Photodynamic Therapy Sessions Research Articles

Quantitative intracellular oxygen availability before and after 5-aminolevulinic acid skin photodynamic therapy

BackgroundDuring photodynamic therapy (PDT) oxygen is transformed into reactive oxygen species (ROS) to induce cellular apoptosis in (pre)malignant cells. Real time oxygen availability measurement is clinically available with the Cellular Oxygen Metabolism (COMET) monitor. MethodsPrimary objective is to show that mitochondrial oxygen availability (mitoPO2) measurement is possible during clinical ALA-PDT. The secondary aim was to determine the pain sensation, because it is the most commonly reported side effect of PDT. Before and after the two fraction PDT treatment, with a 2-hour dark period, mitoPO2 was measured and reported pain was documented with a visual analog scale (VAS) 0–100. ResultsNine patients were included. Before the first PDT session the median signal quality was [IQR] 55.0% [34.2–68.0], which decreased after session one to 0% [0.0–10.0]. MitoPO2 was 40.0 [17.7–53.8] mmHg and increased afterwards to 61.8 [38.2–64.8] mmHg. This likely the result of the delay time between the illumination stop and the mitoPO2 measurements in a vasodilated, visibly red lesion.Before session two signal quality was 10.4% [0–20.15], 40% lower than at the start. In 5 patients the signal quality after session 2 was too low because of photobleaching and insufficient regeneration of PpIX, median 0% [0–10]. Subjects reported low median VAS scores, all below 3, directly after the mitoPO2 measurements. ConclusionWith COMET we were able to reliably measure mitochondrial oxygen concentrations during photodynamic therapy. Signal quality drastically decreases after a PDT session because of PpIX deterioration during the illumination phase.

Photodynamic therapy for periprosthetic joint infection

Introduction. The increase in the number of patients with joint and hip diseases is an actual problem in the clinical medicine. Objective: to improve outcomes of the combined surgical treatment of patients with deep periprosthetic infection (PPI) by developing and improving surgical techniques using spacers and laser technologies.Material and methods. Thirty-five patients with suppurated large joints as a complication after their replacement were examined and treated. In 9 (25.7 %) patients, PPI developed within 3–12 months after the primary arthroplasty. Twenty (57.1 %) patients developed PPI within 1–2 years after the surgery. In 4 (11.4 %) cases, suppuration in the endoprosthetic area developed in 2–3 years, and in 2 (5.7 %) patients – in 3–3.5 years. The age of the patients was 47–70 years. The main group consisted of 20 patients, the control group – of 15 patients. Patients from the main group had laser photodynamic therapy (PDT) session after the removal of endoprosthetic elements and devitalized tissues.Results. Patients from the main group had uneventful postoperative course – less pain syndrome, rapid resolution of the infl ammatory process, wound healing by the primary tension.Conclusion. Application of a new intraoperative PDT technique, developed by the authors, promotes rapid resolution of purulent-infl ammatory process and better healing of postoperative wounds by primary tension.

The effect of photodynamic therapy on the wound process dynamics in patients with purulent hand diseases

Despite the progress in modern surgery, the number of patients with purulent finger and hand diseases keeps growing these days in the clinical practice of surgeons. In recent years, there has been a tendency to develop more severe forms of panaritium and phlegmon in an increasingly young contingent of patients. Increasingly, doctors refuse to use the classical method of managing a postoperative wound of the hand involving the installation of drainage tubes. This phenomenon is polygenic and calls for special attention due to the frequent deplorable consequences of a treatment failure. The high urgency of this issue in Moscow Hospital No. 4 has become a rationale to study the effect of photodynamic therapy (PDT) on the course of the wound process in patients with this pathology.The purpose of this work is to develop a technique to advance the treatment outcomes for patients with purulent finger and hand diseases in case of open postoperative wound treatment.This study includes a comparative analysis of the wound process dynamics in 49 (49.5%) patients who underwent a photodynamic therapy session in the postoperative period and in 50 (50.5%) patients who received an open wound treatment after the operation. Photodynamic therapy was performed on the second postsurgical day by a laser apparatus “Atkus-2” (wave length 661 nm) with a gel form of the chlorinseries photosensitizer photoditazin in the form of an application at the rate of 1 g ml per 3–5 cm2 of the wound surface. The power density was chosen in the range of 0.1–1 W / cm2, and the time of exposure to the wound varied from 30 to 400 seconds, depending on the area of the wound.To assess the dynamics of the wound process in the postoperative period, we took measurements of all the patients’ wound areas on the 1st and 5th days, monitored the gross impression daily. In the patients who received PDT, we observed an earlier wound cleansing and remitting of the inflammatory process, acceleration of the edge epithelization, and earlier appearance of the granulation tissue by an average of 2 days. In the group of patients who were treated with PDT in the postoperative period, on the 5th day, the wound defect decreased by an average of 1 cm2, which amounted to 22.4%, in the control group – by 18%. The analysis of cytological and morphological patterns also revealed an accelerated switch from the inflammatory stage of the wound process to the reparative one - the reparative processes in the PDT group began earlier by 2 days. The microbiological analysis of wound exudate showed a downregulation of microflora after a PDT session - only in 6 cases pathogens were identified in the repeated seeding, which amounted to 12.24% of the group compared to 38% of the control group. After a session of photodynamic therapy, patients noted a significant reduction in pain, including during dressings. The pain syndrome immediately after the session decreased by 2–3 points. By the 5th day it became moderate – 4–5 points. In the control group, this indicator on the 2nd day was 8 points, decreasing by the 5th day to 6 points. For all analyzed indicators, the groups had statistically significant differences (p <0.001). Acceleration of postoperative wounds healing enabled to shorten the inpatient stay by 6 days and bring a vast improvement to the treatment quality for this group of patients, which allows considering photodynamic therapy as a high potential method for postoperative treatment of purulent finger and hand diseases.

Patterns of multiple human papillomavirus clearance during 5-aminolevulinic acid-based photodynamic therapy in patients with genital warts

BackgroundMultiple human papillomavirus infections are commonly encountered in genital warts. Infection can be eliminated using 5-aminolevulinic acid-based photodynamic therapy. The aim of this study was to identify the preponderant genotypes and patterns of human papillomavirus co-infection clearance during photodynamic therapy in patients with genital warts. MethodsWe conducted a retrospective study between January 2020 and February 2021 at two hospitals in Guangzhou, China. Human papillomavirus typing and quantitative detection were performed before starting treatment and after each session of photodynamic therapy. ResultsA total of 97 patients participated in the study. Co-infections with low-risk and high-risk types were common in genital warts. Types 6 was the most common type detected, followed by types 52, 11, 58, 51 and 56. Patients with multiple infections were more likely to have high-risk human papillomavirus infection. The viral load of high-risk human papillomavirus before treatment was significantly lower than that of low-risk human papillomavirus, and decreased faster during therapy. In addition, high-risk types were cleared more readily than low-risk types, and 51.4% of high-risk types were eliminated after three rounds of therapy. A transient increase in viral load, especially low-risk types, was observed after two sessions of therapy. ConclusionsLow-risk human papillomavirus was preponderant in patients co-infected with low-risk and high-risk types. Photodynamic therapy effectively eliminated multiple human papillomavirus infections. The response to photodynamic therapy was mainly determined by the low-risk types in patients infected with combinations of low-risk and high-risk types.

Effects of multiple sessions of antimicrobial photodynamic therapy (aPDT) in the treatment of periodontitis in patients with uncompensated type 2 diabetes: A randomized controlled clinical study

BackgroundThe aim of this study was to compare, through clinical and microbiological analysis, the use of multiple applications of aPDT as an adjuvant therapy to non-surgical periodontal treatment of stage III and IV grade C periodontitis in type 2 diabetic (DM2) patients. MethodsThirty-four patients with non-compensated DM2 and periodontitis were randomly divided into two groups: SRP Group (n = 17): scaling and root planing (SRP); and SRP+aPDT Group (n = 17): SRP followed by 3 consecutive aPDT applications, immediately, 48 and 96 h after in pockets with probing depth (PD) ≥5 mm. In SRP+aPDT, after 1 min of irrigation with methylene blue (10 mg/ml), the sites were irradiated with a 660 nm diode laser for 50 s (157 J/cm2, 4.7 J, 100 mW). Porphyromonas gingivalis (P. gingivalis) and Prevotella intermedia (P. intermedia) were quantified by real-time qPCR. Periodontal clinical and microbiological data (baseline, 90 and 180 days) were statistically analyzed (α = 5%). ResultsThere was a significant reduction in PD and bleeding on probing at 90 and 180 days post-treatment in both groups (p<0.05). The SRP+aPDT group presented a significant reduction in the number of residual pockets at 90 and 180 days (p<0.05). The SRP+aPDT group presented reduced PD means in deep pockets 180 days post-treatment (p<0.05). No differences were observed in P. gingivalis and P. intermedia levels (p>0.05). ConclusionThe results of present study indicate that the use of multiples aPDT sessions as adjuvant therapy in the periodontal treatment of uncompensated diabetic patients with periodontitis promotes additional clinical benefits.

Predictors of human papillomavirus persistence or clearance after 5-aminolevulinic acid-based photodynamic therapy in patients with genital warts

BackgroundNumerous studies have confirmed that 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) is an effective treatment for human papillomavirus-associated diseases. In this study, we evaluated the variables associated with human papillomavirus (HPV) persistence or clearance after ALA-PDT in patients with genital warts. MethodsWe performed a retrospective chart review of all patients with genital warts or subclinical HPV infection who received ALA-PDT treatment between January 2019 and December 2020 at Nanfang Hospital and Dermatology Hospital of Southern Medical University and analyzed the predictors of HPV persistence or clearance. HPV genotype and viral load assays were analyzed before treatment and after each session of photodynamic therapy. ResultsMultiple sexual partners, a history of recurrent HPV infection, and severe pain response during photodynamic therapy were associated with higher odds of viral persistence after three rounds of ALA-PDT. Infection with single strains of HPV, and mucosal and subclinical infection were more likely to be cleared after three rounds of photodynamic therapy. ConclusionOur findings suggest that patients with multiple sexual partners, a history of recurrent infections, and severe pain response during photodynamic therapy should undergo close surveillance and monitoring, and may need additional photodynamic therapy sessions. Infection with a single strain of HPV, and mucosal or subclinical infections are more likely to be cleared after three courses of ALA-PDT treatment. These findings may improve the efficiency of ALA-PDT in clinical practice.

3-year follow-up of half-dose verteporfin photodynamic therapy for central serous chorioretinopathy with OCT-angiography detected choroidal neovascularization

To assess the 3-year outcome of half-dose verteporfin photodynamic therapy (PDT) in central serous chorioretinopathy (CSC) with optical coherence tomography angiography (OCT-A) detected choroidal neovascularization (CNV), we performed a retrospective, interventional study. Patients were divided into 2 groups according to the fluorescein angiography: point source leakage in group 1 and diffuse oozing in group 2. Data were collected from patients including changes of best-corrected visual acuity (BCVA), size of CNV, central macular thickness (CMT), choroidal thickness (CT), reabsorption of subretinal fluid (SRF), sessions of half-dose PDT, and the number of intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF). There was a total of 34 eyes in 32 patients included. The mean sessions of half-dose PDT was 1.50 ± 0.75. The mean number of IVI of anti-VEGF was 1.38 ± 3.34. BCVA improved from 0.38 ± 0.33 to 0.20 ± 0.22 (p < 0.001). Mean CMT was significantly reduced along with reduced CT and increased size of CNV. SRF was totally reabsorbed in 31 eyes. Patients in group 1 had significant less sessions of PDT and better final BCVA. In conclusion, half-dose PDT treatment was effective for CSC with CNV. Patients with diffuse oozing in FA may fare less well with half-dose PDT.

Co-Encapsulation of Methylene Blue and PARP-Inhibitor into Poly(Lactic-Co-Glycolic Acid) Nanoparticles for Enhanced PDT of Cancer.

The development of resistance against photodamage triggered by photodynamic therapy (PDT) is ascribed mainly to the cellular redox defenses and repair. If the tumor tissue is not promptly eliminated by the first few PDT sessions, PDT-resistance can be favored, challenging the efficacy of the treatment. Although the mechanism of PDT resistance is still unclear, in vitro assays have evidenced that it can be developed through the PARP damage-repair signaling pathway. Therefore, inhibition of poly(adenosine diphosphate (ADP)-ribose) polymerase (PARP) has the potential to increase PDT efficacy. This work reports on the synthesis of a controlled release system of a photosensitizer, methylene blue (MB) and a PARP-inhibitor, the veliparib. MB and veliparib were co-encapsulated in poly(lactic-co-glycolic acid) (PLGA) nanoparticles (VMB-NPs). A colloidal stable aqueous suspension of nanoparticles was obtained. The average hydrodynamic diameter was 90 nm and a narrow size distribution was obtained, with a polydispersity index (PDI) of 0.08. The release kinetics of MB and veliparib from VMB-NPs showed an initial burst of 8.7% and 58.3% release of the total amounts of MB and veliparib respectively, in the first 6 h, and a delayed release of up to 11.3% and 70%, in 19 days, for MB and veliparib, respectively. The VMB-NPs showed no cytotoxicity in the dark but the viability of B16F10-Nex2 cells decreased by 36% when the cells were irradiated (102 J/cm2, 660 nm) and treated with VMB-NPs containing 1.0 µM of MB and 8.3 µM of veliparib. Considering the increased photoactivity even at low MB and veliparib concentrations and the absence of cytotoxicity in dark, the co-encapsulation of MB and veliparib was shown to be a promising strategy to improve the PDT efficacy.

Clinico-microbiological Efficacy of Indocyanine Green as a Novel Photosensitizer for Photodynamic Therapy among Patients with Chronic Periodontitis: A Split-mouth Randomized Controlled Clinical Trial.

Objective:Conventional nonsurgical periodontal therapy, i.e., scaling and root planing (SRP), is not sufficient to completely eradicate the microorganisms present in dental plaque biofilm due to the incapability of instruments to reach the inaccessible areas of a tooth with anatomical variations. Hence, to increase the effectiveness of SRP, many adjunctive treatment strategies are proposed, including photodynamic therapy (PDT). Therefore, the purpose of this study was to determine the clinical and microbiological efficacy of PDT using Indocyanine green (ICG) as a novel photosensitizer for the treatment of chronic periodontitis.Materials and Methods:Twenty individuals who fulfilled the eligibility criteria were enrolled for this randomized controlled clinical trial using split-mouth design. Treatment sites from each individual were randomly allocated into two groups: SRP was done for the sites of the control group and an additional session of PDT using ICG was performed for the sites of the test group. Subgingival plaque samples were collected from both the sites and sent for quantitative analysis of Treponema denticola, Porphyromonas gingivalis, and Tannerella forsythia using real-time polymerase chain reaction (RT-PCR) technique. Probing pocket depth (PD), clinical attachment loss (CAL), and count of all the three microorganisms were assessed at baseline and after 3 months.Results:After 3 months, PD and CAL showed statistically significant improvement in the test sites (P < 0.001) compared to the control sites. However, the differences in the microbiological parameters were statistically nonsignificant between the groups.Conclusion:ICG as a photosensitizer may enhance the outcomes of SRP and can be used for PDT for the nonsurgical management of periodontal diseases.

Photodynamic therapy for preinvasive vaginal cancer.

5592 Background: Photodynamic therapy (PDT) is an effective method for the treatment of various cancers resulting in apoptosis, autophagy and ischemic necrosis of irradiated tissues. The purpose of the study was to analyze the efficacy of PDT for pre-invasive vaginal cancer treatment. Methods: PDT results were studied in 20 patients aged 32-65 years with verified pre-invasive vaginal cancer. All patients received PDT with the Latus diode laser and Photolon or Photolan photosensitizers. The effect was evaluated with extended colposcopy. The criteria for efficiency included normalization of the colposcopic picture and the absence of atypical cells. The sizes of the irradiation fields varied from 1.5 to 2 cm, the number of fields - from 1 to 4, the power density - from 0.1 to 0.17 W/cm2, the light dose - from 40 to 100 J/cm2. The duration of a PDT session varied from 10 to 30 min, depending on the number of irradiation fields. The irradiation field necessarily included an area of normal tissue 3-5 mm surrounding the lesion. 4 to 6 sessions were required to restore the normal layer of stratified squamous epithelium. The antitumor efficacy of PDT was evaluated based on the results of visual observation of changes in the area of the treated pathological foci and information on the presence or absence of clinical symptoms of the disease 1 and 3 months after the treatment (WHO criteria). Results: Complete regression was registered in 100% of patients after 3 months. Repeated courses of PDT were required in cases with a wide spread of pathological foci and the impossibility of their simultaneous irradiation. At follow-up after 1 month, 3 of 20 patients (15%) showed local foci of atypical changes in the epithelium managed with repeated PDT courses. In 6 months, stable remission of the disease clinical symptoms in the treated pathological foci was registered. The results of the cytological study performed 3 months after PDT were normal in 100% patients; no negative changes were registered 6 and 12 months after PDT. Conclusions: The results of PDT in the treatment of patients with pre-invasive vaginal cancer demonstrated its high therapeutic efficacy and a minimal number of adverse reactions, which allows recommending PDT in the treatment of pre-invasive vaginal cancer.

Subretinal fluid morphology in chronic central serous chorioretinopathy and its relationship to treatment: a retrospective analysis on PLACE trial data.

PurposeTo explore subretinal fluid (SRF) morphology in chronic central serous chorioretinopathy (cCSC) after one session of either high‐density subthreshold micropulse laser (HSML) treatment or half‐dose photodynamic therapy (PDT).MethodsWe retrospectively obtained optical coherence tomography (OCT) scans from a subset of patients from a randomized controlled trial on treatment‐naïve eyes with cCSC allocated to either HSML treatment or half‐dose PDT. OCT scans were evaluated prior to treatment and 6–8 weeks post‐treatment, where we measured maximum SRF height and width, calculated the maximum height‐to‐maximum width‐ratio (maxHWR) and calculated the total SRF volume.ResultsForty‐one eyes of 39 cCSC patients were included. SRF morphology ranged from flat to dome‐shaped, quantified as maxHWR ranging between 0.02 and 0.12. SRF volume was median 0.373 μl (range: 0.010–4.425 μl) and did not correlate to maxHWR (rho = −0.004, p = 0.982). Half‐dose PDT was superior to HSML treatment in complete SRF resolution (RR = 3.28, p = 0.003) and in morphological changes of SRF (Δmaximum height, p = 0.001; Δmaximum width, p < 0.001; Δvolume, p = 0.025). SRF resolved completely in 19/22 PDT‐treated eyes (86%) and 5/19 HSML‐treated eyes (26%). SRF volume increased in five eyes (26%) after HSML treatment, and in none of the eyes after half‐dose PDT. SRF morphology at baseline did not predict treatment outcomes.ConclusionSRF morphology changed after both HSML treatment and half‐dose PDT in cCSC, with SRF disappearing in most PDT‐treated patients, whereas SRF volume increased in a sizeable proportion of HSML‐treated patients. Baseline SRF characteristics measured in this study were unable to predict outcomes after either HSML treatment or half‐dose PDT.

One year outcomes of treat and extend and pro re nata (PRN) treatment regimens with aflibercept for polypoidal choroidal vasculopathy.

To compare the 1-year outcomes of treat-and-extend and pro re nata (PRN) treatment regimens with aflibercept for polypoidal choroidal vasculopathy (PCV), by the means of visual acuity (VA), frequency of recurrence of polypoidal lesions and developed fibrosis, and the number of intravitreal injections, and thus to determine which one is preferable in the maintenance phase in PCV. In our prospective study, only naive and previously untreated PCV patients were included. Initially one session of photodynamic therapy (PDT) and three monthly intravitreal injections of 2.0 mg aflibercept (IAIs) were applied in 38 eyes. After this loading phase, they were re-examined and 30 PCV eyes with no exudative phenomena were included in the study. They were divided in two groups; in the first one (16 patients) the PRN treatment modality of IAIs was applied, while in the second one (14 patients) the treat-and-extend regimen was applied. Over a 12-month period, VA significantly improved in treat-and-extend group (logMAR BCVA 0.41 ± 0.15 vs 0.57 ± 0.24 at baseline, p = 0.044), while in the PRN group VA remained stable (logMAR BCVA 0.70 ± 0.36 vs 0.65 ± 0.18 at baseline, p = 0.61). During the maintenance phase, the patients of treat-and-extend group did not encounter development/progression of fibrosis or any recurrent episodes, whereas the patients of PRN group had significantly more recurrent episodes (0 vs 1.37 ± 0.5, p < 0.001) and the frequency of development/progression of fibrosis was significantly higher (0% vs 44%, p = 0.02). However, the treat-and-extend treatment regimen was accompanied by significantly more administered IAIs (6 ± 0 vs 5.13 ± 1.08, p = 0.006). We highlighted the superiority of treat-and-extend regime with IAIs, which seems to yield better functional outcomes by preventing recurrence and subfoveal fibrosis, although a greater number of injections is required.

Photodynamic Therapy for Retinal Hemangioblastoma: Treatment Outcomes of 17 Consecutive Patients

To report the efficacy of photodynamic therapy (PDT) for management of retinal hemangioblastoma. Retrospective case series. Seventeen patients with retinal hemangioblastoma treated with PDT. The medical records of 17 patients with retinal hemangioblastoma treated with PDT were reviewed, and treatment outcomes were assessed. Photodynamic therapy was performed with 6 mg/m2 body surface area of verteporfin infused intravenously over 10 minutes activated by 50 J/cm2 laser light at 689 nm for 83 or 166 seconds. Tumor control, subretinal and intraretinal fluid resolution, and visual outcome. Eighteen retinal hemangioblastomas in 17 eyes were treated with PDT. Median patient age was 31 years (mean, 36 years; range, 7-66 years), and median follow-up was 51 months (mean, 61 months; range, 2-144 months). Genetic testing confirmed von Hippel-Lindau disease in 8 of 17 patients (47%). The tumors were unilateral in all patients and unifocal in most patients (n= 13/17 [76%]). The tumor median basal diameter was 3.5 mm (mean, 3.4 mm; range, 1.5-6.0 mm) and median thickness was 2.1 mm (mean, 2.3 mm; range, 1.0-5.0 mm). The tumor location was juxtapapillary in 9 of 18 cases (50%). Associated findings included subretinal fluid (n= 14/17 [82%]) and macular edema (n= 12/17 [71%]). The median number of PDT sessions was 1.5 (mean, 1.8; range, 1.0-4.0). Standard duration of PDT (83 seconds) was used in all cases except 2, in which double duration (166 seconds) was used. Outcomes revealed tumor control in 13 of 18 tumors (72%), partial or complete resolution of subretinal fluid in 10 of 14 eyes (71%), and partial or complete resolution of macular edema in 7 of 12 eyes (58%), and stable or improved visual acuity in 12 of 17 eyes (71%). Photodynamic therapy-related transient exudative response was noted in 4 of 17 eyes (24%). Photodynamic therapy is an effective treatment for both juxtapapillary and peripheral retinal hemangioblastomas, providing satisfactory rates of tumor control and visual stabilization and improvement. Patients should be monitored for PDT-related transient exudative response.

Influence of photosensitizing agent and number of photodynamic therapy sessions on resistance of fiberglass posts to displacement within the canal

Aim: To evaluate the influence of the type of photosensitizing agent and the number of photodynamic therapy (PDT) sessions on the resistance of cemented fiberglass posts to displacement within the root canal. Methodology: Fifty bovine primary incisors were randomly divided into five experimental groups according to the type of photosensitizing agent and to the number of PDT sessions: CG without PDT (control); GF1M one PDT session with methylene blue; GF2M two PDT sessions with methylene blue; GF1T one PDT session with toluidine blue; and GF2T two PDT sessions with toluidine blue. Exacto® fiberglass posts were cemented with RelyX U200® in the root canal and kept for 15 days in distilled water. The specimens were sectioned with an average thickness of 1.56 mm at the cervical, middle, and apical root thirds and subjected to the push-out test. After the test, the fractured specimens were analyzed under a stereomicroscope to determine the fracture pattern. The data obtained were treated by one-way ANOVA (α=0.05). Results: There was no statistical difference in the comparison of the proposed treatments and the analyzed root thirds (P>0.05). Conclusions: The type of photosensitizing agent used and the number of PDT sessions do not influence the resistance of cemented intraradicular fiberglass posts to displacement.

Reduction of gingival inflammation after 3 sessions of antimicrobial photodynamic therapy in generalized periodontitis non-surgical treatment: a randomized controlled clinical trial

The aim of this randomized controlled study was to investigate changes in periodontal clinical parameters of individuals with generalized periodontitis with association of scaling and root planing (SRP) and multiple sessions of antimicrobial photodynamic therapy (aPDT). With a split-mouth model, patients received SRP alone in control side and SRP and three sessions of aPDT in all teeth of the test side with 0.01% methylene blue solution (Formula & Action, Sao Paulo, Brazil) and 5 min of pre-irradiation time. The irradiation was carried out with red laser source with Indium Gallium Aluminum Phosphide, with wavelength of 660 nm, output power of 100 mW, output energy of 9 J, fluence of 300 J/cm2, 90 s time, output spot of 3 mm2, irradiance of 3.33 W/cm2 (Laser Duo, MMOptics, Sao Paulo, Brazil), and in contact with the gum (mesiobuccal, distobuccal, mesiolingual, distolingual sites), in continuous wave mode. Clinical parameters measured at six sites per tooth (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) at baseline, 45 and 90 days after intervention, were probing depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Twenty-four individuals with mean age of 52 years (± 12.7), 11 men and 13 women, were treated; 1626 sites received SRP and 1668 sites SRP and aPDT. PI reduced significantly in both groups. BOP had a higher reduction in the aPDT group (P > 0.001). Levels of PD and CAL in both sides improved, with no statistical difference between therapies. Although 3 sessions of aPDT associated with SRP provided no additional effect on PD and CAL levels after periodontal treatment, it showed a beneficial effect in gingival inflammation in a 3-month follow-up, which maybe can be attributed to several applications of aPDT after mechanical treatment of periodontitis.

Correlation of the ALA-PDT Treatment Efficacy and the HPV Genotype Profile of Genital Warts after Cryotherapy Failure and Podophyllotoxin Therapy in Male Patients.

Background: Genital warts are the manifestation of the human papillomavirus (HPV) infection, which may last for weeks or months before the clinical presentation. The primary aim of the study was the correlation of the DNA HPV genotypes eradication with the treatment response in male patients with persistent genital warts. Methods: Twenty-one male patients (age range: 22–58) after failure of cryotherapy and podophyllotoxin treatment were enrolled in the study. Genetic tests (Real Time - PCR method) analyzed the presence of DNA-HPV before and 6 months after four sessions (4 weeks apart) of photodynamic therapy with 5-aminolaevulinic acid (ALA-PDT). The treatment efficacy was evaluated before each PDT session and at the end of the study. Results: The single HPV DNA type was present in 15/21 of the patients (13/15 HPV6). The high-risk HPV types were found in 8/21 subjects, of which 6/8 had several types. Six months after four sessions of PDT, complete response was found in 16/21 (76.19%; p = 0.0007) of patients, and DNA HPV clearance was found in 66.67% (p = 0.03). The eradication rate differed among patients with primary low-risk and high-risk HPV types—76.92% (10/13; p = 0.0003) and 50% (4/8; p = 0.05) respectively. Conclusion: ALA-PDT is an effective treatment even after the failure of previous modalities. The persistence of clinical lesions and high oncological risk HPV types should be an indication for treatment prolongation.

Acquired verruciform epidermodysplasia on a tattoo was successfully treated with photodynamic therapy

We present a 44-year-old man with multiple flat papules over a tattoo, diagnosed with acquired verruciform epidermodysplasia (EV). The lesions completely disappeared after 3 sessions of photodynamic therapy (PDT) with topical methyl aminolevulinate. PDT could be considered the treatment of choice in human papillomavirus lesions located over tattoos since it resolves the lesions preserving the integrity of the design.

Сombined endoscopic photodynamic therapy for stenosing cancer in the only lung lobe

A clinical case of stenosing cancer in the only lung lobe treated with endoscopic photodynamic therapy (PDT) in combination with argon-plasma coagulation (APC) is presented. Material and methods . A patient with central cancer of the left lung (pT2N0M0, st 1b) had a radical extended pneumonectomy on the left. In 28 months, central metachronous endobronchial cancer of the right main bronchus (cT1N0M0 stIA) developed. Histological examination revealed G2 squamous cell carcinoma. Because of bronchial stenosis in the only lung lobe, the patient was treated with endoscopic PDT followed by APC at the site of the tumor. Lakhta-Milon laser (Russia) with wavelength 662 nm, optical fibers having a microlens and a cylindrical diffuser 1.0 cm long were used for the treatment. Radiation power 500 mW, energy density 70 J/cm 2 . Three hours before PDT, the patient was injected intravenously and dropwise 100 mg of Photoditazine dissolved in 100 ml of physiological solution (ratio 1.2 mg per 1 kg of body weight). Irradiation was made from 3 positions: a flexible light guide with a microlens irradiated the upper lobe spur; then the tumor was irradiated with a light guide having a cylindrical diffuser via residual bronchial lumens. APC of the tumor was performed electrosurgically with device APC ERBE VIO 300D. ForcedCoag mode, power 80 W, argon flow rate 1 liter per minute. Results . One day after the first PDT session, dyspnea became gradually less; on day 6 the patient had the second PDT session by the same technique. After it, his condition improved, vital signs stabilized: shortness of breath and expiratory stridor decreased; respiratory rate – 22 per/min; heart rate – 94 beats/min; sat. O 2 = 86%. Later, despite multiple courses of chemotherapy, the tumor was growing which required regular PDT-APC recanalization at 2–6-week intervals. Such a combined endoscopic treatment maintained a satisfactory quality of life in the patient for 1.5 years. Conclusion . PDT combined with APC can be used as an independent effective technique in antitumor therapy in patients with stenosing lung cancer when other surgical and chemoradial options are ineffective. It also significantly prolongs the life of patients.

Influence of two photodynamic therapy sessions and different photosensitizers on the bond strength of glass-fiber posts in different regions of intraradicular dentin

Although photodynamic therapy associated with photosensitizers can promote microbial reduction, studies evaluating the consequences of two photodynamic therapy sessions associated with different photosensitizers on the bond strength of glass-fiber posts to endodontically treated intraradicular dentin are scarce. This in vitro study aimed to investigate the influence of two photodynamic therapy sessions using methylene blue or curcumin photosensitizers on the bond strength of glass-fiber posts to intraradicular dentin in different root thirds. Seventy-two teeth were divided into 9 experimental groups according to photosensitizer type, concentration and light-activation: Control - deionized water; Methylene blue 50 mg/L; Methylene blue 50 mg/L + laser; Methylene blue 100 mg/L; Methylene blue 100 mg/L + laser; Curcumin 500 mg/L; Curcumin 500 mg/L + LED; Curcumin 1000 mg/L; and Curcumin 1000 mg/L + LED. Push-out bond strength of the fiber posts to endodontically treated dentin was evaluated using a universal test machine (n = 8). Bond strength data underwent Kruskal-Wallis test, followed by Dunn test for comparison between treatments, and Friedman test for comparison between thirds (α = 0.05). Illustrative scanning electron microscopy images were obtained to qualify the failure mode. Curcumin at higher concentration, activated or not by blue LED, decreased the bond strength values in the apical region when compared with the control group (P < 0.05). There was no difference between two photodynamic therapy sessions using methylene blue photosensitizer (activated or not) and the control group regardless of concentrations and root canal depth evaluated (P > 0.05). Regarding intraradicular depth, the different thirds showed no statistical difference on bond strength values (P > 0.05). All experimental groups presented predominance of mixed-type failure, excepting the methylene blue group at higher concentration activated by red laser, and the curcumin photosensitizer at both concentrations activated by blue LED. Methylene blue at a 50 mg/L concentration can be applied in two PDT sessions, after biomechanical preparation and before glass-fiber post luting, as it presents no influence on root dentin bond strength in in vitro conditions.

Methyl aminolevulinate photodynamic therapy after partial debulking in the treatment of superficial and nodular basal cell carcinoma: 3-years follow-up.

The increase in the number of basal cell carcinoma (BCC) lesions has prompted use of minimally invasive therapies, including Photodynamic therapy (PDT). . The objective of the present work was to analyze the efficacy of methyl aminolevulinate-mediated photodynamic therapy (MAL-PDT) in patients suffering from superficial or nodular BCCs. A total of 220 BCC lesions (76 superficial and 144 nodular), clinically diagnosed and confirmed by histopathology analysis, were treated in 174 patients (mean age 72.5). Debulking using curettage was performed before two or three MAL-PDT sessions (λ = 630 nm; 90 J/cm2; 23 min) at 4-week intervals. Analyses of clinical clearance and cosmetic outcome were carried out by direct examination, dermoscopy, photographs, as well as by fluorescence diagnosis using a Wood's lamp. Evaluations were carried out at the different PDT sessions and follow-ups over a 3-year period. MAL-PDT was safe and highly tolerated. After an average of 2.6 MAL-PDT sessions, the overall clearance rate at 3-year follow-up was 96.1 % (95 % confidence interval [CI] 100 %-92 %) for superficial BCCs and 95.2 % (95 % [CI] 99 %-92 %) for nodular BCCs after an average of 2.7 sessions. Minimal side effects such as crushing, erythema and edema were reported. All BCC lesions showed excellent or good cosmetic results. The protocol followed in the present study has shown that MAL-PDT is a safe and effective treatment for superficial and nodular types of BCC.