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1.
Zhonghua Shao Shang Za Zhi ; 37(4): 386-390, 2021 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-33887886

RESUMO

Scars are the result of abnormal repair of skin tissue trauma. Recently, fractional laser is more and more widely used in the treatment of scars, but its mechanism is not clear. Studies have shown that fractional laser could produce multiple microthermal zones in target skin, induce wound repair responses, affect the function of epidermal and dermal cells, induce changes in blood vessels and collagens, and change the expression of heat shock proteins, microRNA, matrix metalloproteinases, cytokines such as transforming growth factor ß, basic fibroblast growth factor, and facilitate drug delivery, thus achieving the effect of treating scars. This article reviews the mechanism of fractional laser in treating scars from three aspects, including the tissue and cell mechanism, molecular mechanism, and drug delivery.


Assuntos
Cicatriz , Lasers de Gás , Cicatriz/patologia , Sistemas de Liberação de Medicamentos , Humanos , Pele/patologia
2.
Cochrane Database Syst Rev ; 3: CD006746, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33755197

RESUMO

BACKGROUND: In at least a third of primary angle closure cases, appositional angle closure persists after laser peripheral iridotomy, and further intervention may be considered. Laser peripheral iridoplasty (LPIp) can be used in treating chronic angle closure when angle closure persists after laser peripheral iridotomy. Previous reviews have found insufficient data to determine its clinical effectiveness, compared to other interventions. This is an update of a Cochrane Review first published in 2008 and updated in 2012. It examines all studies to date to establish whether LPIp shows any effectiveness over other available treatment options. OBJECTIVES: To assess the effectiveness of laser peripheral iridoplasty in the treatment of people with chronic angle closure, when compared to laser peripheral iridotomy, medical therapy or no further treatment. SEARCH METHODS: We searched various electronic databases. The date of the search was 20 December 2020. SELECTION CRITERIA: We included only randomised controlled trials (RCTs) assessing the use of LPIp in cases of suspected primary angle closure (PACS), confirmed primary angle closure (PAC), or primary chronic angle-closure glaucoma (PACG). We applied no restrictions with respect to gender, age or ethnicity of participants. Trials evaluating LPIp for acute attacks of angle closure were not eligible. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two authors independently assessed studies for risk of bias using Cochrane's 'risk of bias' tool. We collected adverse effects information from the trials. MAIN RESULTS: We included four RCTs involving 252 participants (276 eyes). In total, three different methods of intervention were used and 15 outcomes reported, with different time points. We used narrative synthesis to describe the majority of the findings, as meta-analysis was only possible for a limited number of outcomes due to the variation in study design and outcomes assessed. Study Characteristics Participants were adults recruited from outpatient settings in the UK, Singapore, China and Korea with either PACS, PAC or PACG. All studies compared argon LPIp (as either a primary or secondary procedure) to an alternative intervention or no further treatment. Three studies were of parallel group design, and one within-person, randomised by eye. All studies showed elements of high risk of bias. Due to the nature of the intervention assessed, a lack of masking of both participants and assessors was noted in all trials. Findings Laser peripheral iridoplasty with iridotomy versus iridotomy alone as a primary procedure Two RCTs assessed the use of argon LPIp as a primary procedure with peripheral iridotomy, compared with peripheral iridotomy alone. However, neither study reported data for the primary outcome, disease progression. Argon LPIp showed no evidence of effect on: final mean intraocular pressure (IOP) at 3 months and 12 months (mean difference (MD) 0.39 mmHg, 95% confidence interval (CI) -1.07 to 1.85; I2 = 38%; 2 studies, 174 participants; low-certainty evidence); further surgical or laser intervention at 12 months (risk ratio (RR) 1.21, 95% CI 0.66 to 2.21; 1 study, 126 participants; low-certainty evidence); or mean number of additional medications required at 12 months (MD 0.10, 95% CI -0.34 to 0.54; 1 study, 126 participants; low-certainty evidence). Complications were assessed at 3 to 12 months (2 studies, 206 participants; low-certainty evidence) and found to be mild and uncommon, with comparable levels between groups. The only severe complication encountered was one case of malignant glaucoma in one study's argon LPIp group. Quality of life measures were not assessed. In the other study, investigators found that argon LPIp showed no evidence of effect on final mean anterior segment optical coherence tomography (AS-OCT) measurements, including anterior chamber depth (MD 0.00 mm, 95% CI -0.10 to 0.10; 24 participants, 48 eyes; very low-certainty evidence). Laser peripheral iridoplasty as a secondary procedure versus no treatment One RCT assessed the use of argon LPIp as a secondary procedure compared with no further treatment in 22 participants over three months. Disease progression, additional medications required, complications, further surgical or laser intervention, and quality of life outcomes were not assessed. There was only very low-certainty evidence regarding final maximum IOP value (MD -1.81 mmHg, 95% CI -3.11 to -0.51; very low-certainty evidence), with no evidence of effect on final minimum IOP values (MD -0.31 mmHg, 95% CI -1.93 to 1.31; very low-certainty evidence). The evidence is very uncertain about the effect of argon LPIp on AS-OCT parameters. The trial did not report AS-OCT measurements for the control group. Laser peripheral iridoplasty as a secondary procedure versus medication One RCT assessed the use of argon LPIp as a secondary procedure compared with travoprost 0.004% in 80 participants over 12 months. The primary outcome of disease progression was reported for this method: argon LPIp showed no evidence of effect on mean final cup/disk ratio (MD -0.03, 95% CI -0.11 to 0.05; low-certainty evidence). Argon LPIp showed no evidence of effect for: mean change in IOP (MD -1.20 mmHg, 95% CI -2.87 to 0.47; low-certainty evidence) or mean number of additional medications (MD 0.42, 95% CI 0.23 to 0.61; low-certainty evidence). Further surgical intervention was required by one participant in the intervention group alone, with none in the control group  (low-certainty evidence). No serious adverse events were reported, with mild complications consisting of two cases of 'post-laser IOP spike' in the argon LPIp group. Quality of life measures were not assessed. The evidence is very uncertain about the effect of argon LPIp on AS-OCT parameters. The trial did not report AS-OCT measurements for the control group. Adverse events Availability of data were limited for adverse effects. Similar rates were observed in control and intervention groups, where reported. Serious adverse events were rare. AUTHORS' CONCLUSIONS: After reviewing the outcomes of four RCTs, argon LPIp as an intervention may be no more clinically effective than comparators in the management of people with chronic angle closure. Despite a potential positive impact on anterior chamber morphology, its use in clinical practice in treating people with chronic angle closure is not supported by the results of trials published to date. Given these results, further research into LPIp is unlikely to be worthwhile.


Assuntos
Glaucoma de Ângulo Fechado/cirurgia , Iris/cirurgia , Terapia a Laser/métodos , Adulto , Viés , Doença Crônica , Glaucoma de Ângulo Fechado/tratamento farmacológico , Humanos , Pressão Intraocular , Terapia a Laser/estatística & dados numéricos , Lasers de Gás/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Ann R Coll Surg Engl ; 103(4): 263-271, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33557701

RESUMO

INTRODUCTION: Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. MATERIALS AND METHODS: Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. RESULTS: Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. CONCLUSION: Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.


Assuntos
Ácido Aminolevulínico/análogos & derivados , Carcinoma Basocelular/terapia , Procedimentos Cirúrgicos Dermatológicos/métodos , Lasers de Gás/uso terapêutico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/economia , Ácido Aminolevulínico/uso terapêutico , Carcinoma Basocelular/economia , Terapia Combinada , Análise Custo-Benefício , Procedimentos Cirúrgicos Dermatológicos/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/economia , Fármacos Fotossensibilizantes/economia , Estudos Retrospectivos , Neoplasias Cutâneas/economia , Resultado do Tratamento , Reino Unido
4.
Laryngoscope ; 131(3): E719-E723, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33593035

RESUMO

OBJECTIVES: Tracheal A-frame deformity is a known consequence of tracheostomy that may lead to obstruction after decannulation. The goal of this study is to demonstrate the feasibility and success of endoscopic carbon dioxide (CO2 ) laser-assisted tracheoplasty of tracheal A-frame deformity in children. METHODS: Retrospective case series of symptomatic children with tracheal A-frame deformity with no other site of airway obstruction (2016-2018). All patients underwent CO2 -laser assisted endoscopic resection tracheoplasty. RESULTS: Eight patients (six male) were included with a median age of 15.4 (IQR 12.3-17.9) years. Patients had a median of two previous open airway surgeries (IQR 1-2.5) and all patients had a history of tracheostomy with successful decannulation. Tracheal A-frame deformity presented as dyspnea on exertion for all patients (n = 8, 100%). Obstructive sleep apnea was confirmed for all patients who underwent polysomnography (4/4, 100%). Median interval from decannulation to development of symptoms was 8.7 years (IQR 5.8-9.3). All patients sized with an age-appropriate endotracheal tube despite the deformity. Endoscopic A-frame tracheoplasty was successful for 7/8 (87.5%) patients and was performed with overnight observation for these patients (8/8, 100%). Unilateral A-frame tracheoplasty was performed successfully for five patients (62.5%), bilateral A-frame tracheoplasty was performed successfully for two patients (25.0%), and one patient (12.5%) did not have complete resolution of symptoms after bilateral A-frame tracheoplasty due to multi-level airway obstruction. CONCLUSIONS: CO2 laser-assisted tracheoplasty is an innovative endoscopic technique to relieve symptoms of airway obstruction for selected patients with tracheal A-frame deformity although avoiding the morbidity and hospital stay duration associated with tracheal resection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E719-E723, 2021.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Endoscopia/métodos , Lasers de Gás/uso terapêutico , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/anormalidades , Adolescente , Extubação/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Traqueia/cirurgia , Traqueostomia/efeitos adversos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(3): e23732, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545938

RESUMO

BACKGROUND: This study is to assess the effectiveness of CO2 laser therapy (COLT) in treating patients with acne depressed scar (ADS). METHODS: Relevant randomized controlled trials will be checked by search the electronic databases of Cochrane Library, PUBEMD, EMBASE, Web of Science, Allied and Complementary Medicine Database, VIP Database, CBM database, and China National Knowledge Infrastructure. All potential randomized controlled trials of COLT for patients with ADS will be identified by 2 independent authors by searching all sources from inception to present. Two authors will independently undertake literature selection, data collection and study quality assessment. Any divergences between 2 authors will be settled down by a third author through discussion. RevMan 5.3 software will be used for statistical analysis. RESULTS: This study will assess the effectiveness of COLT for patients with ADS. CONCLUSIONS: This study may provide helpful evidence to determine whether COLT is an effective intervention for patients with ADS. STUDY REGISTRATION: OSF (osf.io/m9ghv).


Assuntos
Acne Vulgar/radioterapia , Humanos , Terapia a Laser , Lasers de Gás , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
6.
Zhonghua Shao Shang Za Zhi ; 37(1): 49-56, 2021 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-33499569

RESUMO

Objective: To explore the clinical effects of fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn. Methods: From April 2018 to April 2019, 12 patients with hypertrophic scar after burn who met the inclusion criteria were admitted to the Department of Plastic Surgery and Burns of Xuzhou Renci Hospital, and were included in this prospective randomized controlled clinical study. There were 7 males and 5 females with age of (32±11) years and scar area of (612±195) cm(2). One scar was selected from each patient and divided into two equal area scars, and they were divided into combined treatment group and laser alone group with 12 scars in each group according to the random number table. The scar in laser alone group was only treated with fractional carbon dioxide laser, while the scar in combined treatment group was injected with autologous granular fat and then treated with fractional carbon dioxide laser. Scars in the two groups were treated once every 2 months, totally 3 times. Before the first treatment and 6 months after the last treatment, the scars in the two groups were evaluated by modified Vancouver Scar Scale (mVSS), hematoxylin-eosin staining and color Doppler ultrasound. Six months after the last treatment, the curative effect of scars in the two groups was evaluated, and the effective number of scar treatment was calculated. The adverse reactions during the whole treatment were recorded. Data were statistically analyzed with independent sample t test, paired sample t test, and McNemar exact probability method test. Results: Six months after the last treatment, the mVSS score of scars in combined treatment group was (4.5±0.4) points, which was significantly lower than (7.8±0.6) points in laser alone group (t=10.000, P<0.01). Six months after the last treatment, the mVSS scores of scars in combined treatment group and laser alone group were significantly lower than those before the first treatment ((13.5±0.7) and (13.8±0.6) points, t=8.805, 9.010, P<0.01). The effective number of scar treatment in combined treatment group was significantly more than that in laser alone group (P<0.05). There was no scar aggravation, infection, or other adverse reactions during the treatment of scars in both groups. Before the first treatment, the scars in both groups had large collagen, disordered arrangement, proliferation of capillaries, infiltration of some inflammatory cells, and disappearance of skin appendages. Six months after the last treatment, the scar collagen in both groups was sparse and orderly arranged, and the vascular density was reduced. The improvement of scars in combined treatment group was more obvious than that of laser alone group. Six months after the last treatment, the scar thickness in combined treatment group was significantly smaller than that in laser alone group (t=2.657, P<0.05). Before the first treatment, the blood flow of scars in both groups was abundant; 6 months after the last treatment, the blood flow of scars in combined treatment group was significantly less than that in laser alone group. Conclusions: Fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn can significantly reduce the pain and itching symptoms of scar, and improve the thickness, texture, and congestion of scar. The combined treatment has synergistic effect and less adverse reactions, providing a more effective treatment for patients with hypertrophic scar.


Assuntos
Queimaduras , Cicatriz Hipertrófica , Lasers de Gás , Adulto , Queimaduras/complicações , Cicatriz , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/patologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
7.
BMC Oral Health ; 21(1): 45, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509189

RESUMO

BACKGROUND: The tongue has been identified as a high-risk site for malignant transformation of oral leukoplakia. The purpose of this study was to investigate the clinicopathological characteristics and treatment outcomes of the dorsal and ventrolateral tongue leukoplakia. METHODS: Demographic data and pathological results of patients who underwent carbon dioxide laser surgery for tongue leukoplakia from 2002 to 2019 were retrospectively reviewed and analyzed statistically. RESULTS: Of the 111 patients enrolled, 80 were males and 31 females, with a mean age of 51.86 ± 11.84 years. The follow-up time was 3.74 ± 4.19 years. Fifteen patients had a postoperative recurrence (13.51%). Four (3.6%) patients developed malignant transformation. Annual transformation rate was 4.03%. There were no differences in the time to develop carcinoma (3.19 ± 1.94 vs. 3.51 ± 2.12 years, P = 0.83), overall cumulative malignant transformation rates (7.41% vs. 2.25%, P = 0.12), and annual transformation rates (2.32% vs. 0.64%, P = 0.099). The prevalence of the ventrolateral tongue leukoplakia was higher than that of the dorsal tongue leukoplakia (P < 0.001). The results of multivariate logistic regression analysis showed that the degree of pathology was the only independent prognostic factor related to postoperative malignant transformation (P = 0.045). CONCLUSIONS: Dorsal tongue leukoplakia is not as frequently encountered clinically as ventrolateral tongue leukoplakia. The response of the dorsal tongue and ventrolateral tongue leukoplakia to laser therapy of are comparable in postoperative recurrence and postoperative malignant transformation. Clinicians should take a more aggressive attitude toward oral tongue leukoplakia with higher grade of dysplasia.


Assuntos
Lasers de Gás , Adulto , Transformação Celular Neoplásica , Feminino , Humanos , Lasers de Gás/uso terapêutico , Leucoplasia Oral/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Língua/cirurgia , Resultado do Tratamento
8.
Int J Pharm ; 595: 120242, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33484919

RESUMO

Platelet-rich plasma (PRP) is rich in cytokines and growth factors and is a novel approach for tissue regeneration. It can be used for skin rejuvenation but the large molecular size of the actives limits its topical application. In this study, low-fluence laser-facilitated PRP was delivered to evaluate its effect on absorption through the skin, infection-induced wound, and photoaging. The PRP permeation enhancement was compared for two ablative lasers: fractional (CO2) laser and fully-ablative (Er:YAG) laser. In the Franz cell experiment, pig skin was treated with lasers with superficial ablation followed by the application of recombinant cytokines, growth factors, or PRP. The transport of interferon (IFN)-γ and tumor necrosis factor (TNF)-α was negligible in intact skin and stratum corneum (SC)-stripped skin. Both lasers significantly elevated skin deposition of IFN-γ and TNF-α from PRP, and fully-ablative laser showed a higher penetration enhancement. A similar tendency was found for vascular endothelial growth factor and epidermal growth factor. Er:YAG laser-exposed skin displayed 1.8- and 3.9-fold higher skin deposition of platelet-derived growth factor (PDGF)-BB and transforming growth factor (TGF)-ß1 from PRP, respectively. According to the confocal images, both laser interventions led to an extensive and deep distribution of IFN-γ and PDGF-BB in the skin. In the in vivo methicillin-resistant Staphylococcus aureus (MRSA) infection model, CO2 laser- and Er:YAG laser-assisted PRP delivery reduced bacterial load from 1.8 × 106 to 5.9 × 105 and 1.4 × 104 colony-forming units, respectively. The open wound induced by MRSA was closed by the laser-assisted PRP penetration. In the mouse photoaging model, elastin and collagen deposition were fully restored by combined PRP and full-ablative laser but not by PRP alone and PRP combined with fractional laser. Laser-facilitated PRP delivery even with a low fluence setting can be considered a promising strategy for treating some dermatological disorders.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Staphylococcus aureus Resistente à Meticilina/efeitos da radiação , Plasma Rico em Plaquetas/metabolismo , Envelhecimento da Pele/efeitos da radiação , Dermatopatias/terapia , Pele/efeitos da radiação , Infecções Cutâneas Estafilocócicas/terapia , Administração Cutânea , Animais , Terapia Combinada , Citocinas/farmacocinética , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/farmacocinética , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Pele/diagnóstico por imagem , Pele/efeitos dos fármacos , Pele/metabolismo , Absorção Cutânea/efeitos da radiação , Envelhecimento da Pele/efeitos dos fármacos , Suínos , Cicatrização/efeitos dos fármacos , Cicatrização/efeitos da radiação
9.
Khirurgiia (Mosk) ; (1): 55-61, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395513

RESUMO

OBJECTIVE: To develop the optimized complex programs, including general magnetotherapy, fractional microablative therapy with a CO2 laser, electromyostimulation with biofeedback of the pelvic floor muscles, and a special exercise therapy complex in late rehabilitation programs for women of different age after reconstructive plastic surgery for rectocele. MATERIAL AND METHODS: There were 200 women of childbearing, peri- and menopausal age with rectocele grade II-III and 20 healthy women of comparable age. All patients were divided into 4 groups by 50 womes: main group, two comparison groups and control group. Surgical treatment of rectocele was followed by long-term postoperative rehabilitation including symptomatic therapy, general magnetotherapy, and electromyostimulation with biofeedback of the pelvic floor muscles, intra-vaginal fractional microablative therapy with a CO2 laser and special complex of therapeutic physical education. RESULTS: General magnetotherapy in early (1 day) postoperative period and complex rehabilitation in long-term postoperative period (within a month after surgery) including 2 procedures of intra-vaginal microablative fractional therapy with carbon dioxide laser, electromyostimulation with biological connection of the pelvic floor muscles and special complex of therapeutic physical education ensured more significant improvement of uterine blood flow regardless age and baseline disorders in the uterine arteries in patients with rectocele. In our opinion, this is primarily due to vasoactive effects of general magnetotherapy, recovery of circulation via relief of spasm in the arteries and arterioles, improved vein contractility and venous outflow. These processes combined with electrical stimulation and therapeutic exercises of pelvic floor muscle followed by their reinforcement, as well as fractional microablative therapy ensured significant vascular effect.


Assuntos
Lasers de Gás , Terapia de Campo Magnético , Distúrbios do Assoalho Pélvico/reabilitação , Retocele/reabilitação , Retocele/cirurgia , Útero/irrigação sanguínea , Técnicas de Ablação , Fatores Etários , Biorretroalimentação Psicológica , Terapia por Estimulação Elétrica , Terapia por Exercício , Feminino , Humanos , Lasers de Gás/uso terapêutico , Diafragma da Pelve/irrigação sanguínea , Diafragma da Pelve/inervação , Distúrbios do Assoalho Pélvico/cirurgia , Gravidez , Procedimentos Cirúrgicos Reconstrutivos
10.
Maturitas ; 144: 37-44, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33358206

RESUMO

PURPOSE: The objectives of this study were to evaluate the feasibility and efficacy of fractional CO2 laser therapy in gynecologic cancer survivors. METHODS: This was a pilot, multi-institutional randomized sham-controlled trial of women with gynecologic cancers with dyspareunia and/or vaginal dryness. Participants were randomized to fractional CO2 laser treatment or sham laser treatment. The primary aim was to estimate the proportion of patients who had improvement in symptoms based on the Vaginal Assessment Scale (VAS). Secondary aims included changes in sexual function assessed using the Female Sexual Functioning Index (FSFI) and urinary symptoms assessed using the the Urinary Distress Inventory (UDI-6). RESULTS: Eighteen women participated in the study, ten in the treatment arm and eight in the sham arm. The majority of participants had stage I (n = 11, 61.1 %) or II (n = 3, 16.7 %) endometrial cancer with adenocarcinoma histology (n = 9, 50 %). In total, 15 (83.3 %) of the participants completed all treatments and follow-up visit. There was no difference in the change in the median VAS score from baseline to follow-up. However, there was an improvement in change in the median total FSFI score with treatment compared with sham (Δ 6.5 vs -0.3, p = 0.02). The change in the median UDI-6 score was lower in the treatment arm (Δ -14.6 vs -2.1, p = 0.17), but this was not statistically significant. There were no reported serious adverse events. CONCLUSIONS: Fractional CO2 laser therapy is feasible in gynecologic cancer survivors, with preliminary evidence of safety. In addition, there was preliminary evidence of improvement in sexual function compared with sham treatment. Clinicaltrial.gov Identifier: NCT03372720 (OSU-17261; NCI-2017-02051).


Assuntos
Dióxido de Carbono/uso terapêutico , Doenças Urogenitais Femininas/cirurgia , Terapia a Laser , Lasers de Gás , Adulto , Idoso , Sobreviventes de Câncer , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Projetos Piloto , Método Simples-Cego , Síndrome , Vagina/cirurgia
11.
J Dermatolog Treat ; 32(1): 73-77, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31172821

RESUMO

Background: It is anticipated that the combined treatments of ablative laser and human stem cell-conditioned media produce the synergistic effects.Objectives: To investigated the effects of human stem cell-conditioned media (HSCM) as a post-procedural agent after fractional CO2 laser procedure in patients with atrophic acne scars and skin pores. Method: Both cheeks of 15 subjects were treated with a fractional CO2 laser. HSCM was randomly applied to one of the resurfacing sites (T) and normal saline was applied to the other site as a control (C). During the next six days, a solution containing 80% HSCM and hyaluronic acid (HA) was applied on the treated side (T) and HA alone was applied to the control side (C). Scar volume and erythema were objectively evaluated using an Antera 3D® CS. Result: After two months, the scar volume was reduced by 23.5% (T) versus 15.0% (C) (p = .143) and the volume of the skin pores was reduced by 37.6% (T) versus 15.9% (C) (p = .006), while the erythema was increased by 2.8% (T) versus 3.1% (C) (p = .934). Atrophic scar and the skin pores in the HSCM-applied area improved by at least 15.0% after a single treatment session, suggesting better results compared with the control side.Conclusion: HSCM may augment the regenerative effects of fractional CO2 laser.


Assuntos
Cicatriz/radioterapia , Meios de Cultivo Condicionados/farmacologia , Lasers de Gás/uso terapêutico , Pele/efeitos dos fármacos , Acne Vulgar/complicações , Adulto , Idoso , Cicatriz/etiologia , Eritema/etiologia , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Lasers de Gás/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Pessoa de Meia-Idade , Pele/patologia , Células-Tronco/citologia , Células-Tronco/metabolismo , Resultado do Tratamento , Adulto Jovem
12.
J Dermatolog Treat ; 32(1): 120-123, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31173504

RESUMO

Divided or kissing nevi are a rare clinical variant of congenital melanocytic nevi developing in adjacent areas of the skin that undergo cleavage during embryogenesis. Penile lesions are even rarer, with only few cases described in the literature. Typically, they present as two opposing dark colored macular or papular lesions on the glans and prepuce, exhibiting a mirror-image symmetry relative to the coronal sulcus. The proposed management ranges from clinical follow-up to surgical excision. However, in this particularly sensitive location the risk of functional and esthetical complications is high, so an alternative treatment option was proposed. We report a case of a penile kissing nevus with its dermoscopic and histopathological characteristics as well as its successful treatment with the carbon dioxide (CO2) laser.


Assuntos
Dióxido de Carbono/química , Lasers de Gás/uso terapêutico , Nevo Pigmentado/terapia , Adolescente , Humanos , Masculino , Pênis/patologia
13.
Medicine (Baltimore) ; 99(39): e22256, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991422

RESUMO

BACKGROUND: Striae distensae (SD) are common and aesthetically undesirable dermal lesions. The aim of this study is to comprehensively evaluate the effectiveness of different therapies in treating striae distensae using network meta-analysis. METHODS: A systematic search of electronic databases up to December 1, 2019 was conducted. Randomized controlled trails (RCTs) examining the effectiveness of different methods in treating striae distensae were included. The primary outcomes are clinical effective rate and patient's satisfaction degree. Risk of bias was assessed by the Cochrane risk of bias tool. Network meta-analysis was based on Bayesian framework. RESULTS: Fourteen trails that met the criteria with 651 subjects were included. The results of the network meta-analysis show that topical tretinoin combined bipolar radiofrequency showed the highest probability of being the best method to improve the clinical effectiveness and patient satisfaction rate of treating SD (84.5% and 95.7% respectively), closely followed by bipolar radiofrequency (75.3% and 84.3% respectively). Among laser treatment, CO2 fractional laser is superior to other lasers in the clinical effectiveness and patient satisfaction (72.0% and 58.1% respectively). Statistics showed the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment (5.4% and 5.1% respectively). CONCLUSION: Based on the results of network meta-analysis, we recommend treating striae distensae with bipolar radio frequency combined topical tretinoin. The commonly used CO2 fractional laser can be considered as alternative treatment candidate. Additional large-scale RCTs are necessary to obtain more precise estimates of their relative efficacy.


Assuntos
Ceratolíticos/administração & dosagem , Lasers de Gás/uso terapêutico , Ablação por Radiofrequência/métodos , Estrias de Distensão/terapia , Tretinoína/administração & dosagem , Administração Tópica , Adolescente , Adulto , Feminino , Humanos , Masculino , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
14.
Medicine (Baltimore) ; 99(30): e20942, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791674

RESUMO

BACKGROUND: To compare clinical effect between Er: YAG and CO2 laser in treatment of oral tumorous lesions. METHODS: A comprehensive search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool (The Cochrane Collaboration, 2011). The clinical value of comparison between Er: YAG and CO2 laser was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results. RESULTS: Finally, 268 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The Er: YAG and CO2 groups were 141 and 127, respectively. The meta-analysis showed significant difference in success (risk ratio  = 21.29, 95% confidence interval [1.09, 1.52], P = .002; P for Heterogeneity = .99, I = 0%) and time of surgery ((P of heterogeneity = .29, I = 20%, Z = 25.69, P of over effect < .00001). The recurrence and complications of CO2and Er: YAG groups had no difference. CONCLUSION: Er: YAG laser had better effects than CO2 laser in eliminating oral tumorous lesions while it needed longer operation time than CO2 laser.


Assuntos
Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Leucoplasia Oral/terapia , Humanos
16.
Medicine (Baltimore) ; 99(27): e19893, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629624

RESUMO

A wide range of therapeutic options are available for the treatment of Bowen disease. However, few studies have been conducted on wide excision using various resurfacing methods. The objectives of this study were:One hundred forty-eight lesions were studied. All lesions were histopathologically confirmed as Bowen disease. Lesions were classified by anatomical site and treatment modality and their dimensions were measured. Punch biopsy was reperformed when a treated lesion was considered to have possibly recurred. Recurrence rates were then compared. Preoperative and intraoperative photos and follow-up images were also taken.The most common site of Bowen disease was the head and neck region. Wide excision was found to provide good outcomes with minimal tumor recurrence. Recurrence after cryotherapy occurred relatively quickly (mean 0.2 years, median 0.2 years) while recurrence after wide excision occurred at a mean 2.5 years. Treatment modality was significantly associated with recurrence (P < .05).The optimal treatment for Bowen disease has not been determined. Wide excision provided lower recurrence than other treatment modalities. Providers should be aware of the multiple treatment options available and select the method most appropriate for each patient. The limitations of our study are that it was retrospectively designed and conducted at a single institution.


Assuntos
Doença de Bowen/cirurgia , Criocirurgia/estatística & dados numéricos , Lasers de Gás/uso terapêutico , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , República da Coreia/epidemiologia , Estudos Retrospectivos
18.
Artigo em Inglês | MEDLINE | ID: mdl-32559037

RESUMO

Peri-implantitis is a biologic complication that can affect the survival of a dental implant. Most surgical and nonsurgical treatments have been relatively ineffective even when using targeted antimicrobial approaches. A growing number of reports are documenting the presence of titanium granules and/or cement in the soft tissues surrounding peri-implantitis-affected dental implants. Two case reports are presented demonstrating how the Nd:YAG or a carbon dioxide (CO2) laser used following regenerative surgeries changed failures into successes as measured by radiographic bone fill and improved clinical parameters. These cases suggest that successful peri-implantitis treatment may need to incorporate decontamination of the soft tissues in addition to the implant's surface. Further studies are warranted to determine if each of these lasers would be successful over a larger patient cohort.


Assuntos
Implantes Dentários , Lasers de Gás , Peri-Implantite , Descontaminação , Humanos , Titânio
19.
Int J Periodontics Restorative Dent ; 40(4): e147-e154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559038

RESUMO

Most dental lasers claim that they can aid in hemostasis during oral and periodontal surgery. To date, there are no studies that compare different lasers' ability to congeal pooled blood. The aim of the study was to see if there was a difference in dental lasers' ability to congeal pooled human blood in vitro. Whole blood was collected from donors, with 0.5 mL (premolar socket volume for all tests) aliquoted into microcentrifuge tubes. Different dental lasers (810-nm diode, 940-nm diode, 1,064-nm Nd:YAG, 2,790-nm Er,Cr:YSGG, 2,940-nm Er:YAG, and 10,600-nm CO2) were applied to the whole blood for 0, 15, 30, and 45 seconds. The sample tubes were centrifuged, and the supernatant color was scored to assess the degree of congealing. Additional samples of blood were tested for time needed for maximum congealing and temperature change. Analysis of supernatant colors showed that there were significant differences in the degrees of congealing for the 810-nm diode, 940-nm diode, and 2,790-nm Er,Cr:YSGG lasers when compared to the 1,064-nm Nd:YAG, 2,940-nm Er:YAG, and 10,600-nm CO2 lasers, but not within those groupings. Additionally, the 1,064-nm Nd:YAG laser increased the temperature of the blood samples more than the other lasers and had a shorter time for maximum congealing. There were differences in the dental lasers' ability to congeal pooled human blood in an in vitro model. Nd:YAG, Er:YAG, and 10,600-nm CO2 lasers were able to achieve a greater degree of congealing at an earlier time point. The Nd:YAG laser produced the most heat and was the fastest to complete coagulation.


Assuntos
Lasers de Gás , Lasers de Estado Sólido , Humanos , Lasers Semicondutores
20.
Oral Health Prev Dent ; 18(1): 543-548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32515426

RESUMO

PURPOSE: To assess the effects of experimental titanium tetrafluoride (TiF4) varnish and commercial sodium fluoride (NaF) varnish with CO2 laser on enamel hardness. MATERIALS AND METHODS: Ninety human enamel samples were randomly assigned to one of the following groups: 1. control (no treatment) (CO); 2. NaF varnish (2.26%) (NF); 3. TiF4 varnish (2.45%) (TF); 4. CO2 laser (La); 5. NaF varnish (2.26%) with CO2 laser (NFL); 6. TiF4 varnish (2.45%) with CO2 laser (TFL). Enamel surface changes were determined by Vickers microhardness (VH) test with a load of 1000 g and a dwell time of 12 s. Each sample was indented three times. Data were analysed using one-way ANOVA and Tukey's test. RESULTS: The mean surface microhardness was 245.5 VH in the CO group, 280.3 VH in group NF, 338.7 VH group TF, 277.0 VH in group La, 345.3 VH in group NFL, and 368.0 VH in group TFL. Statistical analysis showed that groups TF, NFL, and TFL had statistically significantly higher surface hardness than the control group (p < 0.05). CONCLUSION: The microhardness of enamel treated with TiF4 varnish with or without laser irradiation was statistically significantly greater than that of the control group. Thus, using TiF4 to increase enamel surface microhardness can be recommended.


Assuntos
Lasers de Gás , Fluoreto de Sódio , Cariostáticos , Esmalte Dentário , Fluoretos , Fluoretos Tópicos , Dureza , Humanos , Pintura , Titânio
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