Experimental and numerical investigation on the transient vascular thermal response to multi-pulse Nd:YAG laser

Laser-Induced Blood Coagulation for Surgical Application: A Scoping Review

There is a lack of evidence-based reviews on the effects of laser irradiation on blood coagulation in the literature, despite a large number of clinical trials. We therefore evaluated the available evidence on laser irradiation parameters used in coagulation of blood to optimize physical parameters. We performed a literature search for recent scientific studies indexed between 2017 and 2023 using the databases of PubMed and ScienceDirect. Articles were selected based on defined inclusion and exclusion criteria, and 78 publications in total were eventually included in this scoping review. The following were found to produce significant benefits in blood coagulation for surgical application: (1) dentistry and oral surgeries: 980 nm, 27 s, 2 W, 1502.7 W/cm2, 26.5 J, 622 J/cm2, 400 μm; (2) urogenital disorders: 532 nm, 4 s, 40 W, 10600 W/cm2, 1.3 J, 424 J/cm2, 600 μm; (3) ophthalmic disorders: 810 nm, 1 s, 1 W, 3540 W/cm2, 0.75 J, 1326 J/cm2, 100 μm; (4) embryological surgeries: 1064 nm, 10 s, 25 W, 35400 W/cm2, 262.5 J, 371000 J/cm2, 332.5 μm; (5) dermatological disorders: 1064 nm, 20 W, 2440 W/cm2, 0.1 J, 24 J/cm2, 670 μm; (6) gastrointestinal disorders: 532 nm, 3 s, 20 W, 1051 W/cm2, 120 J, 26500 J/cm2, 760 μm; (7) neurological surgeries: 2.5 s, 1.5 W, 1035 W/cm2, 2 J, 1584 J/cm2, 385 μm; (8) pulmonary disorders: 1320 nm, 5s, 35 W, 12450 W/cm2, 250 J, 65000 J/cm2, 700 μm (9) cardiovascular disorders: 1064 nm, 16.5 s, 5 W, 1980.5 W/cm2, 900 J, 760 J/cm2, 400 μm. In conclusion, our scoping review identifies that combining data from all clinically heterogeneous studies suggests that laser irradiation reflects an effective method for inducing blood coagulation in several medical fields.

Aiming to personalized laser therapy for nevus of Ota: melanin distribution dependent parameter optimization

Aiming to the personalized laser therapy of nevus of Ota (NO), a local thermal non-equilibrium model was employed to optimize laser wavelength, pulse duration, and energy density under different melanin depth and volume fraction. According to our simulation, the optimal pulse duration is between 15 and 150 ns to limit heat transfer inside the hyperplastic melanin, and 50 ns is recommended to decrease the energy absorption by normal melanin in epidermis. Correlations of the minimum and the maximum energy densities are proposed with respect to melanin depth and volume fraction for the 755-nm and 1064-nm lasers. For the same NO type, the therapy window of the 755-nm laser is larger than that of 1064-nm. For NO with shallow depth or low volume fraction, the 755-nm laser is recommended to make the treatment more stable owing to its lager therapy window. For deeper depth or higher volume fraction, the 1064-nm laser is recommended to avoid thermal damage of epidermis. Through comparison with clinical data, the optimized laser parameters are proved practicable since high cure rate can be achieved when energy density falls into the range of predicted therapy window. With developing of non-invasive measurement technology of melanin content and distribution, personalized treatment of NO maybe possible in the near future.

Transient Thermal Response of Blood Vessels during Laser Irradiation Monitored by Laser Speckle Contrast Imaging

Real-time monitoring of blood flow and thrombosis formation induced by laser irradiation is critical to reveal the thermal-damage mechanism and successfully implement vascular-dermatology laser surgery. Laser speckle contrast imaging (LSCI) is a non-invasive technique to visualize perfusion in various tissues. However, the ability of the LSCI to monitor the transient thermal response of blood vessels, especially thrombus formation during laser irradiation, requires further research. In this paper, an LSCI system was constructed and a 632 nm He-Ne laser was employed to illuminate a Sprague Dawley rat dorsal skin chamber model irradiated by a 1064 nm Nd: YAG therapy laser. The anisotropic diffusion filtering (ADF) technique is implemented after temporal LSCI (tLSCI) processing to improve the SNR and temporal resolution. The speckle flow index is used to characterize the blood-flow velocity to reduce the computational cost. The combination of the tLSCI and ADF increases the temporal resolution by five times and the SNR by 17.2 times and 16.14 times, without and with laser therapy, respectively. The laser-induced thrombus formation and vascular damage during laser surgery can be visualized without any exogenous labels, which provides a powerful tool for thrombus monitoring during laser surgery.

Study on the Raman spectral characteristics of dynamic and static blood and its application in species identification

This paper proposes a method to identify the blood of 4 poultry species (chicken, duck, goose and pigeon) based on Raman spectroscopy and its baseline. Samples were prepared by pretreatment methods of freezing, thawing, and dilution. The Raman spectra of dynamic blood and static blood were measured, respectively, and the spectral differences between the two research schemes were analyzed. The four species of poultry blood were identified based on the Raman spectroscopy and its baseline. The results show that the method can realize the identification of four species of poultry blood. In addition, the potential of Raman spectroscopy as a technique for determining carotenoids in blood has been clearly confirmed, which opens up the possibility to quickly determine whether poultry eats feed containing carotenoids without sample preparation.

Wavelength optimization for the laser treatment of port wine stains

Based on the well-known principle of selective photothermolysis, laser has been a promising way for the treatment of port wine stains (PWSs). The laser wavelengths used for PWS's clinical treatment include but are not limited to pulsed dye laser (PDL) in 585-600 nm, long-pulse 755-nm alexandrite, and 1064-nm Nd:YAG lasers. The objective of this study was to investigate the optimal wavelength for PWS's laser treatment. A two-scale mathematic model was constructed to simultaneously quantify macroscale laser energy attenuation in two-layered bulk skin and microscale local energy absorption on target blood vessels within Krogh unit. The effects of morphological parameters, including epidermal melanin content, epidermal thickness, dermal blood content, blood vessel depth, and diameter on laser energy deposition within target blood vessels, were investigated from the visible to near-infrared bands (500-1100 nm). The energy deposition ratio of target blood vessel to epidermal surface was proposed to determine the optimal laser wavelength for PWS with different skin morphological parameters. The bioheat transfer modeling and animal experiment are also conducted to prove our wavelength optimization. The optimal wavelengths for lightly pigmented skin with small and shallow target blood vessels are 580-610 nm in the visible band. This wavelength coincides with commercially used PDL. The optimal wavelength shifts to 940 nm as the epidermal pigmentation increases or the size and blood vessel depth increases. The optimal wavelength changes to 1005 nm as the epidermal pigmentation or the size and burying depth of target blood vessel further increases. Nine hundred forty nanometers can be selected as a general wavelength in PWS treatment to meet the need in most widely morphological structure. Lasers with wavelengths in the 580-610, 940, and 1005 nm regions are effective for treating PWS because of their high optical selectivity in blood over the epidermis.

Vascular damage mechanism and parameter optimization under alexandrite laser irradiation: a theoretical study

The 755-nm Alexandrite Laser has a good clinical effect in treating resistant port wine stain, without causing thermal damage of normal tissue and side effects such as purpura. However, little is known about the mechanism of vascular damage induced by 755-nm laser irradiation, which restricts the optimization of laser parameters. In this work, the thermal damage model and the pressure damage model were used to study the damage mechanism of 755-nm laser irradiation on vessels, and the incident energy density and pulse width required for vascular damage were determined according to the damage mode. Under the irradiation of 755-nm laser, the vascular injury pattern was the co-occurrence of vessel rupture and vessel constriction, and the energy density required for the treatment of vessels with a diameter of 200 μm to reach the damage threshold was the lowest.

Extraction of the Structural Properties of Skin Tissue via Diffuse Reflectance Spectroscopy: An Inverse Methodology

For the laser treatment of vascular dermatosis, the blood vessel morphology and depth in skin tissue is essential to achieve personalized intelligent therapy. The morphology can be obtained from the laser speckle imaging, and vessel depth was extracted by an inverse methodology based on diffuse reflectance spectrum. With optimized spot size of 0.5 mm and known optical properties, the proposed method was experimentally validated via the spectral measurement of microcapillary with known size and depth embedded in an epoxy resin-based skin phantom. Results prove that vessel depth can be extracted with an average relative error of 5%, thereby providing the foundation for a personalized, precise, and intelligent laser treatment of vascular dermatosis.

Improving imaging depth by dynamic laser speckle imaging and topical optical clearing for in vivo blood flow monitoring

Laser speckle contrast imaging (LSI) is a promising non-invasive full-field blood flow monitoring technique. However, it is still far from clinic practice due to insufficient contrast-to-noise ratio (CNR) and limited detection depth. In this study, an in vivo laser speckle imaging visualization system was constructed to observe the blood circulation on a dorsal skin. A dynamic laser speckle imaging (dLSI) scheme, other than traditional laser speckle contrast analysis method, was applied to separate the dynamic light scattering from the static one to increase the image CNR. Based on the theoretical optimization for dLSI, at least two pixels are required for speckle pattern sampling and a spatial window size of 7 × 7 was optimal to balance the spatial resolution and statistical accuracy. The in vivo experiment observation shows that the CNR is improved 8.4 times by dLSI. The blood vessels were more pronounced, and more capillaries can be observed than in traditional laser speckle contrast images. Topical optical clearing technique by thiazone was combined with dLSI to increase the sampling depth from 700 to 1000 μm.

A pilot study of minimal invasion combined PDL/Nd:YAG laser in treating facial epidermoid cyst

OBJECTIVES

To compare the efficacy and complication of minimal invasion and combined pulsed dye laser/Nd:YAG laser and traditional surgical excision in the treatment of facial epidermoid cyst.

METHODS

A total of 100 patients with facial epidermoid cyst aged from 16 to 65 years and cyst diameter ranged from 0.3 to 3.0 cm were treated and followed up. Patients were divided into the minimal invasion and combined pulsed dye laser/Nd:YAG laser treatment group and traditional surgical excision group. All patients were followed up for 12 months including scar size, recurrence rate, incidence of complications, and patient global satisfaction.

RESULTS

The mean operative time in the minimal invasion and combined pulsed dye laser/Nd:YAG laser treatment was 15.23 ± 7.02 minutes, which is significantly shorter than that of surgical excision (27.26 ± 10.12 minutes, P < .05). After 12 months, the average scar size in minimal invasion and combined pulsed dye laser/Nd:YAG laser group was 0.54 ± 0.35 cm, while that of traditional surgical excision group was 1.77 ± 0.81 cm (P < .05). No statistical difference was found between two groups in the wounds split, hematoma, early and late recurrence rates (P > .05), while the patients' global satisfaction in the pulsed dye laser/Nd:YAG laser group is much higher than that of the traditional surgical excision group.

CONCLUSION

The treatment of minimal invasion and combined pulsed dye laser/Nd:YAG laser is effective and safe for medium-size facial epidermoid cysts. For facial epidermoid cyst ranging for 0.3 cm to 3.0 cm, considering the cosmetic factors, minimal invasion and combined pulsed dye laser/Nd:YAG laser should be particularly recommended.

Thermal coagulum formation and hemostasis during repeated multipulse Nd:YAG laser treatment of cutaneous vascular lesions: animal experiment study

Laser therapy has been widely used to treat port-wine stain (PWS) and other cutaneous vascular lesions via selective photothermolysis. High incident laser fluence is always prohibited in clinic to prevent the thermal damage in normal skin tissue, leading to insufficient energy deposition on the target blood vessel and incomplete clearance of PWS lesion. In this study, repeated multipulse laser (RMPL) irradiation was proposed to induce acute thermal damage to target blood vessels with low incident fluence (40 J/cm² for 1064-nm Nd:YAG laser). The feasibility of the method was investigated using animal models. Repeated multipulse irradiation cycles with 10-min intervals were performed in RMPL. A hamster dorsal skin chamber model with a visualization system was constructed to investigate the instant generation of thermal coagulum and relevant hemostasis by thrombus formation during and after irradiation under 1064 nm Nd:YAG single multipulse laser (SMPL) and RMPL irradiation. The diameter of the target blood vessel and the size of thermal coagula were measured before and after laser irradiation. The reflectance spectra of the dorsal skin were measured by a reflectance spectrometer during RMPL. Stasis thermal coagula that clogged the vessel lumen were generated during SMPL irradiation with low incident fluence. However, there was no acute thermal damage of blood vessels. Reflectance spectra measurement showed that the generation of thermal coagula and subsequent thrombus formation increases blood absorption by more than 10% within the first 10 min after laser irradiation. Acute vessel thermal damage could be induced in the target blood vessel by RMPL with low incident fluence of 40 J/cm². Compared with our previous SMPL study, nearly 30% reduction in incident laser fluence was achieved by RMPL. Low fluence RMPL may be a promising approach to improve the therapeutic outcome for patients with cutaneous vascular lesions by improving energy deposition on the target blood vessel.

Clinical efficacy of 595-nm pulsed-dye laser in treatment of childhood facial spider nevi: a retrospective study of 110 patients

Background:

Spider nevi (SN) are quite common in children. SN are treated via different techniques, and complete removal often requires multiple treatments. However, few studies have evaluated the treatment of SN. The present study aimed to evaluate the therapeutic effect and safety of a 595-nm pulsed-dye laser (PDL) for treating facial SN in children.

Methods:

A total of 110 children aged 0.2 to 12 years with facial SN were treated with a 595-nm PDL in a single institution from January 2016 to February 2018. In accordance with the treatment method, the patients were retrospectively divided into the small-spot-combined-with-large-spot group (SL-group) and the large-spot group (L-group). Patients with poor therapeutic results were re-treated every 6 weeks until the lesions disappeared. The minimum follow-up period was 1 year. The groups were compared using independent-samples t tests, Mann-Whitney U test, Chi-square test, and Fisher exact probability test.

Results:

The therapeutic efficacy was significantly higher in the SL-group than in the L-group, with clearance rates of 90.9% and 53.0% after the primary treatment, respectively (χ² = 17.937, P < 0.001). For skin lesions with a central spider body diameter ≥1 mm, the once-treatment cure rates were 100% in the SL-group and 34.8% in the L-group (χ² = 20.780, P < 0.001). For skin lesions with a central spider body diameter <1 mm, the once-treatment cure rates were 82.6% in the SL-group and 62.8% in the L-group (χ² = 3.961, P = 0.138). The rates of adverse reactions and recurrence did not differ between the two groups (P = 0.141 and P = 1.000, respectively).

Conclusions:

The 595-nm PDL might be a safe and effective treatment option for facial SN in children. The small-spot-combined-with-large-spot method is especially suitable for SN with a central spider body diameter ≥1 mm.

Theoretical Study on Pressure Damage Based on Clinical Purpura during the Laser Irradiation of Port Wine Stains with Real Complex Vessels

Port wine stains (PWSs) are congenital dermal vascular lesions composed of a hyperdilated vasculature. Purpura represented by local hemorrhage from water vaporization in blood during laser therapy of PWS is typically considered a clinical feedback, but with a low cure rate. In this study, light propagation and heat deposition in skin and PWSs is simulated by a tetrahedron-based Monte Carlo method fitted to curved bio-tissues. A curvature-corrected pressure damage model was established to accurately evaluate the relationship between purpura-bleeding area (rate) and laser therapy strategy for real complex vessels. Results showed that the standard deviation of Gaussian curvature of the vessel wall has negative relation with the fluence threshold of vessel rupture, but has positive relation with the effective laser fluence of vessel damage. This finding indicated the probable reason for the poor treatment of PWS, that is, considering purpura formation as a treatment end point (TEP) only leads to partial removal of vascular lesions. Instead, appropriate purpura area ratio with marked effects or rehabilitation should be adopted as TEP. The quantitative correlation between the fluence of a pulsed dye laser and the characteristics of vascular lesions can provide personalized and precise guidance for clinical treatments.

Glucose in Conjunction with Multiple Laser Pulses on Laser Treatment of Port-wine Stain: An in vivo Study

Port-wine stain (PWS) birthmark is a congenital microvascular malformation of the skin. A 1064-nm Nd:YAG laser can achieve a deeper treatment, but the weak absorption by blood limits its clinical application. Multiple laser pulses (MLPs) are a potential solution to enhance the curative effect of a Nd:YAG laser. To reduce the pulse number (p_n) required for the thermal destruction of the blood vessel, the effect of glucose in conjunction with MLP was investigated. In vivo experiments were performed on a dorsal skin chamber model. Different concentrations (20, 25, 30, and 40%) of glucose were applied to the sub-dermal side of the hamster skin before laser irradiation. Identical vessels with diameters of 200 ± 30 and 110 ± 20 μm were chosen as representatives of typical PWS vessels. Instant thermal responses of the blood vessel were recorded by a high-speed camera. The required p_n for blood vessel damage was compared with that without glucose pretreatment. Results showed that the use of glucose with a concentration of 20% combined with MLP Nd:YAG laser to damage blood vessels is more appropriate because severe hemorrhage or carbonization easily appeared in blood vessels at higher glucose concentration of 25, 30, and 40%. When 20% glycerol is pretreated on the sub-dermal hamster skin, the required p_n for blood vessel damage can be significantly decreased for different power densities. For example, p_n can be reduced by 40% when the power density is 57 J/cm². In addition, generation of cavitation and bubbles in blood vessels is difficult upon pretreatment with glucose. The combination of glucose with MLP Nd:YAG laser could be an effective protocol for reducing the p_n required for blood vessel damage. Randomized controlled trial (RCT) and human trials will be conducted in the future.

Gold nanospheres enhanced photothermal therapy in a rat model

BACKGROUND AND OBJECTIVE

Efficient photothermal conversion of gold nanoparticles with strong light absorption suggests their wide use as selective photothermal agents in biomedical fields. The aim of this study is to investigate the use of gold nanospheres (GNPs) as exogenous visible light absorbers to improve laser treatment of port-wine stains.

MATERIALS AND METHODS

Thiol-terminated methoxypolyethylene glycol modified GNPs (PEG-GNPs) with peak extinction matching the visible light wavelength of the laser being used were synthesized. An in vitro capillary experiment was prepared to investigate the thermal response of blood vessels with and without injection of 4.54 mg PEG-GNPs in mice prior to irradiation by a frequency-doubled Nd:YAG laser at a wavelength of 532 nm.

RESULTS

The in vitro results demonstrated that the photocoagulation size in blood vessels after exposed to laser light increased with the increment of concentration of PEG-GNPs in blood within a certain range. However, the unwanted thermal response (i.e., cavitation) occurred when the concentration of PEG-GNPs in blood was larger than 2.5 mg/ml. The in vivo results suggested that more obvious blood thermal response can be induced by laser light after injection of PEG-GNPs. After injection of 4.54 mg PEG-GNPs, laser radiant exposure required for thread-like constriction of blood vessels decreased from 12.5 to 9.8 J/cm2 with the pulse duration of 10 ms, from 15 to 11.85 J/cm2 with the pulse duration of 30 ms, respectively.

CONCLUSION

This in vitro and in vivo experimental results show that PEG-GNPs combined with laser light could be a promising modality to reduce the radiant exposure required for obvious blood thermal response, thereby providing a potential strategy for improving the laser treatment of cutaneous vascular lesions. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Successful Treatment of Reticular Blue Veins of the Lower Eyelid by Long-Pulse Nd: YAG - Case Report with 8-Year Follow-Up

BACKGROUND:

Facial reticular blue veins are of esthetic concern. Most often these veins develop on the lower lids. The safest and most effective way of treatment is by vascular lasers.

CASE REPORT:

We report on a successful reticular vein treatment using a long-pulsed 1064 nm Nd: YAG laser. We present a follow-up of 8 years with constant esthetic improvement without unwanted adverse events.

CONCLUSION:

There was no relapse demonstrating the efficacy of Nd: YAG laser.

Relation between denaturation time measured by optical coherence reflectometry and thermal lesion depth during radiofrequency cardiac ablation: Feasibility numerical study

BACKGROUND/OBJECTIVE

Radiofrequency (RF) catheter ablation is a minimally invasive medical procedure used to thermally destroy the focus of cardiac arrhythmias. Novel optical techniques are now being integrated into RF catheters in order to detect the changes in tissue properties. Loss of birefringence due to fiber denaturation at around 70°C is related to changes in accumulated phase retardation and can be measured by polarization-sensitive optical coherence reflectometry (PS-OCR). Since irreversible thermal lesions are produced when the tissue reaches 50°C, our goal was to seek the mathematical relationship between both isotherms.

MATERIALS AND METHODS

A two-dimensional model based on a coupled electric-thermal problem was built and solved using the finite element method. The model consisted of cardiac tissue, blood, and a non-irrigated electrode with a sensor embedded in its tip to maintain a specific target electrode temperature. Computer simulations were conducted by varying the tissue characteristics. Lesion depth was estimated by the 50°C isotherm, while the denaturation time (TD) was taken as the time at which the 70°C isotherm reached a depth of 0.75 mm (which corresponds to the optical depth reached by PS-OCR technology).

RESULTS

A strong correlation (R²  > 0.83) was found between TD and lesion depth and an even stronger correlation (R² > 0.96) was found between TD and the time required to achieve a specific lesion depth. For instance, the ablation time required to ensure a minimum lesion depth of 3 mm was 1.33 × TD + 3.93 × seconds.

CONCLUSIONS

The computer results confirmed the strong relationship between denaturation time and lesion depth and suggest that measuring denaturation time by PS-OCR could provide information on the ablation time required to reach a specific lesion depth. Lasers Surg. Med. 50:222-229, 2018. © 2017 Wiley Periodicals, Inc.