Cysteamine Isobionic-Amide Complex Versus Kligman's Formula for the Treatment of Melasma: Equal Efficacy and Rapid Onset of Action.

BACKGROUND: Modified Kligman's formula (mKF) is the gold standard treatment for melasma; however, its prolonged use is not recommended due to side effects. Cysteamine is a potent, safe, and effective depigmenting agent. Here, we conducted a double-blind, randomized, and placebo-controlled clinical trial to assess the efficacy of cysteamine isobionic-amide -- a complex with enhanced depigmenting efficacy -- and compared it to mKF for the treatment of melasma. METHODS: This study involved a total of 80 patients divided into 3 groups: cysteamine-isobionic amide, placebo, or mKF. The modified Melasma Area Severity Index (mMASI) score and spectrophotometric evaluation were conducted at baseline, week 4, week 8, and week 16. Dermatological assessment, patients’ feedback, and satisfaction including quality-of-life scores were also collected. RESULTS: At week 4, cysteamine isobionic-amide and mKF groups showed an equivalent onset of action in terms of mMASI and skin pigmentation contrast reduction. The 2 groups significantly reduced melasma severity and improved the overall skin condition with a comparable efficacy at week 16. Quality of life of melasma patients was significantly improved in the cysteamine isobionic-amide group at week 8 and further at week 16 (P<0.001) compared to the mKF group. Patients’ feedback and satisfaction were higher with the cysteamine isobionic-amide product compared to mKF. CONCLUSION: Cysteamine isobionic-amide provided a rapid onset of action and was as effective as the mKF for the treatment of melasma. The data suggest that cysteamine isobionic-amide could potentially be an acceptable alternative to mKF for the long-term treatment of melasma. J Drugs Dermatol. 2024;23(2):9-16.  doi:10.36849/JDD.7428.

Efficacy of Fractional Carbon Dioxide (CO2) Laser versus Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) and Potassium-Titanyl-Phosphate (KTP) Lasers in the Treatment of Acanthosis Nigricans.

Background: Acanthosis nigricans (AN) is a common chronic skin disorder clinically presents by velvety hyperpigmented lesions mainly at the flexural areas. Fractional photothermolysis has been reported to improve both pigmentary and textural changes by removing thin layers of skin with minimal thermal damage. Other options are the Q-switched (Qs) Nd:YAG (1064 nm) and Qs KTP (532 nm) lasers. Both can induce collagen remodeling by dermal photo-mechanical microdamage. Aim of the Work: The aim of this study was to assess the clinical efficacy and the safety of fractional CO2 laser versus Qs Nd:YAG and KTP lasers in the treatment of acanthosis nigricans. Methods: This randomized-controlled split neck study was conducted on 23 patients suffering from AN. For each patient, one side of the neck was randomly assigned to fractional CO2 laser and the other side to Qs Nd:YAG and KTP lasers every four weeks for four months followed by 4 monthly follow-up assessment. Acanthosis Nigricans Area and Severity Index (ANASI) score, melanin and erythema indices as well as Patient Satisfaction Scale (PSS) were used to assess improvement on each side separately. Results: There was no statistically significant difference regarding the clinical improvement between the side treated with Fractional CO2 laser and the side treated with Qs Nd:YAG and KTP lasers (P value >0.05). In most patients, both sides showed improvement during different sessions of therapy, as regards ANASI scores, melanin indices, patient satisfaction scores, and side effects. Conclusion: In this study, we concluded that both fractional CO2 and Q-switched lasers proved to be a safe and effective line of treatment of acanthosis nigricans.

Comparative Study Between the Efficacy of Fractional CO2 Laser/Radiofrequency, PRP and a Combination of Both in the Treatment of Striae Distensae: A Pilot Study.

Purpose: The work aims to compare the effect of platelet-rich plasma versus fractional CO22 laser/radiofrequency versus both methods combined in treating striae distensae. Patients & Methods: The study included ten female patients with striae alba with Fitzpatrick IV skin. Three sites of striae were chosen; one was treated with platelet-rich plasma, another with fractional CO2 /radiofrequency (CO2/RF), and the third received both treatments. Every patient received three treatment sessions one month apart. Patients were photographed, and a skin biopsy was taken from each area before and one month after treatment. Results: Assessment of the clinical photos showed that fractional CO2/radiofrequency gave a mild improvement in 22%, moderate improvement in 55.5% and marked improvement in 22.5%. Clinically, the combined treatment showed mild improvement in 44% of patients, moderate results in 33% and marked improvement in 23% of patients. The PRP as an only mode of treatment showed poor improvement in 22%, mild improvement in 23% and moderate improvement in 55% of patients. Biopsy results showed a decrease in collagen and elastin after treatment with the solitary methods, while the combined approach resulted in an increase in collagen and a reduction in elastin. Conclusion: Fractional CO2 laser/radiofrequency combined with PRP or either of them showed clinical improvement to variable degrees with superior results clinically and histologically with the combined method.

A core outcome domain set for clinical research on capillary malformations (the COSCAM project): an e-Delphi process and consensus meeting.

BACKGROUND: There is limited evidence on the best available treatment options for capillary malformations (CMs), mainly due to the absence of uniform outcome measures in trials on therapies. A core outcome set (COS) enables standard reporting of trial outcomes, which facilitates comparison of treatment results. OBJECTIVES: To develop a core outcome domain set (CDS), as part of a core outcome set (COS), for clinical research on CMs. METHODS: Sixty-seven potentially relevant outcome subdomains were recognized based on the literature, focus group sessions, and input from the COSCAM working group. These outcome subdomains were presented in an online Delphi study to CM experts (medical specialists and authors of relevant literature) and (parents of) patients with CM (international patient associations). During three e-Delphi study rounds, the participants repeatedly scored the importance of these outcome subdomains on a seven-point Likert scale. Participants could also propose other relevant outcome subdomains. Consensus was defined as ≥ 80% agreement as to the importance of an outcome subdomain among both stakeholder groups. The CDS was finalized during an online consensus meeting. RESULTS: In total 269 participants from 45 countries participated in the first e-Delphi study round. Of these, 106 were CM experts from 32 countries, made up predominantly of dermatologists (59%) and plastic surgeons (18%). Moreover, 163 (parents of) patients with CM from 28 countries participated, of whom 58% had Sturge-Weber syndrome. During the two subsequent e-Delphi study rounds, 189 and 148 participants participated, respectively. After the entire consensus process, consensus was reached on 11 outcome subdomains: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health-related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. CONCLUSIONS: We recommend the CDS to be used as a minimum reporting standard in all future trials of CM therapy. Our next step will be to select suitable outcome measurement instruments to score the core outcome subdomains. What is already known about this topic? Besides physical and functional sequelae, capillary malformations (CMs) often cause emotional and social burden. The lack of uniform outcome measures obstructs proper evaluation and comparison of treatment strategies. As a result, there is limited evidence on the best available treatment options. The development of a core outcome set (COS) may improve standardized reporting of trial outcomes. What does this study add? A core outcome domain set (CDS), as part of a COS, was developed for clinical research on CMs. International consensus was reached on the recommended core outcome subdomains to be measured in CM trials: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health-related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. This CDS enables the next step in the development of a COS, namely to reach consensus on the core outcome measurement instruments to score the core outcome subdomains. What are the clinical implications of this work? The obtained CDS will facilitate standardized reporting of treatment outcomes, thereby enabling proper comparison of treatment results. This comparison is likely to provide more reliable information for patients about the best available treatment options.

Laser-Induced Smoke in Dermatologic Practice: A Survey to Explore Hazard Perceptions, Safety Measures and Unmet Needs.

Introduction: Inhalation of laser-induced smoke is a potential health hazard to exposed physicians and laser operators. To date, little is known about the perception of health hazards related to laser-induced smoke exposure among physicians and the actual use of safety measures to mitigate these risks. Methods: In May 2020, 514 members of the European Society for Lasers and Energy-Based Devices (ESLD) were invited by email to participate in an online survey. The survey comprised 16 questions including multiple-choice and open-ended questions. Results: Responses were received from 109 participants. The majority (90%) were aware of potential hazards and highlighted a desire for better protective measures (60%). A smoke evacuation system was frequently used with ablative lasers (66%) and fractional ablative lasers (61%), but less the case with non-ablative lasers (30%) and hair removal lasers (28%). The COVID-19 outbreak had no clear effect on the use of smoke evacuation systems. Prior to the COVID-19 outbreak, mainly surgical masks were used (40-57%), while high filtration masks (FFP1, FFP2 or FFP3) were used by only a small percentage (15-30%). Post COVID-19 outbreak, the use of high filtration masks increased significantly (54-66%), predominately due to an increase in the use of FFP2 masks. Reasons mentioned for inadequate protective measures were sparse knowledge, limited availability, discomfort, excessive noise, high room temperatures, and financial costs. Conclusion: While there is considerable awareness of the hazards of laser-induced smoke among physicians and laser operators, a substantial number of them do not use appropriate protective measures. The implementation of regulations on safety measures is hampered by sparse knowledge, limited availability, discomfort, excessive noise, financial issues, and high room temperatures.

Periocular rejuvenation using a unique non-ablative long-pulse 2940 nm Er:YAG laser.

The periocular region is challenging for cosmetic laser surgeons. Surgery and laser resurfacing have traditionally been used to correct periorbital lines and wrinkles. Although effective, the associated downtime with these methods has made many people reluctant to decide for such treatments. More recently, the non-ablative long-pulse 2940 nm Er:YAG laser is being used to improve the structure and function and hence the appearance of skin in the periorbital region. The objective of this study is to evaluate the safety and efficacy of long-pulse 2940 nm Er:YAG laser for non-ablative treatment of periorbital static wrinkles and skin laxity. This is a prospective analysis of 30 patients treated for periorbital rejuvenation using three sessions of non-ablative long-pulse Er:YAG laser over a 3-month period. All patients were assessed according to Fitzpatrick's classification of periorbital wrinkles to class I, II, or III and were treated with 2940 nm Er:YAG laser using a fluence of 3.75 J/cm2, a repetition rate of 1.7-2 Hz, and with the SMOOTH™ pulse mode (250 ms). The treatment sessions were performed on each patient, 4 weeks apart. Patient improvement was assessed before each laser session as well as at 12 months after the final treatment. Blind photographic evaluations were performed by three independent physicians using unlabeled before and after photos arranged in non-chronological order. Reviewers were asked to determine the before and after photos. Patients were asked to answer a questionnaire measuring satisfaction 4 weeks after each session, and to report any adverse reactions. There was statistically and clinically significant improvement in the Fitzpatrick classification of the periorbital wrinkles. Blinded evaluators correctly identified the before and after photos in all cases. All patients reported mild edema and erythema, which persisted for 1 to 2 days, and superficial peeling of the skin for 4 to 6 days after each laser treatment. No long-term adverse effects were reported. The non-ablative long-pulse 2940 nm Er:YAG laser seems to be a safe and effective treatment for periocular rejuvenation with minimal and tolerable adverse reaction. The improvement attained from the laser sessions was persisting after 1 year denoting the long-term efficacy of the procedure.

Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia.

Facial erythema is one of the most common outpatient complaints in dermatology. There are various causes of facial erythema and several devices are available for its treatment. Pulsed dye laser (PDL) and intense pulsed light (IPL) are the two common light devices used for these conditions. In this review, we evaluated the literature to assess efficacy of IPL versus PDL in facial erythema and telangiectasia. We searched published articles including clinical trials or reviews articles, case series, and case reports. Electronic databases (MEDLINE and PubMed) were searched to retrieve the articles. Reference lists of selected articles were also considered for the review. Articles published in English language until June 2021 were considered for this review.

Novel Management of Rhinophyma by Patterned Ablative 2940nm Erbium:YAG Laser.

INTRODUCTION: Rhinophyma is a cosmetic disorder that causes emotional distress if the symptoms are extensive or obvious enough. Treatment options range from topical antibiotics or isotretinoin, surgical resection, cryosurgery, electrocautery, dermabrasion and more recently laser therapy. With the limitations of surgical techniques, lasers gained popularity for treating rhinophyma. However, laser ablation is invasive and can lead to side effects and prolonged downtime. Fractional photothermolysis (FP) was introduced to overcome the limitations posed by conventional ablative lasers. To the best of our knowledge, there are no previous studies to evaluate the use of Er:YAG in an ablative mode with a fractional handpiece for the treatment of rhinophyma. AIM OF THE WORK: The goal of this study was to evaluate the efficacy and safety of fractional ablative 2940 nm Er:YAG laser for the treatment of mild to moderate rhinophyma. PATIENTS AND METHODS: Sixteen patients having mild to moderate rhinophyma were treated with fractional ablative 2940 nm Er:YAG laser. All patients received 4 laser treatments and were followed up over the following 3 months. An additional follow-up appointment 6 months after the last session was arranged to detect any signs of recurrence. OUTCOME MEASURES: Patient questionnaire was used to evaluate patient subjective satisfaction. Objective evaluation was performed by a blind assessment of clinical photographs that were taken before and 3 months after the final treatment by two independent blinded evaluators. RESULTS: Patient questionnaire taken 3 months after last treatment revealed that 8 patients (50%) were "very satisfied", 4 patients (25%) were satisfied, and 4 patients (25%) were somewhat satisfied. None of the patients assessed their results as not satisfying. CONCLUSION: In conclusion, the use of patterned ablative Er:YAG laser with a PS01 handpiece and parameters used in this study comprise an effective tool for treatment of mild to moderate rhinophyma with rapid postoperative recovery compared with conventional surgical procedures and other ablative lasers.

The Automatic Detection of Cognition Using EEG and Facial Expressions.

Detecting cognitive profiles is critical to efficient adaptive learning systems that automatically adjust the content delivered depending on the learner's cognitive states and skills. This study explores electroencephalography (EEG) and facial expressions as physiological monitoring tools to build models that detect two cognitive states, namely, engagement and instantaneous attention, and three cognitive skills, namely, focused attention, planning, and shifting. First, while wearing a 14-channel EEG Headset and being videotaped, data has been collected from 127 subjects taking two scientifically validated cognitive assessments. Second, labeling was performed based on the scores obtained from the used tools. Third, different shallow and deep models were experimented in the two modalities of EEG and facial expressions. Finally, the best performing models for the analyzed states are determined. According to the used performance measure, which is the f-beta score with beta = 2, the best obtained results for engagement, instantaneous attention, and focused attention are EEG-based models with 0.86, 0.82, and 0.63 scores, respectively. As for planning and shifting, the best performing models are facial expressions-based models with 0.78 and 0.81, respectively. The obtained results show that EEG and facial expressions contain important and different cues and features about the analyzed cognitive states, and hence, can be used to automatically and non-intrusively detect them.

Generic outcome set for the international registry on Laser trEAtments in Dermatology (LEAD): a protocol for a Delphi study to achieve consensus on what to measure.

INTRODUCTION: While laser technology has expanded the armamentarium of treatment for various skin diseases during the past years, heterogeneity in study outcomes hampers comparability and appropriate evidence synthesis. Part of these issues can be addressed by developing a generic outcome set. Using the Delphi method, this study aims to seek consensus between key stakeholders on relevant generic outcomes (what to measure) for implementation in the international registry on Laser trEAtments in Dermatology (LEAD). The registry is focused on collecting research data on various laser treatments for skin disorders. METHODS AND ANALYSIS: By reviewing the literature and involvement of key stakeholder groups and adult patients in need or after laser surgery and health professionals, a preliminary list of outcomes will be generated and categorised into domains. Using these outcomes, an international three-round Delphi study will be performed to rate the importance of outcomes in the selection of a generic outcome set. Participants are allowed to provide new outcomes to the preliminary list for revisions during the first Delphi round. Finally, results will be discussed during a consensus meeting to agree on generic outcomes to be used in the LEAD registry. ETHICS AND DISSEMINATION: An ethics approval was not applicable (W19_290 # 18.336). The study is registered with the Cochrane Skin Core OUtcome Set INitiative) and the Core Outcome Measures in Effectiveness Trials initiative. Procedures will be conducted according to the Declaration of Helsinki. The findings will be disseminated through peer-reviewed publications and conference presentations.

Gut Microbiota and the Alteration of Immune Balance in Skin Diseases: From Nutraceuticals to Fecal Transplantation.

The P.N.E.I. (Psycho-Neuro-Endocrine-Immunology) approach is represented by the interdisciplinary concept of bidirectional cross-talk between the psycho-neuro-endocrine and immune systems, which can influence the immune response. The well-known Gut-Brain Axis and the Gut-Skin Axis can be merged in a bigger network- the Gut-Brain-Skin Axis, with complex regulation by cytokines, neuro-peptides, neuro-hormones and another messenger (signalling) molecules and maybe the most important modulator of the Gut-Brain-Skin Axis/ the gut microbiota. The role of gut bacterial homeostasis is very important, and the homeostatic imbalance of the immune response may be a relevant etiologic/pathophysiologic factor for extra-intestinal and intestinal inflammatory, allergic and autoimmune diseases. The Low Dose Cytokines Medicine (LDM) is an innovative therapeutic approach. It is based on the most advanced knowledge in molecular biology and low dose pharmacology with the primary outcome. The SKA (Sequential Kinetic Activation) technology, codified and standardised by GUNA S.p.a. -Italy- makes the low doses of signalling molecules able to be active even below the minimum dose classically considered as effective and the significative efficacy of orally administered low-dose signalling molecules is the most representative aspect of LDM. The Physiologic Nutraceuticals and the Low Dose Medicine are two of the most promising approaches for the treatment of skin diseases based on the rebalance of the immune response and the recovery of gut dysbiosis.

Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars.

BACKGROUND: Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS. OBJECTIVE: The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS. PATIENTS AND METHODS: Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars' improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera. RESULTS: The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group. CONCLUSION: Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.

Efficacy and safety of long pulse 1064 and 2940 nm lasers in noninvasive lipolysis and skin tightening.

Noninvasive body shaping is becoming a growing demand. The aim of this study was to investigate the efficacy and safety of the combined treatments of 1064 nm Nd:YAG and 2940 nm Er:YAG in noninvasive lipolysis and skin tightening. Ten females were enrolled, and all women's side of the waist or the lower part of the abdomen were treated. In the first step, the 1064 nm Nd:YAG was used. As a second step, the 2940 nm Er:YAG laser was applied. Each woman was treated four times, once every 2 weeks. The effects were determined by comparative photo documentation, waist circumference measurement, two-dimensional B-mode ultrasonography and low-dose native computer tomography (CT), whereas body fat was monitored with bioelectric impedance. The tissue firmness was measured by ultrasound shear wave elastography. Combined laser treatment significantly reduced waist circumference and total body fat. Ultrasonography has revealed that the treatment considerably decreased fat thickness and improved skin stiffness in the treated region. Subcutaneous fat volume, measured by low-dose CT, displayed a moderate decrease in the waist region. The combined 1064 nm Nd:YAG and 2940 nm Er:YAG laser treatment results in the reduction of fat tissue and tightens the skin as confirmed by objective measurements.

Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study.

PURPOSE: The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO2 (Fr: CO2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions. PATIENTS AND METHODS: This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO2 laser, and combined Fr: CO2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months. RESULTS: A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO2 laser. CONCLUSION: According to our study, combined Fr: CO2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO2 alone showed poor improvement. Combined ablative Fr: CO2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.

Characterizing Focused Attention and Working Memory Using EEG.

Detecting the cognitive profiles of learners is an important step towards personalized and adaptive learning. Electroencephalograms (EEG) have been used to detect the subject's emotional and cognitive states. In this paper, an approach for detecting two cognitive skills, focused attention and working memory, using EEG signals is proposed. The proposed approach consists of the following main steps: first, subjects undergo a scientifically-validated cognitive assessment test that stimulates and measures their full cognitive profile while putting on a 14-channel wearable EEG headset. Second, the scores of focused attention and working memory are extracted and encoded for a classification problem. Third, the collected EEG data are analyzed and a total of 280 time- and frequency-domain features are extracted. Fourth, several classifiers were trained to correctly classify and predict three levels (low, average, and high) of the two cognitive skills. The classification accuracies that were obtained on 86 subjects were 84% and 81% for the focused attention and working memory, respectively. In comparison with similar approaches, the obtained results indicate the generalizability and suitability of the proposed approach for the detection of these two skills. Thus, the presented approach can be used as a step towards adaptive learning where real-time adaptation is to be done according to the predicted levels of the measured cognitive skills.

Fractional erbium-doped yttrium aluminum garnet laser-assisted drug delivery of hydroquinone in the treatment of melasma.

BACKGROUND: Melasma is a difficult-to-treat hyperpigmentary disorder. Ablative fractional laser (AFL)-assisted delivery of topically applied drugs to varied targets in the skin has been an area of ongoing study and research. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser as an assisted drug delivery for enhancing topical hydroquinone (HQ) permeation into the skin of melasma patients. PATIENTS AND METHODS: Thirty female patients with bilateral melasma were randomly treated in a split-face controlled manner with a fractional Er:YAG laser followed by 4% HQ cream on one side and 4% HQ cream alone on the other side. All patients received six laser sessions with a 2-week interval. The efficacy of treatments was determined through photographs, dermoscopic photomicrographs and Melasma Area Severity Index (MASI) score, all performed at baseline and at 12 weeks of starting therapy. The patient's level of satisfaction was also recorded. RESULTS: Er:YAG laser + HQ showed significantly better results (p<0.005) with regard to decrease in the degree of pigmentation as assessed on the 4-point scale than HQ alone. There was a significant decrease in MASI scores on Er:YAG laser + HQ side vs HQ side. Minor reversible side effects were observed on both sides. CONCLUSION: AFL-assisted delivery of HQ is a safe and effective method for the treatment of melasma.

Building Bridges through Science.

Science is ideally suited to connect people from different cultures and thereby foster mutual understanding. To promote international life science collaboration, we have launched "The Science Bridge" initiative. Our current project focuses on partnership between Western and Middle Eastern neuroscience communities.

Radiation Damage in XFEL: Case study from the oxygen-evolving complex of Photosystem II.

Structural changes induced by radiation damage in X-ray crystallography hinder the ability to understand the structure/function relationship in chemical reactions. Serial femtosecond crystallography overcomes this problem by exposing the sample to very short and intense laser pulse leading to measurement before destruction. Here we use molecular modeling to map the radiation damage during the 10-50 fs to the intensity, the energy and the time duration of the laser pulse on the oxygen-evolving complex (OEC) of photosystem II. In the model, the nuclei move classically in a fully quantum potential created by electron density under the effect of strong laser pulse in the Ehrenfest dynamics regime. The results show that the Mn-Mn and Mn-Ca distances are less affected by radiation damage due to the their heavy masses, while one µ-oxo bridge (O5) moves significantly. The radiation damage may induce conformational changes of the water ligands but only bond elongation for the amino acids ligands. These effects are relatively intensity independent from 1016 to 1017 W/cm2, but changes increase dramatically if the beam intensity is increased to 1018 W/cm2. In addition, the self amplified spontaneous emission (SASE) nature of the laser beam does not affect the dynamics of the ions.