Exploring the biphasic dose-response effects of photobiomodulation on the viability, migration, and extracellular vesicle secretion of human adipose mesenchymal stem cells

Photobiomodulation (PBM) is a well-established medical technology that employs diverse light sources like lasers or light-emitting diodes to generate diverse photochemical and photophysical reactions in cells, thereby producing beneficial clinical outcomes. In this study, we introduced an 830 nm near-infrared (NIR) laser irradiation system combined with a microscope objective to precisely and controllably investigate the impact of PBM on the migration and viability of human adipose mesenchymal stem cells (hADSCs). We observed a biphasic dose-response in hADSCs' viability and migration after PBM exposure (0-10 J/cm2), with the 5 J/cm2 group showing significantly higher cell viability and migration ability than other groups. Additionally, at the optimal dose of 5 J/cm2, we used nanoparticle tracking analysis (NTA) and found a 6.25-fold increase in the concentration of extracellular vesicles (EVs) derived from hADSCs (PBM/ADSC-EVs) compared to untreated cells (ADSC-EVs). Both PBM/ADSC-EVs and ADSC-EVs remained the same size, with an average diameter of 56 nm measured by the ExoView R200 system, which falls within the typical size range for exosomes. These findings demonstrate that PBM not only improves the viability and migration of hADSCs but also significantly increases the EV yield.

Efficacy of Laser in Hair Removal: A Network Meta-analysis

BACKGROUND

Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions.

METHODS

The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot.

RESULTS

A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars.

CONCLUSION

Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.

Biophotonic Effects of Low-Level Laser Therapy on Adipose-Derived Stem Cells for Soft Tissue Deficiency

PURPOSES

The objectives of this study are to use diode lasers for low-level laser therapy (LLLT) and to assess its applicability and effects in adipose-derived stem cell (ADSC) growth processes.

METHODS

Studies were conducted on the diode laser with wavelengths of 622.7, 527.1, and 467.3 nm. The mechanism of action of LLL illumination was studied on ADSCs, isolated from human tissue, and then cultured by examining different wavelengths to determine the relevant light parameters for optimal responses. We used enzyme-linked immunosorbent assay and real-time polymerase chain to determine the percentages of fibroblast-mediated procollagen type 1 and matrix metallopeptidase 1 (MMP-1), MMP-2, and MMP-9 production at different wavelengths. The levels of lactate dehydrogenase produced by ADSCs after LLL illumination were assessed as well. Clinical results from 20 patients treated for soft tissue deficiency were collected for assessment of ADSC-assisted lipotransfer.

RESULTS

Low-level laser (622.7 nm) illumination on cell cultures in vitro increased ADSCs proliferation, type 1 procollagen expression, collagen production, as well as MMP-1, MMP-2, and MMP-9 relative expression. Statistical analysis demonstrated a significant difference in red light (622.7 nm) versus green light (527.1 nm) and blue light (467.3 nm, P < 0.05). No significant differences were noted between the effects of green and blue lights. In clinical application, all patients attained significant improvement with treatment in the final outcome assessment after 6 months.

CONCLUSIONS

Low-level laser illumination may affect ADSCs growth processes and ADSC-assisted lipotransfer for soft tissue deformity, scar treatment, wound healing, and other reconstructive surgery.

Imaging and Histopathological Analysis of Microvascular Angiogenesis in Photodynamic Therapy for Oral Cancer

The objective of this study is to use imaging and histopathological analysis to characterize and monitor microvascular responses to photodynamic therapy (PDT). In vivo chicken chorioallantoic membranes (CAMs) and a stimulated malignant oral lesions animal model were used to determine the blood flow and the biological activities of Photofrin^® (2.5 mg/kg) exposed to different laser power densities at 630 nm. The vascular changes, the velocity of the blood flow, the speckle flow index (SFI) of fluorescence changes, and ultrastructure damage in the microvasculature before and after PDT were recorded. The subcellular localization of Photofrin^® revealed satisfactory uptake throughout the cytoplasm of human red blood cells at 10 s and 20 s before PDT. The mean blood-flow velocities of the veins and arteries were 500 ± 40 and 1500 ± 100 μm/s, respectively. A significant decrease in the velocities of the blood flow in the veins and arteries was detected in the CAM model after PDT. The veins and arteries of CAMs, exposed to the power densities of 80, 100, and 120 mW/cm², had average blood-flow velocities of 100 ± 20, 60 ± 10, and 0 μm/s and 300 ± 50, 150 ± 30, and 0 μm/s, respectively. In the stimulated malignant oral lesions animal model, the treated tumors exhibited hemorrhage and red blood cell extravasation after PDT. The oxyhemoglobin and total hemoglobin levels decreased, which resulted in a decrease in tissue oxygen saturation, while the deoxyhemoglobin levels increased. PDT using Photofrin^® has the ability to cause the destruction of the targeted microvasculature under nonthermal mechanisms selectively.

Single Cell Effects of Photobiomodulation on Mitochondrial Membrane Potential and Reactive Oxygen Species Production in Human Adipose Mesenchymal Stem Cells

Photobiomodulation (PBM) has recently emerged in cellular therapy as a potent alternative in promoting cell proliferation, migration, and differentiation during tissue regeneration. Herein, a single-cell near-infrared (NIR) laser irradiation system (830 nm) and the image-based approaches were proposed for the investigation of the modulatory effects in mitochondrial membrane potential (ΔΨm), reactive oxygen species (ROS), and vesicle transport in single living human adipose mesenchymal stem cells (hADSCs). The irradiated-hADSCs were then stained with 2′,7′-dichlorodihydrofluorescein diacetate (H₂DCFDA) and Rhodamine 123 (Rh123) to represent the ΔΨm and ROS production, respectively, with irradiation in the range of 2.5–10 (J/cm²), where time series of bright-field images were obtained to determine the vesicle transport phenomena. Present results showed that a fluence of 5 J/cm² of PBM significantly enhanced the ΔΨm, ROS, and vesicle transport phenomena compared to the control group (0 J/cm²) after 30 min PBM treatment. These findings demonstrate the efficacy and use of PBM in regulating ΔΨm, ROS, and vesicle transport, which have potential in cell proliferation, migration, and differentiation in cell-based therapy.

Cryogen spray cooling mitigates inflammation and injury-induced CISD2 decline in rat spinal cord hemisection model

Therapeutic strategies for traumatic spinal cord injury generally involve rectifying concomitant destruction to the spinal cord from inflammation, mitochondrial dysfunction, and eventual neuronal apoptosis. Elevating the expression of spinal cord injury-attenuated CDGSH iron-sulfur domain-2 has been shown to mitigate the pathologies above. In the current work, hypothermia was induced via continuous cryogen spray cooling in a rat spinal cord hemisection model. Spinal cord injury was shown to elevate the mRNA expression of proinflammatory mediators, including NFκB, iNOS, TNF-α, and regulated upon activation, normal T-cell expressed and secreted as well as lower CDGSH iron-sulfur domain-2 expression. Cryogen spray cooling treatment was shown to attenuate inflammatory reactions and elevate CDGSH iron-sulfur domain-2 expression. Immunohistochemical analysis of the glial fibrillary acidic protein, caspase-3 and NeuN in spinal cord injured rats that underwent cryogen spray cooling treatment revealed notable reductions in injury-induced astrocytic activation, apoptosis, neuronal loss, and decline in CDGSH iron-sulfur domain-2 expression. These results demonstrate the CDGSH iron-sulfur domain-2 preserving effects of cryogen spray cooling, which could contribute to the prevention of astrocytic activation, astrocyte-mediated neuroinflammation, apoptosis, and neuron loss.

Laser hair removal following forehead flap for nasal reconstruction

The forehead flap is a dependable option for nasal reconstruction owing to its reliability and anatomic likeness to nasal skin. For patients with low hairlines, the vertical design of the paramedian forehead flap can intrude into the scalp, thus incorporating hair into the nasal reconstruction. The inadequate length of the forehead flap or shift to an oblique design may result in eyebrow elevation and asymmetry. Therefore, laser hair removal (epilation) on the forehead flap has been proposed to improve esthetic results. An alexandrite laser (755 nm, 10 to 20 ms, 18-mm spot size) with a Dynamic Cooling Device^™ (DCD^™) cooling system was used for hair removal in 22 patients (16 male and 6 female patients) after nasal reconstructions using forehead flaps from December 2011 to September 2016. All patients received cryogen spray cooling laser treatment (CSC-LT). The mean follow-up period was 24 months, with a range between 18 and 50 months. The average duration of treatment was 1.8 months (range, 1-5 months). The energy density ranged from 14 to 18 J/cm² with an average of 17.2 J/cm². The number of treatments ranged from 2 to 4 (mean 2.8). Patients had satisfactory esthetic results over 11.1 months (range, 8-18 months). Residual white hairs were observed in 3 patients, and 4 patients had tiny black residual hairs without deteriorating cosmesis. Using an alexandrite laser to remove hair on the forehead is safe and reliable in nasal reconstruction with superior recipient site cosmesis.

Continuous cooling system in conjunction with laser surgery for ear reshaping

When the cartilage on the prominent ears is reshaped, the arising stress returns the tissue to its initial configuration. Laser irradiation of areas of maximal stress leads to stress relaxation and results in a stable configuration. Sixty auricles were harvested from 30 New Zealand white rabbits and cut into a rectangle measuring 50 mm by 25 mm with an average thickness of approximately 1.3 mm. Bilateral skin was included for ex vivo studies. Continuous cryogen spray cooling (CSC) with laser energy was delivered to the exposed cartilage for reshaping. In clinical applications, from January 2006 to December 2016, a total of 50 patients with 100 bat ears who underwent CO₂ laser reshaping (otoplasty) were assessed. A continuous cooling system (4 °C) in conjunction with a CO₂ laser was applied to make a retroauricular-approached incision and reshape the ear cartilage. The well cartilage bending correlated with the different parameters demonstrated in the continuous CSC protected group. All 100 (100%) of the subjects experienced early complications (≤ 1 month) related to laser exposure with swelling, while 5 (5%) experienced ecchymosis, 2 (2%) minimal hematoma, 2 (2%) scarring, 1 (1%) minor infection, 1 (1%) under correction, 1 (1%) overcorrection, and 1 (1%) relapse. These problems were corrected and/or had resolved after 3 months. All patients achieved good to excellent results in our final outcome assessment (> 6 months). Laser reshaping has a potential use in certain surgical procedures involving the cartilage. The appropriate conditions for laser ear reshaping clearly depend on the laser wavelength used, energy controlling, and tissue optical properties.

Transoral vertical ramus osteotomy fixed with Kirschner pins

Transoral vertical ramus osteotomy (VRO) has been condemned because the condyle has the potential to sag, and because it needs lengthy maxillomandibular fixation. We have therefore introduced a simple method of fixation, and examined its effectiveness and complications. After the osteotomy, the proximal and distal segments are trimmed to adapt to each other. Four Kirschner (K) pins 0.9mm in diameter are inserted percutaneously from the proximal to the distal segment while the condyle is positioned in the glenoid fossa. This is followed by a brief period of maxillomandibular fixation. We have reviewed the records of 95 patients who had unilateral or bilateral vertical ramus osteotomy fixed with K pins, after which the mean (SD) period of fixation was 19 (11) days. Fixation failed in two patients because excursion of the jaw was either too heavy or too early. The fixations were redone. All other fixations remained stable, including the 20 dual-jaw procedures in which VRO preceded maxillary osteotomy. The mean (SD) maximal mouth opening at final follow-up was 44 (7) mm, and in only one patient was it less than 30mm. Numbness of the lip or chin developed in seven patients, five of whom had other anterior mandibular procedures. Four patients had discomfort on palpation of the site of the pins, and one required removal. The new method was effective, and resulted in few complications within its limitations.

Comparing the effectiveness of laser vs. conventional endoforehead lifting

The objective of this study was to compare the efficacy and safety of laser versus conventional endoforehead lifting. Over a period of 12 years (January 2000-January 2012), a total of 110 patients with hyperactive muscles over the frontal region have been collected for a retrospective study. The SurgiLase 150XJ CO₂ laser system, in conjunction with the flexible FIBERLASE, was used. The endoscope was 4 mm in diameter with an angle of 30°. The primary efficacy measurement was the assessment of the final outcome for using laser vs. conventional methods. Both groups were observed at three weeks, six weeks and six months after surgery. The most common complication in early convalescence (three weeks) was swelling. This was followed by local paraesthesia, ecchymosis, localized hematomas and scar with alopecia. All these problems disappeared completely after the 6-month study period. Based on a chi-square analysis, there were clinically and statistically significant differences favouring the laser endoforehead surgery in the operative time, early and late complications. All patients achieved significant improvement after both laser and conventional endoforehead surgery in the final outcome. However, the early and late complications indicated a greater difference in the laser group.

Genital Tuberculosis Presenting as Acute Scrotum Mimicking Fournier's Gangrene

Genital tuberculosis usually presents as local symptoms such as lower abdominal pain and a sensation of scrotal bloating. We report a rare case of genital tuberculosis in a 46-year-old man presenting with symptoms that mimic Fournier's gangrene. He had a progressive local symptoms of scrotal tenderness, redness, swelling, and local rise in temperature. The patient underwent emergency open debridement, and pathology confirmed tuberculosis infection. Recovery was uneventful after 6 months of anti-tuberculosis drug treatment. Literature of genital tuberculosis is also reviewed.

Protective effect and antibody response of DNA vaccine against salmonid alphavirus 3 (SAV3) in Atlantic salmon

This work reports the effect of two DNA vaccines against salmonid alphavirus 3 (SAV3) in Atlantic salmon. Presmolts were vaccinated by intramuscular injection of plasmids encoding the SAV3 structural polyprotein C-E3-E2-6K-E2 (pCSP), E2 only (pE2), or plasmid without insert (pcDNA3.3). E2 is expressed at the surface of cells transfected with pCSP and internally in cells transfected with pE2. A commercial vaccine based on inactivated SAV (NCPD) was used for comparison. At 10 weeks post-vaccination, only fish vaccinated with pCSP showed antibody against E2 and virus-neutralizing activity. Vaccinated fish were infected with SAV3 to determine protection by virus quantitation in serum after 7 days and scoring of pathological changes after 21 days. Fish vaccinated with both pCSP and NCPD vaccines showed significant virus reduction in serum, while fish vaccinated with pE2 did not. All fish vaccinated with pcDNA3.3 and pE2 showed pathological changes in organs typical of PD, 60% of fish vaccinated with NCPD showed PD pathology, while fish vaccinated with pCSP did not show PD pathology. Taken together, DNA vaccination with pCSP provided strong protection for salmon against SAV3 infection, which in part may be due to production of virus-neutralizing antibodies.

Noninvasive imaging analysis of biological tissue associated with laser thermal injury

BACKGROUND

The purpose of our study is to use a noninvasive tomographic imaging technique with high spatial resolution to characterize and monitor biological tissue responses associated with laser thermal injury.

METHODS

Optical doppler tomography (ODT) combines laser doppler flowmetry (LDF) with optical coherence tomography (OCT) to obtain high resolution tomographic velocity and structural images of static and moving constituents in highly scattering biological tissues. A SurgiLase XJ150 carbon dioxide (CO₂) laser using a continuous mode of 3 watts (W) was used to create first, second or third degree burns on anesthetized Sprague-Dawley rats. Additional parameters for laser thermal injury were assessed as well.

RESULTS

The rationale for using ODT in the evaluation of laser thermal injury offers a means of constructing a high resolution tomographic image of the structure and perfusion of laser damaged skin. In the velocity images, the blood flow is coded at 1300 μm/s and 0 velocity, 1000 μm/s and 0 velocity, 700 μm/s and 0 velocity adjacent to the first, second, and third degree injuries, respectively.

CONCLUSION

ODT produces exceptional spatial resolution while having a non-invasive way of measurement, therefore, ODT is an accurate measuring method for high-resolution fluid flow velocity and structural images for biological tissue with laser thermal injury.

Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation

BACKGROUND

Shift in large fluid volumes and massive blood loss during liver transplantation frequently leads to rapid changes in hemoglobin (Hb) concentration; thus, to ensure adequate tissue oxygenation, accurate and rapid determination of Hb concentration is essential in transplant recipients. The Radical-7 Pulse CO-Oximeter provides a noninvasive and continuous way to monitor Hb concentration (SpHb) in real time and is an ideal candidate for use during liver transplantation. In this study, we assessed the relationship between SpHb and total Hb (tHb) obtained from arterial blood samples during surgery.

METHODS

Forty patients undergoing liver transplantation were enrolled in this study. tHb and time-matched SpHb were measured at 5 different phases throughout surgery. Paired SpHb and tHb levels were assessed using linear regression, Bland-Altman analysis, and the Critchley polar plot method.

RESULTS

A total of 161 paired measurements with sufficient signal quality were analyzed. The correlation between SpHb and tHb was 0.59 (P < .001). Bland-Altman analysis revealed that a bias between SpHb and tHb was 2.28 g/dL, and limits of agreement (LoA) were from -0.78 to 5.34 g/dL. Trending analysis showed that 87% of data were located within the acceptable trending area, indicating that the trending ability was not satisfied.

CONCLUSIONS

The Radical-7 Pulse CO-Oximeter was not sufficient to monitor Hb levels and trends during liver transplantation surgery in our cohort. In particular, in critical patients and in those with low Hb levels, invasive Hb measurement should be used for assessment.

Beware Neck Pain in a Haemodialysis Patient: Spontaneous Spinal Epidural Haematoma

Spontaneous spinal epidural haematoma is a rare and devastating disorder. To the best of our knowledge, only 4 haemodialysis patients with the diagnosis of spontaneous spinal epidural haematoma have been reported in the literature. Here, we reported a 70-year-old male haemodialysis patient who presented with a sudden onset of severe sharp neck pain. Spontaneous spinal epidural haematoma with cord compression from C2 to C6 was diagnosed by magnetic resonance imaging. After emergency surgery, the patient recovered completely from the profound neurological deficits. The relevant literatures were also reviewed.

Nasolabial and forehead flap reconstruction of contiguous alar-upper lip defects

BACKGROUND

Defects of the nasal ala and upper lip aesthetic subunits can be challenging to reconstruct when they occur in isolation. When defects incorporate both the subunits, the challenge is compounded as subunit boundaries also require reconstruction, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, we used nasolabial flaps for upper lip reconstruction and a forehead flap for alar reconstruction.

METHODS

Three men and three women aged 21-79 years (average, 55 years) were treated for defects of the nasal ala and upper lip that resulted from cancer (n = 4) and trauma (n = 2). Unaffected contralateral subunits dictated the flap design. The upper lip subunit was excised and replaced with a nasolabial flap. The flap, depending on the contralateral reference, determined accurate alar base position. A forehead flap resurfaced or replaced the nasal ala. Autologous cartilage was used in every case to fortify the forehead flap reconstruction.

RESULTS

Patients were followed for 25.6 months (range, 1-4 years). All the flaps survived, and there were no complications. Satisfactory aesthetic results were achieved in every case. With the exception of a small vertical cheek scar and a vertical forehead scar, all incisions were concealed within the subunit borders.

CONCLUSION

From preliminary experience, we advocate combining nasolabial flap reconstruction of the upper lip with a forehead flap reconstruction of the ala to preserve normal facial appearance. This combination addresses an important void in the algorithmic approach to central facial reconstruction.

Pre-operative serum albumin level substantially predicts post-operative morbidity and mortality among patients with colorectal cancer who undergo elective colectomy

The quantitative relationship between serum albumin level and surgical outcomes has not been clearly established. This study included 3732 patients with colon cancer who underwent a potentially curative colectomy. Post-operative mortality and morbidity were analysed according to the patients' demographic data, pre-operative comorbidities, and tumour-related factors. Age, asthma, renal impairment, and albumin level were significantly associated with post-operative morbidity and mortality in the multivariate analyses. Logistic regression analysis revealed linear relationships of post-operative morbidity and mortality with albumin level. The morbidity and mortality rates decreased by 7.3% and 15.6%, respectively, for each 0.1 g/dL increase in albumin level. This finding remained significant in the hypoalbuminaemia subgroup but not in the normoalbuminaemia subgroup. That is, the morbidity and mortality rates significantly decreased by 8.7% and 17.7%, respectively (both P < 0.001), in the former group and decreased by 2.7% (P = 0.112) and 11.6% (P = 0.092), respectively, in the latter group. This study demonstrated that serum albumin level linearly predicted the post-operative morbidity and mortality among the colorectal cancer patients. Pre-operative serum albumin level may therefore be used as a continuous rather than a categorical marker of disease severity, especially among patients with hypoalbuminaemia.

Quantitative assessment of brain shifting in the late phase postevacuation in unilateral and bilateral chronic subdural hematomas

AIM OF THE STUDY

Recurrence is more common in bilateral chronic subdural hematomas (CSDHs) than in unilateral. Our aim was to quantitatively compare the late phase of brain shifting postevacuation in unilateral and bilateral CSDHs.

MATERIALS AND METHODS

We reviewed computed tomography (CT) scans and medical records of consecutive patients with CSDHs who underwent burr hole drainage. CT scan images (preoperative and postoperative days [PODs] 30 and 60) were imported to Adobe Photoshop, and temporal and spatial changes in brain shifting between PODs 30 and 60, and also the subdural space on POD 60, were analyzed.

RESULTS

The bilateral group exhibited a significantly greater late phase of brain shifting than the unilateral group between PODs 30 and 60 (P < 0.001). The median late phase of brain shifting of the bilateral group was 8.9 mm (interquartile range [IQR]: 8.3-9.0 mm) between PODs 30 and 60, while that of the unilateral group was 1.8 mm (IQR: 1.3-2.5 mm).

CONCLUSIONS

The postevacuation late phase of brain shifting is statistically greater in bilateral CSDHs than in unilateral CSDHs, which might facilitate bridging vein tearing and consequent rebleeding. This may be one factor accounting for the higher recurrence rate of bilateral CSDHs.

Prognostic factors for Taiwanese patients with cutaneous melanoma undergoing sentinel lymph node biopsy

BACKGROUND/PURPOSE

Sentinel lymph node biopsy (SLNB) is a standard procedure in the management of clinically node-negative melanoma. However, few studies have been performed on SLNB in Asia, which is an acral melanoma-prevalent area. This study evaluated the clinicopathologic prognostic factors of disease-free survival (DFS) and overall survival (OS) in Taiwanese patients with cutaneous melanoma who received wide excision and SLNB. The prognosis of patients with false-negative (FN) SLNB was also evaluated.

METHODS

Malignant melanoma cases were reviewed for 518 patients who were treated between January 2000 and December 2011. Of these patients, 127 patients with node-negative cutaneous melanoma who received successful SLNB were eligible for inclusion in the study.

RESULTS

The SLNB-positive rate was 34.6%. The median DFS was 51.5 months, and the median OS was 90.9 months at the median follow-up of 36.6 months. Multivariate analysis revealed that patients whose melanoma had a Breslow thickness greater than 2 mm had a significantly shorter DFS than patients whose melanoma had a Breslow thickness of 2 mm or less [hazard ratio (HR), 3.421; p = 0.005]. Independent prognostic factors of OS were a Breslow thickness greater than 2 mm (HR, 4.435; p = 0.002); nonacral melanoma (HR, 3.048; p = 0.001); and an age older than 65 years (HR, 2.819; p = 0.036). During the follow-up period, 13 of 83 SLN-negative patients developed a regional nodal recurrence. The SLNB failure rate was 15.7% and the FN rate was 22.8%. Compared to patients with a true-positive SLNB, patients with FN SLNB had a significantly shorter DFS (p = 0.001) but no significant difference in OS (p = 0.262).

CONCLUSION

Except for the pathologic subtypes, prognostic factors in Taiwan are similar to those used in other melanoma-prevalent countries. Identifying and closely monitoring patients at risk of nodal recurrence after a negative SLNB is important.

Real-time photothermal imaging and response in pulsed dye laser treatment for port wine stain patients

BACKGROUND

This study was performed to assess the photothermal response of highly focused laser energy using infrared thermal imaging instrument to detect and assess the actual temperature distribution during flash lamp pumped pulsed dye laser (FLPPDL) treatment for port wine stain (PWS) patients and avoiding its complications.

METHODS

A retrospective review of 40 patients with PWS birthmark treated with FLPPDL (l = 585 nm, tp = 1500 ms, 7 mm spot) was conducted over a 2-year period. Subjects' ages ranged between 28 and 46 years (mean 29 years); there were 24 females and 16 males. Twenty patients received non-cooling laser treatment (NC-LT) using light dosages of 5-12 J/cm 2 . Another 20 patients received cryogen spray cooling laser treatment (CSC-LT) using light dosages of 5-12 J/cm 2 . A real-time infrared thermal imaging and the thermal wave equation were used for assessment. The results of temperature distributions related to the energy change were analyzed.

RESULTS

Proper temperature measurement using infrared thermal imaging instrument and thermal wave equation in non-cooled PWS patients showed that the energy density of pulsed dye laser (PDL) higher than 7 J/cm 2 can reach >44°C and result in burn injury. However, when energy densities beyond 10 J/cm 2 were administered, along with using CSC, thermal damage was could still be minimized without the risk of damage to the treated area.

CONCLUSION

Using infrared thermal imaging instrument and thermal wave equation, we can predict the skin temperature distribution in FLPPDL for PWS patients during the treatment. In conjunction with CSC, the complications can be minimized.

3-D titanium mesh reconstruction of defective skull after frontal craniectomy in traumatic brain injury

INTRODUCTION

Decompressive craniectomy (DC) is a treatment strategy used to reduce intracranial pressure in patients with traumatic brain injuries. However, this procedure has a number of shortcomings, such as excessive sinking of the skin flap, which can lead to cerebral compromise and negatively affect the appearance of the patient. The reconstruction of skull defects has been proposed as a means to overcome these disadvantages. Few previous studies have reported the reconstruction of frontal skull defects using titanium mesh. The aim of this study was to provide a comprehensive review of aesthetic and surgical outcomes associated with this procedure and to list the complications encountered during the repair of frontal skull defects using three-dimensional (3-D) titanium mesh.

METHODS

A retrospective review was conducted using records from seven adult patients (32-60 years of age) who received titanium mesh implants at a university hospital in Taiwan between January 2011 and June 2012. Aesthetic outcomes, the function of cranial nerves V and VII, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated.

RESULTS

An algorithm capable of accounting for bifrontal skull defects and median bone ridges was developed to improve computer-assisted design/manufacturing (CAD/CAM) of one-piece 3-D titanium mesh implants, thereby making it possible to repair bifrontal skull defects in a single operation. Following this procedure, aesthetic and functional outcomes were excellent and the implants in all patients appeared stable. However, extended healing times in two of the patients resulted in subclinical infections, which were resolved by administering antibiotics over a period of 2 weeks. No patients suffered trigeminal or facial dysfunction.

CONCLUSIONS

Our findings support the use of 3-D titanium mesh in frontal skull reconstruction. Few complications were encountered, the contours of the forehead were faithfully rendered, and the cosmetic appearance of patients was excellent. For patients with bifrontal skull defects, the use of one-piece implants in a single operation provides numerous advantages over conventional staged surgeries. This application helps to reduce operating time, which is particularly beneficial for elderly patients and those requiring bifrontal cranioplasties.

Assessment of videoendoscopy-assisted abdominoplasty for diastasis recti patients

BACKGROUND

The objective of this retrospective analysis was to assess the treatment of endoscope abdominoplasty for diastasis recti deformity patients.

METHODS

From January 1999 to January 2011, 88 patients ranging from 35 to 46 years in age were treated with videoendoscopy-assisted minimally invasive surgery. All patients were Asian. Early (< 3 months) and late (> 6 months) complications were assessed throughout a follow-up period of up to 66 months.

RESULTS

Observations were conducted at the end of three weeks, six months, and 66 months. Early on, all patients experienced numbness with local paresthesia (100%) closely after treatment, and reported the feelings to subside by six months post-treatment. Four patients (4.5%) experienced ecchymosis, and three patients (3.4%) were affected by seroma. One patient (1.1%) had dyspnea immediately after surgery, which recovered after oxygen (O2) administration. Only one patient (1.1%) experienced minimal skin loss, which recovered after 3 months of surgery, and there were no further complications. Hypertrophic scars were apparent in three patients (3.4%) who showed no unwanted signs or further complications after post-operative scar care. No hematoma had been reported. All complications subsided (> 6 months) postoperatively.

CONCLUSIONS

Videoendoscopy-assisted abdominoplasty can be used for diastasis recti deformity with minimal excess skin. Our study demonstrated effects against the formation of seroma and other complications.

Brown-Sequard Syndrome: A Rare Presentation of Spontaneous Cervical Spinal Epidural Haematoma

Spontaneous spinal epidural haematoma is a rare but well-known entity that has been considered a surgical emergency. Brown-Sequard syndrome resulting from spontaneous cervical spinal epidural haematoma is rare. Only 11 cases have been described in the literature. We reported an 85-year-old female who presented with Brown-Sequard syndrome at the right C5 level, and an acute haematoma located from the C3 to C6 level was diagnosed from the series images. Within two weeks after decompressive surgery, the previous neurological deficits had gradually improved. (Hong Kong j.emerg.med. 2014;21:107-111)

Comparing the Effectiveness of 1064 vs. 810 nm Wavelength Endovascular Laser for Chronic Venous Insufficiency (Varicose Veins)

BACKGROUND AND OBJECTIVE

The objective of this study was to compare the efficacy and safety of Endovenous Laser Photocoagulation (EVLP) at wavelengths of 1064 nm versus 810 nm for chronic venous insufficiency (varicose veins) in a large series of patients.

STUDY DESIGN/MATERIALS AND METHODS

A retrospective review was conducted of 108 patients with chronic venous insufficiency treated over a 8-year period. Subjects' ages ranged between 16 to 79 years; there were 83 females and 25 males, all of whom were Asian. Patients (n=54) received EVLP at wavelengths of 1064 nm (EVLP-1064 nm), Nd:YAG laser. Subsequent patients (n=54) received 810 nm (EVLP-810 nm), Diode laser. The primary efficacy measurement was the quantitative assessment of final outcome for 1064 nm versus 810 nm. Patients were monitored for adverse effects as well.

RESULTS

Complications were observed at 3 weeks (early), 6 weeks (late) and 6 months after EVLP. In both groups, the commonest complication in early convalescence was swelling. This was followed by Local paraesthesia, pigmentation, superficial burns, superficial phlebitis, and localized hematomas. At 6 weeks postoperatively, local paraesthesia, persistent hyperpigmentation, and minimal scarring were presented. These problems all disappeared completely after the 6 months study period. Based on chi-squared analysis, there were clinical, and statistically significant differences in the severity score of final results favoring the EVLP-810 nm group.

CONCLUSION

All patients achieved good or excellent improvement after EVLP-1064nm and EVLP-810nm. However, the difference of final outcome was significant, and indicates that improvement was greater in the Diode group. Further studies of different wavelengths and optimization of cryogen spray cooling (CSC) may lead to improved results in the eradication of varicose veins.

Cardiac autonomic function and insulin resistance for the development of hypertension: a six-year epidemiological follow-up study

BACKGROUND AND AIMS

To explore the impact of cardiac autonomic function (CAF) and insulin resistance (IR) on incident hypertension.

METHODS AND RESULTS

In 1996, 1638 subjects finished baseline examination, which included anthropometry, blood pressures, CAF, blood biochemistry, plasma insulin, urine examination and electrocardiogram. CAF included standard deviation of normal-to-normal intervals or RR intervals (SDNN), low- and high-frequency power spectrum (LF and HF), and LF/HF ratio at supine for 5 min, the RR interval changes during lying-to-standing maneuver, and the ratio between the longest RR interval during expiration and the shortest RR interval during inspiration (E/I ratio). We used homeostasis model assessment to define beta cell function (HOMA-B) and insulin resistance (HOMA-IR). In total, 992 non-hypertensive participants completed the follow-up assessment in 2003 and 959 participants were included for the final analysis. Incident hypertension was determined by blood pressure status at follow-up. In unadjusted model, both square root of HOMA-IR (OR:3.37, 95%CI: 2.10-6.64) and HOMA-B (OR:0.996, 95%CI: 0.992-0.999) were related to incident hypertension. In multivariate model, square root of HOMA-IR (OR:1.97, 95%CI: 1.05-3.70), but not HOMA-B, was associated with incident hypertension. After further adjustment for baseline CAF, the positive relationship between the square root of HOMA-IR and incident hypertension disappeared. In contrast, LF/HF ratio (OR:1.18, 95%CI: 1.01-1.37), HF power (OR:0.98, 95%CI: 0.96-0.999), and E/I ratio (OR:0.71, 95%CI: 0.54-0.95) were each independently associated with incident hypertension after further adjustment for HOMA measures.

CONCLUSION

Sympathovagal imbalance with an apparently decreased parasympathetic tone is an important predictor of incident hypertension independent of IR.

Predicting hospital mortality in adult patients with prolonged stay (>14 days) in surgical intensive care unit

BACKGROUND

The aim of this paper was to identify the factors at surgical intensive care unit (SICU) admission and during the following SICU course that influence hospital mortality of patients with prolonged SICU stay (>14 days).

METHODS

This prospectively-planned study enrolled 1661 patients over 16 years old with prolonged SICU stay in a tertiary-care teaching hospital over a 4-year period. Data at SICU admission, physiologic factors on the 14th SICU day and the indications of prolonged ICU stay were collected. A multivariate logistic regression model with a least absolute shrinkage and selection operator technique was adopted to identify factors associated with hospital mortality in prolonged-stay patients at the 14th SICU day.

RESULTS

Prolonged-stay patients accounted for 9.7% of the total SICU admissions, but consumed 51.7% of total SICU days. The hospital mortality of these patients was 34%. For predicting the hospital mortality in prolonged SICU stay patients, the predictors at ICU admission included gender, longer pre-ICU days, higher Charlson comorbidity index, and not admitted from emergency. Predictors on the 14th SICU day included lower Glasgow coma scale, lower mean arterial pressure, higher dosage of inotropes required, higher serum lactate level, higher serum bilirubin level, lower platelet count, and the use of renal replacement therapy. Among the indications for prolonged SICU stay, predictors included the need for mechanical circulatory support, worsening acute encephalopathy with altered mental status, hemodynamic instability due to bleeding, and sepsis with unstable vital signs.

CONCLUSION

This validated predictive model reached clinically accurate discriminatory power, and may serve to improve patient care and resource utilization in the SICU.

Update on flashlamp pumped pulsed dye laser treatment for port wine stains (capillary malformation) patients

BACKGROUND AND AIMS

Currently, the method of choice for the treatment of port-wine stains is laser photocoagulation. Because of evolving treatment options, it is no longer enough for port-wine stains merely to be lightened through laser treatment. The best course of management consists of the most appropriate laser that will produce the most complete clearing of a lesion in the fewest treatment sessions with the least morbidity. The goal is generally accomplished with the use of yellow-light lasers. Materials (Subjects) and Methods: Absorption of laser energy by melanin causes localized heating in the epidermis, which may, if not controlled, produce permanent complications such as hypertrophic scarring or dyspigmentation. Refinements of the results can be achieved by using the flashlamp-pumped pulsed dye laser (FLPDL) in conjunction with the cryogen spray cooling (CSC) system. In our related studies, the infrared thermal image instrument is used for doctors in determining the optimum laser light dosage and preventing the side effects caused by FLPDL. Topic application of angiogenesis inhibitor (Imiquimod) in conjunction with pulsed dye laser treatment for the PWS patients has been assessed for improvement of FLPDL treatment.

RESULTS

We present the clinical effect of FLPDL, and the efficacy and safety of cooled laser treatment of PWS birthmarks. Our clinical outcome in the laser treatment of patients with PWS has been achieved to maximize thermal impact on targeted vessels, while minimizing adverse complications.

CONCLUSIONS

CSC in conjunction with FLPDL can improve the treatment of PWS. The infrared image instrument is helpful for doctors in determining the optimum laser light dosage. Topic application of angiogenesis inhibitor (Imiquimod) in conjunction with laser treatment for the PWS patients is promising in the near future.

Long term follow-up of intralesional laser photocoagulation (ILP) for hemangioma patients

BACKGROUND AND OBJECTIVES

Hemangiomas remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional photocoagulation (ILP) for treatment. The objective of our study is to review the long term results of a large series of hemangiomas in patients treated by ILP. Materials (Subjects) and Methods: A retrospective review of 684 hemangiomas in patients were treated by ILP with an Nd:YAG (neodymium-yttrium-aluminium-garnet) (1064 nm) laser over a period of 10 years (January 1996-January 2005). Patients' ages ranged from one month to 11 years 5 months (mean, 1 year 10 months). The patient group consisted of 474 females and 210 males.

RESULTS

Patients were treated with an Nd:YAG laser delivered through a 600 m optical fiber. Laser power was set at 7 to 15 watts (W) and delivered with pulse duration of 7 to 15 seconds (s). The results showed 603 (88.6%) patients had more than 50% reduction of the volume in hemangiomas at 3 months after one treatment; and 663 (96.9%) patients had more than 50% reduction of the volume at 3 months after two treatments. Patients who had continuous ILP achieved excellent results.

CONCLUSIONS

Postoperative complications have been related to photocoagulation that has been delivered too extensively or superficially, with resultant ulceration, infection, bleeding, and scarring. These complications can be avoided if this potential for harm is kept in mind.

Comparing the effectiveness of Q-switched Ruby laser treatment with that of Q-switched Nd:YAG laser for oculodermal melanosis (Nevus of Ota)

BACKGROUND AND OBJECTIVE

The objective of this study was to compare the efficacy and safety of Q-switched Ruby laser versus Q-switched neodymium:yttrium-aluminium-garnet (Nd:YAG) laser for oculodermal melanosis (Nevus of Ota) birthmarks in a large group of patients.

STUDY DESIGN/MATERIALS AND METHODS

A retrospective review was conducted of 94 patients with Nevus of Ota treated with a Q-switched Ruby laser and a Q-switched Nd:YAG laser over a 3-year period. The subjects' ages ranged from 3 to 64 years; there were 70 females and 24 males, all of whom were of Asian descent. The number of treatments ranged from 1 to 8. Duration of treatment ranged from 6 months to 3 years and 10 months, with a mean of 14 months. Patients (n=47) received Q-switched Ruby laser treatment (694 nm) using light dosages of 7-10 J cm(-2). Subsequent patients (n=47) received Q-switched Nd:YAG laser treatment (1064 nm) using light dosages of 7-10 J cm(-2). The primary efficacy measurement was the quantitative assessment of clearing and fading response using the DermaSpectrometer for the Q-switched Ruby laser group versus the Q-switched Nd:YAG laser group.

RESULTS

Based on a paired t-test, clinical and statistically significant differences in clearing and fading response were observed amongst the Q-switched Ruby laser-treated subjects as preferred to the appearance of Q-switched Nd:YAG laser-treated group (P<0.05). In both groups, transient hyperpigmentation resolved in all subjects within 6 months. Permanent hyperpigmentation or scarring was not observed in either group.

CONCLUSION

Use of a Q-switched Ruby laser resulted in better clearing and fading as compared with Q-switched Nd:YAG laser.

Cigarette smoking and proteinuria in Taiwanese men with Type 2 diabetes mellitus

AIMS

Cigarette smoking is a well-known risk factor associated with diabetic nephropathy. The objective of this study was to further investigate the dose-response effect of tobacco exposure on proteinuria in males with Type 2 diabetes.

METHODS

Five hundred and nine males with Type 2 diabetes were selected from a cohort participating in a glucose control study in Taiwan. Pack-years of cigarette smoking were calculated to define tobacco exposure. Proteinuria was identified if albumin-to-creatinine ratio was > or = 30 mg/g in at least two of three consecutive urine tests. Logistic regression and trend tests were used to delineate the association between smoking status and proteinuria.

RESULTS

Compared with non-smokers, those who had smoked 15-30 or more than 30 pack-years were respectively 2.78 (95% CI 1.34-5.76, P < 0.01) and 3.20 (95% CI 1.74-5.86, P < 0.001) times more likely to develop proteinuria. The dose-response effect of tobacco exposure on the development of proteinuria is highly significant in all subjects (P = 0.001) and in subgroups with relatively short duration of diabetes mellitus (P < 0.001), good blood pressure control (P = 0.001) and those of young age (P = 0.007).

CONCLUSIONS

The current study shows a clear dose-response effect of cigarette smoking on development of proteinuria in male Type 2 diabetic patients. These findings reinforce the urgent need to encourage diabetic patients to stop smoking regardless of age, duration of diabetes mellitus or status of blood pressure control.

Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarks

BACKGROUND AND OBJECTIVE

The objective of this study was to improve port wine stain (PWS) therapeutic outcome in response to laser therapy. Our specific aim was to determine whether the combined use of pulsed dye laser (PDL) therapy and topical Imiquimod versus PDL alone can improve PWS therapeutic outcome.

STUDY DESIGN/MATERIALS AND METHODS

This pilot study involved a retrospective review of 20 subjects, all Asian, with PWS. Subject ages ranged between 3 and 56 years. Upon enrollment, three test sites were prospectively identified on each subject for treatment assignments to the following regimens: (A) PDL+Imiquimod; (B) PDL alone; and (C) Imiquimod alone. PDL test sites received a single treatment with a 585 nm wavelength; 1.5 milliseconds pulse duration; spot size 7 mm using a light dosage of 10 J/cm2 with cryogen spray cooling. For the PDL+Imiquimod and Imiquimod alone test sites, subjects were instructed to apply Imiquimod topically to the sites once daily for 1 month after PDL exposure. Subjects were followed-up at 1, 3, 6, and 12 months after PDL exposure to evaluate each of the three test sites. The primary efficacy measurement was the quantitative assessment of blanching responses as measured by a DermoSpectrometer to calculate the hemoglobin-index of each site at 1, 3, 6, and 12 months after PDL exposure. Subjects were also closely monitored for any adverse effects.

RESULTS

Based on paired sample test analysis, there were clinically, and statistically significant, differences in blanching responses over time favoring PWS receiving PDL+Imiquimod as compared to either PDL or Imiquimod alone (P<0.05). At 12 months, it should be noted that there was some evidence of redarkening of PWS test sites treated by PDL+Imiquimod and PDL alone, presumably due to revascularization of blood vessels. However, based on comparison of the hemoglobin-indices determined at 1 and 12 months after PDL exposure, there was less revascularization of PWS test sites treated with PDL+Imiquimod as compared to PDL alone (P<0.05). Transient hyperpigmentation was noted in 10% (n = 2) and 40% (n = 8) of subjects on the PDL+Imiquimod and PDL alone test sites, respectively. On all sites, hyperpigmentation resolved spontaneously without medical intervention within 6 months. Permanent hypopigmentation or scarring was not observed on any test site.

CONCLUSION

Based on the results of this pilot study, PDL+Imiquimod resulted in superior blanching responses over time as compared to PDL alone for treatment of test sites on PWS lesions. Although the PDL+Imiquimod approach is intriguing, clinical validation in large PWS patient samples is required.

Minimizing superficial thermal injury using bilateral cryogen spray cooling during laser reshaping of composite cartilage grafts

Composite cartilage grafts were excised from New Zealand rabbit ears. Flat composite grafts (of cartilage and overlying skin graft on both surfaces) were obtained from each ear and cut into a rectangle measuring 50 mm by 25 mm (x by y) with an average thickness of approximately 1.3 mm (z), skin included. Specimens were manually deformed with a jig and maintained in this new position during laser illumination. The composite cartilage grafts were illuminated on the concave surface with an Nd:YAG laser (1,064 nm, 3 mm spot) at 10 W, 20 W, 30 W, 40 W, 50 W. Cryogen spray cooling (CSC) was applied to both exterior (convex) and interior (concave) surfaces of the tissue to reduce thermal injury to the grafts. CSC was delivered: (1) in controlled applications (cryogen released when surface reached 40 degrees C, and (2) receiving only laser at above wattage, no CSC [representing the control group]. The specimens were maintained in a deformation for 15 minutes after illumination and serially examined for 14 days. The control group with no CSC caused injury to all specimens, ranging from minor to full thickness epidermal thermal injury. Although most levels of laser and CSC yielded a high degree of reshaping over an acute time period, after 14 days specimens exposed to 30 W, 40 W, 50 W retained shape better than those treated at 10 W and 20 W. The specimens exposed to 50 W with controlled CSC retained its new shape to the highest degree over all others, and thermal injury was minimal. In conclusion, combinations of laser and CSC parameters were effective and practical for the reshaping of composite cartilage grafts.

In vitro and in vivo photosensitizing applications of Photofrin in malignant melanoma cells

BACKGROUND

The object of the present study was to evaluate the feasibility of photodynamic therapy (PDT) for malignant melanomas through in vivo and in vitro processes.

METHODS

Photofrin (porfimer sodium) was evaluated through in vitro processes with human malignant melanoma cells (MMCs). The in vitro absorption and photosensitizing activity of Photofrin was examined in an MMC culture system. The in vivo biological activity of Photofrin applied to subcutaneous implanted melanoma (SIM) in nude mice and exposed to different total light dosages at 630 nm was studied by determining the destruction of the tumors. Subcelluar localization and binding were observed under a fluorescent confocal microscope.

RESULTS

MMCs incubated with Photofrin at a concentration of about 3.5 microg/ml and exposed to laser light at 630 nm with a power density of 100 mW/cm2, showed 50% cell killing. An electron microscopic study demonstrated significant destruction of the target after PDT.

CONCLUSION

Detection of the photosensitizer Photofrin was localized and its distribution fully observed. PDT-Photofrin has the capability to destroy MMCs through in vitro and in vivo SIM treatment.

Mitochondrion-targeted photosensitizer enhances the photodynamic effect-induced mitochondrial dysfunction and apoptosis

Recently, the mitochondrion has been considered as a novel pharmacological target for anticancer therapy due to its crucial role involved in arbitrating cell apoptosis. We have previously demonstrated that 488-nm laser irradiation induced a specific mitochondrial reactive oxygen species (mROS) formation and apoptotic death. In this study, we used a second generation of photosensitizers, the benzoporphyrin-derivative monoacid ring A (BPD-MA). We investigated specifically mechanisms at the mitochondrial level for BPD-MA coupled with 690-nm laser irradiation, the photodynamic effect (PDE) of BPD-MA, using conventional and laser scanning imaging microscopy in intact C6 glioma cells. We demonstrated BPD-MA localized mainly in the mitochondrial area. The phototoxicity induced by 1-10 J 690-nm laser irradiation was minor as compared to that induced by 488-nm laser irradiation. Unlike other mitochondrion-targeted photosensitizers, the dark toxicity induced by BPD-MA (0.05-5 mg/mL, effective doses used for the PDE) was relatively low. Nevertheless, the PDE of BPD-MA using 0.5 mg/mL coupled with 5J 690-nm irradiation induced profound and rapid (< 1 min) mitochondrial swelling, mROS formation, and severe plasma membrane blebbing as compared to that induced by 488-nm laser irradiation (< 10 min). Later, the PDE of BPD-MA resulted in positive propidium iodide cell-death stain and positive TUNEL apoptotic nuclear stain and DNA laddering. Finally, the PDT of BPD-MA also instantaneously promoted the mitochondrion to diminish its covalent binding with a mitochondrial marker, MitoTracker Green. We conclude that the PDT of BPD-MA targeted primarily and compellingly the mitochondrion to induce effective mitochondria-mediated apoptosis and thus may serve as a powerful photosensitizer for clinical cancer therapy.

Contribution of somatic cell-associated activation of plasminogen to caseinolysis within the goat mammary gland

Functional regression of the mammary gland is partly reflected by proteolysis of milk protein and tissue protein. The involvement of the plasminogen activation system in degradation of milk protein and mammary tissue damage has been demonstrated under inflammatory conditions. In this study, mammary secretion from 23 dairy goats primarily grouped as lactation (milking twice daily) or involution (milking once daily or less) was used to determine the ratio of gravity-precipitated casein to total milk protein (casein ratio) as an index of caseinolysis, and activities of components of plasminogen activation system as well as their expressions on somatic cells. Based on the casein ratio, lactation goats were subcategorized as very active (71.8 +/- 1.0%) or less active (29.9 +/- 1.0%) in mammary function; involution goats were subcategorized as gradual (21.7 +/- 1.0%) or acute (5.9 +/- 0.2%) involution. This result suggests that caseinolysis occurred during regular lactation as well as during involution. On the other hand, activities of components of the plasminogen activation system in mammary secretion were increased along with the decreasing casein ratio, in contrast to the similar activities of their counterparts in circulation throughout various mammary statuses. Correlation analysis between casein ratio and activities of plasminogen activation system of goat milk indicated a significant negative relationship for plasmin (r = -0.64), plasminogen (r = -0.69), and urokinase-type plasminogen activator (uPA; r = -0.78) during involution but not during lactation. As for the cellular components of plasminogen activation system, there was an increase in immunoreactivity on somatic cells toward both monoclonal antibodies of human uPA and human uPA receptor under involution conditions suggesting their upregulation relative to lactation condition. Collectively, these results suggest that plasminogen activation system within the mammary gland differentially contribute to milk caseinolysis along the various stages of goat lactation. Meanwhile, a somatic cell-mediated local elevation of plasmin activity may be committed to extensive caseinolysis during involution.

Modulation of HER2 expression by ferulic acid on human breast cancer MCF7 cells

BACKGROUND

The molecular mechanisms underlying the mitogenic effect of ferulic acid (FA), an active compound derived from Angelica sinensis, have never been elucidated. It was the aim of this study to investigate the proliferative effect of FA on human breast cancer cell lines and to elucidate its modulation mechanism on HER2 expression in MCF7 line.

MATERIALS AND METHODS

By using MCF7 (oestrogen receptor-positive; ER+, HER2-low), BT474 (ER+, HER2-high), MDAMB231 (ER-, HER2-low) and SKBR3 (ER-, HER2-high) human breast cancer cell lines as in vitro models, the mitogenic effects of FA were assessed by trypan blue dye exclusion assay and DNA flow cytometry. Ferulic acid-modulated cell signalling and HER2 gene expression were evaluated in MCF7 line by Western blot and real-time RT-PCR analysis.

RESULTS

Ferulic acid ER-dependently stimulated cell proliferation on MCF7 cells in a concentration-dependent manner. The HER2 oncogene (one of the prognostic factors of breast cancer) and ESR1 gene (oestrogen receptor-alpha; ERalpha) transcription were markedly up-regulated by FA treatment. Besides, HER2 signalling and its downstream molecules such as AKT and ERK1/2 were involved in FA-modulated ERalpha and cyclin D1 synthesis. Addition of anti-HER2 antibody, trastuzumab, abrogated FA-enhanced proliferative effect on MCF7 cells, indicated a positive feedback control for the action of HER2 in this setting. The fact that the ER antagonist blocked most of the FA-up-regulated HER2 expression, and that trastuzumab down-regulated ERalpha gene expression, suggested a cross-talk between ERalpha and HER2 signalling on MCF7 cells.

CONCLUSION

The authors' conclude that FA causes human breast cancer cell proliferation by up-regulation of HER2 and ERalpha expression.

Topical application of photofrin for photodynamic diagnosis of oral neoplasms

BACKGROUND

The prognosis of patients with oral cancer can be improved by early diagnosis. Exact demarcation of tumor margins could contribute to optimum results in surgical excision and reconstruction. Therefore, the purpose of this study was to evaluate Photofrin (Quadra Logic Technologics, Inc., Vancouver, British Columbia, Canada) with protoporphyrin IX fluorescence as a new diagnostic procedure: photodynamic diagnosis for the detection of hyperplastic and malignant changes in oral tissue.

METHODS

Twenty patients with oral neoplasms received 2.5 mg/ml Photofrin solution topically. After a period of 3 hours, the patients underwent fluorescence illumination (lambdaex = 370 to 450 nm). Guided by their visible fluorescence, lesions were biopsied at four suspicious sites for each patient. All specimens were analyzed and measured by a pathologist. A quantitative analysis of the fluorescence contrast between the neoplastic and healthy tissue was performed using the red, green, and blue mode and the gray scale mode. Statistical analysis was performed by means of the analysis of variance test for multiple comparisons.

RESULTS

The sensitivity of the neoplastic tissue evaluated using the red, green, and blue and the gray scale modes combined was 92.45 percent in the macroscopic study and 93.75 percent in the microscopic study. The specificity of the neoplastic tissue evaluated using the red, green, and blue and gray scale modes combined was 95.65 percent in the macroscopic study and 97.50 percent in the microscopic study. Five patients (25 percent) displayed hyperkeratosis, nine (45 percent) displayed squamous hyperplasia, and six (30 percent) displayed squamous cell carcinoma. It is likely that Photofrin induced the visible red fluorescence. Some fluorescence could be detected in the surrounding healthy tissue. The intensity of the light was much lower than that from the lesions. The difference between healthy tissue and the lesions as a group was statistically significant.

CONCLUSIONS

Light-induced fluorescence detection using topical Photofrin provides a sensitive, noninvasive technique for the early identification of malignant neoplasms in the oral cavity. Further study by the authors will evaluate fluorescence-guided photodynamic therapy for oral cancers in early stages.

Relationship of serum immunoglobulin and IgG subclass levels to race, ethnicity and behavioral characteristics in HIV infection

BACKGROUND

To determine whether demographic and behavioral factors affect immunoglobulin regulation in HIV infection, we studied injection drug users, women, and minority ethnic and racial groups with and without HIV infection.

MATERIAL/METHODS

A prospective cross-sectional study of ambulatory persons with or at risk for HIV infection was conducted. We enrolled 48 injection drug users (IDUs) and 43 non-IDUs seropositive for HIV and 22 seronegative at-risk individuals in the Bronx, New York City. Sixteen HIV-seronegative, non-IDUs controls were also studied. Total serum immunoglobulin levels, IgG subclasses and lymphocyte phenotypes were measured.

RESULTS

Serum IgG, IgA, IgG(1) and IgG(3) were increased in all stages of HIV infection controlling for injection drug use, gender, race and age (p0.05). Serum IgM levels were significantly decreased in HIV seropositives compared to HIV seronegatives (p<0.02). Two patterns of serum immunoglobulin level elevation were found in HIV infection: 1) IgG, IgG(1) and IgG(3) levels were elevated in early and advanced HIV infection; 2) IgA, IgG(2) and IgG(4) levels were elevated only in advanced HIV infection. IgG levels were increased in Blacks compared to Caucasians with HIV infection (p=0.01).

CONCLUSIONS

Serum IgG, IgG(1) and IgG(3) levels are increased in early HIV infection, while serum IgA, IgG(2), and IgG(3) levels are increased only in advanced HIV infection. In contrast, serum IgM levels are decreased in HIV infection. HIV-seropositive Blacks have higher serum IgG levels than HIV-seropositive Caucasians. Further studies are necessary to determine the mechanism(s) underlying the different patterns of immunoglobulin elevation in HIV infection.

Combining the CO2 laser and the endoscope to remove soft tissue masses from the forehead area

OBJECTIVE

The aim of this study was to provide a retrospective analysis of treatment that combines the laser and the endoscope.

BACKGROUND DATA

Previously, surgeons faced many complications arising from endoscope-assisted surgery in the region of the forehead. In order to reduce the incidence of complications, such as swelling and hematoma, the CO2 laser is added to endoscope-assisted surgery.

METHODS

Between January 1996 and January 2003, 42 patients were treated for the removal of a benign tumor. The group was comprised of 18 males and 24 females, and their ages ranged from 5 to 64 years. The SurgiLase 150XJ CO2 laser system, used in conjunction with the flexible FIBERLASE (Sharplan, NJ), was used in all cases. The endoscope was 4 mm in diameter, with an angle of 30 degrees (Snoden Pancer, USA). The dissection was performed by relaying images from the endoscope to a monitor. The basic instrumentation consists of elevators, a nerve hook, retractors, and endoscopic scissors. Suction of the smoke generated by laser evaporization was also necessary.

RESULTS

Of the 42 cases treated, 30 patients displayed lipomas, 10 patients displayed inclusion cysts, and two patients displayed dermoid cysts. After surgery, the follow-up period ranged from 6 months, to 2 years and 6 months, with an average of 1 year and 7 months. In this retrospective review, the incidences of early complications of these 42 patients included one case of scalp alopecia, three of scar alopecia, one of numbness, and three of ecchymosis. No hematoma cases were recorded. Evaluation after 6 months revealed the later complication of one scar alopecia.

CONCLUSIONS

SurgiLase CO2 laser, used in conjunction with endoscopic surgery, enables plastic surgeons to work at a distance through small incisions without causing bleeding. Visible scars are reduced and recovery time is diminished.

Distribution of Xylella fastidiosa in Sycamore Associated with Low Temperature and Host Resistance

Experiments were conducted in the field and laboratory to determine effects of low temperatures on Xylella fastidiosa populations in American sycamore. Roots and shoots from naturally infected trees at two locations were collected monthly. Sap extracted from the samples was tested by enzyme-linked immunosorbent assay for presence of X. fastidosa and was diluted and plated on periwinkle wilt medium to determine populations of viable bacteria. Cumulative rainfall and hours below temperature thresholds (-5 to 10°C) were recorded at each site. Bacterial populations in shoots were negatively correlated with cumulative hours below -5°C air temperature (r= -0.96). In roots, bacterial populations were only weakly correlated with cumulative hours below soil temperature thresholds (-0.61 < r <-0.25). Bacterial populations were not correlated with monthly rainfall. In the laboratory, resistant and susceptible sycamore trees were inoculated with X. fastidiosa and held in the dark at 5°C or 22°C. After 12 weeks, inoculated stem sections were collected and sap was extracted and tested as described previously. Stems that tested positive for X. fastidiosa were divided into additional samples and tested as described above. Results of the laboratory study indicated no significant effects of low-temperature treatment (5°C) or host resistance on viable bacteria. Bacterial detection frequency and population size were greatest near the inoculation point and the primary direction of early bacterial spread was acropetal.

Phase II study of weekly oxaliplatin and 24-h infusion of high-dose 5-fluorouracil and folinic acid in the treatment of advanced gastric cancer

To investigate the efficacy and safety of combining weekly oxaliplatin with weekly 24-h infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA) in treatment of patients with advanced gastric cancer. Patients with histologically confirmed, locally advanced or recurrent/metastatic gastric cancer were studied. Oxaliplatin 65 mg m⁻² 2-h intravenous infusion, and 5-FU 2600 mg m⁻² plus FA 300 mg m⁻² 24-h intravenous infusion, were given on days 1 and 8, repeated every 3 weeks. Between January 2001 through January 2002, 55 patients were enrolled. The median age was 64 years (range: 22–75). In all, 52 patients (94.5%) had recurrent or metastatic disease and three patients had locally advanced disease. Among 50 patients evaluable for tumour response, 28 patients achieved partial response, with an overall response rate of 56% (95% confidence interval (CI): 41.8–70.3%). All 55 patients were evaluated for survival and toxicities. Median time to progression and overall survival were 5.2 and 10.0 months, respectively, during median follow-up time of 24.0 months. Major grades 3–4 toxicities were neutropenia in 23 cycles (7.1%) and thrombocytopenia in 16 cycles (5.0%). Treatment was discontinued for treatment-related toxicities in nine patients (16.4%), of whom eight were due to oxaliplatin-related neurotoxicity. One patient (1.8%) died of neutropenic sepsis. This oxaliplatin-containing regimen is effective in the treatment of advanced gastric cancer. Except for neurotoxicity that often develops after prolonged use of oxaliplatin, the regimen is well tolerated.