Squamous cell carcinoma of the dorsal hands and feet after repeated exposure to ultraviolet nail lamps.

Gel nails are a common artificial nail option. Ultraviolet (UV) nail lamps are commonly used to cure gel nails. Ultraviolet A radiation is a known mutagen that penetrates into the nail bed. Although previously reported, the role of UV nail lamps in the carcinogenesis of both keratinocyte carcinoma and melanoma remains controversial. Herein, we report a patient taking the photosensitizing agent hydrochlorothiazide who developed numerous squamous cell carcinomas on the dorsal hands and feet with a 10-year history of UV nail light exposure every 2-3 weeks.

Estimation of short-circuit current induced by ELF uniform electric fields in grounded humans with different body shapes based on a semi-ellipsoidal model.

It has been reported that when a grounded human is exposed to an electric field at power frequency, a short-circuit current flowing from the feet to the ground is proportional to the square of his or her height. The current, however, should also vary with the body surface area, that is, body shape, even in people with the same height. In the present study, we confirmed this hypothesis using an analytical solution derived from a semi-ellipsoidal model. The short-circuit currents were calculated for various numerical human body models in which the horizontal length of a voxel was varied from 1.8 to 3.0 mm, and the results for different body shapes were compared. Finally, we derived an approximate expression for estimating the short-circuit current from the left-right width (2b), frontal thickness (2c), and height (a) of a human from the analytical solution. The short-circuit currents obtained from the approximate expression are consistent with those obtained from numerical calculations for 48 differently shaped human body models with a correlation coefficient of 0.9942. Hence, we concluded that the short-circuit current can be determined depending on the similarity ratio (a/b) and the ellipticity ratio (c/b) of the human body as well as the height. This finding is consistent with the numerical human body models that have been used previously, in which the similarity and ellipticity ratios were very close. Therefore, we can make the limited conclusion that the short-circuit current is proportional only to the square of the height. Additionally, numerical calculations showed that the short-circuit current is the same whether one foot or both feet are grounded.

The risks following the exposure to radiation associated with the surgical correction of limb deformities in children are minimal.

AIMS: The aim of this study was to quantify the risk of developing cancer from the exposure to radiation associated with surgery to correct limb deformities in children. PATIENTS AND METHODS: A total of 35 children were studied. There were 19 girls and 16 boys. Their mean age was 11.9 years (2 to 18) at the time of surgery. Details of the radiological examinations were recorded during gradual correction using a Taylor Spatial Frame. The dose area product for each radiograph was obtained from the Computerised Radiology Information System database. The effective dose in millisieverts (mSv) was calculated using conversion coefficients for the anatomical area. The lifetime risk of developing cancer was calculated using government-approved Health Protection Agency reports, accounting for the age and gender of the child. RESULTS: Correction was undertaken in five femurs, 18 tibiae, and 12 feet. The median duration of treatment was 45 months (11 to 118). The mean effective dose was 0.31 mSv (0.05 to 0.64) for the femur, 0.29 mSv (0.01 to 0.97) for the tibia, and 0.027 mSv (0.001 to 0.161) for the foot. The cumulative exposure gave 'negligible' risk in 26 children and 'minimal' risk in nine children, according to Public Health England categories. These results are below the mean annual background radiation in the United Kingdom. CONCLUSION: The lifetime attributable risk of developing cancer from repeated exposure to radiation was negligible or minimal in all children. This is the first study to quantify the exposure to radiation from serial radiographs in children with limb deformities who are treated surgically using circular external fixation, linking this to the risk of developing cancer. Cite this article: Bone Joint J 2019;101-B:241-245.

Punctate Radiation Dermatitis of the Foot and Ankle Caused by Distal Embolization of 90Y Microspheres During Liver Directed Therapy.

A 41-year-old man with gastric adenocarcinoma presented with hepatic metastases. The metastases were refractory to systemic chemotherapy, so radioembolization with Y microspheres was performed. Because of stasis or saturation of the tumor with embolic particles, 79% of the microspheres were injected. At follow-up, the patient complained of "red bumps" that had developed on his right foot/ankle the day after the radioembolization. Because a portion of the dose was still in the catheter when withdrawn from the right femoral artery, the interventional radiologist used a Geiger counter to confirm radioactivity in the cutaneous lesions and thus the distal embolization of the microspheres.

Postoperative Radiotherapy After Limb-sparing Surgery for Soft-tissue Sarcomas of the Distal Extremities.

BACKGROUND: Soft-tissue sarcomas (STS) of the distal extremities are a rare disease entity, hence proper treatment strategy is not well established. We evaluated the local control, survival and complications of treating sarcomas in the wrist, hand, ankle and foot with limb-sparing surgery (LSS) and postoperative radiotherapy (PORT). PATIENTS AND METHODS: Seventeen patients with STS in wrist, hand, ankle and foot who received PORT after LSS from August 2008 to November 2015 were retrospectively reviewed. Primary outcome was 5-year local recurrence-free survival (LRFS). Secondary outcomes were 5-year distant metastasis-free survival (DMFS) and toxicities. RESULTS: The median age was 32 (range=12-78) years. The most frequent STS location was the foot in 11 patients (64%) followed by two patients each in the wrist, hand and ankle, respectively. Fourteen patients (82%) underwent wide resection with flap grafts and the same number of patients achieved clear resection margins. The median postoperative radiation dose was 54 (range=46-60) Gy. Five patients also received chemotherapy. At a median follow-up of 39 (range=6-87) months, 5-year LRFS and DMFS were both 100%. Only one patient experienced grade 3 radiation dermatitis and there was no major wound complication. Radiation-induced bone fracture occurred in two patients. CONCLUSION: PORT after LSS showed excellent local control for STS in the wrist, hand, ankle and foot. Considering the good local control and saving of limb function without any significant toxicity, the combination of LSS followed by PORT could be an appropriate and safe modality for STS of the distal extremities.

Low-level laser therapy reduces the fatigue index in the ankle plantar flexors of healthy subjects.

Low-level laser therapy (LLLT) has been suggested as a resource capable of increasing resistance to fatigue and enhancing muscle performance through its metabolic and photochemical effects. This study evaluated the immediate effects of the application of LLLT on neuromuscular performance of the plantar ankle flexors in healthy subjects through a fatigue-induced protocol. This is a randomized controlled clinical trial, attended by 60 young and physically active volunteers of both genders. The subjects were randomly assigned into three groups, control, placebo, and laser, and underwent a preliminary evaluation of the isokinetic performance of plantar flexors and electromyographic activity of the soleus muscle to ensure homogeneity between groups. After the application of the respective intervention protocols, participants were induced to fatigue by performing 100 isokinetic concentric contractions of ankle plantar flexors at a speed of 90°/s. The dynamometric fatigue index (DFI) and median frequency were recorded during the fatigue protocol for comparison between groups. The group receiving the laser application showed significantly lower dynamometric fatigue index (p = 0.036) when compared to control and placebo groups. In relation to the median frequency during the fatigue test, there was a decrease in all groups, however with no differences between them. We suggest that LLLT being applied prior to exercise can reduce the fatigue index in the ankle plantar flexors of healthy subjects.

[Radiation exposure from shoe-fitting fluoroscopes]. / Strahlenexposition bei Schuhdurchleuchtungsapparaten.

It is 40 years ago that a very popular X-ray device disappeared in German shoe shops: the shoe-fitting fluoroscope or Pedoskop. Since the 1930s, these X-ray machines were an integral part of any good shoe business. Following the entry into force X-Ray Regulation (RöV 1973) the use of these devices was prohibited in Germany.

Expression of mPGES-1 and IP mRNA is reduced by LLLT in both subplantar and brain tissues in the model of peripheral inflammation induced by carrageenan.

The increase in PGE2 production by microsomal PGE synthase-1 (mPGES-1) in CNS contributes to the severity of the inflammatory and pain responses in the model of edema formation and hyperalgesia induced by carrageenan. PGI2, alike to PGE2, plays an important role in the inflammation. Low-level laser therapy (LLLT) has been used in the treatment of inflammatory pathologies, reducing both pain and the acute inflammatory process. In this work, we studied the effect of LLLT on the expression of both mPGES-1 and IP messenger RNA (mRNA), in either subplantar or total brain tissues obtained from rats submitted to model of edema formation and hyperalgesia induced by carrageenan administration. The test sample consisted of 30 rats divided into five groups: A1 (control-saline), A2 (carrageenan-0.5 mg/paw), A3 (carrageenan-0.5 mg/paw + LLLT), A4 (carrageenan-1.0 mg/paw), and A5 (carrageenan-1.0 mg/paw + LLLT). The animals from groups A3 and A5 were irradiated 1 h after induction of inflammation by carrageenan injection. Continuous-wave red laser with wavelengths of 660 nm and dose of 7.5 J/cm(2) was used. Six hours after carrageenan-induced inflammation, mPGES-1 and prostacyclin receptor (IP) mRNA expression were significantly increased both in subplantar and brain tissues. LLLT was able to reduce both mPGES-1 and IP mRNA expression in subplantar and brain tissues. We suggest that LLLT is able to reduce both inflammation and hyperalgesia observed in the model of edema formation and hyperalgesia induced by carrageenan, by a mechanism involving the decrease in the expression of both mPGES-1 and IP.

Design and production of 3D printed bolus for electron radiation therapy.

This is a proof-of-concept study demonstrating the capacity for modulated electron radiation therapy (MERT) dose distributions using 3D printed bolus. Previous reports have involved bolus design using an electron pencil beam model and fabrication using a milling machine. In this study, an in-house algorithm is presented that optimizes the dose distribution with regard to dose coverage, conformity, and homogeneity within the planning target volume (PTV). The algorithm takes advantage of a commercial electron Monte Carlo dose calculation and uses the calculated result as input. Distances along ray lines from the distal side of 90% isodose line to distal surface of the PTV are used to estimate the bolus thickness. Inhomogeneities within the calculation volume are accounted for using the coefficient of equivalent thickness method. Several regional modulation operators are applied to improve the dose coverage and uniformity. The process is iterated (usually twice) until an acceptable MERT plan is realized, and the final bolus is printed using solid polylactic acid. The method is evaluated with regular geometric phantoms, anthropomorphic phantoms, and a clinical rhabdomyosarcoma pediatric case. In all cases the dose conformity are improved compared to that with uniform bolus. For geometric phantoms with air or bone inhomogeneities, the dose homogeneity is markedly improved. The actual printed boluses conform well to the surface of complex anthropomorphic phantoms. The correspondence of the dose distribution between the calculated synthetic bolus and the actual manufactured bolus is shown. For the rhabdomyosarcoma patient, the MERT plan yields a reduction of mean dose by 38.2% in left kidney relative to uniform bolus. MERT using 3D printed bolus appears to be a practical, low-cost approach to generating optimized bolus for electron therapy. The method is effective in improving conformity of the prescription isodose surface and in sparing immediately adjacent normal tissues.

Immediate effects of monochromatic infrared energy on microcirculation in healthy subjects.

OBJECTIVE: The purpose of this study was to evaluate the influence of monochromatic infrared energy (MIRE) on the microcirculation of the skin surface of the feet in healthy subjects. BACKGROUND DATA: Near-infrared energy was shown to increase microcirculation in an animal study. In humans, only one case study demonstrated that MIRE increases microcirculation in the skin of the lower limbs. METHODS: Thirty healthy volunteers were recruited and randomly allocated into three groups to receive either: (1) active MIRE; (2) sham MIRE (placebo group); or (3) warm packs (control group) on the feet. The MIRE device comprised an array of 60 x 890 nm LEDs attached to flexible pads (3×7.5 cm). Each diode spot size was 0.2 cm(2), and each LED power was 12 mW with a power density of 60 mW/cm(2). The arrays were placed in direct contact with the skin for 30 min delivering a total fluence of 108 J/cm(2) over an area of 22.5 cm(2). Capillary blood cell velocity (CBV) and superficial skin blood flow (flux) were recorded before and after intervention. RESULTS: Significant differences among the three groups were recorded in both CBV and flux (both p<0.05). Post-hoc comparisons indicated that a significantly greater increase in both CBV and flux occurred in the active MIRE group than in the placebo group and control group (all p<0.05). CONCLUSIONS: A 30-min MIRE produced a significantly greater increase in the CBV and flux of the feet in the active MIRE group than in the placebo and control groups.

Effect of optically modified polyethylene terephthalate fiber socks on chronic foot pain.

BACKGROUND: Increasing experimental and clinical evidence suggests that illumination of the skin with relatively low intensity light may lead to therapeutic results such as reduced pain or improved wound healing. The goal of this study was to evaluate prospectively whether socks made from polyethylene terephthalate (PET) incorporating optically active particles (Celliant) ameliorates chronic foot pain resulting from diabetic neuropathy or other disorders. Such optically modified fiber is thought to modify the illumination of the skin in the visible and infrared portions of the spectrum, and consequently reduce pain. METHODS: A double-blind, randomized trial with 55 subjects (38 men, 17 women) enrolled (average age 59.7 +/- 11.9 years), 26 with diabetic neuropathy and 29 with other pain etiologies. Subjects twice completed the Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), McGill Pain Questionnaire (MPQ), and SF-36 a week apart (W(1+2)) before receiving either control or Celliant socks. The same questionnaires were answered again one and two weeks (W(3+4)) later. The questionnaires provided nine scores for analyzing pain reduction: one VAS score, two BPI scores, five MPQ scores, and the bodily pain score on the SF-36. Mean W(1+2) and W(3+4) scores were compared to measure pain reduction. RESULTS: More pain reduction was reported by Celliant subjects for 8 of the 9 pain questions employed, with a significant (p = 0.043) difference between controls and Celliant for McGill question III. In neuropathic subjects, Celliant caused more pain reduction in 6 of the 9 questions, but not significantly. In non-neuropathic subjects 8 of 9 questions showed more pain reduction with the Celliant socks. CONCLUSION: Socks with optically modified PET (Celliant) appear to have a beneficial impact on chronic foot pain. The mechanism could be related to the effects seen with illumination of tissues with visible and infrared light. TRIAL REGISTRATION: ClinicalTrials.gov NCT00458497.

Pulsed infrared light therapy does not increase nitric oxide concentration in the blood of patients with type 1 and type 2 diabetes mellitus.

The purpose of this study was to determine if NO blood concentrations increased acutely following an 8-week course of pulsed infrared light therapy (PILT) which could be linked to an improvement in peripheral protective sensation (PPS) in patients who have profound chronic diabetic peripheral neuropathy. A total of 22 subjects with the diagnosis of type 1 (N = 2) or type 2 (N = 20) diabetes participated in the study. PILT was administered to one foot chosen at random with the other foot serving as a within-subject control (no treatment). Patients underwent 24 treatments (3 times/week, for 8 weeks) for 30 min per treatment. Venous blood samples were taken during the last 5 min of treatment from veins in the dorsum of the control and experimental feet and were later analyzed for NO concentration. Contrary to the popular supposition, PILT treatments actually resulted in a significantly (P < 0.05) decreased concentration of NO. Additionally, there were no significant differences between the treated and untreated feet. Since in individuals where PILT has significantly improved PPS, PILT did not stimulate an increased NO content in the blood, it appears that infrared light improves peripheral protective sensation in patients by a mechanism other than an increased NO production.

Effect of chronic intermittent exposure to AM radiofrequency field on responses to various types of noxious stimuli in growing rats.

There are several reports of altered pain sensation after exposure (from a few minutes to hours in single or repeated doses for 2-3 weeks) to electromagnetic fields (EMF) in adults. The commonly utilized noxious stimulus is radiant heat. The nociceptive responses are known to be influenced by characteristics of stimulus, organism, and environment. We studied the pattern of nociceptive responses to various noxious stimuli in growing rats exposed to radiofrequency field (73.5 MHz amplitude modulated, 16 Hz power density 1.33 mw/cm(2), SAR = 0.4 w/kg) for 45 d (2 h/d). Threshold current for stimulation of nociceptive afferents to mediate motor response of tail (TF), vocalization during stimulus (VD), and vocalization after discharge (VA); the withdrawal latency of tail (TFL) and hind paw (HPL) to thermal noxious stimulus and tonic pain responses were recorded in every rat. The TFL was not affected, HPL was decreased (p < 0.01), and the thresholds of TF and VD were not affected, while, that of VA was significantly decreased. The tonic pain rating was decreased (p < 0.01). A decrease in the threshold of VA (p < 0.01) is indicative of an increase in the emotional component of the response to the phasic pain, whereas a decrease in the pain rating indicates analgesia in response to the tonic pain. The results of our study suggest that chronic (45 d), intermittent (2 h/d) amplitude modulated RF field exposure to the peripubertal rat increases the emotional component of phasic pain over a basal eaualgesic state, while late response to tonic pain is decreased. The data suggest that amplitude modulated RF field differentially affects the mechanisms involved in the processing of various noxious stimuli.

Basal cell carcinoma of the sole: possible association with the shoe-fitting fluoroscope.

Basal cell carcinoma of the sole is very rare. This report describes an occurrence in which a basal cell carcinoma may have developed in relation to radiation exposure from a shoe-fitting fluoroscope. The obvious limitation is that there is no record or means to measure any amount of radiation that a person may have received from this primitive fluoroscope. We conclude that radiation very likely did induce this lesion in this individual.

Locus coeruleus activation by foot shock or electrical stimulation inhibits amygdala neurons.

The noradrenergic nucleus locus coeruleus (LC) has a direct projection to the basal lateral amygdala (BLA). Behavioral, lesion and pharmacological studies suggest that this pathway has an important role in mediating responses to emotional stimuli and in the formation of long term memory. The effect of LC activation on the activity of BLA neurons in vivo is not known. Therefore, in the present experiments, simultaneous extracellular unit recordings were made in the two regions while the anesthetized rat received electrical stimulation of the paw to simulate a real-life acute stressor, commonly used as an aversive reinforcer in conditioning experiments. All LC neurons exhibited a multiphasic excitatory response followed by prolonged inhibition. Responses of BLA cells were more heterogeneous, but predominantly inhibitory, with a release from inhibition during the refractory phase of LC. Direct electrical stimulation of the LC with a single pulse also elicited an inhibitory response in BLA. BLA response to both footshock and LC stimulation was partially blocked by the beta adrenergic receptor antagonist, timolol, infused into the BLA. These experiments are the first to report in vivo effects of activation of the noradrenergic system on neuronal activity in the BLA.

[Change of afferent impulsing of peripheral nerve caused by polarized light with various wave lengths].

Change of impulse activity in branches of n. saphenus caused by influence of linearly polarized light with various wave lengths on the skin of rat's hind limb was studied. It was established that polarized light effect on skin receptor endings depended on wave length. Exposure of skin to red and blue parts of spectrum increased afferent impulsing of peripheral nerve for a short time, and influence of polychromatic polarized light (400-2000 nm) significantly decreased it for a long time (like lidocaine effect).

Application of heavy-ion CT.

In treatment planning for hadron therapy, information about the relative stopping power in a patient's body is used to calculate the range of incident ions. This information is obtained from computed tomography (CT) images using a conversion table from x-ray CT numbers into stopping powers relative to the stopping power of water. In treatment planning at the National Institute of Radiological Sciences (NIRS), the conversion table has been created based on the polybinary tissue model. However, it has not been fully verified that the model is accurate enough for use in real animal tissues. In order to irradiate heavy ions more precisely in radiotherapy, we have to evaluate the accuracy of the polybinary tissue calibration in animal tissues. We have measured animal tissue samples with a heavy-ion CT (HICT) and an x-ray CT. The x-ray CT image was converted to an image of relative stopping power by using the table derived from the polybinary tissue calibration (polybinary-tissue-model CT (PTCT) image). On the other hand, with HICT, the two-dimensional distribution of relative stopping power can be obtained directly. A comparison between PTCT and HICT images enabled us to verify the accuracy of the conversion table derived from the polybinary tissue calibration. Consequently, it was found that the agreement between the relative stopping powers of PTCT and HICT is 1.6% for fat, muscle and bone.

Suppression of pain by exposure of acupuncture points to polarized light.

BACKGROUND: According to clinical studies, the stimulation of acupuncture points (APs) by a variety of methods (eg, needles, pressure, etc) is an effective method for the treatment of many pain syndromes. However, no experimental proof exists showing that the exposure of APs to low-intensity incoherent polarized (P) light evokes an analgesic affect. OBJECTIVES: The authors' previous work, using mice, shows that the exposure of APs to low-intensity microwaves effectively decreases pain. The purpose of the present study was to determine whether exposure of APs to low-intensity incoherent P light evokes a statistically significant reduction in pain. METHODS: The effects of P light on behavioural responses to acute and tonic pain were tested in mice. The threshold of vocalization during electrical stimulation of the foot (acute pain) was measured before and after exposure of AP E-36 to P light. The duration of licking the formalin-injected foot (tonic pain) was investigated in control mice and mice exposed to P light on APs E-36, V-56 and V-60 or on skin that did not contain analgesic APs. RESULTS: Exposure of APs to P light evoked a statistically significant increase in pain threshold by 34.2% to 59.1%, and shortened the licking time by 32.3% to 50% in mice. The most effective AP was E-36 in both the painful foot and the normal foot. After 2 min, 6 min and 10 min of P light exposure, analgesia was 7.6%, 30.9% and 50%, respectively. The exposure to P light on skin that did not contain analgesic APs did not evoke significant effect. CONCLUSIONS: The results show the efficacy of pain suppression by exposure of antinociceptive APs to P light.

Improved foot sensitivity and pain reduction in patients with peripheral neuropathy after treatment with monochromatic infrared photo energy--MIRE.

The medical records of 2239 patients (mean age=73 years) with established peripheral neuropathy (PN) were examined to determine whether treatment with MIRE was, in fact, associated with increased foot sensitivity to the Semmes Weinstein monofilament (SWM) 5.07 and a reduction in neuropathic pain. The PN in 1395 of these patients (62%) was due to diabetes. Prior to treatment with MIRE, of the 10 tested sites (5 on each foot), 7.1+/-2.9 were insensitive to the SWM 5.07, and 2078 patients (93%) exhibited loss of protective sensation defined by Medicare as a loss of sensation at two or more sites on either foot. After treatment, the number of insensate sites on both feet decreased to 2.4+/-2.6, an improvement of 66%. Of the 2078 (93%) patients initially presenting with loss of protective sensation, 1106 (53%) no longer had loss of protective sensation after treatment (P<.0001); 1563 patients (70%) also exhibited neuropathic pain in addition to sensory impairment. Prior to treatment with MIRE, pain measured on the 11-point visual analogue scale (VAS) was 7.2+/-2.2 points, despite the use of a variety of pain-relieving therapeutic agents. After treatment with MIRE, pain was reduced by 4.8+/-2.4 points, a 67% reduction. Therefore, MIRE appears to be associated with significant clinical improvement in foot sensation and, simultaneously, a reduction in neuropathic pain in a large cohort of primarily Medicare aged, community-dwelling patients, initially diagnosed with PN. The quality of life associated with these two outcomes cannot be underappreciated.