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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
Medicine (Baltimore) ; 99(22): e20383, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481424

RESUMO

BACKGROUND: This study will explore the effect and safety of CO2 laser (COL) for the management of patients with primary otosclerosis (PO). METHODS: The following electronic databases will be searched from inception to the present: PUBMED, EMBASE, The Cochrane Library, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, VIP, WANGFANG, and China National Knowledge Infrastructure. No language limitation will be applied. All relevant randomized controlled trials using COL to treat patients with PO will be included. Two researchers will identify studies, collect data and evaluate the risk of bias of each included study independently. Any different views between 2 researchers will be resolved by a third researcher via discussion. Data analysis will be carried out using RevMan 5.3 software. RESULTS: This study will evaluate the effect and safety of COL for the treatment of PO through hearing gain, tinnitus severity, incidence of intraoperative, health-related quality of life, other morbidities, and adverse events. CONCLUSION: This study will provide evidence for the effect and safety of COL in patients with PO. STUDY REGISTRATION NUMBER: INPLASY202040110.


Assuntos
Lasers de Gás/uso terapêutico , Otosclerose/cirurgia , Humanos , Lasers de Gás/efeitos adversos , Resultado do Tratamento
9.
BJOG ; 127(11): 1338-1346, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32333820

RESUMO

BACKGROUND: Laser therapy is now being proposed for the treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). OBJECTIVES: To systematically review the available literature on laser therapy for POP and UI. SEARCH STRATEGY: PubMed, Web Of Science and Embase were searched for relevant articles, using a three-concept (POP, UI, laser therapy) search engine composed as (concept 1 OR concept 2) AND concept 3. SELECTION CRITERIA: Only full-text clinical studies in English. DATA COLLECTION AND ANALYSIS: Data on patient characteristics, laser setting, treatment outcome and adverse events were independently collected by two researchers. There was a lack of methodological uniformity so meta-analysis was not possible and the results are presented narratively. MAIN RESULTS: Thirty-one studies recruiting 1530 adult women met the inclusion criteria. All studies showed significant improvement either on UI, POP or both; however the heterogeneity of laser settings, application and outcome measures was huge. Only one study was a randomised controlled trial, two studies were controlled cohort studies. All three were on UI and used standardised validated tools. The risk of bias in the randomised controlled trial was low on all seven domains; the controlled studies had a serious risk of bias. No major adverse events were reported, mild pain and burning sensation were the most commonly described adverse events. CONCLUSIONS: All studies on vaginal and/or urethral laser application for POP and UI report improvement, but the quality of studies needs to be improved. TWEETABLE ABSTRACT: There is weak evidence that laser therapy is effective for urinary incontinence and pelvic organ prolapse #LASER#UI#POP.


Assuntos
Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária/cirurgia , Feminino , Humanos , Lasers de Gás/efeitos adversos , Lasers de Estado Sólido/efeitos adversos , Projetos de Pesquisa/normas , Resultado do Tratamento
10.
Maturitas ; 135: 34-39, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32252962

RESUMO

OBJECTIVES: To evaluate the safety of and patient satisfaction with fractional CO2 laser for the treatment of vulvo-vaginal atrophy (VVA) in postmenopausal patients. STUDY DESIGN: Patients affected by VVA were considered for the study. All women were treated using a Lumenis AcuPulse DUO (Lumenis, Yokneam, Israel) in fractionated mode with a 28 mm probe, FemTouch™. Pain during different steps of the procedure (introduction, rotation and extraction of probe and laser impulse transmission) was evaluated on a 7-point Likert scale. The occurrence of side-effects was evaluated at the end of the procedure, and in the three-month follow-up (after the last treatment) complications were classified as 'early' (occurring within 30 days) or late (after 30 days). Participant satisfaction was measured on a 7-point Likert scale (1= strongly disagree, 7= strongly agree). The institutional review board approved the study protocol. RESULTS: Fifty-three women were enrolled in the study. No severe complications occurred after a median follow-up of six months. One patient (1.9 %) reported dizziness immediately after treatment, which completely resolved within 15 min. A minor bleeding occurred related to tip introduction and rotation. One patient (1.9 %) aborted the procedure because of discomfort on probe introduction but decided to repeat the procedure after two weeks. Two patients (3.7 %) reported symptoms of dysuria within 7 days of the procedure. The mean overall pain score at first treatment, evaluated on the 7-point Likert scale, was 3.57 ± 1.50. The mean pain scores related to probe introduction and rotation were 3.13 ± 1.37 and 2.32 ± 1.08, whereas pain scores for extraction and laser impulse transmission were 1.23 ± 0.27 and 1.13 ± 0.37 respectively. Mean overall pain score (1.27; CI 95 % 0.83-1.71, p < 0.001) and pain scores related to probe introduction (0.54; CI 95 % 0.18-0.90, p = 0.001) and probe rotation (0.46; CI 95 % 0.12-0.90, p = 0.003) all statistically significantly decreased between the first and third treatment (Fig. 1). Mean pain scores related to laser activation (0.01; CI 95 % -0.06 - 0.20, p = 0.07) and extraction (0.08; CI 95 % -0.04-0.19, p = 0.31) did not change over the course of treatment. Overall, patient satisfaction with the procedure was high: 89.7 % of patients would highly (value 5-7) recommend the procedure and 94.9 % would be ready to repeat the procedure to maintain results. Discomfort related to treatment was lower than expected for 41 % of patients (value 5-7) and as expected for 48.7 % (value 3-4). CONCLUSION: Fractional CO2 laser for treatment of VVA seems a safe therapeutic option. No severe complications occurred. A minority of patients reported mild complications, but these resolved without the need for treatment. Most discomfort was related to probe introduction and rotation. Overall, patients were highly satisfied, and they would repeat laser treatment.


Assuntos
Dióxido de Carbono/uso terapêutico , Lasers de Gás/uso terapêutico , Doenças Vaginais/cirurgia , Idoso , Atrofia/cirurgia , Feminino , Humanos , Israel , Pessoa de Meia-Idade , Satisfação do Paciente , Pós-Menopausa , Estudos Prospectivos , Resultado do Tratamento , Vagina/patologia , Vulva/patologia
11.
Lasers Med Sci ; 35(5): 1213-1222, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32030555

RESUMO

The aim of this in vitro study was to evaluate the protective effect of short-pulsed CO2 9.3 µm laser irradiation against erosion in human enamel without and combined with TiF4 and AmF/NaF/SnCl2 applications, respectively, as well as compared to the protective effect of these fluoride treatments alone. After polishing, ninety enamel samples (3 × 3mm) were used for 9 different treatment groups: 4% TiF4 gel (pH 1.5, 24,533 ppm F-); AmF/NaF/SnCl2 rinse (pH 4.5; 500 ppm F-, 800 ppm Sn2); CO2 laser (average power 0.58 W); CO2 laser (0.58 W) + TiF4; CO2 laser (0.58 W) + AmF/NaF/SnCl2; CO2 laser (0.69 W); CO2 laser (0.69 W) + TiF4; CO2 laser (0.69 W) + AmF/NaF/SnCl2; negative control (deionized water). TiF4 gel was brushed on only once before the first erosive cycling, while samples treated with AmF/NaF/SnCl2 were daily immersed in 5 ml of the solution before cycling. Laser treatment occurred with a CO2 laser (wavelength 9.3 µm, pulse repetition rate 100 Hz, pulse duration 14.6 µs/18 µs, average power 0.58 W/0.69 W, fluence 1.9 J/cm2/2.2 J/cm2, beam diameter 0.63 mm, irradiation time 10 s, air cooling). TiF4 was applied only once, while AmF/NaF/SnCl2 was applied once daily before the erosive challenge. Surface loss (in µm) was measured with optical profilometry immediately after treatment, and after 5 and 10 days of erosive cycling (0.5% citric acid, pH 2.3, 6 × 2 min/day). Additionally, scanning electron microscopy investigations were performed. All application measures resulted in loss of surface height immediately after treatment. After 5 days, significantly reduced surface loss was observed after applying laser irradiation (both power settings) followed by applications of TiF4 or AmF/NaF/SnCl2 solution (p < 0.05; 2-way ANOVA and Tukey test) compared to fluoride application alone. After 10 days, compared to after 5 days, a reduced tissue loss was observed in all groups treated with AmF/NaF/SnCl2 solution. This tissue gain occurred with the AmF/NaF/SnCl2 application alone and was significantly higher when the application was combined with the laser use (p < 0.05). Short-pulsed CO2 9.3 µm laser irradiation followed by additional application of AmF/NaF/SnCl2 solution significantly reduces the progression of dental enamel erosion in vitro.


Assuntos
Esmalte Dentário/patologia , Esmalte Dentário/efeitos da radiação , Fluoretos/uso terapêutico , Lasers de Gás/uso terapêutico , Erosão Dentária/cirurgia , Esmalte Dentário/ultraestrutura , Humanos , Compostos de Estanho/uso terapêutico
12.
Lasers Med Sci ; 35(5): 1193-1203, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32006264

RESUMO

This study investigated the combined effect of CO2 laser irradiation and Remin Pro paste on microhardness of enamel white spot lesions (WSLs). Seventy-eight intact premolars were randomly assigned into six groups and then stored in a demineralizing solution to create WSLs. Afterwards, the teeth in group 6 (negative control) remained untreated, while groups 1 and 4 were exposed to CO2 laser irradiation (20 Hz, 1 W, 30 s) and Remin Pro paste, respectively. In groups 2 and 3, the teeth were exposed to laser either before (group 2) or after (group 3) Remin Pro application. The teeth in groups 1 to 5 were then immersed in artificial saliva for 90 days while subjected to fluoride mouthwash and weekly brushing. Finally, the teeth were sectioned, and Vickers microhardness was measured at the enamel surface and at 50, 100, and 150 µm from the surface. One sample of each group was also examined with scanning electron microscope (SEM). Data were analyzed by two-way analysis of variance (ANOVA) and Tukey's test. The significance was set at 0.05. Laser irradiation followed by Remin Pro application (group 2) caused a significant increase in total WSLs' microhardness compared with laser alone (group 1) and control groups (P < 0.05). Microhardness at depths of 100 and 150 µm was also significantly greater in group 2 compared with those of group 3 and control groups (P < 0.05). Combined application of CO2 laser with Remin Pro paste, when laser is irradiated before the paste, is suggested for re-hardening of WSLs in deep layers of enamel.


Assuntos
Cárie Dentária/cirurgia , Esmalte Dentário/patologia , Esmalte Dentário/efeitos da radiação , Lasers de Gás/uso terapêutico , Cremes Dentais/uso terapêutico , Esmalte Dentário/ultraestrutura , Dureza , Humanos
13.
J Glaucoma ; 29(5): 367-373, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32053553

RESUMO

PRECIS: A modified CO2 laser-assisted sclerectomy surgery (CLASS) based on the characteristics of Chinese eyeball was carried out in Chinese patient and was confirmed to be effective and safe during long-term follow-up. PURPOSE: The purpose of this study was to study the long-term efficacy and safety of modified CLASS in Chinese patients with primary open-angle and pseudoexfoliative glaucoma. METHODS: We enrolled 25 medically uncontrolled primary open-angle and pseudoexfoliative glaucoma patients in this prospective, interventional case series. A combination of modified CLASS and preoperative laser iris management was administered to 29 eyes. Visual acuity, intraocular pressure (IOP), slit-lamp examinations, visual field, and gonioscopy were carried out at baseline and until 24 months postoperatively. Ultrasound biomicroscopy examinations were repeated at 3, 12, and 24 months postsurgically. RESULTS: Mean patient age was 53.92±12.08 years. Mean preoperative IOP was 30.66±10.41 mm Hg; and mean postoperative IOP was 8.17±3.76, and 13.25±2.73, 13.76±2.50, and 13.76±2.50 mm Hg at 1 day, and 6, 12, and 24 months, respectively. Proportional changes in IOP from baseline at 6, 12, and 24 months was 58.33%, 56.25%, and 58.97% (P<0.001), respectively. Complete postoperative success rates at 12 and 24 months were 62.07% and 48.28%. Qualified success rates at 12 and 24 months postoperatively were both 89.66%. Number of medications administered per patient reduced from 3 at baseline to 0 at 12 and 24 months (P<0.0001). Two patients demonstrated severe peripheral anterior synechiae (6.90%). Ultrasound biomicroscopy examination revealed a severe scleral lake diminution in 1 patient (3.40%) at 12 months and 2 patients (6.90%) at 24 months. CONCLUSION: Combination of modified CLASS and preventive laser iris management was effective and safe in the long-term treatment of primary open-angle glaucoma patients.


Assuntos
Síndrome de Exfoliação/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Esclerostomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/etnologia , China/epidemiologia , Síndrome de Exfoliação/diagnóstico , Síndrome de Exfoliação/fisiopatologia , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esclera/cirurgia , Tonometria Ocular , Acuidade Visual/fisiologia , Campos Visuais/fisiologia
14.
Lasers Med Sci ; 35(6): 1367-1376, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31927647

RESUMO

The aim of this study was to assess and compare the efficacy of fractional CO2 laser, Q-switched Nd:YAG laser (1064 nm), and their combined use in treatment of keratosis pilaris. The study included twenty female patients. For each patient, three areas were randomly assigned to treatment by either fractional CO2 laser (area A) or Q-switched laser (1064 nm) (area C), or both types of laser (area B). All patients were assessed by digital photography at baseline and 1 month after the last session. Assessment was done by two non-blinded and two blinded investigators (blinded investigators do not know which area is treated with which machine and non-blinded knows). Patients reported the degree of satisfaction or any adverse effects also after 1 month from the last session. The three treatment modalities led to overall improvement in the KP lesions. According to patients' score and investigator two, area B showed statistically significant improvement compared to areas A and C (p=0.001 and p=0.039, respectively). The first blinded investigators' assessment revealed that there was statistically significant improvement in area C compared to A and B (p = 0.023). The assessment of both investigator one and the second blinded investigator revealed that there was improvement in the three areas with no statistically significant difference between them. Both fractional CO2 and Q-switched Nd:YAG laser (1064 nm) proved to be safe and effective in the treatment of keratosis pilaris regarding not only pigmentation but also follicular prominence; their combination may have an additive effect.


Assuntos
Anormalidades Múltiplas/cirurgia , Doença de Darier/cirurgia , Sobrancelhas/anormalidades , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Adolescente , Adulto , Feminino , Humanos , Lasers de Gás/efeitos adversos , Lasers de Estado Sólido/efeitos adversos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
15.
Lasers Med Sci ; 35(5): 1185-1191, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31970563

RESUMO

The aim of this controlled randomized double-blinded clinical trial was to evaluate the use of a CO2 laser with or without topical application of acidulated fluorides in the prevention of dental caries in partially erupted first permanent molars. We selected 61 healthy children at high risk of caries, all between 6 and 8 (7.1 ± 0.8) years of age and with 4 partially erupted first permanent molars. A CO2 laser device emitting at 10.6 µm was used (0.5 W, 0.05 mJ per pulse, 10 kHz). Each first molar in an individual was randomly assigned to one treatment: (L) CO2 laser (0.066 J/cm2); (FL) 1.23% acidulated fluoride gel and CO2 laser (0.066 J/cm2); (V) 5% fluoride varnish, or (S) sealant (control). Patients were followed-up at 3, 6, 12, and 18 months after treatment, through direct visual examination and by an operator blinded to the treatments (kappa ≥ 0.70). The International Caries Detection and Assessment System (ICDAS-II) index was used to assess the soundness of tooth structure or the presence of white spot lesions, cavitated enamel, and/or dentin lesions. The Yildiz Visual Index was used to evaluate sealant retention. Results were evaluated using Kaplan-Meier survival analysis, and the hazard ratio of the treatments was estimated using shared frailty models with a gamma distribution, which considered the patient as a cluster. There were no significant differences among treatments compared to sealants. After 18 months, the use of a CO2 laser with or without acidulated fluorides was shown to be effective in preventing caries on the occlusal surface of partially erupted permanent first molars in children at high risk for caries.


Assuntos
Cárie Dentária/prevenção & controle , Lasers de Gás/uso terapêutico , Dente Molar/efeitos da radiação , Erupção Dentária/efeitos da radiação , Criança , Cárie Dentária/epidemiologia , Cárie Dentária/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Dente Molar/patologia , Selantes de Fossas e Fissuras/uso terapêutico , Modelos de Riscos Proporcionais , Resultado do Tratamento
16.
Lasers Med Sci ; 35(6): 1357-1365, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31984457

RESUMO

Different devices have been used to enhance topical drug delivery. Aim of this study was to compare the efficacy of different skin pretreatment regimens in topical drug delivery. In six ex vivo human abdominal skin samples, test regions were pretreated with fractional CO2 and Er:YAG laser (both 70 and 300 µm ablation depth, density of 5%), microneedling (500 µm needle length), fractional radiofrequency (ablation depth of ± 80-90 µm), and no pretreatment. The fluorescent agent indocyanine green (ICG) was applied. After 3 h, fluorescence intensity was measured at several depths using fluorescence photography. Significantly higher surface fluorescence intensities were found for pretreatment with fractional Er:YAG and CO2 laser and for microneedling vs. no pretreatment (p < 0.05), but not for radiofrequency vs. no pretreatment (p = 0.173). Fluorescence intensity was highest for the Er:YAG laser with 300 µm ablation depth (mean 38.89 arbitrary units; AU), followed by microneedling (33.02 AU) and CO2 laser with 300 µm ablation depth (26.25 AU). Pretreatment with both lasers with 300 µm ablation depth gave higher fluorescence intensity than with 70 µm ablation depth (Er:YAG laser, 21.65; CO2 laser, 18.50 AU). Mean fluorescence intensity for radiofrequency was 15.27 AU. Results were comparable at 200 and 400 µm depth in the skin. Pretreatment of the skin with fractional CO2 laser, fractional Er:YAG laser, and microneedling is effective for topical ICG delivery, while fractional radiofrequency is not. Deeper laser ablation results in improved ICG delivery. These findings may be relevant for the delivery of other drugs with comparable molecular properties.


Assuntos
Sistemas de Liberação de Medicamentos , Verde de Indocianina/administração & dosagem , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Agulhas , Ablação por Radiofrequência , Administração Cutânea , Fluorescência , Humanos , Verde de Indocianina/farmacologia , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Tomografia de Coerência Óptica
17.
Female Pelvic Med Reconstr Surg ; 26(2): 155-158, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990806

RESUMO

OBJECTIVE: Optical coherence tomography is a noninvasive technology that visualizes tissue microstructure with high spatial resolution. We designed a novel vaginal system that demonstrates a clear distinction between vaginal tissues planes. In this study, we sought to compare vaginal tomographic images of premenopausal, perimenopausal, and postmenopausal women, demonstrate feasibility of tracking vaginal tissue changes after treatment with fractional-pixel CO2 laser therapy, and obtain a histologic correlation of these findings. METHODS: Enrolled subjects underwent imaging and were divided into 3 groups based on menopausal status. Women with genitourinary syndrome of menopause who received fractional-pixel CO2 laser therapy were assessed before and after treatment. A cadaveric vagina was used to obtain tomographic and histologic images to assess for accuracy. Our primary outcome was mean vaginal epithelial thickness. Statistical analysis was performed using analysis of variance and t tests, respectively. RESULTS: Among 6 women, the mean vaginal epithelial thickness decreased with menopause (P < 0.01). Although change in epithelial thickness after fractional-pixel CO2 laser treatment varied between the 2 subjects evaluated, it increased significantly for the subject who reported improvement of vaginal symptoms (P < 0.01). Using a cadaveric specimen, optical biopsy was correlated to an hematoxylin and eosin-stained biopsy of the same vaginal site. CONCLUSIONS: This study establishes feasibility of optical coherence tomography in providing an optical biopsy of the vaginal epithelium and lamina propria. In addition, it demonstrates vaginal changes as women enter menopause. This report is the initial phase of a longitudinal cohort study to evaluate changes in vaginal microstructure after energy-based treatment.


Assuntos
Biópsia Guiada por Imagem/métodos , Terapia com Luz de Baixa Intensidade/métodos , Tomografia de Coerência Óptica/métodos , Vagina , Doenças Vaginais , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Lasers de Gás/uso terapêutico , Estudos Longitudinais , Pessoa de Meia-Idade , Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Pré-Menopausa/fisiologia , Resultado do Tratamento , Vagina/diagnóstico por imagem , Vagina/patologia , Doenças Vaginais/etiologia , Doenças Vaginais/patologia , Doenças Vaginais/fisiopatologia , Doenças Vaginais/terapia
18.
Lasers Med Sci ; 35(4): 979-989, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31897815

RESUMO

Caries prevention with different lasers has been investigated in laboratory studies and clinical pilot trials. Objective of this in vitro study was to assess whether 9.3-µm microsecond short-pulsed CO2 laser irradiation enhances enamel caries resistance without melting, with and without additional fluoride application. Seven groups of enamel, totaling 105 human enamel samples, were irradiated with 2 different carbon dioxide lasers with 2 different energy application systems (original versus spread beam; 9.3 µm wavelength, pulse repetition rate 43 Hz vs 100 Hz, fluence ranges from 1.4 to 3.9 J/cm2, pulse duration 3 µs to 18 µs). The laboratory pH-cycling was performed with or without additional fluoride, followed by cross-sectional microhardness testing. To assess caries inhibition, the mean relative mineral loss delta Z (∆Z) was determined. To evaluate for melting, scanning electron microscopy (SEM) examinations were performed. For the non-laser control groups with additional fluoride use, the relative mineral loss (ΔZ, vol% × µm) ranged between 512 ± 292 and 809 ± 297 (mean ± SD). ΔZ for the laser-irradiated samples with fluoride use ranged between 186 ± 214 and 374 ± 191, averaging a 58% ± 6% mineral loss reduction (ANOVA, P < 0.01 to P < 0.0001). For the non-laser-treated controls without additional fluoride, the mineral loss increased (ΔZ 914 ± 422 to 1224 ± 736). In contrast, the ΔZ for the laser-treated groups without additional fluoride ranged between 463 ± 190 and 594 ± 272 (P < 0.01 to P < 0.001) indicative of 50% ± 2% average reduction in mineral loss. Enhanced caries resistance was achieved by all applied fluences. Using the spread beam resulted in enhanced resistance without enamel melting as seen by SEM. CO2 9.3-µm short-pulsed laser irradiation with both laser beam configurations resulted in highly significant reduction in enamel mineral loss. Modifying the beam to a more homogenous profile will allow enamel caries resistance even without apparent enamel melting.


Assuntos
Cárie Dentária/prevenção & controle , Cárie Dentária/cirurgia , Lasers de Gás/uso terapêutico , Fluoretos/química , Dureza , Humanos , Minerais/metabolismo
19.
Int J Pediatr Otorhinolaryngol ; 131: 109844, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31901483

RESUMO

OBJECTIVE: Identify incidence and factors associated with respiratory complications after type 1 cleft repair. METHODS: Retrospective chart review of patients who underwent cleft repair over a 5-year period performed by a single surgeon. Primary endpoint was respiratory complications (oxygen desaturation <90%). Fisher's exact test was used to identify differences between repair types (endoscopic carbon dioxide laser-assisted repair and injection laryngoplasty). Logistic regression was used to identify predictors of respiratory events. RESULTS: Fifty-five patients were included. Thirty-four (62%) patients underwent endoscopic carbon dioxide laser-assisted repair and 21 (38%) underwent injection laryngoplasty. Average hospital stay for each group was 1.6 days (SD = 3.1) and 0.6 days (SD = 0.9), respectively. Desaturations occurred in three patients (9%) in the laser-assisted repair group and one patient (4%) in the injection group. All occurred within 3 h after surgery and resolved with supplemental oxygen, oral airway placement, and/or mask ventilation. Two affected patients had comorbid diagnosis of asthma (one had poor medication compliance), and one had a history of developmental delay and hypotonia. In the injection group, desaturations occurred in one patient with a history of tracheal stenosis and double aortic arch. No correlation existed between repair type and desaturation (p = 0.57). No variables were significant predictors of events. CONCLUSIONS: In this cohort, respiratory events after type 1 laryngeal cleft repair occurred early in the postoperative period, in children with cardiac and pulmonary comorbidities. This suggests postoperative admission may only be necessary for a select group of patients undergoing type 1 cleft repair. However, further research is needed to determine criteria for same-day discharge.


Assuntos
Anormalidades Congênitas/cirurgia , Laringoplastia/efeitos adversos , Laringoplastia/métodos , Laringe/anormalidades , Oxigênio/sangue , Complicações Pós-Operatórias/etiologia , Asma/complicações , Criança , Pré-Escolar , Estudos de Coortes , Deficiências do Desenvolvimento/complicações , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Injeções , Laringe/cirurgia , Lasers de Gás/uso terapêutico , Tempo de Internação , Masculino , Hipotonia Muscular/complicações , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Estudos Retrospectivos , Estenose Traqueal/complicações , Anel Vascular/complicações
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