Deep Tissue Research Articles

Neutrophil extracellular traps-inspired DNA hydrogel for wound hemostatic adjuvant

Severe traumatic bleeding may lead to extremely high mortality rates, and early intervention to stop bleeding plays as a critical role in saving lives. However, rapid hemostasis in deep non-compressible trauma using a highly water-absorbent hydrogel, combined with strong tissue adhesion and bionic procoagulant mechanism, remains a challenge. In this study, a DNA hydrogel (DNAgel) network composed of natural nucleic acids with rapid water absorption, high swelling and instant tissue adhesion is reported, like a band-aid to physically stop bleeding. The excellent swelling behavior and robust mechanical performance, meanwhile, enable the DNAgel band-aid to fill the defect cavity and exert pressure on the bleeding vessels, thereby achieving compression hemostasis for deep tissue bleeding sites. The neutrophil extracellular traps (NETs)-inspired DNAgel network also acts as an artificial DNA scaffold for erythrocytes to adhere and aggregate, and activates platelets, promoting coagulation cascade in a bionic way. The DNAgel achieves lower blood loss than commercial gelatin sponge (GS) in male rat trauma models. In vivo evaluation in a full-thickness skin incision model also demonstrates the ability of DNAgel for promoting wound healing. Overall, the DNAgel band-aid with great hemostatic capacity is a promising candidate for rapid hemostasis and wound healing.

Microwave‐Responsive Nanoplatform with Robust ROS Generation and Inhibiting Effects of Two‐Component System and Quorum Sensing for the Treatment of MRSA‐Induced Osteomyelitis

AbstractThe hypoxic environment of deep tissue and the weak energy of microwave (MW) are still the major limitations of MW catalytic therapy. In this work, an MW‐responsive nano‐platform consisting of an Mn‐doped porphyrin metal–organic framework loaded with calcium peroxide (Mn0.1PCC) is designed to regulate the microenvironment of the injection site and enhance the generation of reactive oxygen species. The excellent MW absorbing properties of Mn0.1PCC improve the Fenton reaction between hydrogen peroxide formed by the hydrolysis of calcium peroxide and released Mn2+ generating more hydroxyl radicals under MW. This process does not consume the oxygen substrate and even produces oxygen to improve the hypoxic environment. Therefore, at a low and safe concentration (125 µg mL−1), the antibacterial rate of Mn0.1PCC against 4 × 108 CFU mL−1 of methicillin‐resistant Staphylococcus aureus (MRSA) after MW irradiation for 15 min is 99.71% ± 0.18%. Mn0.1PCC, upon exposure to MW, prevents the recurrence of bacterial infections and overcomes drug resistance by inhibiting quorum sensing and the two‐component system of MRSA. It can also induce macrophage M1 polarization, up‐regulate the pro‐inflammatory factor tumor necrosis factor‐α, and enhance the phagocytosis of macrophage to bacteria. This strategy provides insights into the development of high‐performance MW‐responsive nanocomposites for the treatment of infections in deep tissues.

Development of Two-Photon Super-Resolution Microscopy

Two-photon excitation microscopy enables in vivo deep-tissue imaging within organisms. This technique is based on two-photon excitation, a nonlinear optical process that uses near-infrared light for excitation, resulting in high tissue permeability. Notably, two-photon excitation occurs only near the focal plane; therefore, minimally invasive tomographic images can be obtained. Owing to these features, two-photon excitation microscopy is currently widely used in medical and life-science research, particularly in the domain of neuroscience for in vivo visualization of deep tissues. However, the use of long-wavelength excitation light in two-photon excitation microscopy has resulted in a larger focused spot size and relatively low spatial resolution, which is a limitation of this technique for further applications. Recent studies have described super-resolution microscopy techniques applied to two-photon excitation microscopy in an attempt to observe living organisms "as they are in their natural state" with high spatial resolution. We have also addressed this topic using an optical approach (two-photon stimulated emission depletion microscopy) and an image analysis approach (two-photon super-resolution radial fluctuation). Here, we describe these approaches together with a discussion of our recent accomplishments.

Proteomics analysis of deep fascia in acute compartment syndrome.

Acute compartment syndrome (ACS) is a syndrome in which local circulation is affected due to increased pressure within the compartment. We previously found in patients with calf fractures, the pressure of fascial compartment could be sharply reduced upon the appearance of tension blisters. Deep fascia, as the important structure for compartment, might play key role in this process. Therefore, the aim of the present study was to examine the differences in gene profile in deep fascia tissue in fracture patients of the calf with or without tension blisters, and to explore the role of fascia in pressure improvement in ACS. Patients with lower leg fracture were enrolled and divided into control group (CON group, n = 10) without tension blister, and tension blister group (TB group, n = 10). Deep fascia tissues were collected and LC-MS/MS label-free quantitative proteomics were performed. Genes involved in fascia structure and fibroblast function were further validated by Western blot. The differentially expressed proteins were found to be mainly enriched in pathways related to protein synthesis and processing, stress fiber assembly, cell-substrate adhesion, leukocyte mediated cytotoxicity, and cellular response to stress. Compared with the CON group, the expression of Peroxidasin homolog (PXDN), which promotes the function of fibroblasts, and Leukocyte differentiation antigen 74 (CD74), which enhances the proliferation of fibroblasts, were significantly upregulated (p all <0.05), while the expression of Matrix metalloproteinase-9 (MMP9), which is involved in collagen hydrolysis, and Neutrophil elastase (ELANE), which is involved in elastin hydrolysis, were significantly reduced in the TB group (p all <0.05), indicating fascia tissue underwent microenvironment reconstruction during ACS. In summary, the ACS accompanied by blisters is associated with the enhanced function and proliferation of fibroblasts and reduced hydrolysis of collagen and elastin. The adaptive alterations in the stiffness and elasticity of the deep fascia might be crucial for pressure release of ACS.

Periodontal and microbiological data in patients with mucous membrane pemphigoid in a French population in 2021-2022: A pilot cross-sectional study.

In the case of mucous membrane pemphigoid with gingival expression (gMMP), the complete healing of the gingiva is generally not achieved despite medical treatment. Therefore, patients' oral comfort is impaired. The dysbiotic periodontal microbiota, generated by a lack of oral hygiene associated with persistent gingival pain, could the immunopathological mechanism to persist. The main objective of this study was to characterize the subgingival microbiota of the gMMP patients, and to highlight a potential link between this microbiological data and the clinical data. Subgingival biofilm was collected from 15 gMMP patients, medically treated or not, but not receiving periodontal treatment. The usual clinical periodontal parameters were recorded. The biofilm was analyzed by polymerase chain reaction quantitative. The risk factors of severe erosive gingivitis and severe periodontitis were assessed using Chi-square or Fischer's exact test were used. Whatever the medical and periodontal conditions of the patients, the results showed the existence of three main communities of periodontopathic, dysbiotic bacteria. The first including Tannnerella forsythia, Peptostreptococcus micros, Fusobacterium nucleatum, and Campylobacter rectus, was found in 100% of the patients, the second enriched with Treponema denticola in 60% and the third enriched with Porphyromonas gingivalis and Prevotella intermedia in 26%. Furthermore, there was a significant positive link between the duration of gMMP and the severity of erosive gingivitis (p = 0.009), and the loss of deep periodontal tissue (p = 0.04). This pilot study suggests a high periodontal risk in gMMP patients. The pathological processes, autoimmune on the one hand and plaque-induced on the other, may amplify each other. The application of periodontal therapy is therefore necessary in parallel with medical treatment. Nevertheless, further controlled studies are required to validate and complement these preliminary results.

A serial case study of the combined use of intraoperative CT and surgical navigation system for the removal of small foreign bodies in the maxillofacial region

PurposeThe removal of small foreign bodies embedded within the deep soft tissues of the maxillofacial region is a complex and challenging task for maxillofacial surgeons. The purpose of this study was to explore the efficacy of the combination of intraoperative CT and surgical navigation for the removal of small foreign objects in the maxillofacial region. MethodsA serial case study was conducted involving all consecutive patients who underwent surgical removal of small foreign bodies in the maxillofacial region. The combination of intraoperative CT and a surgical navigation system was used at a single medical institution from January 2018 to December 2022. Comprehensive data, including patient demographics, characteristics of the foreign bodies, previous surgical interventions, duration of the surgical procedure, and removal success rate were collected for this study. Relevant data were recorded into Microsoft Excel sheet and analyzed using SPSS version 22.0. ResultsNine patients (6 males and 3 females) were included in this study, with an average age of 37 years. Each patient had previously undergone an unsuccessful removal attempt utilizing conventional surgical methods based on preoperative CT imaging or C-arm guidance at a local healthcare facility. Four patients also experienced unsuccessful attempts with preoperative CT image-based navigation systems. However, by employing the combined approach of intraoperative CT and surgical navigation, the foreign bodies were successfully removed in all 9 patients. The mean duration of the surgical procedure was 59 min, and the average size of the foreign bodies was approximately 26 mm³. Postoperative follow-up exceeding 6 months revealed no complications. ConclusionThe combined use of a surgical navigation system and intraoperative CT represents a potent and effective strategy for the precise localization and subsequent removal of small foreign bodies from the soft tissue structures of the maxillofacial region. This integrative approach appears to increase the success rate of surgical interventions in such cases.

Time-of-flight resolved stimulated Raman scattering microscopy using counter-propagating ultraslow Bessel light bullets generation

We present a novel time-of-flight resolved Bessel light bullet-enabled stimulated Raman scattering (B2-SRS) microscopy for deeper tissue 3D chemical imaging with high resolution without a need for mechanical z-scanning. To accomplish the tasks, we conceive a unique method to enable optical sectioning by generating the counter-propagating pump and Stokes Bessel light bullets in the sample, in which the group velocities of the Bessel light bullets are made ultraslow (e.g., vg ≈ 0.1c) and tunable by introducing programmable angular dispersions with a spatial light modulator. We theoretically analyze the working principle of the collinear multicolor Bessel light bullet generations and velocity controls with the relative time-of-flight resolved detection for SRS 3D deep tissue imaging. We have also built the B2-SRS imaging system and present the first demonstration of B2-SRS microscopy with Bessel light bullets for 3D chemical imaging in a variety of samples (e.g., polymer bead phantoms, biological samples such as spring onion tissue and porcine brain) with high resolution. The B2-SRS technique provides a > 2-fold improvement in imaging depth in porcine brain tissue compared to conventional SRS microscopy. The method of optical sectioning in tissue using counter-propagating ultraslow Bessel light bullets developed in B2-SRS is generic and easy to perform and can be readily extended to other nonlinear optical imaging modalities to advance 3D microscopic imaging in biological and biomedical systems and beyond.

Texture differences of microchambers and macrochambers in heel pads between the elderly with and without diabetes

ObjectiveThis study aims to use the texture analysis of ultrasound images to distinguish the features of microchambers (a superficial thinner layer) and macrochambers (a deep thicker layer) in heel pads between the elderly with and without diabetes, so as to preliminarily explore whether texture analysis can identify the potential injury characteristics of deep tissue under the influence of diabetes before the obvious injury signs can be detected in clinical management. MethodsUltrasound images were obtained from the right heel (dominant leg) of eleven elderly people with diabetes (DM group) and eleven elderly people without diabetes (Non-DM group). The TekScan system was used to measure the peak plantar pressure (PPP) of each participant. Six gray-level co-occurrence matrix (GLCM) features including contrast, correlation, dissimilarity, energy, entropy, homogeneity were used to quantify texture changes in microchambers and macrochambers of heel pads. ResultsSignificant differences in GLCM features (correlation, energy and entropy) of macrochambers were found between the two groups, while no significant differences in all GLCM features of microchambers were found between the two groups. No significant differences in PPP and tissue thickness in the heel region were observed between the two groups. ConclusionsIn the elderly with diabetes who showed no significant differences in PPP and plantar tissue thickness compared to those without diabetes, several texture features of ultrasound images were found to be significantly different. Our finding indicates that texture features (correlation, energy and entropy) of macrochambers could be used for early detection of soft tissue damage associated with diabetes.

Non-Surgical Electromagnetic and Thermal Therapies for Chronic Lower Back Pain

Objective: The objective of this review article is to analyze the efficacy and safety of non-surgical electromagnetic and thermal therapies in managing chronic lower back pain. The review will focus on modalities such as short-wave therapy, therapeutic ultrasound, and diathermy, assessing their clinical outcomes and practical implications in treating this prevalent condition. Theoretical Framework: Electromagnetic and thermal therapies represent non-invasive alternatives for treating chronic lower back pain. Diathermy, using electric currents, generates heat that improves circulation and reduces muscle stiffness. Therapeutic ultrasound and short-wave therapy penetrate deep tissues, increasing blood flow and stimulating healing. These modalities are promising options for patients who avoid surgery, reducing pain and enhancing functionality without significant risks. Method: A systematic review was conducted by consulting major scientific databases to identify studies on non-surgical electromagnetic and thermal therapies applied to the treatment of chronic lower back pain. Using specific keywords, recent articles exploring these techniques were collected. This analysis allowed for the consolidation of information on the efficacy of these therapies and highlighted areas needing further investigation, reinforcing evidence-based clinical practice. Results and Discussion: The systematic review shows that non-surgical electromagnetic and thermal therapies are effective in relieving chronic lower back pain, with studies highlighting improvements in pain and functionality. However, variability in treatment protocols underscores the need for standardization to enhance comparability and replicability of results. Further research is essential to elucidate underlying mechanisms and improve clinical practices.

Endemic pediatric fungal infections in India: clues to diagnosis.

This review is intended to familiarize readers with an emerging group of fungal infections that mostly manifest in immunocompetent individuals. This group was initially considered endemic to the tropics, but increasing worldwide prevalence has been reported. The organisms have been divided into dominant non-invasive forms and dominant invasive forms for ease of understanding. The non-invasive organisms include the group Entomophthoromycota, under which two genera Basidiobolus and Conidiobolus, have been identified as human pathogens. They present with plaques in the extremities and rhinofacial region, respectively. The invasive organisms are dematiaceous fungi (phaeohypomycosis), which includes Cladophialophora and Exophiala among others. They cause invasion of deep tissues, with the central nervous system being the most common target. The mycology, epidemiology, diagnosis, and treatment options have been summarized in brief. The clinical presentation, imaging manifestations, differentiation from other common infections and malignancies that show similar features have been detailed.

Evaluation of Silicone-Based Gel for the Treatment of Hypertrophic Scarring in Rat Models

Background: Hypertrophic scarring represents an aberrant response to wounds in certain individuals, manifesting with symptoms such as itching, tenderness, pain, and pigmentation. This study aimed to investigate the impact of a silicone-based gel on the healing of hypertrophic scars, particularly those originating from deep tissue wounds.Methods: A rat model of wound healing and scarring was established, and 12 rats were randomly assigned to three groups: Dermatix Ultra group, SFG-100 silicone-gel group, and non-treated group. Rats in the treated groups (Dermatix Ultra and SFG-100 silicone-gel) received twice-daily applications for 8 weeks. Histologic analysis, including biopsy, was conducted to evaluate the scar elevation index, epidermis thickness, and the number of granulation veins.Results: Overall, both the Dermatix Ultra and SFG-100 silicone-gel groups exhibited improvements in hypertrophic scar healing, accompanied by a significant reduction in skin pigmentation. Histopathologically, scars in both treated groups displayed a notable decrease in scar elevation index, epithelial thickness, and collagen disorganization compared to the non-treated group. However, no significant difference was observed between the Dermatix Ultra and SFG-100 silicone-gel groups.Conclusion: The results suggest that SFG-100 silicone-gel is an effective therapeutic agent for hypertrophic scars. Further research is warranted to elucidate the mechanisms underlying its efficacy and to optimize its application for clinical use.

Preliminary X-ray diffraction and ligand-binding analyses of the N-terminal domain of hypothetical protein Rv1421 from Mycobacterium tuberculosis H37Rv.

Mycobacterium tuberculosis can reside and persist in deep tissues; latent tuberculosis can evade immune detection and has a unique mechanism to convert it into active disease through reactivation. M. tuberculosis Rv1421 (MtRv1421) is a hypothetical protein that has been proposed to be involved innucleotide binding-related metabolism in cell-growth and cell-division processes. However, due to a lack of structural information, the detailed function of MtRv1421 remains unclear. In this study, a truncated N-terminal domain (NTD) of MtRv1421, which contains a Walker A/B-like motif, was purified and crystallized using PEG 400 as a precipitant. The crystal of MtRv1421-NTD diffracted to a resolution of 1.7 Å and was considered to belong to either the C-centered monoclinic space group C2 or the I-centered orthorhombic space group I222, with unit-cell parameters a = 124.01, b = 58.55, c = 84.87 Å, β=133.12° or a = 58.53, b = 84.86, c = 90.52 Å, respectively. The asymmetric units of the C2 or I222 crystals contained two or one monomers, respectively. Interms of the binding ability of MtRv1421-NTD to various ligands, uridine diphosphate (UDP) and UDP-N-acetylglucosamine significantly increased the melting temperature of MtRv1421-NTD, which indicates structural stabilization through the binding of these ligands. Altogether, the results reveal that a UDP moiety may be required for the interaction of MtRv1421-NTD as a nucleotide-binding protein with its ligand.

Pathlength-selective, interferometric diffuse correlation spectroscopy (PaLS-iDCS).

Diffuse correlation spectroscopy (DCS) is an optical method that offers non-invasive assessment of blood flow in tissue through the analysis of intensity fluctuations in diffusely backscattered coherent light. The non-invasive nature of the technique has enabled several clinical applications for deep tissue blood flow measurements, including cerebral blood flow monitoring as well as tumor blood flow mapping. While a promising technique, in measurement configurations targeting deep tissue hemodynamics, the standard DCS implementations suffer from insufficient signal-to-noise ratio (SNR), depth sensitivity, and sampling rate, limiting their utility. In this work, we present an enhanced DCS method called pathlength-selective, interferometric DCS (PaLS-iDCS), which improves upon both the sensitivity of the measurement to deep tissue hemodynamics and the SNR of the measurement using pathlength-specific coherent gain. Through interferometric detection, PaLS-iDCS can provide time-of-flight (ToF) specific blood flow information without the use of expensive time-tagging electronics and low-jitter detectors. The new technique is compared to time-domain DCS (TD-DCS), another enhanced DCS method able to resolve photon ToF in tissue, through Monte Carlo simulation, phantom experiments, and human subject measurements. PaLS-iDCS consistently demonstrates improvements in SNR (>2x) for similar measurement conditions (same photon ToF), and the SNR improvements allow for measurements at extended photon ToFs, which have increased sensitivity to deep tissue hemodynamics (~50% increase). Further, like TD-DCS, PaLS-iDCS allows direct estimation of tissue optical properties from the sampled ToF distribution without the need for a separate spectroscopic measurement. This method offers a relatively straightforward way to allow DCS systems to make robust measurements of blood flow with greatly enhanced sensitivity to deep tissue hemodynamics, enabling further applications of this non-invasive technology.

Sub 20 nm Upconversion Photosensitizers for Near‐Infrared Photodynamic Theranostics

AbstractEfficient type II photodynamic therapy (PDT) requires stable and biocompatible photosensitizers (PS) that present low dark cytotoxicity, are photo‐excitable in deep tissue regions, and can efficiently penetrate and kill cells via in situ singlet oxygen production. Here, heavy‐metal‐free organic PS are combined with near‐infrared (NIR)‐excitable small (&lt;20 nm) upconversion nanoparticles (UCNPs) into UCNP‐PS nanohybrids for accomplishing such advanced PDT conditions. UCNP‐to‐PS energy transfer efficiencies between 11% and 42% and 1O2 generation quantum yields between 74% and 86% resulted in efficient NIR‐sensitized PDT. HeLa cells incubated with UCNP‐PS can be efficiently destroyed via 808 nm laser irradiance at 140 mW cm−2 for 3 min (&lt;30% cell viability) or 3.2 W cm−2 for 6 min (&lt;10% cell viability). Theranostic functionality of UCNP‐PS is demonstrated via live cell in situ imaging of intracellular UCNP‐PS‐mediated 1O2 production, which resulted in cell death, most probably via apoptosis. Preliminary in vivo experiments are also performed and the consequences for a detailed in vivo study toward clinical translation are discussed. The combined PDT and deep‐tissue imaging properties of the nanomolecular PS present a large potential for future implementation into advanced in vivo photodynamic theranostics.

Examination of patients with diabetes mellitus and peripheral arterial disease according to the adapted ischaemic criteria of the WIfI classification

Objective. To combine the determination of ischemia class indicators according to the WIfI classification and simultaneous performance of ultrasound duplex scanning of the arteries of both lower extremities during the initial examination of patients with diabetes mellitus and peripheral arterial disease to predict healing, determine the risk of amputation and the need for revascularisation. Materials and methods. We treated 74 patients with diabetes mellitus and peripheral arterial disease who had signs of infection, ulceration or destruction of deep foot tissues. Patients were divided into two groups: the main group – 43 patients (ischaemia class was determined by the WIfI classification with simultaneous performance of ultrasound duplex scanning of the lower extremity arteries with assessment of lesions by ultrasound criteria) and the control group – 31 patients (ischaemia class according to the WIfI classification was determined only by portable Doppler). Patients in both groups received comprehensive treatment. Results. During the 1–year follow–up, the frequency of re–hospitalisation associated with deterioration of the condition due to limb ischaemia in the main group was statistically significantly (p=0.03) lower than in the control group. Conclusions. The integration of ultrasound duplex scanning at the initial stage of diagnosis allows to determine the degree of ischemia more accurately and to refer the patient for vascular correction in time.

In vivo tumor imaging and therapy based on near-infrared cadmium-free quantum dots

Near-infrared fluorescence imaging technology, which possesses superior advantages including real-time and fast imaging, high spatial and temporal resolution, and deep tissue penetration, shows great potential for tumor imaging in vivo and therapy. Ⅰ-Ⅲ-Ⅵ quantum dots exhibit high brightness, broad excitation, easily tunable emission wavelength and superior stability, and do not contain highly toxic heavy metal elements such as cadmium or lead. These advantages make Ⅰ-Ⅲ-Ⅵ quantum dots attract widespread attention in biomedical field. This review summarizes the recent advances in the controlled synthesis of Ⅰ-Ⅲ-Ⅵ quantum dots and their applications in tumor imaging in vivo and therapy. Firstly, the organic-phase and aqueous-phase synthesis of Ⅰ-Ⅲ-Ⅵ quantum dots as well as the strategies for regulating the near-infrared photoluminescence are briefly introduced; secondly, representative biomedical applications of near-infrared-emitting cadmium-free quantum dots including early diagnosis of tumor, lymphatic imaging, drug delivery, photothermal and photodynamic therapy are emphatically discussed; lastly, perspectives on the future directions of developing quantum dots for biomedical application and the faced challenges are discussed. This paper may provide guidance and reference for further research and clinical translation of cadmium-free quantum dots in tumor diagnosis and treatment.

Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries.

Diabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI). We evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource-poor settings such as in Africa. The management of DFI very often is adapted to the financial and practical realities of the resource-poor regions. The application of the point-of-care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi-quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs. In the practical and resource-saving management of DFI, the 'therapeutic' use of Gram stains is not common in resource-rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.

Fiber Optic Devices for Diagnostics and Therapy in Photomedicine

AbstractPhotonic technologies have made enormous impacts on modern medicine, advancing disease diagnostics and treatments as well as health monitoring. A long‐standing challenge in the use of light and its widespread effects in photomedicine is the finite penetration of light in tissues. However, judiciously engineered optical fibers helped overcome this challenge and advance light delivery to deep tissues with spatial precision and desired accessibility. In recent years, the development of photonic technologies including optical biomaterials, fiber functionalization, and biomedical device innovations has greatly expanded the scope of light‐based healthcare. Here, the fundamentals and materials of fiber optics to endow themselves with biocompatibility, flexibility, and diverse functionalities required for long‐term implantation are overviewed. The design strategies of lab‐on‐fiber techniques, operation requirements to construct fiber optic sensors, and their health monitoring applications as wearable and implantable devices are presented. The use of fiber optics in major light‐based therapeutic modalities including optogenetics, photodynamic therapy, photobiomodulation, photochemical cross–linking, and photothermal therapy is illustrated to enhance their effectiveness, specificity, and feasibility. In short, a comprehensive review is provided on the fiber optic techniques and the latest photonic devices, which are envisioned to evolve photomedicine in clinical and point‐of‐care practices.

Photodynamic therapy for cancer: mechanisms, photosensitizers, nanocarriers, and clinical studies.

Photodynamic therapy (PDT) is a temporally and spatially precisely controllable, noninvasive, and potentially highly efficient method of phototherapy. The three components of PDT primarily include photosensitizers, oxygen, and light. PDT employs specific wavelengths of light to active photosensitizers at the tumor site, generating reactive oxygen species that are fatal to tumor cells. Nevertheless, traditional photosensitizers have disadvantages such as poor water solubility, severe oxygen-dependency, and low targetability, and the light is difficult to penetrate the deep tumor tissue, which remains the toughest task in the application of PDT in the clinic. Here, we systematically summarize the development and the molecular mechanisms of photosensitizers, and the challenges of PDT in tumor management, highlighting the advantages of nanocarriers-based PDT against cancer. The development of third generation photosensitizers has opened up new horizons in PDT, and the cooperation between nanocarriers and PDT has attained satisfactory achievements. Finally, the clinical studies of PDT are discussed. Overall, we present an overview and our perspective of PDT in the field of tumor management, and we believe this work will provide a new insight into tumor-based PDT.

Combination of deep tissue massage and stretching: Does it affect the healing of low back pain injuries?

Background and Study Aim. Low Back Pain (LBP) is an abnormal condition in the lower back which is accompanied by a painful sensation so that it will experience limitations in moving. Therefore, the need for special treatment in dealing with Low Back Pain (LBP) in order to reduce pain. Material and Methods. This research is a pre-experimental research using the approach one group pretest and posttest design. In this study, the results of the initial test data (pretest) were measured in the form of low back pain results with VAS, Modified Schober Test, Fingertip to Floor, and ODI, then giving treatment by combining deep tissue massage with stretching. Therapy is given to patients 3 times a week for 3 weeks, then the final data measurement (Posttest) is carried out. The subjects of this study were patients at the LKP Rumah Sehat Mandiri clinic for the last 5 months who had experienced low back pain injuries. Sampling in this study used purposive sampling so that there were 20 people with an age range of 20-60 years. The analysis in this study uses the SPSS Version 26 application. Results. The results showed that the indicators of pain, flexion, extension, right flexion, left flexion and function had a significant effect using a combination of deep tissue massage and stretching with a significant value si showing 0.000 &lt; 0.05. In the left flexion indicator, a significance value of 0.001 &lt; 0.05 was obtained, so it can be concluded that there is a significant difference in the deep tissue massage combination of stretching treatment. Conclusions. The results of this study provide evidence that the combination of deep tissue massage and stretching provides a significant reduction in the healing of low back pain injuries in patients. That way a combination of deep tissue massage and stretching can be applied to treat low back pain injury healing.