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Tian R, Wang Q, Li S, Nong X. Non-invasive efficacy assessment of pulsed dye laser and photodynamic therapy for port-wine stain. Indian J Dermatol Venereol Leprol 2024; 0:1-9. [PMID: 38841964 DOI: 10.25259/ijdvl_985_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/28/2023] [Indexed: 06/07/2024]
Abstract
Port wine stain (PWS) is a congenital vascular malformation that commonly occurs on the face and neck. Currently, the main treatments for port wine stain are pulsed dye laser (PDL) and photodynamic therapy (PDT). However, the efficacy evaluation of PWS mostly relies on the subjective judgement of clinicians, and it is difficult to accurately respond to many small changes after treatment. Therefore, some non-invasive and efficient efficacy assessment methods are also needed. With the continuous development of technology, there are currently many visualisation instruments to evaluate PWS, including dermoscopy, VISIA-CR™ system, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), Photoacoustic imaging (PAI), laser speckle imaging (LSI) and laser Doppler imaging (LDI). Among them, there are simple and low-cost technologies such as dermoscopy and the VISIA-CR™ system, but they may not be able to observe the deeper structures of PWS. At this time, combining techniques such as HFUS and OCT to increase penetration depth is crucial to evaluate PWS. In the future, the combination of these different technologies could help overcome the limitations of a single technology. This article provides a systematic overview of non-invasive methods for evaluating treatment efficacy in port wine stains and summarises their advantages and disadvantages.
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Affiliation(s)
- Rongqian Tian
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qin Wang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Sijin Li
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiang Nong
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Kandukuri J, Jain A, Karmarkar P, Gadagkar H, Aberman H, Wang Q, Rege A. Realtime assessment of vascular occlusion and reperfusion in animal models of intraoperative imaging - a pilot study. Innov Surg Sci 2024; 9:25-35. [PMID: 38826630 PMCID: PMC11138401 DOI: 10.1515/iss-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/04/2023] [Indexed: 06/05/2024] Open
Abstract
Objectives Intraoperative monitoring of blood flow (BF) remains vital to guiding surgical decisions. Here, we report the use of SurgeON™ Blood Flow Monitor (BFM), a prototype system that attaches to surgical microscopes and implements laser speckle contrast imaging (LSCI) to noninvasively obtain and present vascular BF information in real-time within the microscope's eyepiece. Methods The ability of SurgeON BFM to monitor BF status during reversible vascular occlusion procedures was investigated in two large animal models: occlusion of saphenous veins in six NZW rabbit hindlimbs and clipping of middle cerebral artery (MCA) branches in four Dorset sheep brain hemispheres. SurgeON BFM acquired, presented, and stored LSCI-based blood flow velocity index (BFVi) data and performed indocyanine green video angiography (ICG-VA) for corroboration. Results Stored BFVi data were analyzed for each phase: pre-occlusion (baseline), with the vessel occluded (occlusion), and after reversal of occlusion (re-perfusion). In saphenous veins, BFVi relative to baseline reduced to 5.2±3.7 % during occlusion and returned to 102.9±14.9 % during re-perfusion. Unlike ICG-VA, SurgeON BFM was able to monitor reduced BFVi and characterize re-perfusion robustly during five serial occlusion procedures conducted 2-5 min apart on the same vessel. Across four sheep MCA vessels, BFVi reduced to 18.6±7.7 % and returned to 120.1±27.8 % of baseline during occlusion and re-perfusion phases, respectively. Conclusions SurgeON BFM can noninvasively monitor vascular occlusion status and provide intuitive visualization of BF information in real-time to an operating surgeon. This technology may find application in vascular, plastic, and neurovascular surgery.
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Affiliation(s)
| | - Aseem Jain
- Vasoptic Medical, Inc., Columbia, MD, USA
| | | | | | | | - Qihong Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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Lertsakdadet BS, Kennedy GT, Stone R, Kowalczewski C, Kowalczewski AC, Natesan S, Christy RJ, Durkin AJ, Choi B. Assessing multimodal optical imaging of perfusion in burn wounds. Burns 2022; 48:799-807. [PMID: 34696954 DOI: 10.1016/j.burns.2021.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022]
Abstract
A critical need exists for early, accurate diagnosis of burn wound severity to help identify the course of treatment and outcome of the wound. Laser speckle imaging (LSI) is a promising blood perfusion imaging approach, but it does not account for changes in tissue optical properties that can occur with burn wounds, which are highly dynamic environments. Here, we studied optical property dynamics following burn injury and debridement and the associated impact on interpretation of LSI measurements of skin perfusion. We used spatial frequency domain imaging (SFDI) measurements of tissue optical properties to study the impact of burn-induced changes in these properties on LSI measurements. An established preclinical porcine model of burn injury was used (n = 8). SFDI and LSI data were collected from burn wounds of varying severity. SFDI measurements demonstrate that optical properties change in response to burn injury in a porcine model. We then apply theoretical modeling to demonstrate that the measured range of optical property changes can affect the interpretation of LSI measurements of blood flow, but this effect is minimal for most of the measured data. Collectively, our results indicate that, even with a dynamic burn wound environment, blood-flow measurements with LSI can serve as an appropriate strategy for accurate assessment of burn severity.
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Affiliation(s)
- Ben S Lertsakdadet
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, USA; Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA.
| | - Gordon T Kennedy
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, USA.
| | - Randolph Stone
- United States Army Institute of Surgical Research, 36950 Chambers Pass, Fort Sam Houston, TX 78234, USA.
| | - Christine Kowalczewski
- United States Army Institute of Surgical Research, 36950 Chambers Pass, Fort Sam Houston, TX 78234, USA.
| | - Andrew C Kowalczewski
- United States Army Institute of Surgical Research, 36950 Chambers Pass, Fort Sam Houston, TX 78234, USA.
| | - Shanmugasundaram Natesan
- United States Army Institute of Surgical Research, 36950 Chambers Pass, Fort Sam Houston, TX 78234, USA.
| | - Robert J Christy
- United States Army Institute of Surgical Research, 36950 Chambers Pass, Fort Sam Houston, TX 78234, USA.
| | - Anthony J Durkin
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, USA; Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA.
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, USA; Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA; Department of Surgery, University of California, Irvine, CA, 92697, USA; Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, CA, 92697, USA.
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Blood loss estimation during posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2022; 10:581-588. [PMID: 34784000 DOI: 10.1007/s43390-021-00440-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Blood loss (BL) during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) may be estimated using a variety of unproven techniques. Patient care and research on BL are likely impacted by a lack of standardization. A novel FDA-approved blood volume (BV) analysis system (BVA-100 Blood Volume Analyzer) allows rapid processing with > 97% accuracy. The purpose of this study was to investigate common methods for BL estimation. METHODS BV assessment was performed with the BVA-100. After obtaining a baseline sample of 5 mL of blood, 1 mL of I-131-labeled albumin was injected intravenously over 1 min. Five milliliter blood samples were then collected at 12, 18, 24, 30, and 36 min post-injection. Intravenous fluid was minimized to maintain euvolemia. Salvaged blood was not administered during surgery. BL was estimated using several common techniques and compared to the BV measurements provided by the BVA-100 (BVABL). RESULTS Thirty AIS patients were prospectively enrolled with major curves of 54° and underwent fusions of 10 levels. BL based on the BVA-100 (BVABL) was 519.2 [IQR 322.9, 886.2] mL. Previously published formulas all failed to approximate BVABL. Multiplying the cell saver volume return by 3 (CS3) approximates BVABL well with a Spearman correlation coefficient and ICC of 0.80 and 0.72, respectively. An extrapolated cell salvage-based estimator also showed high intraclass correlation coefficient (ICC) and Spearman coefficients with less bias than CS3. CONCLUSION Published formulaic approaches do not approximate true blood loss. Multiplying the cell saver volume by 3 or using the cell salvage-based estimator had the highest correlation coefficient and ICC. LEVEL OF EVIDENCE Prospective cohort Level 2.
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Wang M, Lin Y, Shi W, Chen X, Mi Z, Jia Z, Pan Q, Wang Z, Han J, Liu H. Topical metformin suppresses angiogenesis pathways induced by pulsed dye laser irradiation in animal models. Exp Dermatol 2021; 31:393-397. [PMID: 34564891 DOI: 10.1111/exd.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Pulsed dye laser (PDL) is the first-line treatment for port-wine stain (PWS). However, only a small portion of the lesions could be completely cleared by PDL treatment, which might be related to the regeneration and revascularization of the vascular structures after laser irradiation. Recently, it is believed that the suppression of regeneration and revascularization of photocoagulated blood vessels can achieve a better therapeutic outcome. We use rabbit ear and SD rat as the animal models to investigate whether PDL-induced angiogenesis can be suppressed by topical metformin. Our results showed that topical application of metformin can effectively suppress the PDL-induced early stage of angiogenesis via inhibition of the AKT/mTOR/P70S6K pathway in animal models.
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Affiliation(s)
- Meiling Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yan Lin
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Wenhao Shi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xuechao Chen
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zihao Mi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhiwei Jia
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Pan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenzhen Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Han
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Huaxu Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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Wang M, Qin Y, Wang T, Orringer JS, Paulus YM, Yang X, Wang X. Removing Subcutaneous Microvessels Using Photo-Mediated Ultrasound Therapy. Lasers Surg Med 2020; 52:984-992. [PMID: 32394475 PMCID: PMC7655656 DOI: 10.1002/lsm.23260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES We have developed a novel anti-vascular technique, termed photo-mediated ultrasound therapy (PUT), which utilizes nanosecond duration laser pulses synchronized with ultrasound bursts to remove the microvasculature through cavitation. The objective of the current study is to explore the potential of PUT in removing subcutaneous microvessels. STUDY DESIGN/MATERIALS AND METHODS The auricular blood vessels of two New Zealand white rabbits were treated by PUT with a peak negative ultrasound pressure of 0.45 MPa at 0.5 MHz, and a laser fluence of 0.056 J/cm2 at 1064 nm for 10 minutes. Blood perfusion in the treated area was measured by a commercial laser speckle imaging (LSI) system before and immediately after treatment, as well as at 1 hour, 3 days, 2 weeks, and 4 weeks post-treatment. Perfusion rates of 38 individual vessels from four rabbit ears were tracked during this time period for longitudinal assessment. RESULTS The measured perfusion rates of the vessels in the treated areas, as quantified by the relative change in perfusion rate, showed a statistically significant decrease for all time points post-treatment (P < 0.001). The mean decrease in perfusion is 50.79% immediately after treatment and is 32.14% at 4 weeks post-treatment. Immediately after treatment, the perfusion rate decreased rapidly. Following this, there was a partial recovery in perfusion rate up to 3 days post-treatment, followed by a plateau in the perfusion from 3 days to 4 weeks. CONCLUSIONS This study demonstrated that a single PUT treatment could significantly reduce blood perfusion by 32.14% in the skin for up to 4 weeks. With unique advantages such as low laser fluence as compared with photothermolysis and agent-free treatment as compared with photodynamic therapy, PUT holds the potential to be developed into a new tool for the treatment of cutaneous vascular lesions. Lasers Surg. Med. © 2020 Wiley Periodicals, LLC.
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Affiliation(s)
- Mingyang Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
| | - Yu Qin
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, No.1239, Siping Road, Shanghai, 200092, China
| | - Tao Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Institution of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, 236 Baidi Road, Tianjin, 300192, China
| | - Jeffrey S Orringer
- Department of Dermatology, University of Michigan, 1910 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109
| | - Yannis M Paulus
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Department of Ophthalmology and Visual Sciences, University of Michigan, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, Michigan, 48109
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, 1530 W.15th Street, 3138 Learned Hall, Lawrence, Kansas, 66045
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
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van Raath MI, Chohan S, Wolkerstorfer A, van der Horst CMAM, Limpens J, Huang X, Ding B, Storm G, van der Hulst RRWJ, Heger M. Clinical outcome measures and scoring systems used in prospective studies of port wine stains: A systematic review. PLoS One 2020; 15:e0235657. [PMID: 32614899 PMCID: PMC7332045 DOI: 10.1371/journal.pone.0235657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Valid and reliable outcome measures are needed to determine and compare treatment results of port wine stain (PWS) studies. Besides, uniformity in outcome measures is crucial to enable inter-study comparisons and meta-analyses. This study aimed to assess the heterogeneity in reported PWS outcome measures by mapping the (clinical) outcome measures currently used in prospective PWS studies. METHODS OVID MEDLINE, OVID Embase, and CENTRAL were searched for prospective PWS studies published from 2005 to May 2020. Interventional studies with a clinical efficacy assessment were included. Two reviewers independently evaluated methodological quality using a modified Downs and Black checklist. RESULTS In total, 85 studies comprising 3,310 patients were included in which 94 clinician/observer-reported clinical efficacy assessments had been performed using 46 different scoring systems. Eighty-one- studies employed a global assessment of PWS appearance/improvement, of which -82% was expressed as percentage improvement and categorized in 26 different scoring systems. A wide variety of other global and multi-item scoring systems was identified. As a result of outcome heterogeneity and insufficient data reporting, only 44% of studies could be directly compared. A minority of studies included patient-reported or objective outcomes. Thirteen studies of good quality were found. CONCLUSION Clinical PWS outcomes are highly heterogeneous, which hampers study comparisons and meta-analyses. Consensus-based development of a core outcome-set would benefit future research and clinical practice, especially considering the lack of high-quality trials.
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Affiliation(s)
- M. Ingmar van Raath
- Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sandeep Chohan
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Chantal M. A. M. van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Xuan Huang
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Baoyue Ding
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - René R. W. J. van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Michal Heger
- Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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In Vivo Assessment of Thermosensitive Liposomes for the Treatment of Port Wine Stains by Antifibrinolytic Site-Specific Pharmaco-Laser Therapy. Pharmaceutics 2020; 12:pharmaceutics12060591. [PMID: 32630457 PMCID: PMC7356038 DOI: 10.3390/pharmaceutics12060591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 01/10/2023] Open
Abstract
Antifibrinolytic site-specific pharmaco-laser therapy (SSPLT) is an experimental treatment modality for refractory port wine stains (PWS). Conceptually, antifibrinolytic drugs encapsulated in thermosensitive liposomes are delivered to thrombi that form in semi-photocoagulated PWS blood vessels after conventional laser treatment. Local release of antifibrinolytics is induced by mild hyperthermia, resulting in hyperthrombosis and complete occlusion of the target blood vessel (clinical endpoint). In this study, 20 thermosensitive liposomal formulations containing tranexamic acid (TA) were assayed for physicochemical properties, TA:lipid ratio, encapsulation efficiency, and endovesicular TA concentration. Two candidate formulations (DPPC:DSPE-PEG, DPPC:MPPC:DSPE-PEG) were selected based on optimal properties and analyzed for heat-induced TA release at body temperature (T), phase transition temperature (Tm), and at T > Tm. The effect of plasma on liposomal stability at 37 °C was determined, and the association of liposomes with platelets was examined by flow cytometry. The accumulation of PEGylated phosphocholine liposomes in laser-induced thrombi was investigated in a hamster dorsal skinfold model and intravital fluorescence microscopy. Both formulations did not release TA at 37 °C. Near-complete TA release was achieved at Tm within 2.0–2.5 min of heating, which was accelerated at T > Tm. Plasma exerted a stabilizing effect on both formulations. Liposomes showed mild association with platelets. Despite positive in vitro results, fluorescently labeled liposomes did not sufficiently accumulate in laser-induced thrombi in hamsters to warrant their use in antifibrinolytic SSPLT, which can be solved by coupling thrombus-targeting ligands to the liposomes.
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Lertsakdadet B, Dunn C, Bahani A, Crouzet C, Choi B. Handheld motion stabilized laser speckle imaging. BIOMEDICAL OPTICS EXPRESS 2019; 10:5149-5158. [PMID: 31646037 PMCID: PMC6788584 DOI: 10.1364/boe.10.005149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/31/2019] [Accepted: 09/03/2019] [Indexed: 05/19/2023]
Abstract
Laser speckle imaging (LSI) is a wide-field, noninvasive optical technique that allows researchers and clinicians to quantify blood flow in a variety of applications. However, traditional LSI devices are cart or tripod based mounted systems that are bulky and potentially difficult to maneuver in a clinical setting. We previously showed that the use of a handheld LSI device with the use of a fiducial marker (FM) to account for motion artifact is a viable alternative to mounted systems. Here we incorporated a handheld gimbal stabilizer (HGS) to produce a motion stabilized LSI (msLSI) device to further improve the quality of data acquired in handheld configurations. We evaluated the msLSI device in vitro using flow phantom experiments and in vivo using a dorsal window chamber model. For in vitro experiments, we quantified the speckle contrast of the FM (KFM) using the mounted data set and tested 80% and 85% of KFM as thresholds for useable images (KFM,Mounted,80% and KFM,Mounted,85%). Handheld data sets using the msLSI device (stabilized handheld) and handheld data sets without the HGS (handheld) were collected. Using KFM,Mounted,80% and KFM,Mounted,85% as the threshold, the number of images above the threshold for stabilized handheld (38 ± 7 and 10 ± 2) was significantly greater (p = 0.031) than for handheld operation (16 ± 2 and 4 ± 1). We quantified a region of interest within the flow region (KFLOW), which led to a percent difference of 8.5% ± 2.9% and 7.8% ± 3.1% between stabilized handheld and handheld configurations at each threshold. For in vivo experiments, we quantified the speckle contrast of the window chamber (KWC) using the mounted data set and tested 80% of KWC (KWC,Mounted,80%). Stabilized handheld operation provided 53 ± 24 images above KWC,Mounted,80%, while handheld operation provided only 23 ± 13 images. We quantified the speckle flow index (SFI) of the vessels and the background to calculate a signal-to-background ratio (SBR) of the window chamber. Stabilized handheld operation provided a greater SBR (2.32 ± 0.29) compared to handheld operation (1.83 ± 0.21). Both the number of images above threshold and SBR were statistically significantly greater in the stabilized handheld data sets (p = 0.0312). These results display the improved usability of handheld data acquired with an msLSI device.
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Affiliation(s)
- Ben Lertsakdadet
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Cody Dunn
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, 2400 Engineering Hall, Irvine, CA 92697, USA
| | - Adrian Bahani
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Christian Crouzet
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, 2400 Engineering Hall, Irvine, CA 92697, USA
- Department of Surgery, University of California, Irvine, 333 City Boulevard West, Suite 1600, Orange, CA 92868, USA
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van Raath MI, van Amesfoort JE, Hermann M, Ince Y, Zwart MJ, Echague AV, Chen Y, Ding B, Huang X, Storm G, Heger M. Site-specific pharmaco-laser therapy: A novel treatment modality for refractory port wine stains. J Clin Transl Res 2019; 5:1-24. [PMID: 31579838 PMCID: PMC6765152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022] Open
Abstract
Despite extensive efforts to optimize laser therapy, i.e., the current gold standard treatment, a majority of port wine stain (PWS) patients responds suboptimally to laser therapy. This paper describes the niceties of a novel PWS treatment modality termed site-specific pharmaco-laser therapy (SSPLT). In contrast to the classic approach of enhancing the extent of intravascular photocoagulation (the photothermal response), SSPLT focuses on optimization of post-irradiation thrombus formation (i.e., the hemodynamic response) by combining conventional laser therapy with the administration of thermosensitive drug delivery systems that encapsulate prothrombotic and antifibrinolytic drugs. The aim of SSPLT is to instill complete lumenal occlusion in target vessels, which has been linked to optimal PWS blanching. RELEVANCE FOR PATIENTS The current treatment options for PWS patients are limited in efficacy. Novel therapeutic modalities are needed to more effectively treat patients with recalcitrant PWSs. SSPLT is an experimental-stage treatment modality that could serve as an adjuvant to pulsed dye laser therapy for a selected group of patients whose PWS is ill-responsive to standard treatment. The expected clinical result of SSPLT is improved lesional blanching.
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Affiliation(s)
- M. Ingmar van Raath
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China,2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Martin Hermann
- 3Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Yasin Ince
- 2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maurice J. Zwart
- 2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Agustina V. Echague
- 4Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yan Chen
- 5Department of Clinical Medicine, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Baoyue Ding
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Xuan Huang
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Gert Storm
- 6Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands,7Department of Controlled Drug Delivery, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Michal Heger
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China,6Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands,Corresponding author: Michal Heger Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China Tel: +86-138-19345926.
Department of Pharmaceutics, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands Tel: +31-30-2533966.
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11
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Wang L, Li Y, Li Y, Li K. Improved speckle contrast optical coherence tomography angiography. Am J Transl Res 2018; 10:3025-3035. [PMID: 30416648 PMCID: PMC6220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/22/2018] [Indexed: 06/09/2023]
Abstract
Optical coherence tomography (OCT) is becoming a clinically useful and important imaging technique due to its ability to provide high-resolution structural imaging in vivo. Optical coherence tomography angiography (OCTA) can visualize vasculature imaging of biological tissues. With the advent of Fourier-domain OCT, numerous OCTA techniques have been developed to detect the microvasculature in vivo. The macular region of the fundus is separated into retinal and choroid regions by segmentation algorithm in the data processing, a false blood flow signal is generated due to bulk motion when vasculature imaging was segmented in the retinal regions. However, the most recent OCT angiographic approaches are sensitive to bulk motion noise. To overcome this limitation, we proposed an improved speckle contrast optical coherence tomography angiography (ISC-OCTA) algorithm to image vasculature network in vivo. The improved speckle contrast image was acquired by the improved speckle contrast algorithm for N consecutive frames of the same location, and the vasculature of the tissue was generated by masking the averaged image with the improved speckle contrast image. ISC-OCTA was tested on in vivo images of a phantom mouse ear and a human macula. Compared to the recently reported algorithms, we found that ISC-OCTA can distinguish the dynamic information of blood flow from static tissue and visualize capillary vessels. Especially when the segmentation data generates false information, the ISC-OCTA algorithm has a significant effect on the suppression of the line noise. ISC-OCTA can provide clear visualization of vessels as other algorithms and may be useful in the diagnosis of ophthalmic diseases.
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Affiliation(s)
- Liwei Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192, China
| | - Yuejie Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192, China
| | - Yilu Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192, China
| | - Kaining Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192, China
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12
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Wu X, Li J, Joypaul K, Bao WW, Wang D, Huang YJ, Li PC, Mei W. Blood flow index as an indicator of successful sciatic nerve block: a prospective observational study using laser speckle contrast imaging. Br J Anaesth 2018; 121:859-866. [PMID: 30236247 DOI: 10.1016/j.bja.2018.05.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/10/2018] [Accepted: 06/07/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Laser speckle contrast imaging allows real-time, non-invasive, quantitative measurements of regional blood flow. The objectives of this prospective observational study were to use laser speckle contrast imaging to evaluate blood flow changes after sciatic nerve block, and to determine whether this novel optical technique can evaluate block success. METHODS This observational study included 63 adult patients undergoing elective lower limb surgery with sciatic nerve block. Blood flow images and blood flow index (BFI) values of toes were recorded using laser speckle contrast imaging 5 min before nerve block and at 5 min intervals until 30 min after sciatic block. The sensitivity, specificity, and cut-off value of laser speckle contrast imaging for predicting successful sciatic block were determined by receiver operator characteristic (ROC) curve analysis. RESULTS The BFI values of toes were significantly increased at each time point after successful sciatic block, compared with the baseline value obtained 5 min before nerve block; in failed sciatic block, there were no significant differences. For successful sciatic block, the highest increase of BFI value was at the big toe. BFI increase of the big toe at 10 min after sciatic block has great potential as an indicator of block success. The area under the ROC curve was 0.954 at a cut-off value of 8.48 perfusion units (PU) with a sensitivity of 89% and a specificity of 100%. CONCLUSIONS Laser speckle contrast imaging might be an early, objective, quantitative, and reliable indicator of successful sciatic block. BFI increase of the big toe not reaching 8.48 PU within 10 min after sciatic block indicates block failure. CLINICAL TRIAL REGISTRATION NCT03169517.
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Affiliation(s)
- X Wu
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Li
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Anaesthesiology, Shenzhen Second People's Hospital, Shenzhen, China
| | - K Joypaul
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Anaesthesiology, Flacq Hospital, Centre-de-Flacq, Mauritius
| | - W W Bao
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Anaesthesiology, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - D Wang
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y J Huang
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - P C Li
- Britton Chance Center for Biomedical Photonics, School of Engineering Sciences, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.
| | - W Mei
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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13
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Ghijsen M, Rice TB, Yang B, White SM, Tromberg BJ. Wearable speckle plethysmography (SPG) for characterizing microvascular flow and resistance. BIOMEDICAL OPTICS EXPRESS 2018; 9:3937-3952. [PMID: 30338166 PMCID: PMC6191642 DOI: 10.1364/boe.9.003937] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 05/04/2023]
Abstract
In this work we introduce a modified form of laser speckle imaging (LSI) referred to as affixed transmission speckle analysis (ATSA) that uses a single coherent light source to probe two physiological signals: one related to pulsatile vascular expansion (classically known as the photoplethysmographic (PPG) waveform) and one related to pulsatile vascular blood flow (named here the speckle plethysmographic (SPG) waveform). The PPG signal is determined by recording intensity fluctuations, and the SPG signal is determined via the LSI dynamic light scattering technique. These two co-registered signals are obtained by transilluminating a single digit (e.g. finger) which produces quasi-periodic waveforms derived from the cardiac cycle. Because PPG and SPG waveforms probe vascular expansion and flow, respectively, in cm-thick tissue, these complementary phenomena are offset in time and have rich dynamic features. We characterize the timing offset and harmonic content of the waveforms in 16 human subjects and demonstrate physiologic relevance for assessing microvascular flow and resistance.
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Affiliation(s)
- Michael Ghijsen
- Laser Microbeam and Medical Program, Beckman Laser Institute, 1002 Health Sciences Road, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Tyler B. Rice
- Laser Associated Sciences Inc., 16 Foxglove Way, Irvine, CA 92612, USA
| | - Bruce Yang
- Laser Associated Sciences Inc., 16 Foxglove Way, Irvine, CA 92612, USA
| | - Sean M. White
- Laser Associated Sciences Inc., 16 Foxglove Way, Irvine, CA 92612, USA
| | - Bruce J. Tromberg
- Laser Microbeam and Medical Program, Beckman Laser Institute, 1002 Health Sciences Road, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
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14
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Regan C, Hayakawa C, Choi B. Momentum transfer Monte Carlo for the simulation of laser speckle imaging and its application in the skin. BIOMEDICAL OPTICS EXPRESS 2017; 8:5708-5723. [PMID: 29296499 PMCID: PMC5745114 DOI: 10.1364/boe.8.005708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 05/03/2023]
Abstract
Due to its simplicity and low cost, laser speckle imaging (LSI) has achieved widespread use in biomedical applications. However, interpretation of the blood-flow maps remains ambiguous, as LSI enables only limited visualization of vasculature below scattering layers such as the epidermis and skull. Here, we describe a computational model that enables flexible in-silico study of the impact of these factors on LSI measurements. The model uses Monte Carlo methods to simulate light and momentum transport in a heterogeneous tissue geometry. The virtual detectors of the model track several important characteristics of light. This model enables study of LSI aspects that may be difficult or unwieldy to address in an experimental setting, and enables detailed study of the fundamental origins of speckle contrast modulation in tissue-specific geometries. We applied the model to an in-depth exploration of the spectral dependence of speckle contrast signal in the skin, the effects of epidermal melanin content on LSI, and the depth-dependent origins of our signal. We found that LSI of transmitted light allows for a more homogeneous integration of the signal from the entire bulk of the tissue, whereas epi-illumination measurements of contrast are limited to a fraction of the light penetration depth. We quantified the spectral depth dependence of our contrast signal in the skin, and did not observe a statistically significant effect of epidermal melanin on speckle contrast. Finally, we corroborated these simulated results with experimental LSI measurements of flow beneath a thin absorbing layer. The results of this study suggest the use of LSI in the clinic to monitor perfusion in patients with different skin types, or inhomogeneous epidermal melanin distributions.
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Affiliation(s)
- Caitlin Regan
- Beckman Laser Institute, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California-Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Carole Hayakawa
- Beckman Laser Institute, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
| | - Bernard Choi
- Beckman Laser Institute, University of California-Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California-Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
- Department of Surgery, University of California-Irvine, 333 City Boulevard West, Suite 1600, Orange, CA 92868, USA
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, 2400 Engineering Hall, Irvine CA 92697, USA
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15
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Wang SP, Chang YJ, Chi CC, Wang SH, Tsai TH. Using pulsed dye laser to treat sebaceous hyperplasia: comparison of short and long pulse-duration pulsed dye laser. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Bailey JK, Blackstone BN, DeBruler DM, Kim JY, Baumann ME, McFarland KL, Imeokparia FO, Supp DM, Powell HM. Effects of early combinatorial treatment of autologous split-thickness skin grafts in red duroc pig model using pulsed dye laser and fractional CO2
laser. Lasers Surg Med 2017; 50:78-87. [DOI: 10.1002/lsm.22702] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 01/05/2023]
Affiliation(s)
- J. Kevin Bailey
- Department of Surgery; The Ohio State University Medical Center; 410 W. 10th Avenue Columbus 43210 Ohio
| | - Britani N. Blackstone
- Department of Materials Science and Engineering; The Ohio State University; Columbus Ohio
| | - Danielle M. DeBruler
- Department of Materials Science and Engineering; The Ohio State University; Columbus Ohio
| | - Jayne Y. Kim
- Department of Biomedical Engineering; The Ohio State University; Columbus Ohio
| | - Molly E. Baumann
- Department of Biomedical Engineering; The Ohio State University; Columbus Ohio
| | | | - Folasade O. Imeokparia
- Department of Surgery; The Ohio State University Medical Center; 410 W. 10th Avenue Columbus 43210 Ohio
| | - Dorothy M. Supp
- Research Department; Shriners Hospital for Children; Cincinnati Ohio
- Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Heather M. Powell
- Department of Materials Science and Engineering; The Ohio State University; Columbus Ohio
- Department of Biomedical Engineering; The Ohio State University; Columbus Ohio
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17
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Regan C, White SM, Yang BY, Takesh T, Ho J, Wink C, Wilder-Smith P, Choi B. Design and evaluation of a miniature laser speckle imaging device to assess gingival health. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:104002. [PMID: 27787545 PMCID: PMC5081569 DOI: 10.1117/1.jbo.21.10.104002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/03/2016] [Indexed: 05/10/2023]
Abstract
Current methods used to assess gingivitis are qualitative and subjective. We hypothesized that gingival perfusion measurements could provide a quantitative metric of disease severity. We constructed a compact laser speckle imaging (LSI) system that could be mounted in custom-made oral molds. Rigid fixation of the LSI system in the oral cavity enabled measurement of blood flow in the gingiva. In vitro validation performed in controlled flow phantoms demonstrated that the compact LSI system had comparable accuracy and linearity compared to a conventional bench-top LSI setup. In vivo validation demonstrated that the compact LSI system was capable of measuring expected blood flow dynamics during a standard postocclusive reactive hyperemia and that the compact LSI system could be used to measure gingival blood flow repeatedly without significant variation in measured blood flow values (p<0.05). Finally, compact LSI system measurements were collected from the interdental papilla of nine subjects and compared to a clinical assessment of gingival bleeding on probing. A statistically significant correlation (?=0.53; p<0.005) was found between these variables, indicating that quantitative gingival perfusion measurements performed using our system may aid in the diagnosis and prognosis of periodontal disease.
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Affiliation(s)
- Caitlin Regan
- University of California, Irvine, Department of Biomedical Engineering, 3120 Natural Sciences II, Irvine, California 92697, United States
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
| | - Sean M. White
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
| | - Bruce Y. Yang
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
| | - Thair Takesh
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
| | - Jessica Ho
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
| | - Cherie Wink
- Concorde Career College, 12951 Euclid Street, Garden Grove, California 92840, United States
| | - Petra Wilder-Smith
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
- University of California, Irvine Medical Center, Department of Surgery, 333 City Boulevard West, Suite 700, Orange, California 92868, United States
| | - Bernard Choi
- University of California, Irvine, Department of Biomedical Engineering, 3120 Natural Sciences II, Irvine, California 92697, United States
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612, United States
- University of California, Irvine Medical Center, Department of Surgery, 333 City Boulevard West, Suite 700, Orange, California 92868, United States
- University of California, Irvine, Edwards Lifesciences Center for Advanced Cardiovascular Technology, 2400 Engineering Hall, Irvine, California 92697, United States
- CHOC Children’s Hospital, 1201 West La Veta Avenue, Orange, California 92868, United States
- Address all correspondence to: Bernard Choi, E-mail:
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18
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Choi B, Tan W, Jia W, White SM, Moy WJ, Yang BY, Zhu J, Chen Z, Kelly KM, Nelson JS. The Role of Laser Speckle Imaging in Port-Wine Stain Research: Recent Advances and Opportunities. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2016; 2016:6800812. [PMID: 27013846 PMCID: PMC4800318 DOI: 10.1109/jstqe.2015.2493961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we review our current knowledge on the etiology and treatment of port-wine stain (PWS) birthmarks. Current treatment options have significant limitations in terms of efficacy. With the combination of 1) a suitable preclinical microvascular model, 2) laser speckle imaging (LSI) to evaluate blood-flow dynamics, and 3) a longitudinal experimental design, rapid preclinical assessment of new phototherapies can be translated from the lab to the clinic. The combination of photodynamic therapy (PDT) and pulsed-dye laser (PDL) irradiation achieves a synergistic effect that reduces the required radiant exposures of the individual phototherapies to achieve persistent vascular shutdown. PDL combined with anti-angiogenic agents is a promising strategy to achieve persistent vascular shutdown by preventing reformation and reperfusion of photocoagulated blood vessels. Integration of LSI into the clinical workflow may lead to surgical image guidance that maximizes acute photocoagulation, is expected to improve PWS therapeutic outcome. Continued integration of noninvasive optical imaging technologies and biochemical analysis collectively are expected to lead to more robust treatment strategies.
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Affiliation(s)
- Bernard Choi
- Departments of Biomedical Engineering and Surgery, the Beckman Laser Institute and Medical Clinic, and the Edwards Lifesciences Center for Advanced Cardiovascular Technology, all at University of California, Irvine 92612 USA
| | - Wenbin Tan
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Wangcun Jia
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Sean M. White
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Wesley J. Moy
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Bruce Y. Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | | | | | - Kristen M. Kelly
- Department of Dermatology and the Beckman Laser Institute and Medical Clinic, all at University of California, Irvine 92612 USA
| | - J. Stuart Nelson
- Departments of Biomedical Engineering and Surgery and the Beckman Laser Institute and Medical Clinic, all at University of California, Irvine 92612 USA
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