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Foster M, Roy A, Kumar G. Large birth mark and unilateral swelling of the lower extremity in a young teenager. BMJ Case Rep 2024; 17:e258892. [PMID: 38702071 PMCID: PMC11085769 DOI: 10.1136/bcr-2023-258892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Abstract
We describe an early adolescent male who was diagnosed with vascular malformation associated with unilateral limb overgrowth based on the clinical findings of a persistent port-wine stain since birth and gradually progressing right lower limb oedema since early childhood. Clinicians should keep in mind to clinically evaluate such malformations in detail, as well as contemplate genetic testing in patients presenting with a large port-wine stain at birth, particularly if well demarcated and lateral in a lower extremity.
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Affiliation(s)
- Michael Foster
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Aparna Roy
- Paediatrics, Case Western Reserve University Hospital, Cleveland, Ohio, USA
| | - Gurinder Kumar
- Paediatrics, Case Western Reserve University Hospital, Cleveland, Ohio, USA
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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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Zhang Y, Ye R, Dong J, Bai Y, He Y, Ni W, Yao M. Efficacy and safety of ablative CO 2 fractional laser and narrowband intense pulsed light for the treatment of hypertrophic scars: a prospective, randomized controlled trial. J DERMATOL TREAT 2023; 34:2202287. [PMID: 37070799 DOI: 10.1080/09546634.2023.2202287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypertrophic scarring is a complex process, and numerous methods have been introduced to treat scars. This study aims to evaluate the effect of combined CO2 fractional laser and narrowband intense pulsed light (IPL) compared to IPL alone in the treatment of hypertrophic scars. MATERIALS AND METHODS This was a prospective, randomized controlled study enrolled 138 patients with hypertrophic scars. The participants were randomly divided into two groups: CO2-IPL and IPL group, and received three sessions at 10-14-week intervals for 3-month follow-up. Two independent plastic surgeons evaluated the treatments using the Patient and Observer Scar Assessment Scales (POSAS). Overall satisfaction was evaluated using the Patient Satisfaction Scale (PSS). RESULTS 101 subjects completed the study. Compared to single IPL, the combination CO2-IPL group showed a significant improvement in itching, color, stiffness, thickness, and irregularity, except for pain, and an enhancement in vascularization, pigmentation, thickness, relief, and pliability of the scar, assessed by POSAS (p < .01). 100% patients in the combination group were satisfied compared to 84% in IPL alone. CONCLUSION The combination of CO2 fractional laser and narrowband IPL efficiently improved the appearance and profile of hypertrophic scars, offering a comprehensive and reliable approach for scar therapy.
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Affiliation(s)
- Yiqiu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Rongan Ye
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Jiying Dong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Yubing Bai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Yu He
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Wei Ni
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Min Yao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
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Jantarakolica T, Wanitphakdeedecha R, Yan C, Yogya Y, Manuskiatti W, Sudhipongpracha T. Dermatology Life Quality Index in Thai Patients with Facial Port-Wine Stains. Dermatol Ther (Heidelb) 2023; 13:2375-2386. [PMID: 37710079 PMCID: PMC10539252 DOI: 10.1007/s13555-023-01011-0] [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: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Port-wine stains (PWS) are congenital capillary abnormalities caused by immature, venule-like vasculature that progressively dilates due to poor endothelial cell differentiation. PWS affects between 0.3% and 0.9% of newborns, with 90% of cases occurring on the face. Individuals with facial PWS and their parents had a significant negative impairment on their quality of life (QoL) and also suffered from psychological disabilities. METHODS This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaires included demographic data, subjective evaluation (SE), and the Dermatology Life Quality Index (DLQI). The questionnaire was performed with a full scale and adjusted scale of validity and reliability test of DLQI using factor analysis and Cronbach's alpha. The study outcome was a subjective evaluation and DLQI in patients who received pulsed dye laser (PDL) treatment. RESULTS Of the 54 patients, 35.2% (19) are male, and 64.8% (35) are female. Regarding age groups, 64.8% (35) are below 5 years old, and 35.2% (19) are older than 5 years. SE results showed that males evaluated an improvement of the facial PWS lesion significantly better than females (P < 0.05). The older age group graded the percentage of improvement better than the younger age group (P < 0.01). The result of the DLQI showed no difference in DLQI between gender. Older age result resulted in a significantly different DLQI compared with younger age (P < 0.01). Parent-reported DLQI improvement was less than self-reported DLQI improvement in patients with PWS treated with PDL (P < 0.05). Concerning the instrument of the study, the validity and reliability analysis of the DLQI questionnaire using factor analysis and Cronbach's alpha have been performed. The adjusted scale with the 5-item DLQI questionnaire is more appropriate in terms validity and reliability. CONCLUSION This study demonstrates that facial PWS reduces the QoL as measured by DLQI. We discovered that the QoL of patients and parents with PWS was significantly impaired. The main influencing factors were older age, the improved perception between gender, and PDL treatments. In addition, we found only five questions that are reliable for PWS. The adjusted five-item DLQI questionnaires are more appropriate regarding validity and reliability. TRIAL REGISTRATION NUMBER TCTR20230210001, COA no. si 1059/2020.
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Affiliation(s)
| | - Rungsima Wanitphakdeedecha
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-Nok Road, Bangkok, 10700, Thailand.
- College of Interdisciplinary Studies, Thammasat University, Bangkok, Thailand.
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-Nok Road, Bangkok, 10700, Thailand
| | - Yuri Yogya
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-Nok Road, Bangkok, 10700, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-Nok Road, Bangkok, 10700, Thailand
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Zhang S, Wang X, Chen H, Cao H, Zhang H, Yang M, Zhu Y, Qin Q, Liu X, Wang J, Zhang G. Clinical efficacy and safety of two different hematoporphyrin monomethyl ether-mediated photodynamic therapy regimen in Chinese children with port-wine stain. Exp Dermatol 2023; 32:1371-1382. [PMID: 37157235 DOI: 10.1111/exd.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
Hematoporphyrin monomethyl ether-photodynamic therapy (HMME-PDT) has achieved encouraging clinical outcomes in adult port-wine stain (PWS). Optimal treatment option for children with PWS was minimal. To compare whether the clinical effectiveness of HMME-PDT with the 5-min (fast) administration treatment regimen (FATR) was better than the 20-min (slow) administration treatment regimen (SATR) for PWS of children in vivo and in vitro. Thirty-four children with PWS were divided into two groups including FATR and SATR. The two groups received three times HMME-PDT, respectively. Treatment efficacy and safety were evaluated in vivo and in vitro. Erythema index (EI) was used to evaluate the clinical outcomes. Both FATR and SATR were effective and safe in children with PWS after HMME-PDT. There were significance differences between the two groups in reductions of EI after the second treatment (p < 0.001) and the third treatment (p < 0.001) with HMME-PDT. The serum HMME concentration reach the peak level at short time compare with SATR group. A significance increased superoxide levels were observed in FATR group compare to SATR groups in vitro (p < 0.05). Our study suggested that HMME-PDT was effective and safe for children with PWS, the therapy regimen with FATR was better in clinical efficacy than that of the SATR.
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Affiliation(s)
- Sheng Zhang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Xiuwei Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Huina Cao
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Hongli Zhang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Ming Yang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Yun Zhu
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Qin Qin
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Xiaoyan Liu
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Jianhua Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Gaolei Zhang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
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Abrouk M, Gianatasio C, Li Y, Waibel JS. Prospective study of intense pulsed light versus pulsed dye laser with or without blue light in the activation of PDT for the treatment of actinic keratosis and photodamage. Lasers Surg Med 2022; 54:66-73. [PMID: 35043459 DOI: 10.1002/lsm.23492] [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: 04/21/2020] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exposure to ultraviolet (UV) light from the sun is known to have a deleterious effect on the skin. Repeated insults to the dermal matrix from UV radiation result in the clinical signs of photodamage, including changes in skin elasticity, color, and texture. UV radiation also leads to the accumulation of DNA mutations and promotes tumor development, resulting in the formation of cutaneous precancerous and cancerous lesions. Continuous-wave incoherent blue light, intense pulsed light (IPL), and pulsed dye laser (PDL) are safe and efficacious light sources commonly used for aminolevulinic acid photodynamic therapy (PDT). The aim of this study was to prospectively evaluate the efficacy of PDT for the treatment of photodamage and actinic keratoses using four different combinations of light sources: PDL, PDL + blue light, IPL, and IPL + blue light. STUDY A total of 220 patients with either photodamage or actinic keratosis (AK) were recruited from the Miami Dermatology Laser Institute (Miami, FL) and were assigned prospectively to undergo one PDT treatment with one of the four light options: PDL, PDL + blue light, IPL or IPL + blue light. Of the 220 patients enrolled in treatment groups, 214 patients completed the study. Of the 214 patients, 88 received treatment for AK, and 126 received treatment for photodamage. All patients gave their consent to participate in the study and to allow their photographs to be utilized for the purpose of scientific presentations. RESULTS Treatment with IPL resulted in a 70.8% reduction of actinic keratoses at a 1-month follow-up. Treatment with IPL and blue light 84.4% reduction of actinic keratoses at 1 month follow up. Treatment with PDL 70.5% reduction of actinic keratoses at 1 month follow up. Treatment with PDL and blue light 69.3% reduction of actinic keratoses at 1 month follow up. Treatment with IPL resulted in an improvement score of 2.9. Treatment with IPL and blue light resulted in an improvement score of 3.0. Treatment PDL resulted in an improvement score of 1.5. Treatment with PDL and blue light resulted in an improvement score of 1.8. CONCLUSION Although all four treatment groups led to some improvement in signs of photoaging, IPL + blue light again demonstrated increased efficacy when compared to IPL, PDL, and PDL + blue light treatment groups. Results from our study were limited by an unequal distribution between treatment groups and a lack of follow-up beyond a 1-month period and warrant further research.
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Affiliation(s)
- Michael Abrouk
- Harvard Massachusetts General Hospital Laser & Cosmetic Dermatology, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | | | - Yumeng Li
- Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jill S Waibel
- Miami Dermatology & Laser Institute, Miami, Florida, USA
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Surgical Treatment for Facial Port Wine Stain by Prefabricated Expanded Cervical Flap Carried by Superficial Temporal Artery. J Craniofac Surg 2019; 30:2124-2127. [PMID: 31503119 DOI: 10.1097/scs.0000000000005612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Port wine stain (PWS) is a congenital benign vascular malformation. Laser treatment is the main therapy for PWS. But some patients are not sensitive to it, and failed laser treatment will leave scars on face. Hence in this study, the authors used prefabricated flap carried by superficial temporal artery to treat PWS. METHODS Nine patients diagnosed with large-scaled PWS (occupying more than half of the cheek) from January 2008 to December 2017 were selected in the study. One of them did not finish the treatment. Eight patients completed all scheduled treatments. In the first stage, superficial temporal vessels were transferred to the donor site and then an expander was implanted. About 80 to 150 days later, PWS was removed and the prefabricated flap was used to repair the wound. All the 8 patients were followed-up for 10 months to 36 months. RESULTS Prefabricated flap survived well. All patients are satisfied with the appearance. The color and texture of prefabricated flap is similar to the surroundings. CONCLUSION The combination of prefabricated flap and skin soft tissue expander not only extends the scale of flap but also enhances the efficacy of surgical treatment. It is a good candidate to treat PWS.
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Hazlewood D, Yang X. Enhanced laser surface ablation with an integrated photoacoustic imaging and high intensity focused ultrasound system. Lasers Surg Med 2019; 51:616-624. [PMID: 30860297 DOI: 10.1002/lsm.23072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Combined laser and ultrasound treatments have been found to have synergistic effects, which may be of particular note in dermatology. We aim to investigate the potential of this technology for dermatology through in vitro and ex vivo experiments. METHODS In vitro tissue phantoms made of agar and tattoo ink and tattooed ex vivo chicken breast tissue were used. An integrated photoacoustic imaging and high intensity focused ultrasound (HIFU) system, using a 5-ns tunable OPO laser system and a 5 MHz HIFU transducer, was used to perform photoacoustic analysis to identify the optical contrast, and perform combined laser and ultrasound ablation. On the tissue phantoms, lines of ablation were created under various operating conditions. The samples were then quantified to determine the level of ablation. Same procedures were performed on the tattooed chicken breast tissue and the tattoo was removed by using combined laser and ultrasound. RESULTS Ablation in the in vitro tissue phantoms was observed with properly synchronized laser and ultrasound while no ablation was found with either laser or ultrasound alone. Increases to the intensity or pulse duration of ultrasound caused an increase in ablation to the samples. The tattoo was removed from the ex vivo chicken breast using combined laser and ultrasound with a radiant exposure of 1.2 J/cm2 while laser and ultrasound alone were unable to remove the tattoo. CONCLUSIONS We determined that by supplementing nanosecond laser pulses with ultrasound, ablation, and tattoo removal can be achieved at laser radiant exposures levels would otherwise be ineffective. The area of ablation can be adjusted through changes in the intensity and duration of the ultrasound burst with a constant laser intensity. Additionally, the system can be used to perform photoacoustic analysis of the tissue to estimate the relative optical absorbance at various available wavelengths, allowing for pretreatment analysis. Lasers Surg. Med. 9999:1-9, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- David Hazlewood
- Bioengineering Program and Institute for Bioengineering Research, University of Kansas, Lawrence, Kansas
| | - Xinmai Yang
- Bioengineering Program and Institute for Bioengineering Research, University of Kansas, Lawrence, Kansas.,Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas
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Hua X, Gao G, Pan S. High-affinity graphene oxide-encapsulated magnetic Zr-MOF for pretreatment and rapid determination of the photosensitizers hematoporphyrin and hematoporphyrin monomethyl ether in human urine prior to UPLC-HRMS. Anal Bioanal Chem 2018; 410:7749-7764. [PMID: 30280226 DOI: 10.1007/s00216-018-1391-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 01/19/2023]
Abstract
In this paper, a high-affinity graphene oxide-encapsulated magnetic Zr-MOF (GO-Mag@Zr-MOF) was synthesized and characterized by SEM, TEM, and XPS for its morphology, structure, and components. Subsequently, the as-prepared GO-Mag@Zr-MOF was, for the first time, employed as magnetic solid-phase extraction (MSPE) adsorbent for pretreatment and determination of photodynamic therapy (PDT) with the photosensitizers hematoporphyrin (Hp) and hematoporphyrin monomethyl ether (HMME) in human urine samples coupled with ultra-performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS). The synthesized GO-Mag@Zr-MOF revealed excellent adsorption efficiency for Hp and HMME in urine samples. Under optimal conditions, the spiked recoveries of the developed method were in the range of 89.5-105.6% with RSDs less than 10%. The limits of detection (LODs) were found to be 0.036 and 0.042 μg/L for Hp and HMME, respectively, while limits of quantitation (LOQs) were 0.12 and 0.14 μg/L. The proposed method was found to be rapid, effective, sensitive, and accurate for clinical analysis. Moreover, this paper, for the first time, carefully expounded the mass spectrum cracking mechanisms of Hp and HMME. Graphical abstract ᅟ.
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Affiliation(s)
- Xin Hua
- Department of Clinical Laboratory, Ningbo No. 2 Hospital, Ningbo, 315010, Zhejiang, China
| | - Guosheng Gao
- Department of Clinical Laboratory, Ningbo No. 2 Hospital, Ningbo, 315010, Zhejiang, China
| | - Shengdong Pan
- Key Laboratory of Health Risk Appraisal for Trace Toxic Chemicals of Zhejiang Province, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, 315010, Zhejiang, China.
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Vivar KL, Kruse L. The impact of pediatric skin disease on self-esteem. Int J Womens Dermatol 2017; 4:27-31. [PMID: 29872673 DOI: 10.1016/j.ijwd.2017.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022] Open
Abstract
Background Pediatric skin disorders can affect children's self-esteem, relationships with caregivers and peers, and performance in school and activities. Objective This review describes common pediatric congenital and acquired dermatologic disorders and the impact that these disorders can have on children's self-esteem. Methods A review of current, English-language literature was conducted with use of the PubMed database. Search terms included atopic dermatitis, acne, infantile hemangiomas, port wine stains, congenital melanocytic nevi, hidradenitis suppurativa, and self-esteem. Results During infancy and toddlerhood, skin disorders such as infantile hemangiomas primarily affect the attachment between child and caregiver. School-aged children with port wine stains and atopic dermatitis report increased bullying, teasing, and social isolation. Acne and hidradenitis typically affect older children and teens and these conditions are associated with increased risks of depression and suicidal ideation. Effective management of these conditions has been shown to increase patients' self-esteem. Conclusion Pediatric dermatologic disorders impact self-esteem throughout childhood. In addition to the surgical and medical management of these disorders, clinicians can also take an active role in the assessment and improvement of the psychosocial impact of these skin disorders.
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Affiliation(s)
- K L Vivar
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - L Kruse
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Tang Y, Xie H, Li J, Jian D. The association between treatment reactions and treatment efficiency of Hemoporfin-photodynamic therapy on port wine stains: A prospective double blind randomized controlled trial. Photodiagnosis Photodyn Ther 2017; 18:171-178. [PMID: 28216012 DOI: 10.1016/j.pdpdt.2017.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/06/2017] [Accepted: 02/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research has focused on treatment efficiency and/or treatment reactions of photodynamic therapy (PDT) on port-wine stain (PWS). But few studies reported the association between them. Hence, here we investigated the association between the treatment efficiency and treatment reactions after Hemoporfin (HMME) mediated photodynamic therapy (PDT) on PWS through a prospective study. METHODS Patients (n=50) with PWS were randomly assigned to the HMME group or the placebo group. Three quit after the first treatment, and forty-seven received two sessions of treatment at an 8-week interval. They were given the treatment at day 1 and evaluations were performed at day 1, day 4 and week 8 in each session. HMME group was treated with HMME while the placebo group was given normal saline instead in the first session, double-blindly. While in the second session, both groups received HMME-PDT treatment. RESULTS After a single treatment, swelling was more severe in younger patients (p<0.05) and the lesion far from centro-facial showed more severe pruritus and scab. Compared with a single treatment, burning sensation had a higher occurrence rate, while burning sensation and scab were less severe in the second treatment. Importantly, severity of scab and pain (5min after irradiation) were found possibly correlated with the treatment efficiency. CONCLUSION HMME-PDT on PWS induces several treatment reactions, including pruritus, burning sensation, pain, swelling, blisters and scab. Two sessions of treatments do not have any accumulation effects on treatment reactions. And there might be a positive correlation between treatment efficiency and the severity of scab or pain (at early stage of the therapy), which might help in regulating treatment modalities.
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Affiliation(s)
- Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, China.
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, China.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, China.
| | - Dan Jian
- Department of Dermatology, Xiangya Hospital, Central South University, China.
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Grillo E, Rita Travassos A, Boixeda P, Cuevas A, Pérez B, Paoli J, Jaén P. Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Grillo E, Rita Travassos A, Boixeda P, Cuevas A, Pérez B, Paoli J, Jaén P. Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:215-23. [PMID: 26744242 DOI: 10.1016/j.ad.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/09/2015] [Accepted: 10/18/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS.
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Affiliation(s)
- E Grillo
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain.
| | - A Rita Travassos
- Clínica Universitária de Dermatologia, Hospital de Santa Maria-Centro Hospital Norte, Lisboa, Portugal
| | - P Boixeda
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| | - A Cuevas
- Department of Pathology, Hospital Ramón y Cajal, Madrid, Spain
| | - B Pérez
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| | - J Paoli
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| | - P Jaén
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
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14
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Moy WJ, Yakel JD, Osorio OC, Salvador J, Hayakawa C, Kelly KM, Choi B. Targeted narrowband intense pulsed light on cutaneous vasculature. Lasers Surg Med 2015; 47:651-7. [PMID: 26227344 DOI: 10.1002/lsm.22393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Laser based therapies are the standard treatment protocol for port wine stain in the United States, but complete removal is infrequently achieved. Intense pulsed light (IPL) offers a broadband light spectrum approach as a viable treatment alternative. Previous studies suggest that IPL can be more effective in treatment of port wine stain by utilizing multiple wavelengths to selectively target different peaks in oxy- and deoxy-hemoglobin. Our study objectives were to (i) determine a characteristic radiant exposure able to achieve persistent vascular shutdown with narrowband IPL irradiation, (ii) determine the degree to which narrowband IPL irradiation can achieve persistent vascular shutdown, and (iii) compare the effectiveness of narrowband IPL radiation to single wavelength pulsed dye laser (PDL) irradiation in achieving persistent vascular shutdown. STUDY DESIGN/MATERIALS AND METHODS We utlized either single pulse or double, stacked pulses in narrowband IPL experiments, with the IPL operating over a 500-600 nm wavelength range on the rodent dorsal window chamber model. We compared the results from our narrowband IPL experiments to acquired PDL data from a previous study and determined that narrowband IPL treatments can also produce persistent vascular shutdown. We ran Monte Carlo simulations to investigate the relationship between absorbed energy, wavelength, and penetration depth. RESULTS For single and double pulse narrowband IPL irradiation we observed (i) little to no change in blood flow, resulting in no persistent vascular shutdown, (ii) marked acute disruption in blood flow and vascular structure, followed by partial to full recovery of blood flow, also resulting in no persistent vascular shutdown, and (iii) immediate changes in blood flow and vascular structure, resulting in prolonged and complete vascular shutdown. Monte Carlo modeling resulted in a 53.2% and 69.0% higher absorbed energy distribution in the top half and the total simulated vessel when comparing the composite narrowband IPL to the 595 nm (PDL), respectively. CONCLUSIONS Our data collectively demonstrate the potential to achieve removal of vascular lesions using a 500-600 nm range. Additionally, the narrowband IPL was tuned to optimize a specific wavelength range that can be used to treat PWS, whereas the PDL can only operate at one discrete wavelength.
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Affiliation(s)
- Wesley J Moy
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California.,Department of Biomedical Engineering, University of California, Irvine, California
| | - Joshua D Yakel
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - O Cecilia Osorio
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Jocelynda Salvador
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Carole Hayakawa
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California.,Department of Chemical Engineering and Materials Science, University of California, Irvine, California
| | - Kristen M Kelly
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California.,Department of Dermatology, University of California, Irvine, California.,Department of Surgery, University of California, Irvine, California
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California.,Department of Biomedical Engineering, University of California, Irvine, California.,Department of Surgery, University of California, Irvine, California.,Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, California
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15
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Fedorova KA, Sokolovskii GS, Nikitichev DI, Battle PR, Krestnikov IL, Livshits DA, Rafailov EU. Orange-to-red tunable picosecond pulses by frequency doubling in a diode-pumped PPKTP waveguide. OPTICS LETTERS 2013; 38:2835-2837. [PMID: 23903156 DOI: 10.1364/ol.38.002835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A compact picosecond all-room-temperature orange-to-red tunable laser source in the spectral region between 600 and 627 nm is demonstrated. The tunable radiation is obtained by second-harmonic generation in a periodically poled potassium titanyl phosphate (PPKTP) multimode waveguide using a tunable quantum-dot external-cavity mode-locked laser. The maximum second-harmonic output peak power of 3.91 mW at 613 nm is achieved for 85.94 mW of launched pump peak power at 1226 nm, resulting in conversion efficiency of 4.55%.
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Affiliation(s)
- K A Fedorova
- Photonics & Nanoscience Group, School of Engineering, Physics and Mathematics, University of Dundee, Dundee, UK.
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16
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Klein A, Bäumler W, Buschmann M, Landthaler M, Babilas P. A Randomized Controlled Trial to Optimize Indocyanine Green-Augmented Diode Laser Therapy of Capillary Malformations. Lasers Surg Med 2013; 45:216-24. [DOI: 10.1002/lsm.22136] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Annette Klein
- Department of Dermatology; University Hospital Regensburg; Regensburg 93042 Germany
| | - Wolfgang Bäumler
- Department of Dermatology; University Hospital Regensburg; Regensburg 93042 Germany
| | - Marius Buschmann
- Department of Dermatology; University Hospital Regensburg; Regensburg 93042 Germany
| | - Michael Landthaler
- Department of Dermatology; University Hospital Regensburg; Regensburg 93042 Germany
| | - Philipp Babilas
- Department of Dermatology; University Hospital Regensburg; Regensburg 93042 Germany
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17
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Bencini PL, Tourlaki A, De Giorgi V, Galimberti M. Laser use for cutaneous vascular alterations of cosmetic interest. Dermatol Ther 2012; 25:340-51. [DOI: 10.1111/j.1529-8019.2012.01463.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Athanasia Tourlaki
- I.C.L.I.D. (Istituto di Chirurgia e Laserchirurgia In Dermatologia); Milano; Italy
| | | | - Michela Galimberti
- I.C.L.I.D. (Istituto di Chirurgia e Laserchirurgia In Dermatologia); Milano; Italy
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18
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Klein A, Szeimies RM, Bäumler W, Zeman F, Schreml S, Hohenleutner U, Landthaler M, Koller M, Babilas P. Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial. Br J Dermatol 2012; 167:333-42. [PMID: 22435991 DOI: 10.1111/j.1365-2133.2012.10950.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete clearance of port-wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may overcome this problem. OBJECTIVES To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp-pumped pulsed dye laser (FPDL). METHODS In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λ(em)=585 nm, 6 J cm(-2) , 0.45 ms pulse duration) and ICG+DL (λ(em)=810 nm, 20-50 J cm(-2) , 10-25 ms pulse duration, ICG-concentration: 2 mg kg(-1) body weight) in a split-face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side-effects up to 3 months after treatment. RESULTS ICG+DL therapy induced photocoagulation of medium and large blood vessels (>20 μm diameter) but not of small blood vessels. According to the investigators' assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P=0.114, P=0.291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P=0.003, P=0.006, respectively). On a 10-point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5.81 ± 2.12) than FPDL treatment (1.61 ± 1.84). CONCLUSION ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.
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Affiliation(s)
- A Klein
- Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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19
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Abstract
Based on the theory of stimulated emission of radiation that was proposed by Albert Einstein in 1916, the first lasers were developed in the 1960s. The first clinical use of laser technology in a German university took place in 1978 in the Department of Dermatology of the Ludwig-Maximilian-University in Munich under the guidance of the former director, Prof. Dr. med. Dr. h.c. mult. Otto Braun-Falco. In the following years, laser technology developed rapidly. Today laser technology is a widely used interdisciplinary therapeutic procedure that has deep clinical and scientific roots in dermatology. There are many conditions in both classic and aesthetic dermatology that are routinely - and sometimes exclusively - treated with lasers. Here we review recent developments in laser medicine. There seems to be a trend to combination procedures. To enhance efficacy, different laser systems are together or lasers are combined with specific topical medications.
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Affiliation(s)
- P Babilas
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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