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1.
J Dermatolog Treat ; 32(1): 78-83, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31076007

RESUMO

Background: Photodynamic therapy (PDT) is an approved and effective treatment for actinic keratosis (AK). The time of complete skin healing is estimated to range between 5 and 10 days, but the role of nutrition in influencing it has never been evaluated.Objective: The aim of this study was to compare the time of skin healing and side effects in omnivores and vegans treated with PDT for AK.Materials and methods: Thirty omnivore and thirty vegan patients, treated with PDT for AK, were enrolled. Side effects, according to local skin response (LSR) score, were compared after 3, 7, and 30 days; the time of complete skin healing was recorded.Results: At day 3, day 7, and day 30 post treatment, vegan group showed higher total LSR score (p = .008, p < .001, p < .001, respectively), highlighting higher edema and vesiculation at day 3 (p < .001, p = .002, respectively), erythema, desquamation, edema, and vesiculation at day 7 (p < .001, p < .001, p < .001, p < .001, respectively) and erythema and desquamation after 30 days (p < .001, p < .001, respectively). The difference of complete skin healing was statistically significant (p < .001).Conclusions: The present study suggests that diet may have a prognostic and predictive role on PDT outcomes in term of side effects and time of skin repair.


Assuntos
Dieta , Ceratose Actínica/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Idoso , Ácido Aminolevulínico/uso terapêutico , Eritema/etiologia , Feminino , Humanos , Ceratose Actínica/patologia , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Veganos
2.
J Nippon Med Sch ; 87(3): 110-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32655090

RESUMO

BACKGROUND: Cutaneous wound healing is a complex, dynamic physiological process. Traditional methods of promoting wound healing are not always effective. Consequently, alternative modalities, such as photodynamic therapy (PDT), are needed. We examined the effectiveness and underlying mechanisms of PDT in a murine model of acute wound healing. METHODS: Two excisional wounds were produced, one on each side of the midline, in C57bL/6J mice. Methyl 5-aminolevulinate hydrochloride (MAL) was applied to the right-side wound. After 1 to 3 hours of incubation, the wound was irradiated with red light. The left-side wound was not treated with MAL or red light. On Day 14, the wounds were excised and subjected to histological and immunohistochemical analysis. RESULTS: During the first week, no difference was seen between the two sides. However, at week 2, PDT-treated wounds exhibited delayed re-epithelialization. On Day 14, hematoxylin and eosin (HE) staining showed a continuous epithelial lining in untreated wounds. In contrast, PDT-treated wounds partially lacked epithelium in the wound bed. Masson's Trichrome (MTC) staining showed a thicker dermis and more collagen fibers and inflammatory cells in PDT-treated wounds than in untreated wounds. Immunohistochemical analyses showed significantly fewer CD31+ blood vessels and greater collagen III density in PDT-treated wounds than in untreated wounds. However, treated and untreated wounds did not differ in collagen I density. CONCLUSIONS: PDT delayed acute wound healing in a murine model of secondary intention wound healing.


Assuntos
Fotoquimioterapia/efeitos adversos , Fenômenos Fisiológicos da Pele , Cicatrização/efeitos da radiação , Animais , Colágeno/metabolismo , Camundongos Endogâmicos C57BL , Modelos Animais , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Pele/metabolismo , Fatores de Tempo , Cicatrização/fisiologia , Infecção dos Ferimentos
3.
Biochem Biophys Res Commun ; 526(1): 98-104, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32197838

RESUMO

Photodynamic therapy (PDT) is an effective oncotherapy and has been approved for clinical application. Unfortunately, its therapeutic efficacy is usually overshadowed by tumor angiogenesis. Thus, a detailed understanding of the tumor angiogenesis upon PDT is imperative. This study aimed to investigate the potential contribution and mechanism of P-21-activated kinase 1 (PAK1) in PDT-induced tumor angiogenesis. Firstly, we found that PAK1 was upregulated upon PDT and associated with tumor angiogenesis. Then, we elucidated the underlying molecular mechanism. Activation of PAK1 prevents hypoxia-inducible factor 1 alpha (HIF-1α) protein from ubiquitin-mediated degradation. Thereafter, HIF-1α accumulation results in the upregulation of vascular endothelial growth factor (VEGF), thus promoting tumor angiogenesis. More importantly, we determined that PAK1 knockdown effectually repressed tumor angiogenesis, which contributes to enhance the therapeutic effect of PDT. Together, PAK1 is a potential novel pharmaceutical target for inhibiting PDT-induced tumor angiogenesis, and PAK1 suppression in combination with PDT may be a potentially effective strategy for anti-tumor therapy.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Neovascularização Patológica/etiologia , Neovascularização Patológica/metabolismo , Fotoquimioterapia/efeitos adversos , Transdução de Sinais , Fator A de Crescimento do Endotélio Vascular/metabolismo , Quinases Ativadas por p21/metabolismo , Linhagem Celular Tumoral , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Complexo de Endopeptidases do Proteassoma/metabolismo , Proteólise , Ubiquitinação
4.
JAMA Ophthalmol ; 138(3): 251-259, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31917395

RESUMO

Importance: The EVEREST II trial showed that for patients with polypoidal choroidal vasculopathy (PCV), intravitreal ranibizumab in combination with verteporfin photodynamic therapy improves visual acuity relative to ranibizumab monotherapy. However, whether combination therapy is incrementally cost-effective relative to monotherapy during a lifetime is unclear. Objective: To assess the incremental cost-effectiveness of combination therapy compared with ranibizumab monotherapy in patients with PCV. Design, Setting, and Participants: This model-based, economic evaluation used 2018 unit cost data from a tertiary eye hospital in Singapore, first- and second-year outcomes and resource use data from a multicenter trial across various Asian countries (EVEREST II) to model a hypothetical cohort of patients with symptomatic PCV. Scenario analyses and deterministic and probabilistic sensitivity analyses were performed to examine uncertainty. Data were collected from October 2018 through April 2019 and analyzed from March through October 2019. Interventions: This model used data from the EVEREST II trial, in which all participants were given 0.5 mg of intravitreal ranibizumab once every 4 weeks for the first 3 months. Subsequent administration occurred as needed. For participants receiving combination therapy, standard fluence (50 J/cm3) photodynamic therapy with 6-mg/m2 verteporfin was administered once during the first 3 months and thereafter as needed. Main Outcomes and Measures: Incremental cost per quality-adjusted life-year (QALY) gained for combination therapy relative to monotherapy for patients with PCV. Results: In this model based on a cohort of 1000 patients aged 68 years, a patient with PCV incurred a total cost in Singapore dollars (SGD) of 92 327 (US $67 399) with combination therapy and SGD 92 371 (US $67 431) with monotherapy during a lifetime horizon, generating a modest cost savings of SGD 44 (US $32) per patient undergoing combination therapy. Lifetime QALYs were estimated to be 7.87 for combination therapy and 7.85 for monotherapy, for an incremental gain of 0.02 QALYs. Combination therapy remained cost-saving or cost-effective in all lifetime scenarios modeled, but during shorter time horizons and at lower monotherapy costs, it may not be cost-effective. Conclusions and Relevance: This study found combination therapy to be a dominant (more effective and less costly) strategy, being similar in costs and slightly more effective than ranibizumab monotherapy during a lifetime horizon. However, decreasing the time horizon to less than 10 years and/or reductions in the cost of monotherapy may result in combination therapy no longer being cost-effective.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/economia , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/economia , Custos de Medicamentos , Fotoquimioterapia/economia , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/economia , Ranibizumab/administração & dosagem , Ranibizumab/economia , Verteporfina/administração & dosagem , Verteporfina/economia , Idoso , Inibidores da Angiogênese/efeitos adversos , Ásia , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/fisiopatologia , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Injeções Intravítreas , Masculino , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ranibizumab/efeitos adversos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Verteporfina/efeitos adversos , Acuidade Visual/efeitos dos fármacos
6.
Indian J Ophthalmol ; 68(1): 224-226, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856532

RESUMO

Corneal collagen cross-linking (CXL) is an effective treatment for arresting progression in keratoconus cases. It is considered safe despite a few complications that have been recorded earlier. In this case series, we report a rare and late complication caused due to severe stromal thinning up to Descemet's membrane in three patients who underwent CXL 3 to 6 years back for keratoconus. Deep anterior lamellar keratoplasty (DALK) was then done for the affected eye with good outcomes. This case series highlights the possible late effects of UVA irradiation post CXL.


Assuntos
Colágeno/efeitos adversos , Substância Própria/patologia , Reagentes para Ligações Cruzadas/efeitos adversos , Lâmina Limitante Posterior/patologia , Ceratocone/tratamento farmacológico , Fotoquimioterapia/efeitos adversos , Adolescente , Topografia da Córnea , Feminino , Seguimentos , Humanos , Masculino , Índice de Gravidade de Doença , Acuidade Visual , Adulto Jovem
7.
J Cosmet Dermatol ; 19(1): 78-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31587493

RESUMO

BACKGROUND: Depending on disease severity, standard acne treatments can vary from topical to systemic therapy. However, poor compliance caused by adverse events and antibiotic resistance is a major cause of treatment failure. AIMS: To determine the effectiveness of photodynamic therapy (PDT) with intense pulsed light (IPL) in the treatment of acne when combined with a cream containing licochalcone A, L-carnitine and decanediol (so-called, 'active formulation') versus PDT alone. PATIENTS/METHODS: Twenty-nine volunteers, aged 21-39 years (26 women and 3 men, mean age 29.41 ± 5.24 years), with mild to severe facial acne, were enrolled. Each subject's face sides were randomized in a split-face manner to either receive PDT (IPL with a 400-720 nm cut-off filter, at 4 sessions with two-week intervals) combined with the active formulation cream twice daily for 10 weeks on one face side; or PDT and the vehicle cream on the other side, with the same treatment protocol. Reduction in acne quantity, melanin index and erythema index were assessed 2 weeks after the second treatment (day 28), 1 week after the fourth treatment (day 49), and 1 month after the fourth treatment (day 70). RESULTS: Compared to baseline, patients in the active formulation group demonstrated a faster onset of reduction in the number of lesions at 2 weeks after the second treatment (p=0.010 for inflammatory acne and p=0.001 for non-inflammatory acne). A significantly greater reduction in lesion count was observed in the active formulation group compared with the vehicle group at all timepoints of evaluation for noninflammatory acne (day 28, day 49, and day 70; p=0.003, 0.005 and 0.002 respectively), and at 1 month after the fourth treatment for inflammatory acne (p=0.036). Compared to the vehicle group, the melanin index of the active formulation group decreased significantly at 1 month after the fourth treatment (p=0.015). CONCLUSION: PDT is more effective in treating acne when combined with a topical cream containing licochalcone A, L-carnitine and decanediol, than PDT alone. Significant acne reduction and improvements in post-inflammatory hyperpigmentation were observed, which offers acne patients a better therapeutic option. It is a safe and effective combination treatment for patients with moderate and severe acne.


Assuntos
Acne Vulgar/tratamento farmacológico , Fotoquimioterapia/métodos , Creme para a Pele/administração & dosagem , Adulto , Carnitina/administração & dosagem , Carnitina/efeitos adversos , Chalconas/administração & dosagem , Chalconas/efeitos adversos , Método Duplo-Cego , Face , Álcoois Graxos/administração & dosagem , Álcoois Graxos/efeitos adversos , Feminino , Humanos , Masculino , Fotoquimioterapia/efeitos adversos , Creme para a Pele/efeitos adversos , Resultado do Tratamento , Adulto Jovem
8.
J Cosmet Dermatol ; 19(1): 10-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654468

RESUMO

BACKGROUND: Photodynamic therapy (PDT) has emerged as the effective new method to treat acne vulgaris. However, no meta-analysis has been published on PDT for acne vulgaris currently. OBJECTIVE: The current meta-analysis and systematic review were carried out to assess the safety and effect of PDT on treating acne vulgaris. METHODS: The electronic databases, including EMBASE, Cochrane Library, and MEDLINE, were systemically retrieved to identify relevant articles for meta-analysis. The primary outcome included mean percentage reduction in the inflammatory lesion count (MPRILC), while the secondary outcome included the total effective response (TER). RESULTS: Altogether 13 randomized controlled trials (RCTs) involving 701 subjects had been enrolled into the current meta-analysis. PDT had certain effect on acne vulgaris in terms of the outcomes of MPRILC (MD: 15.97, 95% CI: 11.93 to 20.00, P < .00001) and TER (RR: 1.55, 95% CI: 1.38-1.74, P < .00001). Totally, 6 articles had been evaluated to have a low bias risk overall. Results of sensitivity and subgroup analyses were similar to meta-analysis results, reflecting the result reliability in this meta-analysis. CONCLUSIONS: PDT is beneficial for improving the clinical efficacy of inflammatory acne vulgaris, which can be widely used to treat inflammatory acne vulgaris in clinic.


Assuntos
Acne Vulgar/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/administração & dosagem , Acne Vulgar/imunologia , Humanos , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Reprodutibilidade dos Testes , Resultado do Tratamento
9.
J Am Acad Dermatol ; 82(4): 862-868, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31525441

RESUMO

BACKGROUND: Blue light photodynamic therapy (PDT) is effective for actinic keratosis, but many patients experience stinging pain during illumination. OBJECTIVE: To compare a conventional regimen (1 hour of 5-aminolevulinic acid [ALA] preincubation, followed by blue light) versus a new modified regimen in which blue light is started immediately after ALA application. METHODS: A clinical trial with a bilaterally controlled, intrapatient study design was conducted with 23 patients. Topical 20% ALA was applied to the entire face and/or scalp. On 1 side of the body, blue light was started immediately and continued for either 30, 45, or 60 minutes (simultaneous PDT). On the contralateral side, the blue light began 1 hour after ALA application and lasted 1000 seconds (conventional PDT). Pain was evaluated on a scale from 0 to 10. Actinic keratosis lesion counts were determined by clinical examination and photography. RESULTS: All patients experienced significantly less pain during simultaneous illumination than during the conventional regimen. At 3 months after treatment, lesion clearance was nearly identical on the 2 sides, as determined by statistical testing of noninferiority ± 15% margin. LIMITATIONS: Although bilaterally controlled, the study was relatively small. Additional studies are recommended. CONCLUSION: The modified PDT regimen is essentially painless, yet it provides treatment efficacy similar to a conventional regimen.


Assuntos
Ácido Aminolevulínico/administração & dosagem , Dermatoses Faciais/tratamento farmacológico , Ceratose Actínica/tratamento farmacológico , Dor/prevenção & controle , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/administração & dosagem , Dermatoses do Couro Cabeludo/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Resultado do Tratamento
11.
J Cosmet Dermatol ; 19(2): 368-374, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31187937

RESUMO

BACKGROUND: Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) has been described as an effective treatment for severe acne. However, very little evidence exists on the optimal concentration of ALA used in PDT for severe acne. OBJECTIVES: To compare the efficacy and safety of PDT with 5% ALA vs 10% ALA in severe acne. METHODS: Twenty-three patients with severe facial acne were randomly assigned to receive PDT with 5% ALA or 10% ALA on the left or right side of the face. Four PDT sessions were conducted with a light dose of 96 J/cm2 . The reduction rates of lesion counts between the two groups were compared at the week-4 and week-12 follow-up visits. Effective rate at the week-12 visit was the primary clinical outcome. Pain and other side effects were evaluated at each visit. RESULTS: The decrease in inflammatory lesions in the 10% ALA group was greater than that in the 5% ALA group at both week-4 (79.2% vs 62.5%, P = 0.009) and week-12 follow-up visits (88.5% vs 78.3%, P = 0.018), while the decrease in noninflammatory lesion counts between the two groups was not statistically significant at each follow-up visit. The effective rate in the 10% ALA group was significantly higher than that in the 5% ALA group (95.7% vs 69.6%, P = 0.02). No significant difference was observed in pain scores between the two groups except in the first treatment session. CONCLUSIONS: Photodynamic therapy using 10% ALA was more effective for severe acne than PDT using 5% ALA.


Assuntos
Acne Vulgar/tratamento farmacológico , Ácidos Levulínicos/administração & dosagem , Dor/diagnóstico , Fotoquimioterapia/métodos , Acne Vulgar/diagnóstico , Administração Cutânea , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Face , Feminino , Seguimentos , Géis , Humanos , Ácidos Levulínicos/efeitos adversos , Masculino , Dor/etiologia , Medição da Dor , Fotoquimioterapia/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
12.
BMJ Case Rep ; 12(11)2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31727637

RESUMO

A patient with choroidal haemangioma in the right eye developed photodynamic therapy (PDT)-induced acute exudative maculopathy within a week of being subjected to PDT (for treating the choroidal haemangioma). The condition was managed with an intravitreal injection of bevacizumab and responded well to therapy.


Assuntos
Neoplasias da Coroide/tratamento farmacológico , Hemangioma/tratamento farmacológico , Degeneração Macular/induzido quimicamente , Fotoquimioterapia/efeitos adversos , Adulto , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Humanos , Degeneração Macular/tratamento farmacológico , Masculino , Baixa Visão/etiologia
13.
Future Microbiol ; 14: 1199-1205, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31625444

RESUMO

Aim: The objective of this study was to investigate the possible synergy between doxycycline and photodynamic therapy against Helicobacter pylori and to evaluate the possible side effects on adenocarcinoma gastric cells with and without protoporphyrin IX. Materials & methods: Three H. pylori strains (ATCC 700392, 43504 and 49503) were grown on solid medium either with, or without, doxycycline at subinhibitory concentrations, and irradiated for 10, 20 and 30 minutes with a 400 nm-peaked light source. The phototoxicity tests on AGS cells were evaluated by MTT assay. Results: The photodynamic therapy and doxycycline combination showed an antibacterial synergistic effect with no significant toxicities. Conclusion: The synergistic treatment could be considered as an interesting therapeutic option.


Assuntos
Antibacterianos/farmacologia , Doxiciclina/farmacologia , Helicobacter pylori/efeitos dos fármacos , Fotoquimioterapia/métodos , Protoporfirinas/farmacologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos da radiação , Dermatite Fototóxica , Sinergismo Farmacológico , Mucosa Gástrica/citologia , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/efeitos da radiação , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/radioterapia , Humanos , Testes de Sensibilidade Microbiana , Fotoquimioterapia/efeitos adversos
16.
Int J Mol Sci ; 20(18)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31491857

RESUMO

The long wavelength absorbing photosensitizer (PS) is important in allowing deeper penetration of near-infrared light into tumor tissue for photodynamic therapy (PDT). A suitable drug delivery vehicle is important to attain a sufficient concentration of PS at the tumor site. Presently, we developed graphene oxide (GO) nanoparticles containing long wavelength absorbing PS in the form of the chlorin derivative purpurin-18-N-ethylamine (maximum absorption wavelength [λmax] 707 nm). The GO-PS complexes comprised a delivery system in which PS was loaded by covalent and noncovalent bonding on the GO nanosheet. The two GO-PS complexes were fully characterized and compared concerning their synthesis, stability, cell viability, and dark toxicity. The GO-PS complexes produced significantly-enhanced PDT activity based on excellent drug delivery effect of GO compared with PS alone. In addition, the noncovalent GO-PS complex displayed higher photoactivity, corresponding with the pH-induced release of noncovalently-bound PS from the GO complex in the acidic environment of the cells. Furthermore, the noncovalently bound GO‒PS complex had no dark toxicity, as their highly organized structure prevented GO toxicity. We describe an excellent GO complex-based delivery system with significantly enhanced PDT with long wavelength absorbing PS, as well as reduced dark toxicity as a promising cancer treatment.


Assuntos
Grafite/química , Nanopartículas/química , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Porfirinas/química , Sobrevivência Celular/efeitos dos fármacos , Humanos , Concentração de Íons de Hidrogênio , Estrutura Molecular , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/química , Oxigênio Singlete , Análise Espectral
18.
Photodiagnosis Photodyn Ther ; 27: 385-387, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301435

RESUMO

Kerion refers to the severe inflammatory reaction which occurs in some cases of fungal infection of the hair or hair follicles. Successful treatment is a challenge for the small number of kerion patients who show poor efficacy of oral antifungal agents. In recent years, photodynamic therapy (PDT) has been proven to be a useful treatment for a variety of fungal infections. In this case report, a 9-year-old Chinese girl presented with erythema, pustular and tender plaques on her scalp for 2 month. The diagnosis of kerion was made based on clinical features and positive mycological findings. After the disease relapsed with oral administration of itraconazole for 6 weeks, she was successfully cured by three sessions of ALA-PDT combined with itraconazole. This case report suggests that ALA-PDT provides a good alternative and adjutant choice for kerion with safety, less side effects, and good repeatability.


Assuntos
Ácido Aminolevulínico/uso terapêutico , Dermatomicoses/tratamento farmacológico , Itraconazol/uso terapêutico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Ácido Aminolevulínico/efeitos adversos , Criança , Quimioterapia Combinada , Feminino , Humanos , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Couro Cabeludo
19.
Clin Cancer Res ; 25(19): 5766-5776, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31266832

RESUMO

PURPOSE: Vertebroplasty (VP) and balloon kyphoplasty (KP) are minimally invasive stabilization procedures for pathologic vertebral compression fractures (VCF). Concurrent administration of photodynamic therapy (PDT) as a tumor-ablative modality has yet to be studied in humans as a potential complement to improved mechanical stability that is afforded by vertebral cement augmentation (VCA). PATIENTS AND METHODS: This first-in-human trial used a single 6 mg/m2 dose of the clinical photosensitizer Visudyne with escalating laser light doses. Following a cohort of light-only controls (n = 6), the drug and light treatment groups (n = 6 each) were 50, 100, 150, and 200 J/cm. VCA was performed within 15 minutes following PDT. Patients were clinically reviewed at 1 and 6 weeks. The primary outcome measure was safety from a neurologic perspective. RESULTS: Thirty patients comprising a variety of primary tumors were treated with PDT and either KP or VP. Vertebral PDT was technically feasible and delivered in all study patients. No dose groups showed significant increases in pain as defined by the generic SF-36 as well as disease-specific EORTC-QLQ-BM22 and EORTC-QLQ-C15-PAL questionnaires. The 50 and 100 J/cm groups showed the most significant pain reduction (P < 0.05). Twelve (40%) patients experienced complications during the study including 3 patients with further vertebral fracture progression by 6 weeks despite VCA. No complications were directly attributed to PDT. CONCLUSIONS: Using the parameters described, vertebral PDT as an adjunct to VCA is safe from a pharmaceutical and neurologic perspective. The results of this trial motivate scale-up study evaluating potential PDT efficacy in vertebral metastatic treatment.


Assuntos
Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Neoplasias/tratamento farmacológico , Fotoquimioterapia/métodos , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/patologia , Adulto , Idoso , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Cifoplastia/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias/cirurgia , Fotoquimioterapia/efeitos adversos , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos
20.
Molecules ; 24(13)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31277423

RESUMO

Antibiotics are commonly used to control, treat, or prevent bacterial infections, however bacterial resistance to all known classes of traditional antibiotics has greatly increased in the past years especially in hospitals rendering certain therapies ineffective. To limit this emerging public health problem, there is a need to develop non-incursive, non-toxic, and new antimicrobial techniques that act more effectively and quicker than the current antibiotics. One of these effective techniques is antibacterial photodynamic therapy (aPDT). This review focuses on the application of porphyrins in the photo-inactivation of bacteria. Mechanisms of bacterial resistance and some of the current 'greener' methods of synthesis of meso-phenyl porphyrins are discussed. In addition, significance and limitations of aPDT are also discussed. Furthermore, we also elaborate on the current clinical applications and the future perspectives and directions of this non-antibiotic therapeutic strategy in combating infectious diseases.


Assuntos
Antibacterianos/farmacologia , Fotoquimioterapia , Porfirinas/farmacologia , Animais , Antibacterianos/efeitos adversos , Antibacterianos/química , Bactérias/efeitos dos fármacos , Humanos , Luz , Fotoquimioterapia/efeitos adversos , Porfirinas/efeitos adversos , Porfirinas/química
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