Lasers in Surgery and Medicine最新文献_第8页

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 Q2 DERMATOLOGY

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

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 Q2 DERMATOLOGY

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% (p_within < 0.001) and 6.5% (p_within = 0.011), while 8.3% (p_within = 0.012) and 3.8% (p_within = 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 (p_between < 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。

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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 Q2 DERMATOLOGY

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 Q2 DERMATOLOGY

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。

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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 Q2 DERMATOLOGY

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 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-02-27 DOI: 10.1002/lsm.23771

Kentaro Oku MD

<div> <section> <h3> Background</h3> <p>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.</p> </section> <section> <h3> Objective</h3> <p>To evaluate the safety, tightening capability, and directivity of the Thermal Thread Technique™ utilizing a high-intensity, high-frequency, parallel ultrasound beam.</p> </section> <section> <h3> Materials and Methods</h3> <p>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.</p> </section> <section> <h3> Results</h3> <p>The average contraction distance from baseline (0 mm) to 8 weeks and 24 weeks posttreatment were 1.91 ± 0.61 mm (<i>p</i> < 0.001) and 1.96 ± 0.67 mm (<i>p</i> < 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 (<i>p</i> < 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.</p> </section> <section> <h3> Conclusion</h3> <p>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.</p> </section> </d

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 Q2 DERMATOLOGY

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

<div> <section> <h3> Objectives</h3> <p>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.</p> </section> <section> <h3> Methods</h3> <p>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.</p> </section> <section> <h3> Results</h3> <p>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.</p> </section> <section> <h3> Conclusion</h3> <p>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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引用次数: 0

Ablative fractional CO2 laser treatment promotes wound healing phenotype in skin macrophages 点阵二氧化碳激光烧蚀治疗可促进皮肤巨噬细胞的伤口愈合表型。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-02-26 DOI: 10.1002/lsm.23772

Martin Wiinberg MSc, Thomas L. Andresen PhD, Merete Haedersdal DMSc, Uffe H. Olesen PhD

<div> <section> <h3> Objectives</h3> <p>Ablative fractional laser (AFL) treatment is a well-established method for reducing signs of skin photoaging. However, the biological mechanisms underlying AFL-induced healing responses and skin rejuvenation remain largely unknown. It is known that macrophages play an important role in orchestrating healing, normalization, and remodeling processes in skin. Macrophage phenotypes are characterized by inflammatory markers, including arginase-1 (Arg1), major histocompatibility class II molecules (MHC II), and CD206. This study aims to explore AFL's effect on macrophage phenotype by evaluating changes in inflammatory markers and the potential concurrent accumulation of Arg1 in the skin.</p> </section> <section> <h3> Methods</h3> <p>Mice (<i>n</i> = 9) received a single AFL treatment on the left side of the back skin (100 mJ/microbeam, 5% density) while the right side of the back remained untreated as control. Treated and untreated skin from each mouse were collected Day 5 posttreatment for flow cytometry and histology analysis. Flow cytometry evaluated the immune infiltration of macrophages and the expression of macrophage inflammatory markers (Arg1, MHC II, and CD206). In addition, Arg1 presence in the skin was evaluated through antibody staining of histology samples and quantification was performed using QuPath image analysis software.</p> </section> <section> <h3> Results</h3> <p>Following AFL, the number of macrophages increased 11-fold (<i>p</i> = 0.0053). Phenotype analysis of AFL-treated skin revealed an increase in the percentage of macrophages positive for Arg1 (<i>p</i> < 0.0001) and a decrease in the percentage of macrophages positive for MHC II (<i>p</i> < 0.0001) compared to untreated skin. No significant differences were observed in percentage of CD206-positive macrophages (<i>p</i> = 0.8952). Visualization of AFL-treated skin demonstrated a distinct pattern of Arg1 accumulation that correlated with the microscopic treatment zones (MTZ). Quantification of the percentage of Arg1-positive area in epidermis and dermis showed a significant increase from 3.5% ± 1.2% to 5.2% ± 1.7 (<i>p</i> = 0.0232) and an increase from 2.2% ± 1.2% to 9.6% ± 3.3 (<i>p</i> < 0.0001) in whole skin samples.</p> </section> <section> <h3> Conclusion</h3> <p>AFL treatment polarizes macrophages toward a wound healing phenotype and induces Arg1 accumulation in the MTZ. We propose that the polarized wound healing macrophages are a major source for the increased Arg1 levels observed in the skin following treatment.</p>

目的：烧蚀点阵激光（AFL）治疗是一种行之有效的减少皮肤光老化迹象的方法。然而，AFL 诱导的愈合反应和皮肤年轻化的生物机制在很大程度上仍不为人知。众所周知，巨噬细胞在协调皮肤的愈合、正常化和重塑过程中发挥着重要作用。巨噬细胞表型以炎症标志物为特征，包括精氨酸酶-1（Arg1）、主要组织相容性II类分子（MHC II）和CD206。本研究旨在通过评估炎症标志物的变化和 Arg1 在皮肤中的潜在并发蓄积，探讨 AFL 对巨噬细胞表型的影响：小鼠（n = 9）的左侧背部皮肤接受一次 AFL 处理（100 mJ/microbeam，5%密度），而右侧背部皮肤作为对照保持未处理状态。收集每只小鼠治疗后第 5 天的治疗和未治疗皮肤，进行流式细胞术和组织学分析。流式细胞术评估了巨噬细胞的免疫浸润和巨噬细胞炎症标志物（Arg1、MHC II 和 CD206）的表达。此外，通过对组织学样本进行抗体染色来评估皮肤中 Arg1 的存在，并使用 QuPath 图像分析软件进行量化：结果：AFL 治疗后，巨噬细胞数量增加了 11 倍（p = 0.0053）。对 AFL 处理过的皮肤进行表型分析后发现，Arg1 阳性的巨噬细胞比例增加了（p 结论：AFL 可使巨噬细胞极化：AFL 处理可将巨噬细胞极化为伤口愈合表型，并诱导 Arg1 在 MTZ 中积累。我们认为，极化的伤口愈合巨噬细胞是治疗后皮肤中 Arg1 含量增加的主要来源。

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引用次数: 0

Time-resolved fluorescence and diffuse reflectance for lung squamous carcinoma margin detection 用于肺鳞癌边缘检测的时间分辨荧光和漫反射。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-02-15 DOI: 10.1002/lsm.23761

Sarah Costa MSc, Qiyin Fang PhD, Thomas Farrell PhD, Erica Dao PhD, Michael Farquharson PhD

Objectives

A major challenge in non-small cell lung cancer surgery is the occurrence of positive tumor margins. This may lead to the need for additional surgeries and has been linked to poor patient prognosis. This study aims to develop an in vivo surgical tool that can differentiate cancerous from noncancerous lung tissue at the margin.

Methods

A time-resolved fluorescence and diffuse reflectance bimodal device was used to measure the lifetime, spectra, and intensities of endogenous fluorophores as well as optical properties of lung tissue. The tumor and fibrotic tissue data, each containing 36 samples, was obtained from patients who underwent surgical removal of lung tissue after being diagnosed with squamous carcinoma but before any other treatment was administered. The normal lung tissue data were obtained from nine normal tissue samples.

Results

The results show a statistically significant difference between cancerous and noncancerous tissue. The results also show a difference in metabolic related optical properties between fibrotic and normal lung tissue samples.

Conclusions

This work demonstrates the feasibility of a device that can differentiate cancerous and noncancerous lung tissue for patients diagnosed with squamous cell carcinoma.

目的：非小细胞肺癌手术的一大挑战是出现肿瘤边缘阳性。这可能导致需要进行更多手术，并与患者预后不良有关。本研究旨在开发一种体内手术工具，可在边缘区分癌与非癌肺部组织：方法：使用时间分辨荧光和漫反射双模设备测量内源性荧光团的寿命、光谱和强度以及肺组织的光学特性。肿瘤和纤维组织数据各包含 36 个样本，均来自确诊为鳞状癌后接受手术切除肺组织但尚未接受任何其他治疗的患者。正常肺组织数据来自 9 个正常组织样本：结果：结果显示，癌组织与非癌组织之间存在显著的统计学差异。结果还显示，纤维化肺组织样本和正常肺组织样本在代谢相关光学特性方面存在差异：这项工作证明了一种能区分鳞状细胞癌患者癌变和非癌变肺组织的设备的可行性。

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引用次数: 0

Full-face and neck resurfacing with a novel ablative fractional 2910 nm erbium-doped fluoride glass fiber laser for advanced photoaging 使用新型烧蚀点阵式 2910 纳米掺铒氟化玻璃光纤激光器进行全脸和颈部换肤，治疗晚期光老化。

IF 2.4 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine

Pub Date : 2024-02-14 DOI: 10.1002/lsm.23764

Taryn N. Murray MD, Jamie K. Hu MD, Paul M. Friedman MD

Objectives

Ablative fractional lasers have long been considered the gold standard for facial resurfacing for advanced photoaging. These lasers offer an improved safety profile compared to traditional ablative lasers but typically require more treatment sessions given their fractional approach. In this study, we evaluate a new novel 2910 nm erbium-doped fluoride glass fiber laser (2910 nm fiber laser) (UltraClear; Acclaro Medical) for full-face and neck resurfacing for the treatment of advanced photoaging.

Methods

Twenty-two healthy subjects aged 44–80 years presenting for advanced facial photoaging and rhytides were enrolled in the study. All subjects received three full-face and neck, multipass treatments utilizing the 2910 nm fiber laser spaced 6–8 weeks apart. Subjects were asked to rate the average level of pain during the treatment. At 90 days following subjects' third treatment subjects evaluated their improvement using a Global Aesthetic Improvement Scale (GAIS) and rated their satisfaction with the treatment. Evaluation of pretreatment and posttreatment photos was completed by two blinded physician reviewers. Reviewers were asked to identify the pretreatment and posttreatment photographs and to rate the degree of improvement utilizing a GAIS.

Results

Fifteen participants completed the study; six were exited from the study (withdrew or lost to follow-up). The average subject GAIS score for overall appearance was 3.8. The average subject satisfaction level at follow-up was 4.8. The average subject pain score was 4.9. One blinded physician reviewer correctly identified 100% of subjects' posttreatment photographs, while the second blinded reviewer correctly identified 93%. Blinded evaluation of digital photographs revealed an average GAIS score of 3.2. Posttreatment skin responses included pin-point hemorrhage, erythema, edema, and soft tissue crusting lasting 5–7 days. There were no instances of infection, scarring or hypopigmentation. There were two instances of temporary hyperpigmentation.

Conclusions

Treatment with the novel 2910 nm fiber laser is safe and effective in treating advanced photoaging and rhytides. Three treatments produced moderate to marked improvement with high patient satisfaction and treatment was associated with less discomfort and downtime compared to conventional fractional ablative lasers.

目的：长期以来，烧蚀点阵激光一直被认为是面部换肤治疗晚期光老化的黄金标准。与传统的烧蚀激光器相比，这些激光器具有更高的安全性，但由于其点阵方式，通常需要更多的治疗疗程。在这项研究中，我们评估了一种新型 2910 nm 掺铒氟化玻璃光纤激光器（2910 nm 光纤激光器）（UltraClear；Acclaro Medical）用于治疗晚期光老化的全脸和颈部换肤：方法：22 名 44-80 岁的健康受试者因晚期面部光老化和褶皱而被纳入研究。所有受试者均接受了三次全脸和颈部多通道治疗，采用 2910 nm 光纤激光，治疗间隔为 6-8 周。研究人员要求受试者对治疗过程中的平均疼痛程度进行评分。在第三次治疗后的 90 天，受试者使用全球美学改善量表（GAIS）评估自己的改善情况，并评定对治疗的满意度。对治疗前和治疗后照片的评估由两名盲人医生审查员完成。审查人员被要求识别治疗前和治疗后的照片，并使用 GAIS 对改善程度进行评分：结果：15 位参与者完成了研究，6 位退出了研究（退出或失去随访）。受试者对整体外观的平均 GAIS 得分为 3.8。随访时受试者的平均满意度为 4.8。受试者的平均疼痛评分为 4.9 分。一位双盲医生评审员对受试者治疗后照片的识别正确率为 100%，而第二位双盲评审员对受试者治疗后照片的识别正确率为 93%。对数码照片的盲法评估显示，受试者的 GAIS 平均分为 3.2 分。治疗后的皮肤反应包括针尖状出血、红斑、水肿和软组织结痂，持续 5-7 天。没有出现感染、疤痕或色素沉着。有两例暂时性色素沉着：结论：使用新型 2910 nm 光纤激光器治疗晚期光老化和褶皱是安全有效的。与传统的点阵烧蚀激光相比，治疗过程中的不适感和停工期较短。

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引用次数: 0