This study aims to evaluate and compare the effectiveness of two noninvasive imaging techniques, reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT), in assessing skin wound healing following microscopic injuries induced by ablative fractional photothermolysis.
Methods
The forearms of participating volunteers were treated and ablated with a CO2-Laser in a fractional pattern using varying power settings (2.5–10 mJ/MTZ). In vivo RCM and LC-OCT images were obtained at predefined time intervals post-laser treatment, ranging from 6 h to 14 days.
Results
Vertical visualization of the lesions through both imaging modalities revealed a healing process characterized by the upward and outward movement of microscopic epidermal necrotic debris, thereby reducing the depth of the injury while forming an external crust. LC-OCT imaging demonstrated more comprehensive results with fewer movement artifacts. Conversely, horizontal visualization with both techniques highlighted a gathering of keratinocytes around the wounds, indicating the initiation of the regenerative process. RCM provided superior image clarity in this horizontal plane.
Conclusions
RCM and LC-OCT offer valuable and complementary noninvasive alternatives to conventional biopsy methods for the assessment and characterization of the skin's wound healing process post-ablative fractional photothermolysis. These findings underscore the potential of such imaging techniques in enhancing our understanding of the wound healing process.
{"title":"Comparing Line-Field Confocal Optical Coherence Tomography and Reflectance Confocal Microscopy on the In Vivo Healing Process of Lesions Induced by Fractional Photothermolysis","authors":"Sergio del Río-Sancho, Stephanie Christen-Zaech, David Alvarez Martinez, Jöri Pünchera, Rastine Merat, Hans Joachim Laubach","doi":"10.1002/lsm.23841","DOIUrl":"10.1002/lsm.23841","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The advent of ablative fractional photothermolysis has revolutionized laser dermatology by providing a method to produce well-standardized, precise, and repeatable microscopic lesions. These wounds typically heal within 1–3 weeks, depending on the body site, with a minimal risk of permanent scarring. This positions ablative fractional photothermolysis as an exemplary in vivo model for studying the skin's wound healing processes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to evaluate and compare the effectiveness of two noninvasive imaging techniques, reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT), in assessing skin wound healing following microscopic injuries induced by ablative fractional photothermolysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The forearms of participating volunteers were treated and ablated with a CO<sub>2</sub>-Laser in a fractional pattern using varying power settings (2.5–10 mJ/MTZ). In vivo RCM and LC-OCT images were obtained at predefined time intervals post-laser treatment, ranging from 6 h to 14 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Vertical visualization of the lesions through both imaging modalities revealed a healing process characterized by the upward and outward movement of microscopic epidermal necrotic debris, thereby reducing the depth of the injury while forming an external crust. LC-OCT imaging demonstrated more comprehensive results with fewer movement artifacts. Conversely, horizontal visualization with both techniques highlighted a gathering of keratinocytes around the wounds, indicating the initiation of the regenerative process. RCM provided superior image clarity in this horizontal plane.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RCM and LC-OCT offer valuable and complementary noninvasive alternatives to conventional biopsy methods for the assessment and characterization of the skin's wound healing process post-ablative fractional photothermolysis. These findings underscore the potential of such imaging techniques in enhancing our understanding of the wound healing process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT05614557.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 1","pages":"121-129"},"PeriodicalIF":2.2,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154481","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}
Claus von der Burchard, Yoko Miura, Boris Stanzel, Jay Chhablani, Johann Roider, Carsten Framme, Ralf Brinkmann, Jan Tode
<div> <section> <h3> Objectives</h3> <p>Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements.</p> </section> <section> <h3> Methods</h3> <p>A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns.</p> </section> <section> <h3> Results</h3> <p>The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose “regenerative retinal laser and light therapies (RELITE)” as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT).</p> <p>Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability:</p> <p><i>Pattern—Dosimetry—Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength—Subcategory—Category</i>.</p> </section> <section> <h3> Conclusion</h3> <p>Regenerative retinal laser and light therapies are widely used for different diseases and may become valu
{"title":"Regenerative Retinal Laser and Light Therapies (RELITE): Proposal of a New Nomenclature, Categorization, and Trial Reporting Standard","authors":"Claus von der Burchard, Yoko Miura, Boris Stanzel, Jay Chhablani, Johann Roider, Carsten Framme, Ralf Brinkmann, Jan Tode","doi":"10.1002/lsm.23833","DOIUrl":"10.1002/lsm.23833","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose “regenerative retinal laser and light therapies (RELITE)” as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT).</p>\u0000 \u0000 <p>Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability:</p>\u0000 \u0000 <p><i>Pattern—Dosimetry—Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength—Subcategory—Category</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Regenerative retinal laser and light therapies are widely used for different diseases and may become valu","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 8","pages":"693-708"},"PeriodicalIF":2.2,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23833","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108852","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}
Cover micrograph: The cover image is based on the article Combined CO2 Laser Vaporization and Bleomycin Injection to Treat Huge Adult Laryngeal Vascular Anomalies: Innovative Application of CO2 Laser in Otolaryngology by Xiufa Wu et al., https://doi.org/10.1002/lsm.23824.
{"title":"Cover Image: Volume 56 Issue 7","authors":"Xiufa Wu, Jing Zhang, Rui Fang, Chunsheng Wei","doi":"10.1002/lsm.23838","DOIUrl":"https://doi.org/10.1002/lsm.23838","url":null,"abstract":"<p>Cover micrograph: The cover image is based on the article Combined CO<sub>2</sub> Laser Vaporization and Bleomycin Injection to Treat Huge Adult Laryngeal Vascular Anomalies: Innovative Application of CO<sub>2</sub> Laser in Otolaryngology by Xiufa Wu et al., https://doi.org/10.1002/lsm.23824.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"i"},"PeriodicalIF":2.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142041521","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}
K. C. C. de Bie, R. A. A. van Kollenburg, L. A. M. J. G. van Riel, M. Almasian, J. E. Freund, P. R. Bloemen, R. Zweije, J. Crezee, B. F. Coolen, G. J. Strijkers, T. M. de Reijke, J. R. Oddens, A. G. J. M. van Leeuwen, D. M. de Bruin
<div> <section> <h3> Background</h3> <p>Focal laser ablation (FLA) serves as a targeted therapy for prostate cancer (PCa). Clinical studies have demonstrated significant variations in ablation volumes with consistent fiber configurations. Consequently, a prediction model is needed for the safe application of FLA in treating PCa.</p> </section> <section> <h3> Objective</h3> <p>This study aimed to evaluate the reproducibility of FLA–induced temperature profiles in controlled ex vivo experiments using clinical laser treatment protocols. Additionally, it sought to examine the effectiveness of the CEM43 model in predicting the zone of irreversible damage (ZID) and to compare these findings with outcomes derived from the Arrhenius model.</p> </section> <section> <h3> Methods</h3> <p>Freshly excised postmortem human prostate and porcine liver specimens were used for controlled ex vivo ablation. Tissues were secured in a Perspex sample holder for precise placement of the laser fiber and thermocouples. FLA was conducted with a 1064-nm Nd:YAG laser at 3 W in continuous-wave mode for 10 min. Pre– and post–FLA 3D T1-weighted 7 T MRI scans were obtained to assess the treatment area. Whole-mount hematoxylin and eosin histological slides were prepared and digitized. On histology, the ZID was defined as the total of vaporized, carbonized, and coagulated tissue. A 2D thermal development map was created from temperature data, using bi-cubic interpolation. The cumulative equivalent thermal isoeffect dose at 43°C in minutes (CEM43) model was applied to predict the ZID, with 240 equivalent minutes (240-CEM43) used as the damage threshold. Additionally, the Arrhenius thermal model was used for comparison of CEM43 results. Predicted ZIDs were compared to MRI and histology.</p> </section> <section> <h3> Results</h3> <p>FLA treatment was performed on ex vivo human prostate samples (<i>n</i> = 2) and porcine liver specimens (<i>n</i> = 5). For human prostate tissue, FLA did not result in an identifiable ZID upon histological macroscopic examination or a lesion on MRI. Ex vivo porcine liver samples showed a clearly demarcated oval-shaped hyperintense lesion surrounding the laser fiber tip on post–FLA MRI. The MRI lesion (range 1.6–2.1 cm<sup>2</sup>) corresponded with the shape and location of the ZID on histology, but was smaller (median 1.7 vs. 3.2, <i>p</i> = 0.02). Histological examination of porcine liver samples revealed ZIDs ranging from 2.1 to 4.1 cm<sup>2</sup>, whereas 240-CEM43–predicted ZIDs ranged from 3.3 to 3.8 cm<sup>2</sup>. Although the median 240-CEM43–pre
背景：病灶激光消融术（FLA）是一种治疗前列腺癌（PCa）的靶向疗法。临床研究表明，在光纤配置一致的情况下，消融量存在很大差异。因此，需要建立一个预测模型，以便安全应用 FLA 治疗 PCa：本研究旨在利用临床激光治疗方案，在受控体外实验中评估 FLA 诱导的温度曲线的可重复性。此外，研究还试图检验 CEM43 模型在预测不可逆损伤区（ZID）方面的有效性，并将这些结果与阿伦尼乌斯模型得出的结果进行比较：方法： 新鲜切除的死后人类前列腺和猪肝标本用于受控体外消融。组织被固定在一个 Perspex 样品支架上，以便精确放置激光光纤和热电偶。在连续波模式下使用 1064 纳米 Nd:YAG 激光器以 3 瓦功率进行 FLA，持续 10 分钟。在进行 FLA 之前和之后，均进行了 3D T1 加权 7 T MRI 扫描，以评估治疗区域。制备并数字化整张苏木精和伊红组织切片。在组织学上，ZID 被定义为汽化、碳化和凝固组织的总和。利用双立方插值法，根据温度数据绘制出二维热显影图。应用 43°C 时的累积等效热等效应剂量（CEM43）模型来预测 ZID，并以 240 等效分钟（240-CEM43）作为损伤阈值。此外，还使用阿伦尼乌斯热模型对 CEM43 结果进行比较。预测的 ZID 与核磁共振成像和组织学进行了比较：在体外人体前列腺样本（n = 2）和猪肝样本（n = 5）上进行了 FLA 处理。对于人体前列腺组织，FLA 在组织学宏观检查中未发现可识别的 ZID，在核磁共振成像中也未发现病变。活体猪肝样本在FLA后核磁共振成像上显示，激光光纤尖端周围有一个界限清晰的椭圆形高强度病变。核磁共振成像病灶（范围为 1.6-2.1 平方厘米）与组织学上 ZID 的形状和位置一致，但更小（中位数为 1.7 vs. 3.2，p = 0.02）。猪肝样本的组织学检查显示 ZID 为 2.1 至 4.1 平方厘米，而 240-CEM43 预测的 ZID 为 3.3 至 3.8 平方厘米。虽然 240-CEM43 预测的 ZID 中位数并不比组织学 ZID 大很多（3.8 对 3.2 平方厘米，p = 0.22），但在大多数实验中，它往往会高估组织学结果。Arrhenius预测的ZID中值与组织学ZID相似（3.2 vs. 3.2 cm2，p = 0.56），但在比较单个实验时，ZID的大小有所不同（范围为2.5-3.2 cm2）：结论：体外人体前列腺 FLA 在组织病理学或核磁共振成像上未显示热损伤。猪肝体外 FLA 在组织病理学上导致可识别的 ZID，在核磁共振成像上导致病变。240-CEM43 通常会高估 ZID，但与组织病理学相比，其变异性较小。阿伦尼乌斯模型的结果与组织学结果的一致性较好，但仍无法预测 FLA 诱导的单个组织学热损伤。实验之间的 ZID 变异性突出表明，有必要为 PCa 治疗中的 FLA 建立一个更全面的预测剂量模型。
{"title":"Outcomes of CEM43 in Predicting Thermal Damage Induced by Focal Laser Ablation in Controlled Ex Vivo Experiments: A Comparison to Histology and MRI","authors":"K. C. C. de Bie, R. A. A. van Kollenburg, L. A. M. J. G. van Riel, M. Almasian, J. E. Freund, P. R. Bloemen, R. Zweije, J. Crezee, B. F. Coolen, G. J. Strijkers, T. M. de Reijke, J. R. Oddens, A. G. J. M. van Leeuwen, D. M. de Bruin","doi":"10.1002/lsm.23834","DOIUrl":"10.1002/lsm.23834","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Focal laser ablation (FLA) serves as a targeted therapy for prostate cancer (PCa). Clinical studies have demonstrated significant variations in ablation volumes with consistent fiber configurations. Consequently, a prediction model is needed for the safe application of FLA in treating PCa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the reproducibility of FLA–induced temperature profiles in controlled ex vivo experiments using clinical laser treatment protocols. Additionally, it sought to examine the effectiveness of the CEM43 model in predicting the zone of irreversible damage (ZID) and to compare these findings with outcomes derived from the Arrhenius model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Freshly excised postmortem human prostate and porcine liver specimens were used for controlled ex vivo ablation. Tissues were secured in a Perspex sample holder for precise placement of the laser fiber and thermocouples. FLA was conducted with a 1064-nm Nd:YAG laser at 3 W in continuous-wave mode for 10 min. Pre– and post–FLA 3D T1-weighted 7 T MRI scans were obtained to assess the treatment area. Whole-mount hematoxylin and eosin histological slides were prepared and digitized. On histology, the ZID was defined as the total of vaporized, carbonized, and coagulated tissue. A 2D thermal development map was created from temperature data, using bi-cubic interpolation. The cumulative equivalent thermal isoeffect dose at 43°C in minutes (CEM43) model was applied to predict the ZID, with 240 equivalent minutes (240-CEM43) used as the damage threshold. Additionally, the Arrhenius thermal model was used for comparison of CEM43 results. Predicted ZIDs were compared to MRI and histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>FLA treatment was performed on ex vivo human prostate samples (<i>n</i> = 2) and porcine liver specimens (<i>n</i> = 5). For human prostate tissue, FLA did not result in an identifiable ZID upon histological macroscopic examination or a lesion on MRI. Ex vivo porcine liver samples showed a clearly demarcated oval-shaped hyperintense lesion surrounding the laser fiber tip on post–FLA MRI. The MRI lesion (range 1.6–2.1 cm<sup>2</sup>) corresponded with the shape and location of the ZID on histology, but was smaller (median 1.7 vs. 3.2, <i>p</i> = 0.02). Histological examination of porcine liver samples revealed ZIDs ranging from 2.1 to 4.1 cm<sup>2</sup>, whereas 240-CEM43–predicted ZIDs ranged from 3.3 to 3.8 cm<sup>2</sup>. Although the median 240-CEM43–pre","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 8","pages":"723-733"},"PeriodicalIF":2.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23834","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036239","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}
William Driscoll, Nicole M. Golbari, Alexander Vallmitjana, Amanda F. Durkin, Mihaela Balu, Christopher B. Zachary
Objectives
The absorption of biostimulatory particulate matter following its application to fractional skin defects remains poorly understood, and even less is known about its in vivo impact in terms of tissue integration. The objectives of this study are twofold: (1) to evaluate the potential of calcium hydroxylapatite (CaHA) to penetrate through skin treated with a fractional laser; and (2) to assess the effectiveness of clinical laser scanning microscopy technologies in monitoring the effects of such treatment over time.
Methods
One area on a volunteer's arm was treated with a fractional erbium laser (Sciton Inc., Palo Alto, CA), while a second area received the same laser treatment followed by CaHA topical application. We used reflectance confocal microscopy (RCM) and multiphoton microscopy (MPM) to noninvasively image beneath the surface of the treated skin to study and monitor the effects of these treatments within 1 h of treatment and at four additional time points over a 6-week period.
Results
One hour posttreatment, at different depths beneath the skin surface, MPM and RCM provided similar visualizations of laser-induced channels. In skin treated by both laser and CaHA, these two imaging methods provided complementary information. RCM captured the lateral and depth distribution of CaHA microspheres and were seen as bright spheres as they became incorporated into the healing tissue. MPM, meanwhile, visualized the CaHA microparticles as dark shadow spheres within the laser-induced channels and encroaching healing tissue. Furthermore, MPM provided critical information about collagen regeneration around the microspheres, with the collagen visually marked by its distinct second harmonic generation (SHG) signal.
Conclusions
This observational pilot study demonstrates that CaHA, a collagen stimulator used as a dermal filler, can not only be inserted into the dermis after fractional laser treatment but remains in the healing skin for at least 6 weeks posttreatment. The noninvasive imaging techniques RCM and MPM successfully captured the presence of CaHA microspheres mid-dermis during the healing phase. They also demonstrated new collagen production around the microspheres, highlighting the effectiveness of these imaging approaches in monitoring such treatment over time.
{"title":"Intradermal Delivery of Calcium Hydroxylapatite With Fractionated Ablation","authors":"William Driscoll, Nicole M. Golbari, Alexander Vallmitjana, Amanda F. Durkin, Mihaela Balu, Christopher B. Zachary","doi":"10.1002/lsm.23830","DOIUrl":"10.1002/lsm.23830","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The absorption of biostimulatory particulate matter following its application to fractional skin defects remains poorly understood, and even less is known about its in vivo impact in terms of tissue integration. The objectives of this study are twofold: (1) to evaluate the potential of calcium hydroxylapatite (CaHA) to penetrate through skin treated with a fractional laser; and (2) to assess the effectiveness of clinical laser scanning microscopy technologies in monitoring the effects of such treatment over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One area on a volunteer's arm was treated with a fractional erbium laser (Sciton Inc., Palo Alto, CA), while a second area received the same laser treatment followed by CaHA topical application. We used reflectance confocal microscopy (RCM) and multiphoton microscopy (MPM) to noninvasively image beneath the surface of the treated skin to study and monitor the effects of these treatments within 1 h of treatment and at four additional time points over a 6-week period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hour posttreatment, at different depths beneath the skin surface, MPM and RCM provided similar visualizations of laser-induced channels. In skin treated by both laser and CaHA, these two imaging methods provided complementary information. RCM captured the lateral and depth distribution of CaHA microspheres and were seen as bright spheres as they became incorporated into the healing tissue. MPM, meanwhile, visualized the CaHA microparticles as dark shadow spheres within the laser-induced channels and encroaching healing tissue. Furthermore, MPM provided critical information about collagen regeneration around the microspheres, with the collagen visually marked by its distinct second harmonic generation (SHG) signal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This observational pilot study demonstrates that CaHA, a collagen stimulator used as a dermal filler, can not only be inserted into the dermis after fractional laser treatment but remains in the healing skin for at least 6 weeks posttreatment. The noninvasive imaging techniques RCM and MPM successfully captured the presence of CaHA microspheres mid-dermis during the healing phase. They also demonstrated new collagen production around the microspheres, highlighting the effectiveness of these imaging approaches in monitoring such treatment over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 1","pages":"46-53"},"PeriodicalIF":2.2,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004521","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}
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