NIR脉冲红外光技术与强脉冲光技术的临床联合应用

目的探讨NIR脉冲红外光技术与强脉冲光技术临床联合应用的疗效及安全胜。方法50例患者接受4～8次NIR脉冲红外光和强脉冲光联合治疗。于治疗前后采用照片对比,由医师对治疗效果进行综合评估,并对患者进行满意度评估。结果经4～6次治疗后,皮肤的亮度明显提高,皮肤松弛改善、色斑淡化、皱纹消除,患者对治疗效果非常满意。结论联合治疗技术有效地改善了皮肤质地及皮肤松弛和色斑的状况,皮肤变得嫩白,无不良反应发生。     

CO2 laser resurfacing and photocarcinogenesis: an experimental study

BACKGROUND AND OBJECTIVES: To examine whether carbon dioxide (CO2) laser treatment has a carcinogenic potential or may influence ultraviolet (UV)-induced carcinogenesis. STUDY DESIGN/MATERIALS AND METHODS: Hairless mice (n = 211) were treated with a Sharplan CO2 laser with FeatherTouch scanner. Simulated solar irradiations were administrated either pre-operatively or pre- and post-operatively. Weekly clinical assessments of skin tumors were performed blinded during the entire observation period of 12 months. RESULTS: No tumors appeared (a) in mice just treated with CO2 laser, (b) in mice exposed to UV irradiation only before CO2 laser treatment or (c) in untreated control mice. Tumors developed in CO2 laser treated mice that were exposed to UV-irradiation both pre- and post-operatively and in UV-irradiated control mice. The time to first, second, and third tumors ranged from 18 to 20 weeks and no significant differences were demonstrated. CONCLUSIONS: CO2 laser treatment does not have a carcinogenic potential in itself, nor does CO2 laser treatment influence UV-induced carcinogenesis.     

强脉冲光治疗13例淤积性皮炎伴发色素沉着疗效观察

目的:观察强脉冲光治疗淤积性皮炎伴发色素沉着的疗效及不良反应。方法:对13例淤积性皮炎伴发双下肢色素沉着患者行强脉冲光治疗,治疗1～4次,每次治疗间隔4周,疗程结束后随访3～6个月,治疗前后疗效对比观察并用χ2检验分析。结果:基本治愈9例,无效2例(均只治疗1次),总有效率84.6%。疗效与治疗次数成正相关,未见其他不良反应及并发症。结论:强脉冲光治疗淤积性皮炎伴发色素沉着疗效满意、安全,是该病的较好治疗手段。     

An animal study of the effects on p16 and PCNA expression of repeated treatment with high-energy laser and intense pulsed light exposure

BACKGROUND AND OBJECTIVE: Non-ablative skin rejuvenation treatments that involve the use of laser/light sources together with cooling devices have gained much popularity in recent years due to the lack of down time that is associated with them. One important but neglected issue is long-term safety. Does the repeated use of non-ablative skin rejuvenation lead to photoaging? Are we creating another sun-bed phenomenon? Recently, we performed an in vitro study to examine the effect of sub-lethal QS 755 nm lasers on the expression of p16INK4a on melanoma cell lines, and found that sub-lethal laser damage could increase DNA damage, which led to an increase in p16 expression. Our objective was to assess the cutaneous effect of repeated exposure to high-energy lasers and intense pulsed light sources on male Institute of Cancer Research (ICR) mice. STUDY DESIGN/MATERIALS AND METHODS: Twenty-eight male ICR mice were divided into four groups. Other than the control group, all groups received either laser (585 nm pulsed dye laser or 1,320 nm Nd:YAG laser) or intense pulsed light (IPL) treatment. All four groups were anesthetized with a mixture of Hypnorm/Dormicum before treatment. The animals were irradiated twice a week for 6 months. Signs of toxicity such as mortality and weight loss were checked once a week. Skin tumor formation was evidenced by lesions of greater than 1 mm in diameter that persisted for 2 weeks. At the end of the 6 months, the expression of proliferating cell nuclear antigen (PCNA) and p16 in the mouse skin was determined by immunohistochemical staining and immunoblotting using specific monoclonal antibodies for mouse PCNA and p16. The results were expressed as mean +/- standard error of the mean (SEM). Statistical difference was assessed by multiple ANOVA. A P-value of <0.05 was considered to be significant. RESULTS: At the end of the 6 months, none of the animals had developed any signs of toxicity such as mortality or weight lost. There was no evidence of tumor formation. There were significant elevations of p16 and PCNA in all treated groups as compared to the control group (ANOVA P < 0.05). This particularly applied to the group that was treated with the 1,320 nm Nd:YAG laser. CONCLUSION: The repeated use of high-energy laser and intense pulsed light source did not cause any toxicity in mice. The changes in p16 and PCNA imply that further studies are necessary to consider the implications of repeated exposure to longer wavelength radiation in human skin.     

Long-pulsed dye laser versus intense pulsed light for photodamaged skin: a randomized split-face trial with blinded response evaluation

OBJECTIVE: In a randomized controlled split-face trial to evaluate efficacy and adverse effects from rejuvenation with long-pulsed dye laser (LPDL) versus intense pulsed light (IPL). MATERIALS AND METHODS: Twenty female volunteers with Fitzpatrick skin types I-III, classes I-II rhytids, and symmetrical split-face photodamage were included in the study. Subjects received a series of three treatments at 3-week intervals with half-face LPDL (V-beam Perfecta, 595 nm, Candela Laser Corporation) and half-face IPL (Ellipse Flex, Danish Dermatologic Development); the interventions being randomly assigned to left and right sides. Primary end-points were telangiectasias, irregular pigmentation and preferred treatment. Secondary end-points were skin texture, rhytids, pain, and adverse effects. Efficacy was evaluated by patient self-assessments and by blinded clinical on-site and photographic evaluations at 1, 3, and 6 months postoperatively. Adverse effects were evaluated by blinded clinical on-site evaluations. RESULTS: Telangiectasia improved from LPDL and IPL treatments with superior vessel clearance from LPDL treatments (postoperative side-to-side evaluations, patient self-assessments, P相似文献   

Full-face photorejuvenation of photodamaged skin by intense pulsed light with integrated contact cooling: initial experiences in Asian patients

BACKGROUND AND OBJECTIVES: For Asian skin, recent "non-ablative" skin rejuvenation techniques have become the focus of attention for darker complected patients. In our earlier research, we have shown that intense pulsed light (IPL) technology can be applied to Asian skin with a high degree of safety and efficacy. In this study, we performed full-face photorejuvenation using a new IPL device incorporating a 560 nm filter and integrated contact cooling system for the improvement of various symptoms associated with photoaging in Asian patients. STUDY DESIGN/MATERIALS AND METHODS: A total of 73 patients were treated with a series of five or more full-face treatments at 3-4 week intervals using IPL with integrated contact cooling. One month after the third and fifth treatments, the patient and the treating physicians subjectively evaluated improvement in five areas-in pigmentation, telangiectasia, fine wrinkles, skin texture, and over-all improvement. In addition, histological changes were evaluated. RESULTS: Pigmentation improvement, telangiectasia reduction, fine wrinkle reduction, smoother skin texture, and over-all improvement were evaluated according to five grades of percentage improvement. In addition, the subjective rating by the patients and the physicians was averaged, and the combined results were evaluated. After the fifth treatment, a combined rating of greater than 60% improvement was given to more than 80% of patients for pigmentation improvement, telangiectasia reduction or removal, smoother skin texture, and overall improvement. Histological evaluations showed strong staining of Type I and Type III collagen. Complications were minor and transitory, with burning sensations and erythema in only two patients. CONCLUSION: Full-face photorejuvenation for Asian patients using this device is not only effective but is also associated with fewer post-treatment complications than other more invasive modalities. We conclude that IPL photorejuvenation can be the basis for safe and effective skin rejuvenation in Asian patients.     

光子嫩肤仪对亚洲人光损害皮肤的全面部嫩肤治疗

目的　应用最新光子嫩肤设备治疗亚洲人皮肤的由光损伤导致的各种表现 ,新的设备中配备了 5 6 0nm的治疗手具和接触冷却 ,以改进疗效。方法　用光子嫩肤配合接触冷却共治疗了 73例患者 ,每例治疗 5次或 5次以上 ,每次治疗的间隔为 3～ 4周。在第 3次和第 5次治疗后 ,患者和医生对疗效进行评价。评价内容包括 5个方面 :色素沉着、毛细血管扩张、细小皱纹、皮肤质地和总体改善情况。此外还进行了皮肤组织病理学检查。结果　改善程度按照百分比划为 5个等级 ,分别评价色素沉着的改善、毛细血管扩张减轻、细小皱纹减轻、皮肤质地好转和总体改善的程度。患者和医生的主观评价进行合并 ,计算平均结果。治疗 5次后 ,80 %以上的患者色素沉着、毛细血管扩张、细小皱纹、皮肤质地和总体改善程度均达到了 6 0 %。皮肤组织病理学检查发现Ⅰ型胶原和Ⅲ型胶原染色增强。结论　应用最新光子嫩肤仪在亚洲人的嫩肤治疗中表明该疗法不仅有效 ,而且比其他有损伤性治疗发生的合并症少 ,安全有效     

595 nm脉冲染料激光和强脉冲光对鸡冠微血管作用的对比研究

目的对比实验研究595nm脉冲染料激光(pulsed dye laser,PDL)和强脉冲光(in-tense pulsed light,IPL)对鸡冠微血管的作用,为临床上应用PDL和IPL治疗鲜红斑痣提供依据。方法以莱杭鸡为实验动物,应用595nmPDL和IPL系统分别照射鸡冠,观察照射后鸡冠局部及其微血管的变化。结果595nmPDL照射后,局部皮肤轻度充血、水肿,无水泡、结痂及瘢痕形成;血管窦腔内充满大量的血凝块和组织细胞,表皮细胞无明显变化。IPL照射后,局部皮肤充血、水肿明显,有灶性水泡或表皮脱落和少许瘢痕形成。血管窦腔内充满大量的组织细胞和少量的血凝块,间质组织明显水肿,表皮和真皮之间渗出明显。结论595nmPDL对血管组织具有高度的选择性,主要造成血管的损伤,对表皮的损伤很轻;相比较IPL的选择性则较差,对多种组织(包括表皮)均有明显的损伤。     

强脉冲光和脉冲染料激光595nm治疗面部毛细血管扩张的比较研究

目的：评价强脉冲光（Intense Pulsed Light,IPL）560～1200nm／590～1200nm和脉冲染料激光595nm不同波长治疗面部毛细血管扩张症的临床有效性。方法：301例患者随机分为3组,A组（IPL560～1 200nm）124例,B组（IPL590～1200nm）79例,C组（脉冲染料激光595nm）98例。分别治疗1～4次,间隔时间4～6周。观察其血管清除率。结果：A、B、C组术中血管完全消失分别为66例（53．23％）、34例（43．04％）、74例（75．51％）;治愈分别为79例（63．71％）、41例（51．90％）、81例（82．65％）;平均治愈次数分别为2．66次、2．85次、1．65次。A、B、C三组总体比较差别具有统计学意义;A、B两组比较差别具有统计学意义;A、C两组和B、C两组比较差别具有统计学意义。结论：IPL560～1200nm／590～1200nm和脉冲染料激光595nm三种波长对面部毛细血管扩张均有可靠疗效,脉冲染料激光595nm波长治愈率优于IPL560～1200nm／590～1200nm波长。     

CO2 laser-resurfacing: increased risk of side effects after uv-exposure-an experimental animal study

BACKGROUND AND OBJECTIVES: Carbon dioxide (CO(2)) laser resurfacing is primarily performed on photodamaged facial skin where patients are further exposed to ultraviolet radiation (UVR) postoperatively. We examined whether pre- and postoperative UVR influences the development of CO(2) laser-induced side effects. STUDY DESIGN/MATERIALS AND METHODS: Hairless mice (n = 211) were treated with a Sharplan CO(2) laser with FeatherTouch scanner. Simulated solar irradiation was administered either preoperatively or pre- and postoperatively. Skin end-points (wounds, texture changes, and pigmentary changes) were evaluated blinded by clinical evaluations, skin reflectance spectroscopy, and histological examinations. RESULTS: Pre- and postoperative UVR exposed mice obtained higher clinical scores of wounds (P < 0.02) and texture changes (P < 0.01) and developed more heavy fibrosis than mice treated with laser but no UVR. UVR exposure after CO(2) laser treatment induced significant hyperpigmentation compared to unexposed control mice (P < 0.003), whereas CO(2) laser treatment itself did not induce pigmentary changes. CONCLUSIONS: UVR increases in an animal model the occurrence of postoperative side effects from CO(2) laser resurfacing.     

Treatment of venous malformations with an intense pulsed light source (IPLS) technology: A retrospective study.

BACKGROUND AND OBJECTIVE: The intense pulsed light source (IPLS) technology provides an innovative concept in the treatment of vascular lesions. We investigated the effectiveness of IPLS in the treatment of venous malformations. STUDY DESIGN/MATERIALS AND METHODS: A retrospective study of 11 patients with venous malformations (VMA) treated with IPLS was initiated. Clinical VMA characteristics recorded were size and location. Data collected included treatment parameters (filters, pulse duration, fluence, and pulse sequencing), % clearance, and side effects (e.g., swelling, blisters, crusting, pain, altered pigmentation, and scarring). RESULTS: Good and very good (70-100%) clearance was achieved in 8 malformations smaller than 100 cm(2). Especially small lesions needed only 2-3 treatments. Three VMA larger than 100 cm(2) could be cleared well in an average of 18 sessions. The most frequently used parameters were the 590 nm filter in long pulse mode, triple pulses, and fluences at an average of 80.4 J/cm(2). Side effects included prolonged erythema in 23.6, swelling in 17.9%, crusting in 4.7%. Bleeding, hypo-, hyperpigmentation, and scarring were rare (0.9% respectively). CONCLUSION: IPLS presents an effective method for treating VMA, especially small malformations, with a justifiable rate of side effects when optimal parameters are chosen.     

Nd：YAG激光与强脉冲光非剥脱性嫩肤的动物实验

目的探讨Nd：YAG激光长脉宽波长1064nm与强脉冲光（intense pulsed light,IPL）波长560～1200nm两种波长照射SD大鼠皮肤后组织学变化趋势,为临床非剥脱性光嫩肤的科学治疗提供理论依据。方法应用两种波长照射SD大鼠背部脱毛皮肤,通过HE染色和免疫组织化学染色方法检测真皮厚度、Ⅰ型和Ⅲ型胶原蛋白的表达,并测定平均吸光度值进行半定量分析。结果两种波长照射后真皮厚度、Ⅰ型及Ⅲ型胶原蛋白平均吸光度值均高于正常对照组（P〈0．05）,激光组均又高于IPL组（P〈O．05）,Ⅰ型胶原蛋白平均吸光度增加值均高于Ⅲ型胶原蛋白（P〈0．001）。结论两种波长均可使SD大鼠真皮厚度和Ⅰ型、Ⅲ型胶原蛋白增加,激光组优于IPL组。Ⅲ型胶原蛋白在照射早期增加幅度较高,而Ⅰ型胶原蛋白在照射后期增加幅度较高,提示非剥脱性光嫩肤真皮重塑机制可能与Ⅰ型胶原蛋白增加的时间和量有关。     

Non-ablative facial skin photorejuvenation with an intense pulsed light system and adjunctive epidermal care

Laser skin resurfacing is popular, but the appearance of the face during healing is unpleasant. Non-ablative photorejuvenation with intense pulsed light (IPL) has been reported as being successful but with varied results. In this study we sought the possibility of enhancing the clinical effects with adjunctive epidermal care. Twenty-five women aged from 32 to 68, skin types I–IV, with a variety of wrinkle types and other conditions associated with photoaged skin, were treated with IPL according to our parameters over six sessions coupled with an adjunctive pretreatment micropeel and applications of nutritive and antipigmenting creams. Macroscopic and histological assessments were performed. At weeks 4 and 8 fair to good satisfaction was noted in 17 and 19 patients, and poor satisfaction in 8 and 6 patients, respectively. The histology showed good dermal collagen remodelling in all cases, with a reduction in elastosis. The results of IPL photorejuvenation can be enhanced, as our trials showed. The good patient satisfaction obtained was clearly demonstrated in the histologies and evaluations throughout the study.     

A side-by-side prospective study of intense pulsed light and Nd:YAG laser treatment for vascular lesions

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins <1 mm were more satisfied after IPL, while those with leg veins >1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.     

Direct tendon attachment and healing to porous tantalum: an experimental animal study

BACKGROUND: The ability to directly attach soft-tissue to metal would have broad clinical application. Previous attempts to obtain normal tendon-to-bone attachment strength have been unsuccessful. In the present study, we hypothesized that when the initial interface mechanical environment is carefully controlled, a highly porous form of tantalum metal would allow the ingrowth of tendon tissue with clinically relevant tendon-to-implant fixation strength approaching that of an intact tendon-to-bone insertion. METHODS: Supraspinatus tendons from forty skeletally mature dogs were reattached to the greater tuberosity between two custom-designed porous tantalum washers. Clinical function as judged on the basis of gait analysis, reattachment fixation strength and stiffness, and tendon function as seen through muscle volume were evaluated preoperatively, immediately postoperatively, and at three, six, and twelve weeks after surgery. Qualitative and quantitative histomorphologic evaluation was performed at three, six, and twelve weeks after surgery. RESULTS: Gait analysis with use of force-plate measurements demonstrated return to a normal gait pattern by three weeks after surgery. Tendon-implant strength as a percentage of normal, contralateral controls increased significantly, from 39% at the time of surgery to 67% at three weeks, 99% at six weeks, and 140% at twelve weeks (p < 0.0014). The stiffness of the construct also increased and approached that of normal tendon, measuring 47% at the time of surgery, 62% at three weeks, 94% at six weeks, and 130% at twelve weeks (p < 0.0299). Supraspinatus muscle volume initially decreased by 33% but recovered to 92% of normal by twelve weeks (p < 0.01). Histomorphologic evaluation showed Sharpey-like fibers inserting onto the surface of the porous tantalum. Quantitative histomorphometric analysis revealed a time-dependent increase in the density of the collagen tissue filling the metal voids below the implant surface of first the bottom washer and then the top washer. CONCLUSIONS: Robust biologic ingrowth of tendon into a porous tantalum implant surface can be achieved under conditions of secure initial mechanical fixation. The strength and stiffness of the tendon-implant construct reached normal levels by six to twelve weeks in this animal model.     

微创距下关节融合术治疗距下关节创伤性关节炎的实验研究

目的 探讨应用阶梯钻微创距下关节融合治疗距下关节创伤性关节炎的可行性,以及不同阶梯钻角度获得的距下关节融合面积及所占后关节面百分比对疗效的影响.方法 选取成人足标本22具,随机分为A、B两组(每组11具).C型臂X线机透视下向距下关节方向打入1枚导针,A组用空心钻沿导针向距下关节钻取隧道,再以动力髋螺钉阶梯钻扩大隧道;B组在A组基础上将阶梯钻于内、外侧各倾斜20°～25°钻入,以增加融合面积.取髂骨松质骨并剪成碎骨块向隧道内打压植骨,空心螺钉固定距下关节.比较两组中距骨、跟骨相对关节面的轴向融合面积及其占后关节面面积的百分比.结果 距下关节融合隧道内关节软骨完全清除,未伤及内外侧关节囊韧带等软组织.植骨块充分填充于融合隧道,未遗留空腔.A组距骨侧轴向融合面积为(293±34)mm2,跟骨侧轴向融合面积为(321±56)mm2,占后关节面面积的百分比分别为43.3%和47.4%,B组中距骨侧轴向融合面积为(433±19)mm2,跟骨侧轴向融合面积为(515±37)mm2,占后关节面面积的比例分别为64.3%和76.1%.两组距骨、跟骨轴向融合面积差异均有统计学意义(P＜0.05).结论 阶梯钻微创距下关节融合术操作安全、方便,对周围软组织影响小,适当调整阶梯钻角度后再次钻入可获得满意的距下关节融合面积,从而提高融合率.

Abstract：

Objective To evaluate feasibility of the minimally invasive subtalar arthrodesis for subtalar traumatic arthritis with a subland drill for dynamic hip screw (DHS),and effects of different fusion areas and their proportions to the posterior articular facet on the treatment. Methods Twenty-two frozen cadaveric specimens of adult feet were randomly assigned into 2 equal groups.In group A,after a guide pin was inserted into the subtalar joint,atunnel was made with a hollow drill along the guide pin.Next the tunnel was expanded with a DHS subland drill.In group B,the tunnel was enlarged to increase the fusion area by driving the DHS subland drill medially and laterally about 20° to 25° respectively,in addition to all the steps of group A.In both groups,morselized spongy bone of ilium was impacted into the tunnel before the subtalar joint was fixed with a hollow screw at last.The axial fusion areas of the talus and calcaneus and their proportions to the posterior articular facet were calculated respectively for both groups and compared. Results The articular cartilage in the tunnel was removed completely and the surrounding soft tissue was not disturbed.The grafted bone was impacted in the tunnel fully and no vacant space left.In group A,the axial talar and calcaneal fusion areas were 293 ± 34 mm2 and 321 ± 56 mm2,which accounted for 43.3％ and 47.4％ of the posterior articular facet respectively.In group B,the axial talar and calcaneal fusion areas were 433 ± 19 mm2 and 515 ±37 mm2,which accounted for 64.3％ and 76.1％ of the posterior articular facet respectively.The differences in the fusion areas were significant between the 2 groups ( P ＜ 0.05 ). Conclusions The procedure of minimally invasive subtalar arthrodesis with a DHS subland drill is safe because the damage to the surrounding soft tissue is minimal.Furthermore,this simple method has a benefit of achieving a broader fusion area,which can facilitate subtalar fusing and reduce complications theatrically.     

Sensitivity of notochordal disc cells to mechanical loading: an experimental animal study

The immature disc nucleus pulposus (NP) consists of notochordal cells (NCs). With maturation NCs disappear in humans, to be replaced by chondrocyte-like mature NP cells (MNPCs); this change in cell phenotype coincidences with early signs of disc degeneration. The reasons for NC disappearance are important to understand disc degeneration, but remain unknown, yet. This study investigated, whether loading induced a change from a notochordal nucleus phenotype to a chondrocyte-like one. An in vivo disc compression model with fixateur externe was used in 36 mature rabbits. Discs were compressed for different time periods (1, 28, 56 days), and compared with uncompressed control discs (56 days without treatment), and discs with sham compression (28 days). Nucleus cell phenotype was determined by histology and immunohistochemistry. NCs, but not MNPCs highly expressed bone-morphogenetic-protein 2 and cytokeratin 8, thus NC and MNPC numbers could be determined. A histologic score was used to detect structural endplate changes after compression (28 days). Control and sham compressed discs contained around 70% NCs and 30% MNPCs, to be decreased to <10% NCs after 28–56 days of loading. NC density fell sharply by >50% after 28–56 days of compression (P < 0.05 vs. controls). Signs of decreased endplate cellularity and increased endplate sclerosis and fibrosis were found after loading. These experiments show that NCs were less resistant to mechanical stress than MNPCs suggesting that increased intradiscal pressures after loading, and limited nutrition through structurally altered endplates could instigate the disappearance of NCs.