The effects of transcutaneous low-level laser therapy on the skin healing process: an experimental model

Abstract

We aim to evaluate the action of transcutaneous laser in the initial wound healing process. The use of low-level laser therapy (LLLT) has proven to be effective on inflammatory modulation and wound healing. The trial was performed on five groups of rats, through a dorsal incision. All groups received treatment on auricular artery. Groups 1 and 3 were treated with transcutaneous LLLT over a period of 15 min. Groups 2 and 4 received one and two inactive laser applications (placebo), respectively. Group 5 was the control one. Blood samples were collected 2 h after the last application of LLLT so that cytokine levels could be measured by ELISA. Tissue fragments were harvested for morphometric, histomorphometric, and RT-qPCR analyses. The morphometric analysis revealed a greater decrease in the wounded area in G1 when compared with G2, whereas in G3, the improvement in the area was greater when compared with G4. Finally, the histomorphometric analysis showed that G1 was the group closer to G5 in terms of collagen fiber count. G2 and G4 had higher amounts of collagen fibers than G5 while G3 had a lower quantity. The use of the transcutaneous LLLT in the current study influenced the wound healing process.

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Comments concerning ‘Meta-analysis of the association between vitiligo and the level of superoxide dismutase or malondialdehyde’

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Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review

Publication date: Available online 5 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Maria Devine, Murtaza Hirani, Justin Durham, Donald R. Nixdorf, Tara Renton
Objective: To systematically identify criteria used to diagnose patients with trigeminal nerve injury. Study design: A systematic review of the literature registered in the PROSPERO database. Inclusion criteria: patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. Results: 28 articles included. Diagnostic tests included clinical neurosensory tests (CNT) (89%), thermal quantitative sensory testing (25%), electromyography (7%) and patient interview (14%). Neuropathic pain was assessed using visual analogue scale (39%), use of neuropathic medication (7%), questionnaires including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing CNT, application of diagnostic terms and diagnostic grading of nerve injury was not consistent among the included articles making direct comparison of results difficult. Conclusion: Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment and outcome reporting between stakeholder organisations in order to progress knowledge in this field.



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KLICK syndrome: an unusual phenotype

Erythrokeratoderma refers to a group of rare inherited disorders with both clinical and genetic heterogeneities.¹ Lesions usually start in infancy and are characterized by localized and well-demarcated erythematous and hyperkeratotic plaques, sometimes with a migratory nature. Erythrokeratoderma is often inherited as an autosomal dominant trait caused by mutations in the genes GJB3, GJB4, or GJA1, encoding connexins 31, 30.3, and 43, respectively. Erythrokeratoderma may be associated with neurological anomalies and can be caused by ELOVL4.² Recently, mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide pathway were also demonstrated to lead to erythrokeratoderma.³

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Striate palmoplantar keratoderma resulting from a missense mutation in DSG1

palmoplantar keratodermas (PPKs, OMIM #144200) refer to a large phenotypically and genetically heterogeneous group of keratinisation disorders characterised by marked hyperkeratosis on the surface of the palms and soles.

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Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal

Summary

Aim

Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD).

Setting and design

This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries.

Study exposure

Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52.

Primary outcome measures

Co-primary efficacy endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-points or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week-16.

Results

740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo.

Conclusions

Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety.

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Pneumocephalus and seizures following combined spinal-epidural for labor

Most cases of pneumocephalus following neuraxial blocks are associated with accidental dural puncture using loss of resistance to air for identification of the epidural space [1]. To our knowledge, there are no published reports in literature following use of saline for loss of resistance. We report the finding of simultaneous pneumocephalus and a cavernoma in a patient who received a combined spinal-epidural analgesia for labor, using loss of resistance to saline (LORS). The patient provided written consent for the authors to publish this report.

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