Combined CO2 Laser Research Articles

Combined CO2 Laser Vaporization and Bleomycin Injection to Treat Huge Adult Laryngeal Vascular Anomalies: Innovative Application of CO2 Laser in Otolaryngology.

The aim of this study was to assess the value of CO2 laser vaporization in treating huge adult laryngeal vascular anomalies (HALVAs) by combining it with bleomycin injection. This study retrospectively reviewed the records of 13 adult patients who underwent 18 different procedures. Methods to treatHALVAs include traditional bleomycin injectionand CO2 laser vaporization combined with bleomycin injection between September 2009 andJanuary 2023. Treatment results were evaluatedby the grade of lumen constriction. A total of five males and eight females, with an average age of 46.3 years (range, 22-66 years), were included in the study. The huge adult laryngeal vascular anomalies in our study were greater than 1633.71 mm3, and the long diameters of the bases were longer than 15 mm. Compared with the bleomycin injection-only group, the results with the CO2 laser vaporization and bleomycin injection combined were better. Both bleomycin injection and CO2 laser vaporization are safe treatment methods. Their combination may produce better results for huge adult laryngeal vascular anomalies.

A nomogram to predict anal condyloma acuminatum recurrence in HIV-negative patients following photodynamic therapy: A decade-long retrospective clinical study at a single tertiary hospital

BackgroundAnal condyloma acuminatum (CA) is marked by its thorny treatment and high recurrence rate. Although 5-aminolevulinic acid photodynamic therapy (ALA-PDT) demonstrates significant efficacy and safety in treating anal CA, it does not completely prevent recurrence. This study aimed to develop and validate a nomogram model in predicting the risk of relapse in HIV-negative patients with anal CA following treatment with ALA-PDT. MethodsA retrospective analysis was conducted on patients diagnosed with anal CA who received combined CO2 laser vaporization and ALA-PDT between January 2013 and May 2023. Patients were divided into recurrence and non-recurrence groups. A nomogram was developed based on factors showing statistical significance in multivariable logistic regression analysis. The discriminative ability and clinical utility of the nomogram were assessed via ROC curves and decision curve analysis, with internal validation performed through bootstrap resampling. ResultsAmong the 176 patients included, 33 (18.75 %) experienced recurrence, while 143 did not. Independent predictors for recurrence included HPV types, history of anal intercourse, and the number of CO2 laser treatments received. Incorporating these predictors, the nomogram demonstrated a superior diagnostic performance (area under the curve = 0.881, 95 % CI: 0.818–0.935) and a significant net benefit in decision curve analysis. ConclusionsThe nomogram accurately predicts the risk of recurrence in HIV-negative patients with anal CA following ALA-PDT. It offers a valuable tool for guiding preoperative clinical decision-making and establishing personalized treatment strategies to minimize the risk of relapse.

Effective keloid management using a combinatorial continuous-wave and repeat fractionated ablative CO2 laser regimen.

Keloids are benign proliferative scars that form as a result of dysregulated growth and collagen deposition in response to cutaneous injury. Laser therapies have emerged as promising options for the treatment of keloids, with performance varying by laser type and lesion characteristics. To assess the combined continuous wave and repetitive fractionated CO2 laser treatment of keloids. A retrospective chart review of 22 cases of keloid scars treated with combined CO2 laser modes. A single session of continuous wave followed by five sessions of fractional delivery. Efficacy was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale. The Numeric Rating Scale was used to assess patient satisfaction and pain. Most patients were female (77.3%) with skin type IV (72.7%), age was 24.3 ± 9.3 years, most keloids were located on the earlobe (56.5%) or arm or hand (17.4%), size ranged from 5 to 10 cm, and time since injury ranged from 3 months to 35 years. No serious adverse events were reported. At 6 months, significant improvements from baseline occurred in all characteristics, scar color (4.8 ± 2.8 to 1.9 ± 1.1), rigidity (5.0 ± 2.8 vs. 5.4 ± 2.8), thickness (5.4 ± 2.8 vs. 2.0 ± 1.1), and irregularity (5.9 ± 2.4 vs. 1.9 ± 0.9). The Vancouver scores followed a similar trend. Patient-rated overall improvement from 37 ± 17.6 at baseline to 16.1 ± 8.5 at 6 months, and improvement in associated pain and pruritus. Combination of two ablative laser delivery modes within a single laser platform provided for effective and safe keloid management and left patients highly satisfied.

Exploring the Efficacy of Fractional Carbon Dioxide Laser as an Add-on Combination to Conventional Therapies for Treatment-Resistant Vitiligo (A Review Article).

Introduction: Vitiligo, a dermatological disorder that leads to depigmented skin patches, presents a significant challenge, particularly in resistant areas such as acral regions. Fractional CO2 laser therapy holds promise as an adjunct to conventional treatment, enhancing repigmentation. This review comprehensively explores its efficacy and safety in resistant-to-treatment vitiligo. Methods: We conducted extensive database searches in PubMed, Embase, and Cochrane, focusing on English-language literature published between 2012 and 2023. We included comparative studies that met the following criteria: (1) Participants had non-segmental vitiligo, with resistant-to-treatment localization engagement; (2) The treatment involved the use of fractional CO2 laser in combination with conventional therapies; and (3) Outcomes were assessed based on the repigmentation ratio or significant difference. We excluded studies from which data from published results could not be extracted. Results: After extensive screening of 52 articles, we finally selected five studies. The results showed that fractional CO2 laser therapy, when combined with other treatments, often shows promise in vitiligo treatment in refractory cases. Although individual responses varied, overall efficacy and safety were promising, with minimal adverse effects and no severe complications. Conclusion: The fractional CO2 laser, when used in conjunction with conventional therapies, emerges as a promising option for treating refractory vitiligo. Large-scale randomized trials and a deeper understanding of the underlying mechanisms are vital for future progress in optimizing treatment protocols, case selection, and safety.

Efficacy of fractional CO2 laser in combination with stromal vascular fraction (SVF) compared with fractional CO2 laser alone in the treatment of burn scars: a randomized controlled clinical trial

BackgroundThe appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO2 lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO2 laser with fractional CO2 laser alone in the treatment of burn scars.MethodThis double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO2 laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings.ResultsThe results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO2 laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO2 laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO2 laser were significantly better than the group treated with fractional CO2 laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO2 laser was significantly higher than the other group.ConclusionThe results confirm the efficacy of SVF injection in combination with fractional CO2 laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions.Trial registration: The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337.

Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials.

The present work aimed to systematically identify the efficacy and safety of fractional carbon dioxide (CO2) laser plus hyaluronic acid (HA) dressing in dealing with facial atrophic acne scars. Randomized controlled trials (RCTs) concerning fractional CO2 laser in combination with HA dressing for treating atrophic acne scars were screened in 8 electronic databases (containing PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed as well as VIP). Besides, for the purpose of evaluating the risk of bias of the enrolled RCTs, the Cochrane Collaboration tool was adopted. Statistical analysis was completed using Revman5.3 software and Stata 14.0 software. Meanwhile, the quality of evidence was assessed by the GRADE system. Finally, 6 studies involving 623 patients were enrolled. According to the findings in this study, compared with fractional CO2 laser alone, fractional CO2 laser therapy combined with HA dressing reduced the scores of ECCA (échelle d'évaluation clinique des cicatrices d'acné) grading scale (MD=-3.37,95% CI [-5.03, -1.70], P<0.0001), shortened the time of crust formation (MD=-0.42,95% CI [-0.80, -0.04], P=0.03) and the time of crust removal(MD=-1.31,95% CI [-1.67, -0.95], P<0.00001), enhanced patient satisfaction (RR=1.85, 95% CI [1.44, 2.38], P<0.00001). All the reported adverse events including hyperpigmentation, erythema, edema, mild itching, and slight burning pain were controllable. In addition, fractional CO2 laser combined with HA dressing therapy had a lower incidence of hyperpigmentation than fractional CO2 laser alone (RR=0.37, 95% CI [0.23, 0.61], P<0.0001). The level of evidence for outcomes was classified to be low to moderate. According to our findings, fractional CO2 laser combined with HA dressing is efficacious and safe option for facial atrophic acne scars. Nevertheless, more high-quality trials are required for further verification in the future.

Combined therapy of local recombinant human interferon α1b injection and acupuncture on verruca vulgaris: a retrospective study.

Verruca vulgaris is always stubborn to treat. We applied a new combined therapy of local recombinanthuman interferonalpha 1b (rhIFNα1b) injection plus acupuncture on verruca vulgaris recently to evaluate the efficacy and safety of the combined therapy. The retrospective study was conducted in The First Hospital of China Medical University from 2018 to 2020. Patients with verruca vulgaris were included. Combined therapy with local rhIFNα1b injection plus acupuncture was set as treatment group, rhIFNα1b injection and carbon dioxide (CO2) laser were set as control groups. A total of 2415 patients were included in the study. The cure rates were 81.85%, 85.93%, and 100% in combined group, rhIFNα1b group, and CO2 laser group, separately. All lesions cured in combined group were located on hands or feet, while majority of lesions cured in other groups were located on other sites. For patients with medium/big single lesion or 6-9 lesions, less treatment times were needed in combined group than rhIFNα1b group. For patients with small single, two to five or more than ten lesions, the treatment times of combined group and rhIFNα1b group were comparable. All patients complained of pain in varying degrees when local injection or laser irradiation. Compared with CO2 laser group, more fever, less swelling or scar was reported in combined group. In conclusion, combined therapy of local rhIFNα1b plus acupuncture was beneficial for verruca vulgaris with limited adverse effects. The therapy was more acceptable by younger female patients with verruca vulgaris.

Investigation of microstructure, mechanical, and corrosion properties of Inconel 617 joints welded by laser–MIG hybrid welding

The demand for Nickel-based superalloy of Inconel 617 material is increasing for manufacturing hot section components of gas turbines, chemical, and nuclear power plants. It has excellent corrosion resistance in high-temperature environments. In the present study, laser–MIG hybrid welding consisting of a 3.5 kW CO2 laser in combination with a MIG welding system was utilized to weld 10 mm thick Inconel 617 plates with the wire feed rates (WFR) of 10 and 11 m/min in a single pass to analyze the welds microstructure, mechanical, and corrosion properties. The results revealed that the microstructure of the weld zone is composed of cellular crystals with dendrites and equiaxed sub-grains. Electron backscattered diffraction (EBSD) studies revealed coarse columnar dendrites and equiaxed grains at the center of weld joints with the same crystallographic orientation across the fusion boundary. The XRD analysis revealed the dominant gamma and gamma prime (γ/γ′) [(Ni/Ni3(AlTi))] phases along with the presence of minor carbide peaks such as Ti (C, N), M23C6, Cr (C, N), and M6C. The BM has a lower hardness (232 HV) and higher impact energy (236 J) than the weld joints. Similarly, the increase in WFR results in a decrease in microhardness (268–256 HV) values and an increase in impact energy (199–212 J). The weld joints exhibit good bend ductility without any cracks. The potentiodynamic polarization results revealed a lower corrosion rate of 0.212 mpy for the base metal than for the weld joints. The increase of WFR increased the weld metal corrosion rate from 0.342 to 0.427 mpy due to an increase in heat input (0.516–0.615 kJ/mm) and solidification time, which caused the coarsening of the grains resulting in lower grain boundary density and anode reaction to accelerate, which deteriorated the corrosion resistance of the welds.

Evaluation of the complex approach effectiveness of atrophic colpitis treatment in menopausal aged women from the pathogenetic view

Objectives: to determine the status of connective tissue and ionized magnesium value before and after complex treatment of atrophic colpitis with the CO2 laser in menopausal women. Materials and methods. 160 women with atrophic colpitis took part in this prospective study and were divided into three groups depending on the therapy. The main group included 55 patients who underwent CO2 laser therapy. The comparison group included 40 women who underwent CO2 laser therapy and local hormonal treatment with suppositories containing estriol and magnesium saturation by magnesium lactate dihydrate. The control group consisted of 65 women who received only suppositories containing estriol. The duration of treatment was 12 months. In addition to general clinical studies, markers of collagen synthesis (Total PINP, Total PІІІNP), collagen resorption marker (Pyriliks-D), as well as the ionized magnesium value in blood serum were determined in all patients.Results. A significant increase and steady retention at the physiological level of the average value of the Total PINP in the comparison group was revealed. The average level of the Total PIІІNP in patients of this group underwent a significant decrease and remained steadily at the upper limit of the physiological norm. A significant decrease and stable retention at the physiological level of the Pyriliks-D was noted in the comparison group against the background of the proposed therapy. Correction of magnesium status in the comparison group leads to a reliable and stable increase in the Mg+ ions concentration in blood serum.Conclusions. The inclusion CO2 laser in combination with local hormonal therapy and long-term correction of mineral metabolism in the treatment of the comparison group led to the stable normalization and prolonged retention at the physiological level for 12 months of the procollagen type I N-terminal propeptide, procollagen type III N-terminal propeptide, collagen resorption marker Pyriliks-D and a significant increase in magnesium concentration. This is confirms the effectiveness of the proposed complex.

Evaluation of combination use of phenytoin cream 1% and fractional CO2 laser in treatment of stable nonsegmental vitiligo: A pilot study.

Vitiligo is an autoimmune disorder of melanocyte characterized by macular and depigmented patches. There are several treatment modalities for this disease, including the use of corticosteroids, calcineurin inhibitors, vitamin D analogous and topical phenytoin. Combination therapy utilizing fractional CO2 laser with different topical agents has been used to enhance treatment response with promising results. In this study, we aimed to evaluate the effect of fractional CO2 laser in combination with topical phenytoin. In this study, 25 patients (11 females and 14 males) with age of 18-59 (mean age of 31.12) with nonsegmental stable vitiligo were recruited with insufficient response to at least 1-year treatment with a monotherapy using topical corticosteroids, calcineurin inhibitors, and/or NB-UVB phototherapy. Patients were treated with a combination of fractional CO2 laser (10,600 nm, pulse energy 30-50 mJ, MIXEL, South Korea, Rating: 220VAC, 3A, 50/60 Hz) with monthly intervals for six sessions and application of phenytoin 1% cream twice daily. Photography was done before and after treatment with Wood's lamp. The severity of disease using VASI score was calculated and compared before and after treatment. The mean VASI score before treatment was 0.55, and sixth month after treatment increased to 1.97 (p-value < 0.001). Patients were divided into three groups based on the vitiligo subtype: acral, upper extremities, and trunk. VASI score was measured in each group: VASI score before and after treatment was 0.50 and 1.48 in acral areas, 0.45 and 2.04 in upper extremities and 0.79 and 3.39 in trunk, respectively. This study revealed that combination therapy with phenytoin and fractional CO2 laser is effective in treatment of vitiligo not only in the upper extremities and trunk, but also interestingly in the acral areas.

Caries inhibition with CO2-laser during orthodontic treatment: a study protocol for a randomized split-mouth controlled clinical trial

IntroductionWhite spot lesions associated with orthodontic treatment are a common problem. Recent studies reported increased resistance to acid demineralization of enamel after sub-ablative CO2-laser irradiation in a combination with fluoride application. The aim of the study is to assess the efficacy of CO2-laser in combination with a fluoride varnish in the prevention, severity, and extent of white spot lesions during orthodontic treatment with fixed appliances.Methods and analysisThis is a protocol for a randomized, split-mouth controlled, clinical trial. The participants will be children aged 12–18 years at high caries risk, requiring fixed orthodontic treatment. The vestibular surfaces of maxillary anterior teeth of eligible patients will be exposed to CO2-laser irradiation in combination with fluoride therapy and fluoride therapy alone followed by bonding of orthodontic brackets. The patients will be recalled 6 and 12 months post-irradiation. Outcome measures will be visual examination with International Caries Detection and Assessment System criteria and SoproLife fluorescence. Data will be analyzed by Student’s t test for paired samples and proportional odds logistic regression model, p<0.05.Ethics and disseminationThe study protocol has been approved by the Committee for Scientific Research Ethics, Medical University-Plovdiv, Bulgaria (Reference number P-605/27.03.2020, Protocol of approval No. 2/01.04.2021) and registered on a publicly accessible database. This research received institutional funding from the Medical University–Plovdiv, Bulgaria. The results will be presented through peer-reviewed publications and conference presentations.Trial registrationClinicalTrials.gov NCT04903275. Registered on June 2021.

The effects of CO2 laser and topical agent combination therapy for onychomycosis: A meta-analysis.

The routine options for onychomycosis are oral, topical, and device-based therapies which are often limited in terms of efficacy and unsatisfactory side effects. Topical agents such as luliconazole, tioconazole, terbinafine, and tazarotene can be more effective when combined with laser therapies. Our aim was to compare the efficacy and satisfaction rates of CO2 laser therapy with topical agents in patients with onychomycosis. PubMed, the Cochrane Library, Embase, and Ovid databases were searched to identify randomized controlled trials (RCTs) evaluating the effects of combined therapies. Selected study data were analyzed for differences expressed as odds ratio (OR) and relative ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes. Efficacy and satisfaction outcomes were assessed using quantitative methods. Our investigations showed that combined CO2 laser and topical treatments significantly increased efficacy 5.38-fold when compared with topical agents alone (OR 5.38; 95% CI; 3.20-9.04; p < 0.00001), with low heterogeneity observed among studies (I2 =38%). Mycological clearance comparison rates were also improved by combined treatments. The higher satisfaction of the combined group was assessed by pooled effect (OR 4.56; 95% CI; 2.78-7.49; p < 0.00001). Our evidence suggests combined therapy may exert positive effects and satisfactory safety for patients with moderate to severe onychomycosis, however, optimal combination options and appropriate dosages require more comprehensive RCTs.

Principles of surgical treatment of chronic post-intubation laryngotracheal stenosis in childhood

Introduction: Post-intubation stenosis of the larynx and trachea in childhood increases annually. This is associated with an increasing number of children with severe pathology of the upper respiratory tract, as well as children requiring artificial ventilation for other reasons. Until now there have been debatable questions about surgical tactics in children with chronic cicatricial laryngeal stenosis. Aim: The aim of this article is to evaluate the effectiveness of different tactics of surgical treatment of children with chronic cicatricial post-intubation stenosis of the larynx, depending on the state of the cartilaginous frame of the larynx. Materials and Methods: We have treated 47 children with chronic cicatricial post-intubation stenosis of the larynx. Preoperative examination included endoscopy and computed tomography of the larynx and trachea. We assessed the cartilaginous framework of the larynx and trachea that influenced the choice of surgical approach. For 20 children with intact laryngeal cartilaginous frame the method of endolaryngeal microsurgery using a CO2 laser was applied. This method allowed to form a wound surface by minimum submucosal resection scar tissue, which made it possible to cover the wound with mucosal microflaps to prevent restenosis. In the surgical treatment of extended stenoses of the middle larynx, there are prerequisites for repeated replacement of the wound with excess scar tissue, which in our observations was avoided by using endoprostheses for a period of 21 days. Despite it, with a lesion of the subglottic part of the larynx, the risk of restenosis remained quite high (5 out of 12 patients), even in the absence of data for damage to the cartilaginous frame of the larynx. In 27 cases of chronic post-intubation cicatricial stenosis of the larynx, in identifying of laryngeal cartilage framework lesion before surgery, extralaryngeal laryngotracheoplasty was performed. Laryngofissure was performed in 18 children, followed by stenting from 6 to 18 months with a T-shaped silicone stent, in 9 cases—one-stage laryngotracheoplasty using auto-cartilage grafts. The applied techniques have shown high efficiency, while the use of autografts made it possible to reduce the stages and duration of surgical treatment. Conclusion: The use of a CO2 laser in combination with balloon laryngoplasty in microsurgical treatment of chronic post-intubation stenosis of the larynx in children significantly expands surgical capabilities due to high accuracy and low level of damage of surrounding tissues.

Combined CO2 laser and intense pulsed light therapy in the treatment of vascular lesions

Combined CO2 laser and intense pulsed light therapy in the treatment of vascular lesions

Оцінка якості життя у динаміці лікування у жінок зі стресовим нетриманням сечі

The article reflects the results of a study of the quality of life in patients of perimenopausal age against the background of CO2-laser use on the eve and after complex treatment. Today in Ukraine, the number of women suffering from stress urinary incontinence is steadily growing, and the problem has moved from purely medical to the rank of medical and social. Stress urinary incontinence significantly reduces the quality of life of women, leading to discomfort, causes a woman to change her usual behavior, makes her more withdrawn, is accompanied by serious psychoemotional disorders (depression, psychological stress, depression), leads to severe physical and moral suffering, social maladaptation. That is why assessing the quality of life in women with stress urinary incontinence is considered extremely relevant. Today, conservative and surgical techniques are used to treat stress urinary incontinence. However, none of these methods contributes to the complete disappearance of symptoms of stress urinary incontinence, and the relapse rate after the disease is high, which forces a woman to long-term follow-up and treatment, significantly worsening her quality of life. The objective: to assess the quality of life before and after the use of a CO2-laser in the complex treatment of stress urinary incontinence in premenopausal patients. Materials and methods. 89 patients with stress urinary incontinence were examined. Depending on the prescribed therapy, it is divided into two groups. The main group included 44 women who were offered CO2-laser therapy in combination with local hormone therapy. The comparison group was formed by 45 women who were prescribed only topical estriol therapy. In order to assess the quality of life of women with stress urinary incontinence, a survey of patients was conducted using a specialized PFDI-20 questionnaire, and the FSFI questionnaire was used to assess the female sexuality index. The quality of life score and female sexuality index were determined before treatment and 6 and 12 months after the start of treatment. Results. According to the PFDI-20 questionnaire, 6 months after the start of treatment, there was no significant difference in the number of points in women in the study groups. After 12 months from the start of treatment, significant differences in the median scores were recorded (the main group – 18 points; the comparison group – 30 points; p&lt;0.05). Evaluating the index of sexual function in the dynamics of treatment according to the FSFI questionnaire, a significant increase in this indicator was noted in women of the main group (median before treatment – 25 points; after 6 months from the start of treatment – 35 points; after 12 months from the start of treatment – 46 points; p&lt;0.05). Evaluating the results of the UDI-6 questionnaire 12 months after the start of treatment, we drew attention to significant differences in the symptoms of urinary incontinence in women who received CO2-laser therapy in combination with local estriol therapy before treatment and compared to women who received only estriol locally. Conclusions. The inclusion of a CO2-laser in combination with local administration of estriol in the complex treatment of stress urinary incontinence can significantly reduce the manifestations of this complication, which is confirmed by a significant decrease in the median score from 55 to 18 in women of the main group according to the results of the PFDI-20 questionnaire (p&lt;0.05). The index of sexual function in women who received the proposed complex based on the results of the FSFI questionnaire experienced a significant increase from 25 to 46 points (p&lt;0.05). The results of a survey using the UDI-6 questionnaire indicate a significant reduction in the symptoms of stress urinary incontinence in women in the main group compared to women who received only local estriol therapy. Keywords: stress urinary incontinence, CO2-laser, estriol, quality of life.

Fractional carbon dioxide laser-assisted delivery of lyophilized-growth factors is a promising treatment modality of post-acne scars.

Lyophilized-growth factors (L-GFs), is a new platelet rich plasma (PRP) preparation that is standardized in growth factors concentrations. The aim of this study was to compare the therapeutic efficacy of ablative fractional CO2 laser in combination with L-GFs vs PRP in post-acne scars. This study was conducted on 45 patients presented with facial post-acne scars. Each patient received three sessions of fractional CO2 laser on both sides of the face followed by topical application of L-GFs on one side and conventional PRP on the other side. Assessment was done before and after treatment semiquantitatively by Echella d'Èvaluation Clinique des Cicatrices d'Acné (ECCA) score and qualitatively by Goodman and Baron's qualitative scar (GBQS) scale, in addition to dermoscopic evaluation. The current study reported significant clinical improvement of post-acne scars on both sides of the face evidenced by significant reduction of both ECCA score and GBQS scale with minimal side effects. The degree of clinical improvement and patients' satisfaction were significantly higher with shorter downtime in response to fractional CO2 laser combined with L-GFs rather than its combination with PRP. In conclusion, laser assisted delivery of L-GFs via fractional CO2 laser could be considered a novel successful therapeutic modality for post-acne scars.

Establishment of Lower Hygroscopicity and Adhesion Strategy for Infrared-Freeze-Dried Blueberries Based on Pretreatments Using CO2 Laser in Combination with Ultrasound

The present study aimed at solving industrial problems of hygroscopicity and adhesion of freeze-dried crisp-texture blueberries without adversely affecting the other properties. CO2-based laser in combination with ultrasound-assisted infusion of soybean protein isolate (SPI) prior to pulse-spouted infrared freeze drying (PSIRFD) was noted to be effective in solving this major problem through the results of dynamic water adsorption analyzer. The main reason why this approach worked was that laser pretreatment reduced the exposure of fruit contents (e.g., sugar, organic acid) outside the epidermis. Also, SPI interacted with the fruit contents to reduce the number of hydrophilic points under the synergistic effect of laser and ultrasound by differential scanning calorimetry, Fourier-transform infrared spectroscopy, and X-ray diffraction analysis. What is more, the sample prepared by this method possessed the better physicochemical properties and lower energy consumption. So, CO2-based laser in combination with ultrasound along with PSIRFD represents an attractive alternative for producing high-quality dried blueberries.

Efficacy and safety of fractional CO2 laser and tranexamic acid versus microneedling and tranexamic acid in the treatment of infraorbital hyperpigmentation

Objective To compare the efficacy and safety of microneedling and fractional CO2 laser in combination with tranexamic acid (TA) in the treatment of infra-orbital hyperpigmentation. Patients and methods This split-face clinical trial performed on 30 volunteers. The patients were randomly assigned to treat with fractional CO2 laser and microneedling, both combined with TA topically. Three monthly treatment sessions were performed. Two blinded dermatologists evaluated the response after each treatment session and one and three months after the last session. We also asked patients to evaluate their overall satisfaction at the final follow up. Adverse effects have also been documented. Results Both methods showed significant improvement in all sessions comparing with the baseline state (p value <.05). There were no significant differences between two methods on the days 30, 90, and 150. But the laser showed significantly higher improvement on day 60. The patients’ satisfaction did not reveal any significant difference between the two sides. Adverse events were temporary with no significant difference between both sides except for erythema that lasts longer with microneedling. Conclusions Both fractional CO2 laser and microneedling in combination with topical TA seem to be effective modalities in the treatment of infraorbital hyperpigmentation with no significant side effects.

Follicular Transplantation, Microneedling, and Adjuvant Narrow-band Ultraviolet-B Irradiation as Cost-Effective Regimens for Palmar-Plantar Vitiligo: A Pilot Study.

Treatment of refractory palmar-plantar vitiligo is particularly challenging because the skin in these regions has a limited supply of follicle-derived melanocytic stem cells. Autologous hair transplantation monotherapy is effective in some forms of vitiligo through the provision of melanocytic stem cells. CO2 laser followed by exposure to light (i.e., sunlight or narrow-band ultraviolet-B [nbUVB]) has independently shown to be an effective treatment strategy. Recently, it was found that the combination of hair transplantation and CO2 laser followed by nbUVB exposure had superior efficacy to either modality as monotherapy. Similar to CO2 laser, microneedling produces skin cell proliferation and releases pro-pigmentary cytokines. Given the important role of the cytokines in vitiliginous skin, microneedling may also be an effective therapeutic modality for refractory vitiligo. Herein, we conducted a pilot study to evaluate the efficacy of hair transplantation and CO2 laser or microneedling followed by nbUVB. Microneedling and fractional CO2 laser in combination with hair transplantation and nbUVB both demonstrated utility in the induction of repigmentation in refractory palmar-plantar vitiligo; however, a larger trial would be needed to determine a difference in treatment efficacy. Nonetheless, microneedling is cost-effective and requires minimal training; therefore, microneedling can be easily incorporated into standard dermatological practice.

A new combined method for treating involutive changes in the periorbital region

Objective. To solve the problem of correction of involutive changes in the periorbital region, it is necessary to approach from the position of a multidisciplinary approach, since a wide range of problems that need to be solved is possible in this localization. Laser therapy methods have been the standard for correcting age-related changes for many years. However, many questions of combined methods remain open, so the search and development of the most effective protocols for their use is an urgent task of modern medicine.&#x0D; Purpose of the study. Based on the study of the results of clinical efficacy and taking into account the indicators of quality characteristics of the skin, as well as microcirculation, to develop a combined method for correcting involutive skin changes in the periorbital region in young and middle-aged patients using fractional Nd:YAG and CO2 laser in combination with lower transconjunctival blepharoplasty.&#x0D; Material and methods. The study involved 108 patients with involutive changes in the skin of the lower eyelid. Depending on the method of treatment, patients were divided into groups. Special methods were used in the study: the study of qualitative characteristics of the skin (cutometry, TEVA-metry, corneometry), microcirculatory processes using laser flowmetry.&#x0D; Results. The effectiveness of the developed combined method is based on a pronounced positive effect on the active and passive mechanisms of hemodynamics at all levels of the microcirculatory bed, which is confirmed by an increase in the integral indicator of MC by 45.92% against 26.35% and 5.77% in the comparison groups, while the coefficient of variation of the indicator of MC increased by 33.02% against 24.19% and 6.46% after applying the components of the method. The use of the combined treatment method leads to the restoration of skin quality characteristics: the moisture index increased by 27% (p 0.05) compared to 14.1%, 7.8% in groups 1 and 2, respectively, the transepidermal water loss index decreased by 47% (p 0.05) (compared to 35%, 12.7% in groups 1 and 2, respectively), the ua/Uf elasticity index increased by 23.2% (p 0.05) (compared to 18.4%, 16.4% in groups 1 and 2, respectively).&#x0D; Conclusion. On the basis of the conducted research it can be concluded that the developed combined method of treatment is highly effective.