Photodiagnosis and photodynamic therapy最新文献

Background: Diabetic retinopathy (DR) is a leading cause of visual impairment and blindness worldwide, necessitating early detection and accurate diagnosis. This study proposes a novel framework integrating Generative Adversarial Networks (GANs) for data augmentation, denoising autoencoders for noise reduction, and transfer learning with EfficientNetB0 to enhance the performance of DR classification models.

Methods: GANs were employed to generate high-quality synthetic retinal images, effectively addressing class imbalance and enriching the training dataset. Denoising autoencoders further improved image quality by reducing noise and eliminating common artifacts such as speckle noise, motion blur, and illumination inconsistencies, providing clean and consistent inputs for the classification model. EfficientNetB0 was fine-tuned on the augmented and denoised dataset.

Results: The framework achieved exceptional classification metrics, including 99.00% accuracy, recall, and specificity, surpassing state-of-the-art methods. The study employed a custom-curated OCT dataset featuring high-resolution and clinically relevant images, addressing challenges such as limited annotated data and noisy inputs.

Conclusions: Unlike existing studies, our work uniquely integrates GANs, autoencoders, and EfficientNetB0, demonstrating the robustness, scalability, and clinical potential of the proposed framework. Future directions include integrating interpretability tools to enhance clinical adoption and exploring additional imaging modalities to further improve generalizability. This study highlights the transformative potential of deep learning in addressing critical challenges in diabetic retinopathy diagnosis.

Background: 5-Aminolevulinic acid photodynamic diagnosis (ALA-PDD) is a method for real-time diagnosis of cancer areas based on the specific accumulation of protoporphyrin IX (PpIX) in tumor cells following ALA administration and subsequent detection using fluorescence. However, its effectiveness is limited due to false negatives caused by tumor cells accumulating low amounts of PpIX after ALA administration. In order to increase the detection sensitivity of ALA-PDD, it is important to understand the characteristics of cells with low or high PpIX accumulation. This research sought to determine the factors affecting ALA-induced PpIX accumulation in tumor cells METHODS: Tumor cells were separated into two groups according to PpIX accumulation levels using FACS and the cellular characteristics were compared.

Results: The data of expression of RANKL, a tumor malignancy marker, showed that tumor cells with low PpIX accumulation are more malignant. Results also showed marked differences in PpIX efflux transporter activity and the extent to which iron atoms are being inserted into the porphyrin ring, resulting in loss of fluorescence. Interestingly, it was found tumor cells with high PpIX accumulation are in dormant state as indicated by low proliferation and suppression of glucose metabolism.

Conclusion: Tumor cells with low PpIX accumulation are characterized as high tumor grade and low cell dormancy.

Objectives: This review aims to compare the effectiveness of photodynamic therapy (PDT) with conization, including loop electrosurgical excision procedure (LEEP) and cold-knife conization (CKC), in treating cervical high-grade squamous intraepithelial lesions (HSIL).

Methods: PubMed, Cochrane Library, Google Scholar, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched. The outcomes assessed were complete response (CR) rate, human papillomavirus (HPV) eradication rate, recurrence rate, and adverse events (AEs).

Results: 9 studies were included. A total of 312 patients received PDT, while 380 underwent conization (LEEP/CKC). There was no significant difference between PDT and conization in the CR rate at 3-6 months (OR: 1.64 [0.97, 2.76]; P = 0.06), 12-month CR (OR: 0.49 [0.13, 1.90]; P = 0.30), HPV eradication rate at 3-6 months (OR: 1.40 [0.95, 2.07]; P = 0.09), HPV eradication rate at 12 months (OR: 0.92[0.47, 1.82]; P = 0.81), or 12-month recurrence rate (OR: 2.97 [0.62, 14.25]; P = 0.17). However, the rate of AEs, including vaginal bleeding (OR: 0.10 [0.03, 0.33]; P = 0.0002), cervical canal adhesion (OR: 0.16 [0.03, 0.90]; P = 0.04), and cervical scar formation (OR: 0.04 [0.01, 0.30]; P=0.002), was significantly lower with PDT than with conization. The degree of heterogeneity was not high.

Conclusion: Based on our systematic review and meta-analysis, it could be concluded that PDT may be a practical approach for cervical HSIL regression compared to conization (LEEP/CKC). However, further high-quality, controlled trials are needed to confirm these findings.

Purpose: To probe into the effects of malnutrition-sarcopenia syndrome on the changes of retinal and choroidal microvasculature.

Methods: To achieve our goals, we employed optical coherence tomography angiography (OCTA), a cutting-edge non-invasive imaging technique, to compare retinal and choroidal parameters in a controlled setting. A total of 22 participants diagnosed with Malnutrition-Sarcopenia Syndrome were enrolled alongside 22 healthy subjects matched for age and gender as controls. Parameters under scrutiny included inner retinal vessel flow density (VFD), total retinal thickness, and choroidal thickness, choroidal vascularity index (CVI). Linear regression analyses were performed to identify any significant variations of systemic profles associated with retinal and choroidal parameters.

Results: Our data unveiled substantial discrepancies in the retinochoroidal microvascular health between the patient cohort and the control group. Specifically, the patients with malnutrition-sarcopenia syndrome showcased notably diminished values in inner retinal VFD, total retinal thickness, choroidal thickness and CVI, all with extreme statistical significance (p<0.0001). Further, body mass index (BMI) exhibited a noteworthy positive association with retinal thickness (p=0.026), whereas skeletal muscle index (SMI) showed a similar trend with choroidal thickness and CVI through both univariate and multiple linear regression analyses. Besides, pearson's correlation analysis also indicated that SMI was positively correlated with choroidal thickness and CVI in the sarcopenia patients.

Conclusions: The collective evidence suggests that malnutrition coupled with sarcopenia exerts deleterious effects on chorioretinal microvasculature, with potential repercussions on visual function. This research underscores the imperative of proactive monitoring and early intervention targeting chorioretinal microvasculature changes in patients battling malnutrition-sarcopenia syndrome.

Introduction: In total laparoscopic hysterectomy, a uterine manipulator with transillumination functionality is often employed as an instrument to visualize the vaginal canal demarcation line. However, the utilization of this device necessitates an external white light source and a fiber optic cable. In this study, we developed a prototype vaginal manipulator (PHARUS Pipe) with a simpler configuration to visualize the vaginal canal separation line.

Methods: The PHARUS Pipe is constructed from a pipe, an annular array of chip-type light-emitting diodes (LEDs) with a wavelength of warm-white and near-infrared light, and a handle. The pipe, with an outer diameter of 30 mm at the tip and a wall thickness of 3 mm, was molded using a light-guiding resin. The annular LED array was positioned on the end face of the handle side of the pipe, and a battery was integrated into the handle. The pipe was designed with an external surface to provide optimal light emission at the tip in a radial direction, i.e., away from the center of the pipe. The visibility of the transillumination passing through a 3-4 mm thick vaginal wall of porcine uterovaginal specimens was evaluated using a near-infrared compatible laparoscopic imaging system.

Results: The position of the tip of the PHARUS Pipe was clearly delineated through the vaginal wall by warm-white and near-infrared transillumination light. Compared with warm-white light, near-infrared light required less current for successful visualization.

Conclusions: The present results suggest the possibility of identifying the human vaginal canal separation line using the PHARUS Pipe.

Background and objectives: The inherent surface porosities of ceramic brackets can enhance bacterial plaque accumulation. This study assessed the in-vitro effect of photodynamic therapy (PDT) with two photosensitizers (PSs) on Streptococcus mutans (S. mutans) load around metal and ceramic brackets bonded to enamel.

Materials and methods: In this in vitro experimental study, 48 sound premolars extracted for orthodontic reasons were randomly assigned to two groups (n=24) for bonding to metal and ceramic brackets. After bracket bonding, the tooth-bracket assemblies were inoculated with S. mutans, and each group was randomly divided into three subgroups (n=8) of control, PDT with toluidine blue O (TBO) and 635 nm laser, and PDT with indocyanine green (ICG) and 808 nm laser. The colony count was quantified in each subgroup, and analyzed by repeated measures ANOVA.

Results: Ceramic brackets showed a significantly higher colony count than metal brackets in the control subgroup by 7.057 log10 CFUs/mL (P<0.05). PDT, irrespective of PS type, significantly decreased the bacterial count around both ceramic (by 7.616 log10 CFUs/mL in the ICG and 7.594 log10 CFUs/mL in the TBO subgroup) and metal (by 7.512 log10 CFUs/mL in the ICG and 7.505 log10 CFUs/mL in the TBO subgroup) brackets (P<0.05). The difference in bacterial count was not significant between the ceramic and metal bracket groups after PDT (P=0.541 for ICG and P=0.101 for TBO).

Conclusion: Within the limitations of this in vitro study and as an attempt to predict what might happen in vivo, the results showed that PDT significantly decreased the bacterial load around metal and ceramic brackets bonded to enamel, irrespective of the type of PS. Thus, PDT may be considered as a possibly efficient strategy to minimize the bacterial load especially around ceramic brackets.

Aim: To present the atrophy progression rate with fundus autofluorescence (FAF) and optical coherence tomography (OCT) findings in patients with extensive macular atrophy with a pseudodrusen-like appearance.

Methods: Eight patients who were followed up with the diagnosis of diffuse macular atrophy accompanied by pseudodrusen were included. Medical records, FAF, and OCT images at consecutive follow-ups were reviewed. Measurement of the atrophic area was performed on autofluorescence images using the Heidelberg RegionFinder software at baseline and each annual visit until the last available follow-up.

Results: The mean age was 56.75 ± 5.92 years (range, 45-65 years). Nyctalopia was observed in all patients. Macular atrophy of various sizes with a larger vertical diameter was present. Diffuse pseudodrusen-like deposits extending to the mid-peripheral retina were identified. The mean follow-up period was 38.33 ± 14.60 months (range, 26-60 months). The mean area of atrophy at baseline was 13.05 ± 7.93 mm² and reached 15.31 ± 7.93 mm² at the first-year follow-up (p<0.001). At the end of the follow-up period, the mean area of atrophy was 17.32 ± 7.90 mm² (p=0.001). The yearly rate of atrophy expansion was 2.13 mm²/year. The mean subfoveal choroidal thickness at baseline decreased markedly during the follow-up period (p=0.000).

Conclusions: The progression rate of macular atrophy in these patients is faster than the geographic atrophy associated with age-related macular degeneration. In this era of therapeutic options, it has become more important to assess atrophy progression. Distinguishing different macular atrophy forms may be crucial for selecting suitable candidates for future interventional treatments.

Background: Photodynamic therapy (PDT) has emerged as a promising adjunctive treatment for glioblastoma (GBM), yet a comprehensive bibliometric analysis of this field is lacking. This study explores research trends, major contributors, and hotspots in PDT for GBM to provide an integrated overview of its development.

Methods: Literature from 1993 to 2024 was retrieved from the Web of Science Core Collection. Bibliometric tools, including CiteSpace, analyzed publication trends, collaborations, and keyword co-occurrence to identify influential authors, institutions, and journals.

Results: A total of 799 publications showed a growing research interest, peaking in 2022. The United States and China were leading contributors, with prominent institutions like the University of California System and Centre National de la Recherche Scientifique. Influential figures, such as Jiro Akimoto and Walter Stummer, advanced clinical applications and fluorescence-guided techniques. Early studies of photodynamic therapy for GBM have focused on evaluating its efficacy and potential side effects, transitioning towards innovative strategies like targeted drug delivery, nanotechnology, and combination therapies. However, the similarities between early and recent studies are in the search for safe and reliable photosensitizers. Keyword analysis highlighted "5-aminolevulinic acid", "in vitro", and "polyethylene glycol compounds" as key areas, while timeline analysis revealed shifts from foundational photosensitizer research to approaches addressing tumor heterogeneity and resistance.

Conclusions: This study provides a systematic overview of PDT research for GBM, spotlighting breakthroughs and collaborative networks. The findings emphasize the importance of preclinical innovation and clinical translation to fully realize PDT's potential in GBM therapy.

Background: In recent years, the number of patients with nontuberculous mycobacteria (NTM) infections caused by invasive procedures such as cosmetic surgery has been increasing. However, treating NTM infections presents significant challenges, with no standardized diagnostic or treatment guidelines currently available.

Methods: This study included 10 patients diagnosed with skin and soft tissue NTM infections following cosmetic surgery. Each patient underwent surgical treatment, followed by PDT after debridement. PDT was performed using topical 20% 5-aminolevulinic acid (ALA, 2 mL: 10 mg) applied to the wound periphery (2 cm margin), followed by a 3-hour incubation under light occlusion and activation with a 635 nm diode laser at an energy density of 120 J/cm². Exposure durations were dynamically adjusted (20-40 minutes) based on real-time pain tolerance. Weekly PDT sessions were administered, with total treatment duration individualized according to wound healing progression. Post-procedural pain was assessed using the Facial Expression Pain Scale (FEPS) and managed through a tiered protocol: ice compression for mild-to-moderate pain (FEPS 2-4) and NSAIDs/opioids for severe pain (FEPS >4). Antibiotics were selected based on the results of drug susceptibility testing.

Results: All ten patients achieved clinical cure, with a notable reduction in the duration of therapy. All patients were followed for over six months without recurrence of infection. Post-PDT pain was universally in all patients, with FEPS scores ranging from 2 to 7, and managed effectively by the final treatment. Transient adverse events included erythema (n=10) and pruritus (n=2), resolving spontaneously within 48 hours. No chronic complications were observed.

Conclusion: The combination of surgical intervention and PDT, along with appropriate antibiotic therapy, is a safe and effective approach for treating skin and soft tissue NTM infections after cosmetic surgery.

Methods: PDT was performed using topical 20% ALA (10 mg/session) applied to the wound periphery (2 cm margin), followed by 3-hour occlusion and 635 nm laser irradiation (120 J/cm²; XD-635AB). Exposure durations were adjusted dynamically (20-40 minutes) based on real-time pain tolerance. Weekly sessions were administered until wound resolution. Pain severity (FEPS) was managed via a tiered protocol: ice/NSAIDs for scores 2-4 and opioids for scores >4. PDT was performed using 20% 5-ALA activated by a 635 nm laser with a light dose of 120 J/cm².

Objective: To compare and analyze the efficacy as well as adverse effects of 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) and carbon dioxide (CO₂) laser therapy in the treatment of vaginal intraepithelial neoplasia II (VaIN II), and assess the feasibility, safety, and influencing factors of ALA-PDT.

Methods: A retrospective review was conducted on the clinical data of 79 patients with VaIN II (PDT group = 37, Laser group = 42) who were treated at the Gynecology Department of the Affiliated Hospital of Qingdao University from January 2022 to January 2024. Follow-up evaluations were carried out at 3, 6, and 12 months after treatment. During these follow-ups, human papillomavirus (HPV) testing, cervical liquid-based cytology (TCT), colposcopy, and vaginal lesion biopsy were utilized to assess key outcomes, including the lesion reversal rate, HPV clearance, and treatment-related adverse reactions in both groups.

Results: The lesion reversal rates following ALA-PDT treatment were 83.3%, 86.1%, and 88.2% at 3, 6, and 12 months, respectively. There was no significant difference when compared to the laser group. However, the negative HPV conversion rates at 6 and 12 months after ALA-PDT treatment were 73.5% and 87.5%, respectively, which were significantly higher than those observed in the CO₂ laser group (P < 0.05). Adverse events related to photodynamic therapy occurred in 13.5% (5/37) of the cases, which was significantly lower than the 35.7% (15/42) in the laser group. In the laser group, increased incidences of vaginal bleeding and scarring were observed. Logistic univariate regression analysis revealed that factors such as a disease duration of more than 1 year, multifocal lesions, and a history of cervical cancer or precancerous surgery negatively influenced lesion reversal at 6 months after ALA-PDT treatment (P < 0.05). Additionally, factors like patient age over 50 years old (menopause), having more than two pregnancies, an imbalance in the vaginal microbiota, a prolonged HPV infection (lasting more than 1 year), and HPV superinfection affected HPV clearance at 6 months after ALA-PDT treatment (P < 0.05).

Conclusion: For the treatment of VaIN II, ALA-PDT exhibits equivalent lesion reversal rates and superior HPV clearance compared to CO₂ laser treatment, while causing minimal anatomical disruption to the vaginal tissue.