Lasers in Surgery and Medicine最新文献_第6页

Hypopigmentation Following Picosecond Laser Treatment for Melasma: A Case Series 皮秒激光治疗黄褐斑后色素减退：一个病例系列。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-11-16 DOI: 10.1002/lsm.70077

Xiaozhun Hang, Davin Sui Lim

Objective

Picosecond lasers (PSL) are increasingly used for treating melasma, with fewer adverse effects reported compared to Q-switched lasers (QSL). However, the incidence of hypopigmentation following PSL treatment remains unexplored in detail. This case series aims to explore outcomes of hypopigmentation following PSL therapy in patients with melasma, and explore potential contributing factors.

Methods

A retrospective chart review identified four patients with hypopigmentation following PSL treatment for melasma, including one referral from another clinic. Across the cohort, 796 patients underwent 3096 sessions between 2021 and 2025. Treatments used 755 and/or 1064-nm wavelengths at low fluences, with intervals of 4–12 weeks.

Results

Three in-clinic patients (0.38%, 95% CI 0.13%–1.10%) and one referral developed hypopigmentation. Changes occurred across both wavelengths and beam profiles. Histology demonstrated preserved melanocyte density with reduced melanin pigment and melanosome content. None of the cases showed meaningful re-pigmentation at 6-month follow-up. No cases of post-inflammatory hyperpigmentation (PIH) were observed.

Conclusion

While hypopigmentation is rare with PSL treatment, it can occur even with conservative low-fluence settings and adequate intervals between sessions. One possible mechanism is thermal beam- stacking, where slow hand movement during treatment may lead to repeated pulses on the same area. This can result in localised thermal accumulation, potentially causing subcellular disruption of melanosomes without overt melanocyte loss. These findings suggest the need for clinician vigilance in monitoring for hypopigmentation, as re-pigmentation may not be achievable. Larger, controlled studies are needed to clarify risk factors and guide safer practice.

目的：皮秒激光（PSL）越来越多地用于治疗黄褐斑，与调q激光（QSL）相比，报告的不良反应较少。然而，PSL治疗后色素沉着降低的发生率仍未详细探讨。本病例系列旨在探讨黄褐斑患者在PSL治疗后色素沉着降低的结果，并探讨潜在的影响因素。方法：回顾性分析了4例PSL治疗黄褐斑后出现色素沉着的患者，其中1例来自其他诊所。在整个队列中，796名患者在2021年至2025年期间接受了3096次治疗。在低影响下使用755和/或1064纳米波长，间隔4-12周。结果：3例临床患者（0.38%,95% CI 0.13% ~ 1.10%）和1例转诊患者出现色素沉着。波长和光束轮廓都发生了变化。组织学显示黑素细胞密度保留，黑色素和黑素小体含量减少。在6个月的随访中，所有病例均未出现有意义的色素沉着。无炎症后色素沉着（PIH）病例。结论：虽然PSL治疗的低色素沉着很少见，但即使在保守的低通量环境和适当的治疗间隔下也可能发生。一种可能的机制是热束叠加，在治疗过程中缓慢的手部运动可能导致同一区域的重复脉冲。这可能导致局部热积累，潜在地引起黑素小体的亚细胞破坏，而没有明显的黑素细胞损失。这些发现提示临床医生在监测色素沉着不足时需要保持警惕，因为再色素沉着可能无法实现。需要更大规模的对照研究来澄清风险因素并指导更安全的实践。

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引用次数: 0

Photobiomodulation in Sjögren's Syndrome: Reflections on Emerging Nonpharmacological Strategies Sjögren综合征的光生物调节：对新兴非药物策略的反思。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-11-05 DOI: 10.1002/lsm.70076

Gianluca Pagnoni, Aurora Vicenzi, Francesca Coppi

引用次数: 0

Formal Response to the Letter to the Editor Entitled “Photobiomodulation in Sjögren's Syndrome: Reflections on Emerging Nonpharmacological Strategies” 对题为“Sjögren综合征的光生物调节：对新兴非药物策略的反思”的致编辑信的正式回复。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-11-05 DOI: 10.1002/lsm.70075

Soraya de Mattos Camargo Grossmann, Laura Cascão Lopes, Luiza Grossmann de Almeida, Mariana Silveira Souza, Laura Maria de Almeida Araújo, Helenice de Andrade Marigo Grandinetti, Rinaldo Borges de Almeida

引用次数: 0

Does Duty Cycle Modification Affect Temperature During Thulium Fiber Laser Lithotripsy? 占空比的改变会影响铥光纤激光碎石术中的温度吗？

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-26 DOI: 10.1002/lsm.70067

Kallan Richards, Katya Hanessian, Ali Albaghli, Gabriel Martin, Daniel Jhang, Adel Battikha, Joshua Ghoulian, Zham Okhunov, D. Duane Baldwin

Objectives

Although the thulium fiber laser (TFL, 1940 nm) efficiently fragments stones, concerns have been raised regarding heat production. Recently, a TFL with a modified duty cycle (MDC) was designed to reduce heat generation. The purpose of this study was to compare heat generation between the MDC and conventional TFL.

Methods

Ten millimeter BegoStone phantoms were placed in the proximal ureter of a kidney and ureter model. The model was submerged in a 35°C saline bath, with continuous saline irrigation (22°C) maintained at 15 mL/min through a ureteroscope. Temperature was measured using a needle thermocouple. Five trials of 60 s continuous laser activation were performed for each power setting: 3 W (0.3 J/10 Hz), 10 W (1 J/10 Hz), 20 W (1 J/20 Hz) and 30 W (0.6 J/50 Hz). Thermal dose was calculated as cumulative equivalent minutes at 43°C (CEM₄₃; injury threshold> 20). Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis with p < 0.05 being significant.

Results

Both lasers produced maximum temperatures (T_max) of 27°C at 3 W. The MDC TFL generated a significantly lower Tmax than the conventional TFL at 10 W (36.9°C vs 42.1°C, p < 0.001), 20 W (38.1°C vs 44.6°C, p < 0.001), and 30 W (52.5°C vs 63.6°C, p < 0.05). CEM₄₃ for the MDC and conventional TFL at 20 W were (0.00 vs 0.90, respectively), and at 30 W (425 vs 275,919, respectively).

Conclusions

The MDC TFL generated lower temperatures at 10, 20, and 30 W. Future studies are necessary to evaluate stone fragmentation efficiency of the MDC TFL.

目的：虽然铥光纤激光器（TFL, 1940 nm）能有效地粉碎石头，但人们对其产生的热量提出了担忧。最近，设计了一种具有改进占空比（MDC）的TFL来减少热量的产生。本研究的目的是比较MDC和传统TFL之间的热量产生。方法：将10毫米BegoStone模型放置于肾脏输尿管近端及输尿管模型。将模型浸泡在35°C生理盐水浴中，通过输尿管镜持续冲洗22°C生理盐水，维持15 mL/min。温度测量使用针热电偶。每种功率设置分别为3 W （0.3 J/10 Hz）、10 W （1 J/10 Hz）、20 W （1 J/20 Hz）和30 W (0.6 J/50 Hz)，进行了5次60 s连续激光激活试验。热剂量计算为43°C下的累积等效分钟（CEM₄₃；损伤阈值bbb20）。使用Kruskal-Wallis和Mann-Whitney U检验进行p的统计分析。结果：两种激光器在3w下产生的最高温度（Tmax）均为27°C。与传统TFL相比，MDC TFL在10 W（36.9°C vs 42.1°C）下产生的Tmax显著低于传统TFL。未来有必要进一步研究MDC TFL的碎石破碎效率。

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引用次数: 0

Therapeutic Effects of Q-Switched 1064 nm Nd:YAG Laser on Rosacea in a Mouse Model: Inflammation and Angiogenesis Modulation 调q 1064 nm Nd:YAG激光对小鼠酒渣鼻模型的治疗作用：炎症和血管生成调节。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-21 DOI: 10.1002/lsm.70074

Jing Shi, Yu-xin Zhang, Dan Ye, Xi Zhao, Hong-mei Zhou, Meng-yao Yang, Jia-hua Guo, Wei-Hui Zeng

Objectives

Rosacea is a chronic inflammatory skin condition with a complex pathogenesis involving immune dysregulation and angiogenesis. Q-switched 1064 nm neodymium:yttrium-aluminum-garnet (QSNY) laser has been demonstrated as an effective treatment for rosacea; however, studies investigating histological changes following QSNY treatment are limited. This study aims to evaluate the therapeutic effects of QSNY and explore its underlying mechanisms.

Materials and Methods

A rosacea-like mouse model was established by intradermal injection of LL37 into BALB/c mice. Hematoxylin and eosin (H&E) staining, along with immunohistochemical staining for myeloperoxidase (MPO) and CD31, were performed to assess inflammation and angiogenesis. mRNA expression levels of rosacea-associated markers were analyzed using real-time quantitative PCR (RT-qPCR) on RNA extracted from skin lesions.

Results

QSNY treatment significantly reduced skin erythema and inflammatory cell infiltration in a rosacea-like mouse model. The number of CD31- and MPO-positive cells were notably decreased following QSNY treatment. Additionally, the mRNA expression levels of rosacea-associated genes, including Toll-like receptor 2 (TLR2), kallikrein 5 (KLK5), cyclic adenosine monophosphate (cAMP), elevated interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF)-1, and VEGF-2 were downregulated.

Conclusion

QSNY effectively mitigates the rosacea phenotype by suppressing inflammation and angiogenesis, highlighting its potential as a therapeutic strategy for rosacea.

目的：酒渣鼻是一种慢性炎症性皮肤病，具有复杂的发病机制，涉及免疫失调和血管生成。调q 1064 nm钕钇铝石榴石（QSNY）激光已被证明是治疗酒渣鼻的有效方法；然而，研究QSNY治疗后组织学变化的研究是有限的。本研究旨在评价QSNY的治疗效果并探讨其作用机制。材料与方法：采用BALB/c小鼠皮内注射LL37建立酒渣鼻样小鼠模型。通过苏木精和伊红（H&E）染色，以及骨髓过氧化物酶（MPO）和CD31的免疫组织化学染色来评估炎症和血管生成。采用实时定量PCR （RT-qPCR）对皮肤病变部位提取的RNA进行分析，分析酒渣鼻相关标志物的mRNA表达水平。结果：QSNY治疗可显著减轻酒渣鼻样小鼠模型皮肤红斑和炎症细胞浸润。经QSNY治疗后，CD31-和mpo阳性细胞数量明显减少。此外，玫瑰痤疮相关基因，包括toll样受体2 （TLR2）、钾化因子5 （KLK5）、环腺苷单磷酸（cAMP）、升高的白细胞介素-1β (IL-1β)、白细胞介素-6 （IL-6）、肿瘤坏死因子-α (TNF-α)、血管内皮生长因子(VEGF)-1和VEGF-2的mRNA表达水平下调。结论：QSNY通过抑制炎症和血管生成有效减轻酒渣鼻表型，突出了其作为酒渣鼻治疗策略的潜力。

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引用次数: 0

Efficacy and Safety of Laser Treatment in Vulvar Lichen Sclerosus: A Systematic Review 激光治疗外阴硬化地衣的疗效和安全性：系统评价。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-15 DOI: 10.1002/lsm.70062

Dongmei Wei, Jian Meng, Qiao Li, Yajing Wang, Yueyue Chen, Xiaoyu Niu

Objectives

This study systematically reviews randomized controlled trials (RCTs) evaluating laser therapy for vulvar lichen sclerosus (VLS) to assess its efficacy and safety, aiming to inform clinical management and guideline development.

Methods

RCTs on laser treatment for VLS were retrieved from PubMed, Embase, Web of Science, and Cochrane databases up to January 2025, limited to English literature. References from included studies were also screened. Data on study characteristics, laser parameters, outcome measures, measurement tools, and assessment time points were extracted and analyzed.

Results

Seven RCTs (332 patients) reported 19 outcomes and 19 measurement tools, each used a total of 28 times. Symptoms and signs were most frequently reported and commonly measured using the Visual Analog Scale (VAS). Most trials indicated improvements in symptoms, signs, quality of life (QoL), and histology after laser therapy. Three studies reported greater symptom/sign improvement than topical corticosteroids (p < 0.05), and three found higher patient satisfaction (p < 0.05). Two studies showed good tolerability via VAS. Adverse events occurred in five studies (147 patients), including five mild cases (local irritation, blisters, urinary tract infection, itching, and pain). Due to heterogeneity and low study quality, a meta-analysis was not performed.

Conclusions

Laser therapy improves symptoms/signs, QoL, and histological outcomes in VLS, with good safety and tolerability. However, the evidence supporting its use as a monotherapy is limited, and benefits for anti-inflammatory, anti-fibrotic, scar-preventive, or anticarcinogenic effects remain unproven. Large-scale, long-term, and high-quality trials are needed, and future research should establish standardized Core Outcome and Measurement Sets to optimize VLS management.

目的：本研究系统回顾了评价激光治疗外阴硬化苔藓（VLS）的随机对照试验（rct），以评估其有效性和安全性，旨在为临床管理和指南制定提供信息。方法：从PubMed、Embase、Web of Science和Cochrane数据库中检索截至2025年1月的激光治疗VLS的随机对照试验，仅限于英文文献。纳入研究的参考文献也被筛选。提取和分析研究特征、激光参数、结果测量、测量工具和评估时间点的数据。结果：7项随机对照试验（332例患者）报告了19种结局和19种测量工具，每种工具共使用28次。症状和体征是最常报告的，通常使用视觉模拟量表（VAS）进行测量。大多数试验显示激光治疗后症状、体征、生活质量（QoL）和组织学改善。三个研究报告了比局部皮质类固醇更大的症状/体征改善(p结论：激光治疗改善了VLS的症状/体征、生活质量和组织学结果，具有良好的安全性和耐受性。然而，支持其作为单一疗法使用的证据是有限的，并且在抗炎、抗纤维化、疤痕预防或抗癌作用方面的益处仍未得到证实。需要大规模、长期和高质量的试验，未来的研究应建立标准化的核心结果和测量集，以优化VLS管理。

{"title":"Efficacy and Safety of Laser Treatment in Vulvar Lichen Sclerosus: A Systematic Review","authors":"Dongmei Wei, Jian Meng, Qiao Li, Yajing Wang, Yueyue Chen, Xiaoyu Niu","doi":"10.1002/lsm.70062","DOIUrl":"10.1002/lsm.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study systematically reviews randomized controlled trials (RCTs) evaluating laser therapy for vulvar lichen sclerosus (VLS) to assess its efficacy and safety, aiming to inform clinical management and guideline development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>RCTs on laser treatment for VLS were retrieved from PubMed, Embase, Web of Science, and Cochrane databases up to January 2025, limited to English literature. References from included studies were also screened. Data on study characteristics, laser parameters, outcome measures, measurement tools, and assessment time points were extracted and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven RCTs (332 patients) reported 19 outcomes and 19 measurement tools, each used a total of 28 times. Symptoms and signs were most frequently reported and commonly measured using the Visual Analog Scale (VAS). Most trials indicated improvements in symptoms, signs, quality of life (QoL), and histology after laser therapy. Three studies reported greater symptom/sign improvement than topical corticosteroids (<i>p</i> < 0.05), and three found higher patient satisfaction (<i>p</i> < 0.05). Two studies showed good tolerability via VAS. Adverse events occurred in five studies (147 patients), including five mild cases (local irritation, blisters, urinary tract infection, itching, and pain). Due to heterogeneity and low study quality, a meta-analysis was not performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Laser therapy improves symptoms/signs, QoL, and histological outcomes in VLS, with good safety and tolerability. However, the evidence supporting its use as a monotherapy is limited, and benefits for anti-inflammatory, anti-fibrotic, scar-preventive, or anticarcinogenic effects remain unproven. Large-scale, long-term, and high-quality trials are needed, and future research should establish standardized Core Outcome and Measurement Sets to optimize VLS management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 10","pages":"760-770"},"PeriodicalIF":1.9,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301572","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

Subdermal 1064-nm Nd:YAG Laser for the Aesthetic Management of Brachial Ptosis: Blinded Clinical Evaluation in 24 Upper Limbs 1064 nm Nd:YAG皮下激光治疗臂膀上睑下垂：24例上肢盲法临床评价。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-13 DOI: 10.1002/lsm.70073

Rosanna Rodríguez-Betancourt, Pedro A. Martínez-Carpio

Background and Objective

Subdermal application of Nd:YAG lasers at wavelengths of 1064, 1320, and 1444 nm has shown promise as a minimally invasive treatment for mild to moderate brachial ptosis. This study explores the efficacy and safety of our procedure, using the 1064 nm wavelength as a standalone modality.

Study Design/Materials and Methods

This was a single-arm, evaluator-blinded clinical trial. A standardized surgical protocol was implemented using subcutaneous delivery of a pure 1064 nm Nd:YAG laser (SP Dynamis, Fotona, Slovenia). The study included 24 upper limbs from 12 female patients diagnosed with stage 2a or 2b brachial ptosis (El Khatib classification). Standardized anthropometric measurements and photographic documentation were obtained at 35 days, 3 months, and 9 months postprocedure. Safety and efficacy were assessed through clinical evaluations and validated patient-reported outcome measures.

Results

Significant esthetic improvements were observed in all treated limbs (p < 0.0001), including reductions in maximum arm circumference (p = 0.0005) and ptosis grade (p = 0.0016) in both arms. The most pronounced changes occurred by Day 35, with additional minor improvements at 3 months that remained stable through the 9-month follow-up. Patient satisfaction was high, and no significant intraoperative or postoperative complications were reported.

Conclusions

Subdermal 1064 nm Nd:YAG laser shows a favorable efficacy and safety profile and, if validated in larger studies, could become a first-line option for mild to moderate brachial ptosis.

背景和目的：1064、1320和1444 nm波长的Nd:YAG激光皮下应用有望作为轻度至中度臂下垂的微创治疗方法。本研究探讨了我们的程序的有效性和安全性，使用1064nm波长作为一个独立的模式。研究设计/材料和方法：这是一项单臂、评估者盲法临床试验。标准化的手术方案是通过皮下输送纯1064 nm Nd:YAG激光（SP Dynamis, Fotona，斯洛文尼亚）。该研究包括来自12名诊断为2a期或2b期臂下垂（El Khatib分类）的女性患者的24条上肢。在手术后35天、3个月和9个月进行标准化人体测量和摄影记录。通过临床评估和经过验证的患者报告的结果测量来评估安全性和有效性。结论：皮下1064 nm Nd:YAG激光具有良好的疗效和安全性，如果在更大规模的研究中得到验证，可能成为轻度至中度臂下垂的一线选择。

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引用次数: 0

International Society of Laser Proctology Position Paper on SiLaC and EPSiT/SiLaC in the Management of Pilonidal Sinus Disease 国际激光直肠学会关于SiLaC和EPSiT/SiLaC在毛窦疾病治疗中的立场文件。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-13 DOI: 10.1002/lsm.70071

Mustapha Ouali, Gonzalo P. Martin-Martin, Salih Avdicausevic, Amine Alam, Pavel Istok, Ints Brunenieks, Vladimir Dobricanin, Vincent de Parades, Jiong Wu, Peter C. Ambe

Objectives

Minimally invasive treatment of pilonidal sinus disease (PSD) via sinus tract laser closure (SiLaC) and endoscopic pilonidal sinus treatment (EPSiT) is being increasingly employed to manage PSD. Despite its wide adoption amongst colorectal surgeons in many nations, there still exists a wide heterogeneity in surgical technique. The International Society of Laser Proctology (ISoLP) was created by experts in laser proctology has the goal of improving laser-based interventions in coloproctology with the aim of improving patient care in this specialized area.

Methods

This position paper is based on the limited evidence from available literature and largely on the expert opinion of ISoLP members with extended expertise in SiLaC and EPSiT.

Results

ISoLP experts in SiLaC and EPSiT procedures have suggested 10 statements to aid in homogenizing the SiLaC procedure alone and in combination with EPSiT, with the goal of improving treatment outcomes.

Conclusion

The 10 ISoLP position statements have a potential of shaping and homogenizing laser-assisted management of PSD.

目的：通过窦道激光闭锁（SiLaC）和内镜下毛毛窦治疗（EPSiT）微创治疗毛毛窦疾病（PSD）越来越多地被用于治疗PSD。尽管它在许多国家的结直肠外科医生中被广泛采用，但在手术技术上仍然存在很大的异质性。国际激光直肠科学会（ISoLP）是由激光直肠科专家创建的，其目标是改进基于激光的直肠科干预措施，以改善这一专业领域的患者护理。方法：本立场文件基于现有文献的有限证据，主要基于ISoLP成员在SiLaC和EPSiT方面的扩展专业知识的专家意见。结果：ISoLP专家在SiLaC和EPSiT程序中提出了10项声明，以帮助SiLaC程序单独或与EPSiT联合均质，以改善治疗结果。结论：10种ISoLP位置声明具有整形和均匀化激光辅助治疗PSD的潜力。

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引用次数: 0

Feasibility Study of a Novel Stent-Based Low-Level Laser Therapy Device for Reducing Severe Radiation-Induced Oral Mucositis 新型支架低水平激光治疗重度放射性口腔黏膜炎的可行性研究。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-07 DOI: 10.1002/lsm.70069

Jong Yun Baek, Kyungmi Yang, Tae Hoon Lee, Sung Uk Lee, Sung Ho Moon, In Young Jo, Keun-Yong Eom, Dongryul Oh

Objectives

Radiation-induced oral mucositis (RIOM) is a severe complication of radiotherapy (RT) for head and neck cancers, impairing quality of life and treatment adherence. Low-level laser therapy (LLLT) shows promise for reducing RIOM severity, but operator-dependent devices limit practicality. This feasibility study assessed the safety and efficacy of a novel intraoral stent-based LLLT device designed for consistent laser delivery.

Materials and Methods

This prospective, single-arm, multicenter study enrolled 15 patients receiving curative RT for head and neck cancers. The stent-based device delivered laser light to 43 oral cavity points at three wavelengths (670, 830, and 910 nm) during 20-min sessions, five times weekly. The primary end point was the incidence of Grade 3 or higher RIOM (WHO oral mucositis scale). Pain severity was a secondary end point (Numeric Pain Rating Scale [NPRS]).

Results

Grade 3 or higher RIOM occurred in 6.6% of patients, significantly lower than historical rates (30%–40%). No patients reported severe pain (NPRS ≥ 8). The device was well-tolerated with no adverse effects, and all patients completed RT as planned.

Conclusions

The intraoral stent-based LLLT device is a safe and potentially effective intervention for reducing severe RIOM. Randomized trials are warranted to confirm these findings.

Trial Registration

This study was a prospective, single-arm feasibility trial and was not registered in a clinical trial registry, as it did not meet the criteria for mandatory registration at the time of its initiation.

目的：放射性口腔黏膜炎（RIOM）是头颈部肿瘤放疗（RT）的严重并发症，影响患者的生活质量和治疗依从性。低水平激光治疗（LLLT）有望降低RIOM的严重程度，但操作者依赖的设备限制了实用性。这项可行性研究评估了一种新型的基于口内支架的LLLT装置的安全性和有效性，该装置设计用于一致的激光传输。材料和方法：这项前瞻性、单臂、多中心研究纳入了15例接受根治性放疗的头颈癌患者。这种基于支架的装置每周5次，每次20分钟，以三种波长（670、830和910 nm）向43个口腔点发射激光。主要终点是3级或以上RIOM （WHO口腔黏膜炎分级）的发生率。疼痛严重程度是次要终点（数值疼痛评定量表[NPRS]）。结果：3级及以上RIOM发生率为6.6%，明显低于历史发生率（30%-40%）。无患者报告剧烈疼痛（NPRS≥8）。该装置耐受性良好，无不良反应，所有患者按计划完成了RT。结论：基于口内支架的LLLT装置是一种安全且潜在有效的减少严重RIOM的干预措施。有必要进行随机试验来证实这些发现。试验注册：该研究是一项前瞻性单臂可行性试验，未在临床试验注册中心注册，因为它在开始时不符合强制注册的标准。

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引用次数: 0

Therapeutic Window of Laser Dosimetry for the Treatment of Knee Osteoarthritis 激光剂量法治疗膝骨关节炎的治疗窗。

IF 1.9 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2025-10-06 DOI: 10.1002/lsm.70072

Yulia Alexandrovskaya, Felix Feldchtein, Andreas Glatz, Anatoly Shekhter, Elizaveta Kon, Valerii Vinokur, Emil Sobol

Objectives

We propose a non-destructive laser method that uses controlled thermomechanical action to treat degenerative cartilage changes. The technique aims to reduce pain, offers a minimally invasive option for early- to mid-stage degeneration, and lessens the need for joint replacement.

Methods

An ex vivo study on laser treatment of articular cartilage involves theoretical modeling of laser-induced heating, stress relaxation, and cartilage denaturation. Theoretical model simulates the laser treatment of a multilayer system using modulated infrared radiation. It integrates the 3D heat diffusion equation with a thermomechanical model of stress relaxation and micropore formation caused by the rupture of chemical bonds. The risk of tissue denaturation is estimated with Arrhenius model. The model validation involves ex vivo temperature measurements obtained with a thermal imaging camera and experimental histological data from pig joints. This approach helps define the optimal laser dosimetry that encourages cartilage repair without causing overheating or denaturation.

Results

Experimental measurements of cartilage temperature and histological structural changes under laser irradiation confirm the model's predictions. The therapeutic window includes a lower limit marking the onset of effective stress relaxation and pore formation, while the upper limit indicates the threshold of tissue overheating and denaturation. Laser irradiation of an articular cartilage with λ = 1470 nm, pulse duration 100 ms, pulse repetition rate 1 Hz, and fiber diameter 0.6 mm shows that the therapeutic window is in the range of 0.5–0.9 W. This therapeutic window is wide enough and depends little on the parameters of cartilage defect being treated or on the conditions of laser radiation delivery for a particular patient.

Conclusion

Laser-induced heating and structural changes in cartilage verify theoretical predictions, establishing a safe and effective therapeutic window. These findings support clinical trials of the 1470 nm laser, used alongside arthroscopy, to repair degenerative cartilage and alleviate knee pain.

目的：我们提出了一种非破坏性的激光方法，利用受控的热机械作用来治疗退行性软骨改变。该技术旨在减轻疼痛，为早期到中期退变提供微创选择，并减少关节置换术的需要。方法：激光治疗关节软骨的离体研究包括激光诱导加热、应力松弛和软骨变性的理论建模。理论模型模拟了使用调制红外辐射的多层系统的激光治疗。它将三维热扩散方程与化学键断裂引起的应力松弛和微孔形成的热力学模型相结合。用阿伦尼乌斯模型估计组织变性风险。模型验证包括用热像仪获得的离体温度测量和猪关节的实验组织学数据。这种方法有助于确定最佳的激光剂量，以促进软骨修复，而不会引起过热或变性。结果：激光照射下软骨温度和组织结构变化的实验测量证实了模型的预测。治疗窗口包括标志有效应力松弛和孔隙形成开始的下限，而上限表示组织过热和变性的阈值。以λ = 1470 nm，脉冲持续时间100 ms，脉冲重复率1 Hz，光纤直径0.6 mm的激光照射关节软骨，治疗窗口在0.5-0.9 W。这个治疗窗口足够宽，并且很少依赖于被治疗的软骨缺陷的参数或特定患者的激光辐射输送条件。结论：激光诱导的软骨加热和结构变化验证了理论预测，建立了一个安全有效的治疗窗口。这些发现支持1470纳米激光与关节镜一起用于修复退行性软骨和减轻膝关节疼痛的临床试验。

{"title":"Therapeutic Window of Laser Dosimetry for the Treatment of Knee Osteoarthritis","authors":"Yulia Alexandrovskaya, Felix Feldchtein, Andreas Glatz, Anatoly Shekhter, Elizaveta Kon, Valerii Vinokur, Emil Sobol","doi":"10.1002/lsm.70072","DOIUrl":"10.1002/lsm.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We propose a non-destructive laser method that uses controlled thermomechanical action to treat degenerative cartilage changes. The technique aims to reduce pain, offers a minimally invasive option for early- to mid-stage degeneration, and lessens the need for joint replacement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An ex vivo study on laser treatment of articular cartilage involves theoretical modeling of laser-induced heating, stress relaxation, and cartilage denaturation. Theoretical model simulates the laser treatment of a multilayer system using modulated infrared radiation. It integrates the 3D heat diffusion equation with a thermomechanical model of stress relaxation and micropore formation caused by the rupture of chemical bonds. The risk of tissue denaturation is estimated with Arrhenius model. The model validation involves ex vivo temperature measurements obtained with a thermal imaging camera and experimental histological data from pig joints. This approach helps define the optimal laser dosimetry that encourages cartilage repair without causing overheating or denaturation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Experimental measurements of cartilage temperature and histological structural changes under laser irradiation confirm the model's predictions. The therapeutic window includes a lower limit marking the onset of effective stress relaxation and pore formation, while the upper limit indicates the threshold of tissue overheating and denaturation. Laser irradiation of an articular cartilage with <i>λ</i> = 1470 nm, pulse duration 100 ms, pulse repetition rate 1 Hz, and fiber diameter 0.6 mm shows that the therapeutic window is in the range of 0.5–0.9 W. This therapeutic window is wide enough and depends little on the parameters of cartilage defect being treated or on the conditions of laser radiation delivery for a particular patient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Laser-induced heating and structural changes in cartilage verify theoretical predictions, establishing a safe and effective therapeutic window. These findings support clinical trials of the 1470 nm laser, used alongside arthroscopy, to repair degenerative cartilage and alleviate knee pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"57 10","pages":"827-836"},"PeriodicalIF":1.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238977","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}

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