Erbium YAG Research Articles

Unsupervised Machine Learning Reveals a Vulvodynia-Predominant Subtype in Bladder Pain Syndrome/Interstitial Cystitis.

Background Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic condition characterized by pelvic pain and urinary symptoms. Despite its significant impact on patients' quality of life, the heterogeneity of BPS/IC symptoms and the presence of comorbidities such as vulvodynia may not be adequately captured by validated questionnaires. Identifying vulvodynia in BPS/IC patients is crucial for providing appropriate treatment options. This study aimed to identify subtypes of BPS/IC patients using unsupervised machine learning and to investigate the prevalence of vulvodynia in each subtype. Methods We conducted a prospective cross-sectional study of 123 BPS/IC patients and 64 age-matched controls. Hierarchical clustering was performed using data from validated questionnaires, including the Numerical Rating Scale-11, Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Pelvic Pain and Urgency/Frequency scores, Overactive Bladder Questionnaire Short Form (OABq SF), Overactive Bladder Symptom Score (OABSS), and Pelvic Floor Distress Inventory-20. The optimal number of clusters was determined using the elbow method, and the characteristics of each cluster were analyzed. All participants underwent a vulvodynia swab test to assess vulvodynia symptoms. Results Unsupervised machine learning revealed three distinct clusters of BPS/IC patients. Clusters 0 and 2 differed significantly, with Cluster 2 characterized by significantly higher vulvodynia scores compared to other clusters (P < 0.001). In contrast, Cluster 2 had lower bladder pain scores (ICSI and ICPI) and overactive bladder symptom scores (OABq SF and OABSS) compared to other clusters. Clusters 0 and 1 were characterized by a predominance of bladder pain and urinary frequency symptoms, with Cluster 0 exhibiting more severe symptoms. Conclusions Our study identified distinct subtypes of BPS/IC patients using unsupervised machine learning, with Cluster 2 representing a vulvodynia-predominant subtype. This finding, along with the potential of targeted therapies such as non-ablative erbium YAG laser for vulvodynia, underscores the importance of assessing extravesical symptoms, particularly vulvodynia, for the diagnosis and treatment of BPS/IC. A tailored approach, including laser therapy for vulvodynia-predominant patients, may be necessary for optimal management of BPS/IC. The vulvodynia swab test plays a crucial role in assessing vulvodynia symptoms, underlining the limitations of validated questionnaires in capturing the full spectrum of BPS/IC symptoms. A comprehensive evaluation of patients, including the vulvodynia swab test, is essential for accurate subtyping and management of BPS/IC. Further research with larger sample sizes and investigation of the relationship between identified subtypes and other clinical data is warranted to advance our understanding and management of BPS/IC.

Effectiveness of fractional erbium–YAG laser, microneedling, platelet-rich plasma in localized stable vitiligo patients: randomized clinical trial

Vitiligo is considered an autoimmune disease, and its treatment is challenging. We assessed and compared the effect of fractional erbium:yttrium–aluminum–garnet (Er:YAG) laser-assisted delivery of platelet-rich plasma versus microneedling (Mn) with platelet-rich plasma (PRP) in enhancing skin repigmentation in localized stable vitiligo patients. In total, 40 patients with localized stable vitiligo were selected in a random manner into two similar groups (20 each). Group (A) was subjected to fractional Er:YAG laser combined with platelet-rich plasma and Group (B) was subjected to microneedling combined with platelet-rich plasma. The procedure was repeated every 2 weeks for up to 6 months. Each individual was assessed clinically utilizing Vitiligo Area Scoring Index (VASI). Fractional Er:YAG + PRP group achieved better pigmentation100% (excellent 30%, very good 15%, good 30% and satisfactory 25%) which is comparable to Mn + PRP where 80% of cases demonstrate repigmentation (20% very good, 10% good and 50% mild). When comparing the VASI scores for both groups after therapy to the baseline VASI, there was a statistically significant decrease [p = 0.001 for group(A) and 0.003 for group(B)]. Regarding the treatment side effects, there was significantly (p = 0.048) side effects among cases treated with microneedling group(B) (25%) than those fractional Er:Yag laser therapy group(A) (5%). Both forms of therapy demonstrated induction of repigmentation of vitiligo, but fractional Er:YAG laser efficacy is greater when combined with platelet-rich plasma.Clinical trials.gov identifier: NCT05511493.

Navigating Treatment Choices for Stress and Urgency Urinary Incontinence Using Graph Theory in Discrete Mathematics.

In this study, we propose a method for navigating the choice of treatment for stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) using graph theory in discrete mathematics. Our previous study accumulated data from 150 patients who underwent tension-free vaginal tape (TVT), transobturator tape (TOT), and vaginal non-ablation Erbium YAG laser (VEL) surgeries between 2014 and 2016. Network diagrams were created using this data. The treatments TVT, TOT, and VEL, along with patient characteristics (1-hour pad test: 1-hrPadTest, Overactive Bladder Symptom Score: OABSS), were represented as nodes and edges in the network diagram. We then employed a heuristic function to select the optimal treatment method for the patients with SUI and UUI. This process enables medical professionals to easily navigate the data for patients with both SUI and UUI concerns by calculating the shortest path connecting the 1-hrPadTest and OABSS. These results, which are consistent with those of previous studies, suggest that VEL is the optimal treatment. Unlike previous studies that employed statistical knowledge that is challenging for patients to understand, our study aids patients in visually comprehending and developing a customized treatment plan. This approach introduces a novel perspective for clinical decision-making in the treatment of urinary incontinence. To the best of our knowledge, this is the first study to apply discrete mathematics to patient decision-making for urinary incontinence treatment.

Pathological Insights on Polypropylene Mesh Complications From Laparoscopic Sacrocolpopexy: A Case Series.

Background The use of polypropylene mesh in laparoscopic sacrocolpopexy (LSC) is a common treatment for pelvic organ prolapse (POP). Despite its widespread application, postoperative complications such as mesh pain and infection sometimes necessitate the removal of the mesh. However, it remains unclear in which cases mesh removal is warranted. Our research focused on the pathological changes at the sacral fixation point of the mesh. We sought to evaluate the pathological alterations of the sacral mesh removed through an innovative approach of transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods This retrospective study included nine patients who underwent mesh removal surgery at the Yokosuka Urogynecology and Urology Clinic in 2023. Extraction surgery was performed using vNOTES with the GelPoint Access Platform (Applied Medical JAPAN HEADQUARTERS, Tokyo, Japan). Non-ablative Erbium YAG and Neodymium YAG lasers (RenovaLase, SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia) were utilized for persistent stress urinary incontinence, fecal incontinence, vaginal erosion, and bleeding after surgery. Patients were categorized based on mesh fixation conditions, including unintended mesh overlap (Group I), excessive traction (Group II), and signs of mesh aging (Group III). This categorization helped to understand the distinct pathological outcomes associated with each condition. Results Pathological findings from the mesh removed via vNOTES varied significantly across the groups. In Group I, characteristic large vacuole formation and accumulation of atypical giant cells were observed, attributed to mesh overlap. Group II presented with vacuole formation, fiber degradation, and tissue destruction as a result of excessive mesh traction. In Group III, the aging of the mesh was marked by cracks in the surrounding tissues and granuloma formation. These detailed observations provide crucial insights into the underlying causes of mesh-related pain and other complications, highlighting the complexity of bodily responses to mesh implants. Conclusion This study demonstrated the effectiveness of vNOTES for polypropylene mesh removal in patients with post-LSC complications, resulting in significant pain reduction. Pathological analysis revealed that mesh-related issues stem from the surgical techniques, mesh properties, and long-term bodily reactions. These findings provide valuable insights for improving mesh design and POP treatment strategies. Despite the technical challenges, vNOTES is recommended for mesh removal in patients with pain. Additionally, the combination of UEL, VEL, targeted laser irradiation, AEL, and Nd:YAG laser treatments showed promising results in managing post-mesh removal complications such as stress urinary incontinence, vaginal erosion, bleeding, and fecal incontinence, offering hope for improved patient outcomes.

A split-face study comparing the efficacy and tolerability of erbium YAG laser and 70% trichloroacetic acid in facial seborrheic keratosis.

Seborrheic keratosis (SK) are benign lesions with cosmetic concerns. Role of TCA and erbium YAG laser has already been described individually in the literature. However, there is a scarcity of data on the comparative evaluation of these two modalities in SK. The aim of this study was to compare the efficacy and safety profile of Erbium YAG laser ablation with 70% TCA for the treatment of facial SK. A total of 50 cases of facial SK were included in the study. Group A included SK lesions on the right side of face treated with Erbium YAG laser ablation while Group B included SK lesions on the left side of face treated with topical 70% trichloroacetic acid. Repeated sessions of laser and TCA application were given at 2-week intervals till cure was achieved or up to a maximum of three sessions. Grading of response to treatment was assessed as complete response (100% clearance), partial response (>50 to 99% improvement), and inadequate or no response (<50% improvement). Complete clearance was observed in 40 (80%) and 29 (58%) cases in Groups A and B, respectively. There was a statistically significant difference in clearance rates between the two groups (P = 0.019). Number of sessions was significantly lesser in laser group (mean ± SD = 1.24 ± 0.43) than in the 70% TCA group (mean ± SD = 1.88 ± 0.79) (P = 0.001). Statistically significant lesser downtime was observed in group A (P = 0.001). Patient satisfaction rate was much higher in group A. Hyperpigmentation was more common in group B (TCA). Although both the treatment modalities achieved good results, erbium YAG laser ablation showed superior results than 70% TCA with better patient satisfaction rates but more downtime. Also, no major adverse effects were observed in the two groups.

Spatially modulated erbium YAG laser as a treatment for diabetic ulcer.

Diabetic ulcers are a significant healthcare challenge, capable of diminishing quality of life, lengthening hospitalisation stay, and incurring substantial costs for patients and healthcare systems. Erbium-doped yttrium-aluminum-garnet (Er-YAG) laser has been evolving as a prospective intervention for addressing wounds of various aetiologies. Despite this, the literature remains limited in appraising the effectiveness of laser therapy specifically in diabetic wounds. This study investigates the impact of employing a spatially modulated Er-YAG laser as a therapeutic approach for treating diabetic ulcers. In a single-arm study conducted from November 2017 to April 2023, patients with hard-to-heal ulcers were treated in a two-step approach of wound debridement using Er-YAG laser for ablation and biostimulation through deep tissue resonance using RecoSMA (Multiline laser system, LINLINE MS, Latvia) laser technology. Ulcers received weekly laser treatment, together with routine care until healing occurred and were then followed up to observe any recurrence. The primary outcome measure was wound closure; the secondary outcome measures were time to closure, and the number of laser treatments required. Data related to sociodemographic details, size and number of diabetic ulcers, and number of sessions related to laser treatment were collected using a predesigned, pretested questionnaire before initiating the treatment. A total of 59 patients attending the clinic during the study period with diabetic ulcers were included in the study. The mean wound surface area at baseline was 25.7cm2 (median: 12cm2). The average number of sessions of laser treatment required was 4.41, ranging from 1-11. The size of the ulcer reduced with each session of laser treatment. The diabetic ulcers healed completely at the end of the treatment, indicating the effectiveness of the Er-YAG/RecoSMA two-step approach. Spatially modulated erbium YAG laser is effective as a therapeutic approach for treating diabetic ulcers.

Number of vaginal lactobacilli in postmenopausal women with vaginal atrophy before and after treatment with erbium–YAG laser: a randomized sham-controlled trial

Primary objectiveTo evaluate the effect of erbium–YAG laser on the number of vaginal lactobacilli in postmenopausal women.Secondary objectivesTo evaluate the effect of erbium–YAG laser on vaginal atrophy symptoms and vaginal pH in postmenopausal women.Materials and methodsA total of 44 postmenopausal women who met the inclusion criteria were randomized in the laser group (n = 22) and sham group (n = 22). Vaginal lactobacilli grading, vaginal pH, vaginal atrophy score, and vaginal atrophy symptoms were assessed before and after treatment with erbium–YAG laser for two consecutive times, with a four-week interval; the results were compared with the effects of the sham procedure. Any adverse events after the treatment were recorded.ResultsA total of 44 women were included, and five were lost to follow-up. Compared with sham procedure, vaginal lactobacilli grading improved in the laser group (5/20 in the laser group and 1/19 in the sham group). However, the improvement did not reach statistical significance (adjusted odds ratio = 5.32, 95% CI = 0.5–56.21). Vaginal atrophy symptoms measured by the visual analog scale (VAS) and vaginal pH were improved in both groups without a statistically significant difference between the two groups. Vaginal “dryness” VAS and vaginal atrophy score after treatment were significantly lowered in the laser group compared with the sham group.ConclusionsThis study showed an improvement in vaginal lactobacilli grading after vaginal laser treatment. However, the difference in vaginal lactobacilli grading after treatment in both groups was not statistically significant.

Fractional Erbium YAG laser versus pulsed dye laser in the treatment of Xanthelasma palpebrarum: Randomized comparative intrapatient study

BackgroundXanthelasma palpebrarum (XP) is a disfiguring benign disorder. Both fractional Er:YAG laser and pulsed dye laser (PDL) have been used successfully in the treatment of XP. ObjectiveTo compare the efficacy of ablative fractional Er:YAG laser and nonablative PDL in the treatment of XP by using the Optical coherence tomography (OCT). Patient and methodsTwenty-eight Patients with bilateral XP lesions were included in this randomized comparative study. The eyelids were randomly assigned to treatment by either fractional Er:YAG laser (2940 nm) or PDL (585 nm) at 2 weeks interval for a maximum of 6 sessions. Patients were evaluated objectively by the optical coherence tomography. ResultsXP lesions on both sides showed a significant improvement in area, color, and thickness. However, The PDL treated lesions showed better improvement and higher patient satisfaction. There were no complications with both modalities and no recurrence within 3 months. ConclusionBoth laser modalities are effective and safe therapeutic options for XP however in small lesions PDL is more effective. Optical coherence tomography (OCT) can be used as an objective noninvasive method for evaluation.

Role of Erbium YAG laser in management of scar at donor site of split thickness skin grafting

A variety of revision treatments available for managing different types of scars, including laser therapy, chemical peeling, cryotherapy, dermabrasion, soft tissue augmentation, intralesional steroid injection, and surgical excision. Rhytides, dyschromias, and specific kinds of scars are among the epidermal and dermal lesions that are successfully treated using erbium YAG lasers. In this study, the use of the Erbium YAG laser to treat scars at the site of skin grafting is highlighted.

A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars.

The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.

Fractional Erbium YAG Laser Resurfacing Versus 20% Trichloroacetic Acid Chemical Peeling in the Treatment of Acne Scars: A Comparative Study.

Acne scarring not only affects the aesthetic appearance of an individual but also has a detrimental effect on mental health and social life. Various treatment modalities are available for acne scars. In this study, fractional erbium-doped yttrium-aluminum-garnet (Er:YAG) laser resurfacing was compared with 20% trichloroacetic acid (TCA) peeling in terms of efficacy and safety. This prospective comparative study included 50 subjects of acne scar who were randomly divided into Groups A and B, 25 patients in each group. Group A was treated with 4 sessions of fractional Er:YAG laser and Group B with 4 session of 20% TCA application as chemical peeling, repeated every 21 days over a period of 3 months. The patients were evaluated for improvement at each visit using Goodman and Baron's qualitative and quantitative acne scar grading. Statistically significant improvement in Goodman and Barron's qualitative acne scar grades was observed in both groups. At the end of therapy, that is, after 12 weeks of therapy, the mean percentage reduction in Goodman and Baron's quantitative acne scar scores was 21.69% ± 16% in Group A and 20.97% ± 8.70% in Group B. In regards of complications, both procedures were well tolerated. We concluded that fractional Er:YAG laser resurfacing and 20% TCA peel application in the treatment of atrophic acne scar are equally efficacious. Both procedures are safe and well tolerated by the patients.

Cutaneous Sporotrichosis of Face with Verrucous Lesions over Nose, Successfully Treated with a Combination of Itraconazole and Terbinafine: A Case Report.

Dear Editor, A 13-year-old boy presented with nasal erythematous, crusted, confluent papules, and nodules persisting for approximately 35 days [Figure 1]. The patient denied contact with sick cats but mentioned playing in the bushes. The clinical diagnosis was cutaneous sporotrichosis, and he started treatment with itraconazole 100 mg per day, which was administered orally for 10 days and then increased to 200 mg per day. The exudate from the skin lesions was directly examined by a potassium hydroxide test, which was negative for fungal presence. At 25°C, a mycosal media culture of the exudate revealed colonies resembling Sporothrix sp, which appeared membranous, beige, wrinkled, and with a blackened halo [Figure 2]. At 37°C, phenotypic reversal for creamy colonies with beige and colorless verse was observed, thus demonstrating dimorphism. The lactophenol cotton blue stain revealed hyaline septate hyphae [Figure 3]. On day 44 of itraconazole treatment alone, the lesions became severely crusted, demonstrating no improvements. Thus, 250 mg of oral terbinafine was added to the treatment regimen. On day 60 of itraconazole use, a skin biopsy was performed. Grocott silver stain revealed rare samples of fungal structures [Figure 4]. Histopathology showed acanthosis of the epidermis, areas with perivascular mononuclear inflammatory infiltrate and fibrosis [Figure 5]. On day 226 of itraconazole and day 182 of terbinafine use, clinical improvement was noted, indicating the end of oral antifungal drugs [Figure 6]. The patient underwent Laser Erbium YAG, an ablative laser, to achieve favorable aesthetic results for the scar and uniformization of the skin of the nasal region.Figure 1: Infiltrated erythematous nodules of sporotrichosis on the nose with verrucous appearanceFigure 2: Culture at 25°C, showing colonies of membranous, beige, wrinkled with a blackened halo, resembling Sporothrix speciesFigure 3: The hyaline septate hyphae of Sporothrix spp. with one pyriform microconidia in daisy arrangement (lactophenol cotton blue stain, ×40)Figure 4: Grocott silver stain presenting a fungal structures (40x)Figure 5: Acanthosis of the epidermis, areas with perivascular mononuclear inflammatory infiltrate, and intense remodeling of dermal collagen with fibrosis. (H and E, 10x)Figure 6: Clinical improvement after terbinafine and itraconazole use. Only residual erythema, papules and nodulesSporotrichosis is a subcutaneous mycosis caused by a thermodimorphic fungus, Sporothrix spp., most commonly S. brasiliensis, S. schenckii, and S. globosa.[1] The lesions manifest in different clinical forms: mainly lymphocutaneous, fixed, cutaneous, disseminated, and extracutaneous. Recently, the incidence of various diseases caused by Sporothrix has been increasing in Brazil, particularly a high disease rate in urban areas. Felines have been reported as a new source of infection that spreads diseases.[2] Itraconazole is a first-line treatment for Sporothrix, but some strains, mainly S. brasiliensis, are resistant.[3–5] Moreover, itraconazole content sometimes does not match the concentrations indicated by manufacturers.[3] Itraconazole has certain pharmacokinetic concerns because of several drug interactions. For example, a high gastric pH reduces its bioavailability. Terbinafine is an alternative drug that can effectively treat cutaneous sporotrichosis, and it is affordable and has fewer interactions with other drugs.[1,4,5] To improve therapeutic outcome, itraconazole has been combined with a second drug and demonstrated good results, for example, with supersaturated potassium iodide (SSKI) solution.[6] SSKI is an alternative for cutaneous forms, which is primarily used for infants. However, compared with terbinafine, SSKI has side effects and issues, such as a lack of standardized commercial formulation and unknown mechanisms of action.[1,4] Studies describing the use of itraconazole with terbinafine are limited. In vitro, terbinafine and itraconazole have synergistic effects because both disrupt ergosterol synthesis in the cell membrane of fungi at different stages. This mechanism is beneficial due to accelerated response against chromoblastomycosis, onychomycosis, and sporotrichosis, where facial lesions can cause aesthetic stigmas and affect the quality of life of patients. In conclusion, the combination of terbinafine and itraconazole can effectively inhibit disease progression faster and thus prevent excessive fibrosis and scars.[5,7–10] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Treatment of xanthelasma palpebrarum by ablative lasers, series of 14 cases

Background: Xanthelasma palpebrarum is the most common type of xanthoma. The objective of our study was to evaluate the efficacy and side effects of ablative lasers in the treatment of xanthelasma. Material and methods: We collected patients presenting xanthelasma of the eyelids treated by ablative laser, over 3 years. Results: 14 patients, with a total of 38 lesions, the average age was 52.9.We observed bilateral lesions in 9 of our patients. Upper eyelid involvement was the most frequent with a percentage of 85.7%. Concerning the types of laser used, 3 patients were treated with a CO2 laser,the other patients were treated with an erbium Yag laser. Concerning the side effects, we noted a rapidly resolving edema in 3 patients, slight hypo-pigmented atrophic scars in 3 patients. Conclusion: Laser therapies are an excellent cosmetic treatment option for xanthelasma palpebrarum with good efficacy and minimal side effects.

A comparative study of efficacy of fractional carbon dioxide laser with and without platelet rich plasma in treatment of facial acne scars

Scarring and facial disfigurement caused by severe acne can cause significant physical and psychosocial distress, particularly in adolescents. In treating acne scars, dermatologists face a therapeutic challenge. Ablative lasers Erbium YAG lasers or carbon dioxide lasers are effective, but they are associated with erythema, post-inflammatory hyperpigmentation, a longer recovery time, and scarring. With the introduction of fractional carbon dioxide lasers, acne scar treatment has become much more effective. PRP contains growth factors, which helps to speed up the natural healing process. As a result, combining fractional CO2 laser with platelet rich plasma has resulted in significant improvement of acne scars with good cosmetic results and skin rejuvenation. Through this study, we intend to assess the efficacy of fractional carbon dioxide laser with platelet rich plasma versus fractional carbon dioxide laser alone in the improvement of facial acne scars.To compare the efficacy of fractional carbon dioxide laser with and without platelet rich plasma (PRP) in treatment of facial acne scars.A total of 30 patients (18-40 years) with facial atrophic scars who attended the out-patient department at the Department of Dermatology, Venereology, and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were randomly assigned to groups A (fractional CO2 with PRP group) and B (fractional CO2 group). Patients in both groups received four sequential treatments, with a four-week interval between each session. A side-by-side comparison of preoperative and post-operative photographs was used to assess the clinical improvement of atrophic scars one month after the last session, using Goodman and Baron's qualitative and quantitative grading system. Furthermore, patients were asked to provide feedback on scar improvement using the patient satisfaction Visual Analogue Score (VAS).Based on Goodman and Baron’s qualitative assessment one month after the last session (4 sessions), 13.33 percent (2) of patients in group A showed reduction by three grades compared to 6.66 percent (1) patient in group B, and 60 percent (9) of patients in both groups showed scar reduction by two grades. Based on Goodman and Baron’s quantitative assessment one month after the last session (4 sessions), 20 percent showed very good reduction in group A compared to 13.3 percent in group B, and 40 percent showed good reduction in group A compared to 33.3 percent in group B. [p=0.732, not statistically significant]. Patients treated with fractional carbon dioxide laser with PRP in group A had a slightly better mean percentage reduction of post acne scars at one month after the last session (4 sessions) compared to patients treated with fractional carbon dioxide laser in group B [75.83 vs 69.34 percent; p=0.72 which was statistically not significant]. At one month after the last treatment session (4 sessions), 66.67 percent (10) of patients in Group A were very satisfied with the treatment, compared to 46.67 percent (7) of patients in Group B. After four treatment sessions, the mean Patient Satisfaction VAS Score in Group A was 2.0, compared to 1.7 in Group B [p=0.000082, which was found to be statistically significant]. The result of this study shows that combination of fractional CO2 laser with intradermal PRP is slightly more efficacious than fractional carbon dioxide laser monotherapy in management of facial acne scars. Patients receiving fractional carbon dioxide laser with PRP were more satisfied with the treatment outcome.

Erbium YAG Laser in the Treatment of Androgenetic Alopecia

The article presents data on the effectiveness of the 2940 nm wavelength erbium-doped yttrium aluminum garnet laser (Er:YAG) in the treatment of androgenetic alopecia (AA) in 85 men. All AA patients underwent a video trichodermatoscopy examination of the scalp using an Aramo-SG video camera (Korea) with ×60 and ×200 lenses, and the Trichoscience diagnostic program. The results of the study were evaluated by videotrichodermatoscopy by the presence of atrophied HF before and after 3 months of laser therapy. A 3-month erbium laser treatment using a 2940-nm Er:YAG laser along with the conventional therapy showed a high efficiency, which was expressed in a decrease in microfibrosis around the hair follicles and an increase in hair growth in the anagen stage.

Morphological and histological changes in the urethra after intraurethral nonablative erbium YAG laser therapy: an experimental study in beagle dogs

The purpose of this study was to investigate the morphological and histological changes in the urethra in beagle dogs after intraurethral Er:YAG laser irradiation in nonablative mode to confirm the safety of this therapy. Six 2-year-old healthy female virgin beagle dogs (13 ± 1.51 kg) were used in this study. The animals were divided into 2 groups: the sham group, which received sham treatment (n = 3) involving insertion of an intraurethral cannula and laser delivery handpiece into the urethra without laser irradiation, and the experimental group (n = 3), which received intraurethral Er:YAG laser irradiation. The laser irradiation parameters were set according to clinical criteria (4 mm spot size, 1.5 J/cm2, 1.4 Hz, and 4 pulses) in nonablative mode. All animals received three sequential sessions at 4-week intervals. Urethrography and urethroscopy were performed in the 12th week and 13th week, respectively, after the first treatment. After urethroscopy, the animals were sacrificed, and urethral tissue was harvested for histological investigations. All procedures were performed under general anesthesia (40 mg/kg 3% sodium pentobarbital, i.v.). Transforming growth factor β1 (TGF-β1) and α-smooth muscle actin (α-SMA) expression levels were measured to evaluate the biochemical characteristics of the scar. Urethral stricture was not found by urethrography or urethroscopy in either group. Urethral epithelium thickness and collagen expression under the urethral mucosa were significantly increased in the experimental group compared with the sham group. However, there were no significant differences in TGF-β1 and α-SMA expression between the experimental group and sham group (p > 0.05). Urethral stricture is not found in beagle dogs after clinically relevant intraurethral nonablative mode Er:YAG laser irradiation. Proliferation of urethral collagen and the urethral mucosa may be one of the mechanisms by which urine leakage symptoms can be improved.

Vaginal non-ablative Er:YAG laser sexual dysfunction therapy in women with interstitial cystitis/bladder pain syndrome: A Case Series

ABSTRACT Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating disease characterized by urinary frequency, urgency, and pelvic pain. Different studies have evaluated sexual well-being and e female sexual dysfunction (FSD) in IC/BPS patients. FSD in women with IC/BPS consists of dyspareunia, altered sexual desire, reduced orgasm frequency and vaginal insufficient lubrication. Recently, it has been repeatedly demonstrated that vaginal non-ablative erbium YAG laser (VEL) therapy can improve objective and subjective symptoms in different conditions. In our experience, VEL was very effective in various indications (stress urinary incontinence, mixed urinary incontinence, overactive bladder, genitourinary syndrome of menopause and FSD). In this study we evaluated the effects of VEL on FSD in women suffering from IC/BPS. Materials and methods This is case series study in which women with IC/BPS were also reporting FSD. The patients were treated with VEL with protocol in which the laser firstly irradiated the whole anterior vaginal wall and then also the entire vaginal canal. Local topical anesthesia was applied to the vagina before the laser irradiation. The therapy consisted in 1 treatment every 30 days, for 3 months. For the assessment of treatment effects we evaluated the personal history including: age at onset of IC/BPS and FSD, type of IC/BPS, bladder IC/BPS surgeries, the numeric rating scale-11 (NRS-11), O'Leary-Sant interstitial cystitis symptom and problem indexes (ICSI and ICPI), functional bladder capacity, daily urinary frequency, female sexual function index (FSFI) and vaginal health index score (VHIS). Follow-up was done 6 months from the first laser session. Potential adverse effects were observed at every visit as well as at 6 months follow-up. Results Six women were treated with the three sessions of VEL and followed for 6 months. The FSFI and VHIS significantly improved in all patients. The NRS-11 scores and the part of pain question of ICSI and ICPI improved as well. The bladder capacity and daily urinary frequency showed a marginal improvement. The therapy effects lasted for 6 months from the first treatment. All observed adverse effects were mild and transient. Conclusion Women suffering from IC/BPS have often impaired sexual life. Our data suggest that, besides being safe, VEL treatment can improve sexual life reducing also pain symptoms in IC/BPS patients. Further larger studies are needed in order to ascertain the relations between vaginal conditions and bladder pain, evaluating the possible role of VEL as a new approach for the treatment of FSD in IC/BPS women. Disclosure Work supported by industry: no.

Evaluation of fractional erbium: YAG laser and glycolic acid 70% peeling in melasma improvement

Melasma is an acquired chronic hyperpigmentation which mainly affects women on sun-exposed areas of the body, especially on the face in Fitzpatrick skin types III-V. The study setting is at the Dermatology Clinic at NILES, Cairo University, Egypt. This study aims to evaluate the clinical efficacy and safety of fractional ablative erbium:YAG Laser therapy versus chemical peeling in treatment of melasma. This study included 30 patients with melasma on their face aged 20-50 years. The patients were divided into two groups. In group I, 15 patients were treated by four sessions of fractional erbium YAG laser at 4 weeks interval. In group II, 15 patients were treated by four sessions of chemical peeling with glycolic acid 70%.The percentage of improvement in patients treated by fractional erbium YAG laser was 20 – 80% with amean 54.33 ± 18.01 and the percentage of improvement in patients treated by chemical peeling was 30 – 85 % with a mean 53.33 ± 18.09. So, there was no significant difference in the percentage of improvement in both groups (P- value = 0.881). It was observed that fractional erbium YAG is as effective as 70% glycolic acid peel in patients with melasma.

Historical development of energetic cataract surgery

This article reviews scientific literature analyzing the history of ultrasound and laser phaco surgery of combined or isolated designs: erbium YAG laser, 1.064 μm Nd:YAG laser for dissection of the lens capsule and nucleus, exclusively-laser technique of lens destruction with 1.44 µm Nd:YAG laser without manual, vacuum or ultrasonic action, femtosecond laser assistance with automated transcorneal delivery of radiation into the eye cavity.

Plasma Radiofrequency Ablation for Scar Treatment.

Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial problems with a negative effect on the quality of life. Many conventional approaches have been proposed for the treatment of scars, including surgical techniques, dermabrasion, chemical peels, topical silicone gel, 5-fluorouracile and dermal fillers injection or autologous fat transfer for atrophic scars, and corticosteroids injection for hypertrophic and keloid scars; however, they have sporadic effects. Ablative lasers, such as carbon dioxide laser or Erbium Yag laser, are associated with many collateral effects limiting their application. Non-ablative laser treatments have been shown to be safer and to have fewer side effects, but they have a reduction of clinical efficacy compared to ablative lasers and a minimal improvement of scars. The demand for minimal invasive and safe technology for the treatment of a scars has stimulated the search for more effective novel therapy with fewer collateral effects. Plasma radiofrequency ablation is a new technique consisting of the generation of plasma energy through the production of ionized energy, which thermally heats tissue in a uniform and controlled manner, through a plasma radiofrequency device, inducing a sublimation of the tissue. The aim of this study is to evaluate the effectiveness of P-RF ablation in the treatment of scars performed with D.A.S. Medical device (Technolux, Italia), which is a tool working with the long-wave plasma radiofrequency principle.