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Optical penetration models for practical prediction of femtosecond laser ablation of dental hard tissue 用于实际预测飞秒激光烧蚀牙科硬组织的光学穿透模型。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-04-02 DOI: 10.1002/lsm.23784
Peter L. Woodfield PhD, Andrei V. Rode PhD, Dzung Dao PhD, Van Thanh Dau PhD, Steve Madden PhD, Laurence J. Walsh PhD, Heiko Spallek PhD, Lee Walsh PhD, Andrew J. Sutton PhD, Omar Zuaiter MPP, Alaa Habeb MCyberSec, Timothy R. Hirst PhD, Ludovic Rapp PhD

Objectives

To develop and practically test high-precision femtosecond laser ablation models for dental hard tissue that are useful for detailed planning of automated laser dental restorative treatment.

Methods

Analytical models are proposed, derived, and demonstrated for practical calculation of ablation rates, ablation efficiency and ablated morphology of human dental enamel and dentin using femtosecond lasers. The models assume an effective optical attenuation coefficient for the irradiated material. To achieve ablation, it is necessary for the local energy density of the attenuated pulse in the hard tissue to surpass a predefined threshold that signifies the minimum energy density required for material ionization. A 1029 nm, 40 W carbide 275 fs laser was used to ablate sliced adult human teeth and generate the data necessary for testing the models. The volume of material removed, and the shape of the ablated channel were measured using optical profilometry.

Results

The models fit with the measured ablation efficiency curve against laser fluence for both enamel and dentin, correctly capturing the fluence for optimum ablation and the volume of ablated material per pulse. The detailed shapes of a 400-micrometer wide channel and a single-pulse width channel are accurately predicted using the superposition of the analytical result for a single pulse.

Conclusions

The findings have value for planning automated dental restorative treatment using femtosecond lasers. The measurements and analysis give estimates of the optical properties of enamel and dentin irradiated with an infrared femtosecond laser at above-threshold fluence and the proposed models give insight into the physics of femtosecond laser processing of dental hard tissue.

目的开发并实际测试用于牙科硬组织的高精度飞秒激光烧蚀模型，该模型有助于详细规划自动激光牙科修复治疗：提出、推导并演示分析模型，用于实际计算使用飞秒激光的人类牙釉质和牙本质的烧蚀率、烧蚀效率和烧蚀形态。这些模型假定了照射材料的有效光学衰减系数。要实现烧蚀，硬组织中衰减脉冲的局部能量密度必须超过预定的阈值，该阈值表示材料电离所需的最小能量密度。使用波长为 1029 nm、功率为 40 W 的碳化物 275 fs 激光器烧蚀成人牙齿切片，并生成测试模型所需的数据。结果：结果：模型与测量到的珐琅质和牙本质消融效率与激光能量曲线相吻合，正确捕捉到了最佳消融能量和每个脉冲消融材料的体积。利用单脉冲分析结果的叠加，可以准确预测 400 微米宽通道和单脉冲宽度通道的详细形状：结论：研究结果对规划使用飞秒激光的自动牙科修复治疗很有价值。通过测量和分析，可以估算出红外飞秒激光以高于阈值的通量照射牙釉质和牙本质时的光学特性，而所提出的模型则有助于深入了解飞秒激光处理牙科硬组织的物理学原理。
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引用次数: 0
Current clinical evidence is insufficient to support HMME–PDT as the first choice of treatment for young children with port wine birthmarks 目前的临床证据不足以支持将 HMME-PDT 作为治疗患有葡萄酒胎记的幼儿的首选方法。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-20 DOI: 10.1002/lsm.23779
Chao Gao MSc, Vi Nguyen BA, Marcelo L. Hochman MD, Lin Gao MD, Elliott H. Chen MD, Harold I. Friedman MD, PhD, John Stuart Nelson MD, PhD, Wenbin Tan PhD

Background

Port wine birthmark (PWB) is a congenital vascular malformation of the skin. Pulsed dye laser (PDL) is the “gold standard” for the treatment of PWB globally. Hematoporphyrin monomethyl ether (HMME or hemoporfin)-mediated photodynamic therapy (HMME–PDT) has emerged as the first choice for PWB treatment, particularly for young children, in many major hospitals in China during the past several decades.

Aim

To evaluate whether HMME–PDT is superior to PDL by comparing the clinical efficacies of both modalities.

Method

PubMed records were searched for all relevant studies of PWB treatment using PDL (1988−2023) or HMME–PDT (2007−2023). Patient characteristics and clinical efficacies were extracted. Studies with a quartile percentage clearance or similar scale were included. A mean color clearance index (CI) per study was calculated and compared among groups. An overall CI (C0), with data weighted by cohort size, was used to evaluate the final efficacy for each modality.

Result

A total of 18 HMME–PDT studies with 3910 patients in China were eligible for inclusion in this analysis. Similarly, 40 PDL studies with 5094 patients from nine different countries were eligible for inclusion in this analysis. Over 58% of patients in the HMME-PDT studies were minors (<18 years old). A significant portion (21.3%) were young children (<3 years old). Similarly, 33.2% of patients in the PDL studies were minors. A small proportion (9.3%) was young children. The overall clearance rates for PDL were slightly, but not significantly, higher than those for HMME–PDT in cohorts with patients of all ages (C0, 0.54 vs. 0.48, p = 0.733), subpopulations with only minors (C0, 0.54 vs. 0.46, p = 0.714), and young children (C0, 0.67 vs. 0.50, p = 0.081). Regrettably, there was a lack of long-term data on follow-up evaluations for efficacy and impact of HMME-PDT on young children in general, and central nervous system development in particular, because their blood-brain barriers have a greater permeability as compared to adults.

Conclusion

PDL shows overall albeit insignificantly higher clearance rates than HMME-PDT in patients of all ages; particularly statistical significance is nearly achieved in young children. Collectively,

背景：葡萄酒港胎记（PWB）是一种先天性皮肤血管畸形。脉冲染料激光（PDL）是全球治疗葡萄酒胎记的 "金标准"。目的：通过比较HMME-PDT和PDL的临床疗效，评估HMME-PDT是否优于PDL：方法：在PubMed上检索所有使用PDL（1988-2023年）或HMME-PDT（2007-2023年）治疗PWB的相关研究。提取患者特征和临床疗效。纳入了具有四分位数百分比清除率或类似比例的研究。计算每项研究的平均颜色清除指数（CI），并在各组间进行比较。根据组群规模对数据进行加权后得出的总CI（C0）用于评估每种方法的最终疗效：结果：中国共有 18 项 HMME-PDT 研究、3910 名患者符合纳入分析的条件。同样，来自 9 个不同国家的 40 项 PDL 研究（5094 名患者）也符合纳入本分析的条件。HMME-PDT研究中超过58%的患者为未成年人（0 ，0.54 vs. 0.48，p = 0.733）、仅有未成年人的亚人群（C0 ，0.54 vs. 0.46，p = 0.714）和幼儿（C0 ，0.67 vs. 0.50，p = 0.081）。遗憾的是，由于幼儿的血脑屏障与成人相比具有更大的通透性，因此缺乏关于 HMME-PDT 对幼儿，尤其是中枢神经系统发育的疗效和影响的长期跟踪评估数据：结论：在所有年龄段的患者中，PDL 的清除率总体上高于 HMME-PDT，尽管微不足道；尤其是在幼儿中，几乎达到了统计学意义。总之，目前的证据不足以支持将 HMME-PDT 作为治疗幼儿血管内皮瘤的首选方法，因为：（1）总体疗效不如 PDL；（2）治疗过程中存在脑膜血管脱靶的风险；（3）需要使用类固醇来减轻副作用；以及（4）缺乏有关 HMME 对幼儿中枢神经系统发育潜在影响的长期数据。
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引用次数: 0
Erbium: YAG laser treatment efficacy and association with histologic features for giant congenital melanocytic nevi management 铒：YAG 激光治疗巨型先天性黑素细胞痣的疗效及其与组织学特征的关系。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-20 DOI: 10.1002/lsm.23776
Yifei Zhao MD, Yun Zou MD, Hui Chen MD, PhD, Yamin Rao MD, Xiaoxi Lin MD, PhD

Background

Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN).

Objective

We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response.

Methods and Materials

Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator's global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment.

Results

Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05).

Conclusion

The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.

背景：关于激光治疗巨大先天性黑素细胞痣（GCMN）的研究有限：关于激光治疗巨大先天性黑素细胞痣（GCMN）的研究有限：目的：我们试图阐明铒：YAG激光对GCMN的疗效，以及与阳性临床反应相关的组织学因素：2019年至2022年间，我们招募了30名接受Er：YAG激光治疗的中型至大型CMN患者。所有患者在激光治疗前后都接受了活检。在治疗后至少 6 个月，通过研究者的总体评估（IGA）、色素沉着 5 点量表和温哥华疤痕量表（VSS）评分来评估临床疗效：在 30 例患者中，18 例（60.0%）病情有所改善（IGA 评分≥3）。8例（26.7%）患者出现色素沉着。8例（26.7%）患者出现增生性疤痕。IGA、色素沉着和 VSS 平均得分分别为 2.93、3.57 和 3.20。格伦茨区病例的 IGA 评分较高（3.24 ± 1.18 vs. 2.22 ± 0.97，p = 0.031），色素沉着率较低（14.3% vs. 55.6%，p = 0.032）。在有黑色素细胞巢和黑色素聚集的病例中，IGA评分更高（3.33 ± 1.24 vs. 2.13 ± 0.89，p = 0.023），再色素沉着率更低（11.1% vs. 50.0%，p = 0.034）。浅层消融的病变比深层消融的病变更少形成增生性疤痕（5.9% 对 53.8%，P 结论：浅层消融的病变比深层消融的病变更少形成增生性疤痕：Er: YAG 激光对 GCMNs 的临床疗效显著。格伦茨区和黑色素细胞巢与黑色素聚集是预测激光疗效的可靠指标。
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引用次数: 0
Treatment of pigmented fungiform papillae of the tongue with 694 nm Q-switched ruby laser 用 694 nm Q 开关红宝石激光治疗舌部色素性真菌乳头。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-13 DOI: 10.1002/lsm.23778
Joy Tao MD, David A. Hashemi MD, MBA, Jordan V. Wang MD, MBE, MBA, Roy Geronemus MD, Ronald Shelton MD
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引用次数: 0
Combined microfocused ultrasound and delicate pulsed light for facial rejuvenation: A prospective, randomized, and split-face study 微聚焦超声波和精细脉冲光联合用于面部年轻化：一项前瞻性、随机和分脸研究。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-10 DOI: 10.1002/lsm.23777
Yawen Wang MB, Jingchen Liang MB, Ying Chen MB, Jun Xia MD, Yanting Liu MD, Jing Liu MD, Youbao Li MB, Mengyao Yang MB, Zhao Wang MD, PhD, Weihui Zeng MB

Objectives

Public's interest in noninvasive skin rejuvenation treatments continues to grow. The advantage of combination therapy lies in that it can target different aspects of skin rejuvenation. This study aimed to assess the efficacy and safety of microfocused ultrasound (MFU) combined with delicate pulsed light (DPL) for facial rejuvenation.

Methods

Twenty-one patients with facial relaxation were enrolled. All patients received whole-face MFU treatment, and one side of the face was randomly assigned to receive DPL. MFU treatment was performed at Months 0 and 3, while DPL treatment was performed at Months 1, 2, 4, and 5. The length and angle of the nasolabial fold and perioral wrinkles, melanin index (MI), erythema index (EI), transepidermal water loss (TEWL), and follow-up time were recorded at Months 0, 3, and 6. Side effects were recorded during treatment and each follow-up visit.

Results

Twenty patients successfully completed the study. At the sixth month, the average length of perioral wrinkles and nasolabial folds on the combined side decreased by 11.5% (pwithin < 0.001) and 6.5% (pwithin = 0.011), while 8.3% (pwithin = 0.012) and 3.8% (pwithin = 0.02) on the MFU side. Compared with MFU treatment alone, the combined treatment also showed significant improvements in nasolabial fold angle (from 28.8 ± 3.4° to 32.7 ± 5.0°) and perioral wrinkle angle (from 39.3 ± 5.0° to 43.7 ± 5.1°). In addition, the combined side had greater benefits than the MFU side in improving MI, EI, TEWL, and skin elasticity (pbetween < 0.05). Except for one patient who withdrew due to increased skin sensitivity after MFU treatment, other subjects did not experience permanent or serious side effects.

Conclusions

The combination of MFU and DPL for facial rejuvenation treatment is safe and effective. The combined treatment has better efficacy in skin firmness, and improving skin tone.

目的：公众对非侵入性嫩肤疗法的兴趣与日俱增。联合疗法的优势在于它可以针对皮肤年轻化的不同方面。本研究旨在评估微聚焦超声波（MFU）与精细脉冲光（DPL）联合治疗面部年轻化的有效性和安全性：方法：21 名面部松弛患者入选。方法：21 名面部松弛症患者入组，所有患者均接受全脸 MFU 治疗，一侧面部随机分配接受 DPL 治疗。在第 0 个月和第 3 个月进行 MFU 治疗，在第 1、2、4 和 5 个月进行 DPL 治疗。在第 0、3 和 6 个月记录鼻唇沟和口周皱纹的长度和角度、黑色素指数（MI）、红斑指数（EI）、经表皮失水率（TEWL）和随访时间。在治疗期间和每次随访时记录副作用：结果：20 名患者顺利完成了研究。第 6 个月时，联合治疗一侧的口周皱纹和鼻唇沟平均长度减少了 11.5%（pwithin within = 0.011），而 MFU 一侧减少了 8.3%（pwithin = 0.012）和 3.8%（pwithin = 0.02）。与单纯的 MFU 治疗相比，联合治疗对鼻唇沟角度（从 28.8 ± 3.4° 到 32.7 ± 5.0°）和口周皱纹角度（从 39.3 ± 5.0° 到 43.7 ± 5.1°）也有显著改善。此外，在改善MI、EI、TEWL和皮肤弹性方面，联合治疗比MFU治疗更有效（pbetween 结论）：MFU 和 DPL 联合用于面部年轻化治疗是安全有效的。联合治疗在紧致皮肤和改善肤色方面有更好的疗效。
{"title":"Combined microfocused ultrasound and delicate pulsed light for facial rejuvenation: A prospective, randomized, and split-face study","authors":"Yawen Wang MB,&nbsp;Jingchen Liang MB,&nbsp;Ying Chen MB,&nbsp;Jun Xia MD,&nbsp;Yanting Liu MD,&nbsp;Jing Liu MD,&nbsp;Youbao Li MB,&nbsp;Mengyao Yang MB,&nbsp;Zhao Wang MD, PhD,&nbsp;Weihui Zeng MB","doi":"10.1002/lsm.23777","DOIUrl":"10.1002/lsm.23777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Public's interest in noninvasive skin rejuvenation treatments continues to grow. The advantage of combination therapy lies in that it can target different aspects of skin rejuvenation. This study aimed to assess the efficacy and safety of microfocused ultrasound (MFU) combined with delicate pulsed light (DPL) for facial rejuvenation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-one patients with facial relaxation were enrolled. All patients received whole-face MFU treatment, and one side of the face was randomly assigned to receive DPL. MFU treatment was performed at Months 0 and 3, while DPL treatment was performed at Months 1, 2, 4, and 5. The length and angle of the nasolabial fold and perioral wrinkles, melanin index (MI), erythema index (EI), transepidermal water loss (TEWL), and follow-up time were recorded at Months 0, 3, and 6. Side effects were recorded during treatment and each follow-up visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients successfully completed the study. At the sixth month, the average length of perioral wrinkles and nasolabial folds on the combined side decreased by 11.5% (<i>p</i><sub>within</sub> &lt; 0.001) and 6.5% (<i>p</i><sub>within</sub> = 0.011), while 8.3% (<i>p</i><sub>within</sub> = 0.012) and 3.8% (<i>p</i><sub>within</sub> = 0.02) on the MFU side. Compared with MFU treatment alone, the combined treatment also showed significant improvements in nasolabial fold angle (from 28.8 ± 3.4° to 32.7 ± 5.0°) and perioral wrinkle angle (from 39.3 ± 5.0° to 43.7 ± 5.1°). In addition, the combined side had greater benefits than the MFU side in improving MI, EI, TEWL, and skin elasticity (<i>p</i><sub>between</sub> &lt; 0.05). Except for one patient who withdrew due to increased skin sensitivity after MFU treatment, other subjects did not experience permanent or serious side effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combination of MFU and DPL for facial rejuvenation treatment is safe and effective. The combined treatment has better efficacy in skin firmness, and improving skin tone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094348","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
Proactive esophageal cooling during laser cardiac ablation: A computer modeling study 激光心脏消融过程中的主动食管冷却：计算机建模研究
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-04 DOI: 10.1002/lsm.23774
Tatiana Gomez Bustamante BSc, Marcela Mercado Montoya MSc, Enrique Berjano PhD, Ana González-Suárez PhD, Erik Kulstad MS

Background and Objectives

Laser ablation is increasingly used to treat atrial fibrillation (AF). However, atrioesophageal injury remains a potentially serious complication. While proactive esophageal cooling (PEC) reduces esophageal injury during radiofrequency ablation, the effects of PEC during laser ablation have not previously been determined. We aimed to evaluate the protective effects of PEC during laser ablation of AF by means of a theoretical study based on computer modeling.

Methods

Three-dimensional mathematical models were built for 20 different cases including a fragment of atrial wall (myocardium), epicardial fat (adipose tissue), connective tissue, and esophageal wall. The esophagus was considered with and without PEC. Laser-tissue interaction was modeled using Beer–Lambert's law, Pennes' Bioheat equation was used to compute the resultant heating, and the Arrhenius equation was used to estimate the fraction of tissue damage (FOD), assuming a threshold of 63% to assess induced necrosis. We modeled laser irradiation power of 8.5 W over 20 s. Thermal simulations extended up to 250 s to account for thermal latency.

Results

PEC significantly altered the temperature distribution around the cooling device, resulting in lower temperatures (around 22°C less in the esophagus and 9°C in the atrial wall) compared to the case without PEC. This thermal reduction translated into the absence of transmural lesions in the esophagus. The esophagus was thermally damaged only in the cases without PEC and with a distance equal to or shorter than 3.5 mm between the esophagus and endocardium (inner boundary of the atrial wall). Furthermore, PEC demonstrated minimal impact on the lesion created across the atrial wall, either in terms of maximum temperature or FOD.

Conclusions

PEC reduces the potential for esophageal injury without degrading the intended cardiac lesions for a variety of different tissue thicknesses. Thermal latency may influence lesion formation during laser ablation and may play a part in any collateral damage.

背景和目的：激光消融越来越多地用于治疗心房颤动（房颤）。然而，食道损伤仍是一种潜在的严重并发症。虽然主动食管冷却（PEC）可减少射频消融过程中的食管损伤，但激光消融过程中 PEC 的效果尚未确定。我们的目的是通过基于计算机建模的理论研究，评估 PEC 在房颤激光消融过程中的保护作用：建立了 20 个不同病例的三维数学模型，包括心房壁（心肌）、心外膜脂肪（脂肪组织）、结缔组织和食道壁的片段。考虑了食管有无 PEC 的情况。使用比尔-朗伯定律模拟激光与组织的相互作用，使用潘尼斯生物热方程计算加热结果，使用阿伦尼乌斯方程估算组织损伤率（FOD），假定评估诱导坏死的阈值为 63%。我们模拟了 20 秒内 8.5 W 的激光照射功率。热模拟延长至 250 秒，以考虑热潜伏期：结果：与无 PEC 的情况相比，PEC 明显改变了冷却装置周围的温度分布，导致温度降低（食管温度降低约 22°C，心房壁温度降低约 9°C）。这种热量的降低导致食管没有出现跨壁病变。只有在食管与心内膜（心房壁的内边界）之间的距离等于或小于 3.5 mm 的情况下，食管才会受到热损伤。此外，无论是就最高温度还是就 FOD 而言，PEC 对穿越心房壁产生的病变影响都很小：结论：对于各种不同厚度的组织，PEC 可降低食管损伤的可能性，而不会降低预期的心脏病变。热潜伏期可能会影响激光消融过程中病灶的形成，并可能对任何附带损伤产生影响。
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引用次数: 0
Efficacy and safety of 1064-nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial 1064 纳米点阵皮秒激光治疗变性男性乳房切除术后疤痕的有效性和安全性：随机对照试验。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-04 DOI: 10.1002/lsm.23775
Suthinee Rutnin MD, Tanat Yongpisarn MD, Nawara Sakpuwadol MD, Amornrut Namasondhi MD, Cherrin Pomsoong MD, Teerapong Rattananukrom MD, MSc, Kunlawat Thadanipon MD

Objectives

Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064-nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM.

Methods

Twenty-two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4-week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three-dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant-rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded.

Results

During the 6-month follow-up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls (p < 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 (p = 0.003) and 3 months (p = 0.041) after the end of laser treatments. PSS was significantly higher on the laser-treated scars than the controls (p = 0.008), and a participant-rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported.

Conclusions

1064-nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.

目的：皮下乳房切除术是变性男性（TM）性别确认疗法的重要组成部分，但手术后留下的疤痕经常会影响他们的生活质量。本研究旨在评估 1064 纳米点阵皮秒激光（FxPico）治疗变性人乳房切除术后增生性和萎缩性疤痕的有效性和安全性：22名患者共35对双侧对称乳房切除术后疤痕。每对对称疤痕中的一人被随机分配接受四次 FxPico 治疗，每次间隔四周。在每次治疗前和最后一次治疗后的 1、3 和 6 个月，使用改良温哥华疤痕量表 (mVSS) 和三维成像技术对所有疤痕的粗糙度、黑色素指数和血红蛋白指数进行评估。此外，还记录了参与者的疤痕满意度（PSS）和疤痕改善情况（全球评估分数，GAS）以及不良反应：结果：在激光治疗疗程结束后的 6 个月随访期间，与未治疗的对照组相比，治疗后疤痕的 mVSS 显著降低（P 结论：治疗后疤痕的 mVSS 显著降低：1064 纳米 FxPico 可用于治疗 TM 中的乳房切除术疤痕，尤其是增生型疤痕。
{"title":"Efficacy and safety of 1064-nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial","authors":"Suthinee Rutnin MD,&nbsp;Tanat Yongpisarn MD,&nbsp;Nawara Sakpuwadol MD,&nbsp;Amornrut Namasondhi MD,&nbsp;Cherrin Pomsoong MD,&nbsp;Teerapong Rattananukrom MD, MSc,&nbsp;Kunlawat Thadanipon MD","doi":"10.1002/lsm.23775","DOIUrl":"10.1002/lsm.23775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064-nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4-week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three-dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant-rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the 6-month follow-up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls (<i>p</i> &lt; 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 (<i>p</i> = 0.003) and 3 months (<i>p</i> = 0.041) after the end of laser treatments. PSS was significantly higher on the laser-treated scars than the controls (<i>p</i> = 0.008), and a participant-rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>1064-nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022151","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
Wavelength-dependent threshold fluences for melanosome disruption to evaluate the treatment of pigmented lesions with 532-, 730-, 755-, 785-, and 1064-nm picosecond lasers 评估使用 532、730、755、785 和 1064 波长皮秒激光治疗色素性病变时黑色素体破坏的波长阈值流量。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-03-04 DOI: 10.1002/lsm.23773
Yu Shimojo PhD, Takahiro Nishimura PhD, Daisuke Tsuruta MD, PhD, Toshiyuki Ozawa MD, PhD, Henry Hin Lee Chan MD, PhD, FRCP, Taro Kono MD, PhD

Background and Objectives

A threshold fluence for melanosome disruption has the potential to provide a robust numerical indicator for establishing clinical endpoints for pigmented lesion treatment using a picosecond laser. Although the thresholds for a 755-nm picosecond laser were previously reported, the wavelength dependence has not been investigated. In this study, wavelength-dependent threshold fluences for melanosome disruption were determined. Using a mathematical model based on the thresholds, irradiation parameters for 532-, 730-, 755-, 785-, and 1064-nm picosecond laser treatments were evaluated quantitatively.

Study Design/Materials and Methods

A suspension of melanosomes extracted from porcine eyes was irradiated using picosecond lasers with varying fluence. The mean particle size of the irradiated melanosomes was measured by dynamic light scattering, and their disruption was observed by scanning electron microscopy to determine the disruption thresholds. A mathematical model was developed, combined with the threshold obtained and Monte Carlo light transport to calculate irradiation parameters required to disrupt melanosomes within the skin tissue.

Results

The threshold fluences were determined to be 0.95, 2.25, 2.75, and 6.50 J/cm² for 532-, 730-, 785-, and 1064-nm picosecond lasers, respectively. The numerical results quantitatively revealed the relationship between irradiation wavelength, incident fluence, and spot size required to disrupt melanosomes distributed at different depths in the skin tissue. The calculated irradiation parameters were consistent with clinical parameters that showed high efficacy with a low incidence of complications.

Conclusion

The wavelength-dependent thresholds for melanosome disruption were determined. The results of the evaluation of irradiation parameters from the threshold-based analysis provided numerical indicators for setting the clinical endpoints for 532-, 730-, 755-, 785-, and 1064-nm picosecond lasers.

背景和目的：黑色素体破坏的阈值流度有可能为使用皮秒激光治疗色素性病变提供一个可靠的数字指标，以确定临床终点。虽然以前曾报道过 755 纳米皮秒激光的阈值，但尚未研究其与波长的关系。本研究确定了黑色素体破坏的阈值流量与波长的关系。利用基于阈值的数学模型，对 532、730、755、785 和 1064 纳米皮秒激光治疗的辐照参数进行了定量评估：使用不同通量的皮秒激光照射从猪眼睛中提取的黑色素体悬浮液。用动态光散射法测量被照射黑色素体的平均粒径，并用扫描电子显微镜观察其破坏情况，以确定破坏阈值。结合获得的阈值和蒙特卡洛光传输建立了一个数学模型，以计算破坏皮肤组织内黑色素体所需的辐照参数：结果：532、730、785 和 1064 纳米皮秒激光的阈值流量分别为 0.95、2.25、2.75 和 6.50 J/cm²。数值结果定量揭示了破坏分布在皮肤组织不同深度的黑素体所需的辐照波长、入射通量和光斑大小之间的关系。计算出的辐照参数与临床参数一致，表明疗效高，并发症发生率低：结论：确定了黑素体破坏的波长阈值。基于阈值分析的辐照参数评估结果为设定 532、730、755、785 和 1064 纳米皮秒激光的临床终点提供了数字指标。
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引用次数: 0
Vectorized facial skin tightening: A study on the Thermal Thread Technique™ utilizing high-intensity, high-frequency, parallel ultrasound beam 矢量化面部紧肤：利用高强度、高频率、平行超声波束的 Thermal Thread Technique™ 研究。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-02-27 DOI: 10.1002/lsm.23771
Kentaro Oku MD

Background

Facial skin tightening with wrinkle/fine line reduction is a highly demanded procedure in the aesthetic field. Although there are studies focused on the types of energy sources, the total amount of thermal energy, and the affected depth, there have been no reports examining the relationship between the shape of thermal energy and the directivity of skin tightening. We have developed a specific method to apply thermal energy to the dermis in continuous parallel lines, resembling a thread, perpendicular to the Relaxed Skin Tension Lines (RSTL) for vectorized collagen contraction using synchronous ultrasound parallel beam technology.

Objective

To evaluate the safety, tightening capability, and directivity of the Thermal Thread Technique™ utilizing a high-intensity, high-frequency, parallel ultrasound beam.

Materials and Methods

A total of 34 cases, both males and females aged between 30 and 70 years with Fitzpatrick skin types 2–4, exhibiting mild to moderate skin laxity, participated. All subjects received one treatment using the Thermal Thread Technique™ utilizing high-intensity, high-frequency parallel ultrasound beam to cover the full face and submental area. 3D clinical images were captured before, 8 weeks, and 24 weeks after the treatment. A quantitative image analysis of captured 3D images was performed to objectively measure the direction and distance of contraction.

Results

The average contraction distance from baseline (0 mm) to 8 weeks and 24 weeks posttreatment were 1.91 ± 0.61 mm (p < 0.001) and 1.96 ± 0.67 mm (p < 0.001) respectively. Regarding the contraction direction at 24 weeks posttreatment, the angle formed between the contraction direction and the base axis, which is perpendicular to the RSTL, was + 9.85° ± 32.94°. Out of 34 cases, 28 met the criteria with the angle within ±22.5° of the base axis (p < 0.001). The average pain score on a 0–5 scale (0 being no pain, and 5 being maximum pain) was 2.63 ± 0.78. No side effects were reported during the treatment or observation period.

Conclusion

The Thermal Thread Technique™ utilizing a high-intensity, high-frequency, parallel ultrasound beam was proven to be clinically safe and effective for vectorized facial skin tightening.

背景：面部紧肤除皱术是美容领域需求量很大的一种手术。虽然有研究关注能量来源的类型、热能的总量和影响深度，但还没有报告研究热能的形状与皮肤紧致的方向性之间的关系。我们开发了一种特殊的方法，利用同步超声平行光束技术，将热能以类似线状的连续平行线施加到真皮层，垂直于皮肤松弛张力线（RSTL），以实现胶原蛋白的矢量化收缩：评估利用高强度、高频率、平行超声波束的热丝技术™的安全性、紧致能力和指向性：共有 34 名年龄介于 30 岁至 70 岁之间的男女受试者参加了此次活动，他们的皮肤类型为 Fitzpatrick 2-4，皮肤松弛程度为轻度至中度。所有受试者均接受了一次使用高强度、高频率平行超声波束的 Thermal Thread Technique™ 治疗，治疗范围包括整个面部和下颌区域。分别在治疗前、治疗后 8 周和 24 周采集三维临床图像。对拍摄的三维图像进行了定量图像分析，以客观测量收缩的方向和距离：结果：从基线（0 毫米）到治疗后 8 周和 24 周的平均收缩距离分别为 1.91 ± 0.61 毫米（p 结论：热丝技术™治疗后的平均收缩距离为 1.91 ± 0.61 毫米：采用高强度、高频率、平行超声波束的 Thermal Thread Technique™ 被证明是临床上安全有效的矢量化面部紧肤方法。
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引用次数: 0
The 730 nm picosecond titanium sapphire laser for treatment of café-au-lait macules in all skin types 730 nm 皮秒钛蓝宝石激光器用于治疗各种肤质的咖啡色黄斑。
IF 2.4 3区 医学 Q1 Medicine
Lasers in Surgery and Medicine
Pub Date : 2024-02-27 DOI: 10.1002/lsm.23769
Joan K. Fernandez MD, Emily L. Guo MD, Heather Richmond MD, Paul M. Friedman MD

Objectives

Café-au-lait macules (CALM) are benign birthmarks presenting as uniformly pigmented, well demarcated, brown patches that can be distressing to patients, especially when located in cosmetically sensitive areas. As with all pigmentary lesions in skin of color patients, CALMs have been particularly challenging to treat. Here we present the first case series characterizing treatment parameters and clinical outcomes utilizing the 730-nm picosecond titanium sapphire laser for the treatment of CALMs. This device provides an additional safe and effective treatment option for these challenging cases.

Methods

We performed a retrospective review of patients treated at a single institution between April 2021 and December 2023. Clinical photographs were graded by 3 outside board-certified dermatologists using a 5-point visual analog scale.

Results

Fourteen patients (age range: 10 months–66 years, mean age: 27.4 years, Fitzpatrick skin types II–VI) were treated for CALM on the face (11) or body (3). On average, patients received 4.3 treatments, with treatment intervals ranging from 4 to 40 weeks. Treatment remains ongoing with the 730-nm picosecond laser for eight patients. Overall, patients were rated to have a mean improvement of 26%–50%. Two patients (FST III and VI) achieved 100% clearance after 4-5 treatment sessions. Our study included four patients whose CALM were of the smooth bordered “coast of California” subtype, three of whom had a mean improvement rating of only 1%–25%. The fourth patient had near complete resolution. Follow up for these patients has ranged from 6 weeks to 1.5 years. Of the patients treated, one patient experienced transient post-inflammatory hyperpigmentation and another transient post-inflammatory hypopigmentation, while a third patient experienced mild persistent guttate hypopigmentation. Three patients experienced partial recurrence indicating that maintenance treatments may be needed in some patients.

Conclusion

The 730-nm picosecond titanium sapphire laser is a safe and efficacious treatment option, in the right morphologic setting, to improve the cosmetic appearance of CALMs in a wide range of ages and skin types. To our knowledge, this is the first reported treatment of CALMs with picosecond lasers in FST V and VI patients. Our study also supports prior studies which have found that CALM with smooth-bordered “coast of California” morphology have a poor response to laser therapy as compared to those with jagged or ill-defined bordered “coast of Maine” morph

目的：咖啡斑（CALM）是一种良性胎记，表现为色素均匀、界限清楚的棕色斑块，会给患者带来痛苦，尤其是位于美容敏感区域时。与有色人种皮肤上的所有色素性病变一样，CALMs 的治疗尤其具有挑战性。在此，我们介绍了首例利用 730 纳米皮秒钛蓝宝石激光治疗 CALMs 的系列病例，描述了治疗参数和临床效果。该设备为这些具有挑战性的病例提供了另一种安全有效的治疗方案：我们对 2021 年 4 月至 2023 年 12 月期间在一家医疗机构接受治疗的患者进行了回顾性研究。临床照片由 3 位外部委员会认证的皮肤科医生使用 5 点视觉模拟评分法进行评分：结果：14 名患者（年龄范围：10 个月-66 岁，平均年龄：10 个月-66 岁10个月-66岁，平均年龄：27.4岁，菲茨帕特里克皮肤类型II-VI）接受了面部（11例）或身体（3例）的CALM治疗。患者平均接受了 4.3 次治疗，治疗间隔从 4 周到 40 周不等。有 8 名患者仍在接受 730 纳米皮秒激光治疗。总体而言，患者的平均病情改善率为 26%-50%。两名患者（FST III 和 VI）在接受了 4-5 次治疗后，病情得到了 100% 的清除。我们的研究包括四名 CALM 属于边界光滑的 "加利福尼亚海岸 "亚型的患者，其中三人的平均改善率仅为 1%-25%。第四位患者的病情几乎完全缓解。这些患者的随访时间从 6 周到 1.5 年不等。在接受治疗的患者中，一名患者出现了一过性的炎症后色素沉着，另一名患者出现了一过性的炎症后色素减退，而第三名患者则出现了轻度的持续性色素减退。三名患者出现了部分复发，这表明一些患者可能需要进行维持治疗：结论：730nm 皮秒钛蓝宝石激光器是一种安全有效的治疗方法，在适当的形态环境下，可改善不同年龄和皮肤类型的 CALMs 的美容外观。据我们所知，这是首次报道用皮秒激光治疗 FST V 和 VI 患者的 CALMs。我们的研究还支持之前的研究，这些研究发现，与锯齿状或边界不清晰的 "缅因州海岸 "形态相比，边界光滑的 "加利福尼亚海岸 "CALM 对激光治疗的反应较差。
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