Effects of Blue Light on the Skin and Its Therapeutic Uses: Photodynamic Therapy and Beyond.

BACKGROUND: Blue light is the most energetic portion of the visible light spectrum. Recent awareness of its ubiquity and potential has led to greater developments in therapeutic uses. OBJECTIVE: Provide up-to-date information on the effects of blue light on the skin, with a focus on the benefits and its place in therapeutic modalities within dermatology. MATERIALS AND METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles related to blue light's effect on the skin and therapeutic modalities using blue light. This search resulted in 223 unique results with 60 articles selected for review. RESULTS: Therapeutic modalities using blue light have been proven to be effective as a monotherapy or component of a comprehensive treatment plan for common dermatologic diseases such as actinic keratosis, acne, cutaneous infections, and psoriasis, and early reports support its use in disseminated superficial actinic porokeratosis and actinic cheilitis. CONCLUSION: The benefits and treatment applications of blue light have proven effective in multiple forms and uses. In the correct setting, blue light can be a useful tool to the practicing dermatologist for many common and sometimes refractory skin diseases while remaining low-risk and convenient. Further standardization and monitoring should be pursued to determine the most appropriate use.

Comparison of long-term outcomes from rib fractures for patients undergoing both operative and non-operative management: a survey analysis.

INTRODUCTION: Surgical stabilization of rib fractures (SSRF) has been gaining popularity for the treatment of rib fractures. Limited literature exists regarding the long-term effects of SSRF versus non-operative (NO) intervention. The goal of this study is to better understand these long-term effects, hypothesizing SSRF patients have better outcomes. METHODS: IRB approved survey study at our Level I trauma center. Patients suffering rib fractures from 1/2017 through 1/2019 were surveyed via phone call and asked five questions. Basic demographics obtained. The five survey questions asked: "Are you still experiencing pain from your rib fractures?"; "If yes, how would you rate your pain 1-10?"; "Are you back to your baseline activity level?"; "If no, is this related to your rib fractures?"; "Do you feel your rib fractures moving/clicking?" Paired t test, Chi square, and median tests were utilized. Significance was set at p < 0.05. RESULTS: 527 patients were called with 228 unsuccessfully reached. 47 refused to participate. 252 patients (47.8%) participated in the survey; 78 SSRF and 174 NO. Age and gender were similar between cohorts. Majority of patients suffered blunt trauma. No significant difference between ISS; 15 SSRF vs 14 NO. SSRF patients had worse chest trauma with median chest AIS of 3 (IQR 3-4) vs 3 (IQR 3-3) for NO (p < 0.001). Response to survey questions revealed similar incidences of pain between SSRF and NO cohorts (28.2% vs 27.6%; p = 0.939), however decreased pain scores for SSRF group (2 vs 4; p = 0.006). Return to baseline activity was better for the SSRF group (75.6% vs 56.3%; p = 0.143) and the incidence of rib fractures being the reason for patients not returning to baseline was decreased (26.3% vs 44.7%; p = 0.380). Lastly, SSRF resulted in significantly less movement of rib fractures (3.8% vs 13.8%; p = 0.031). CONCLUSION: Patients who undergo SSRF show significant long-term improvements in pain scores and better return to baseline function with less overall issues from their rib fractures compared to those managed non-operatively.

Discrepancies in rib fracture severity between radiologist and surgeon: A retrospective review.

BACKGROUND: Chest computed tomography (CT) scans are important for the management of rib fracture patients, especially when determining indications for surgical stabilization of rib fractures (SSRFs). Chest CTs describe the number, patterns, and severity of rib fracture displacement, driving patient management and SSRF indications. Literature is scarce comparing radiologist versus surgeon rib fracture description. We hypothesize there is significant discrepancy between how radiologists and surgeons describe rib fractures. METHODS: This was an institutional review board-approved, retrospective study conducted at a Level I academic center from December 2016 to December 2017. Adult patients (≥18 years of age) suffering rib fractures with a CT chest where included. Basic demographics were obtained. Outcomes included the difference between radiologist versus surgeon description of rib fractures and differences in the number of fractures identified. Rib fracture description was based on current literature: 1, nondisplaced; 2, minimally displaced (<50% rib width); 3, severely displaced (≥50% rib width); 4, bicortically displaced; 5, other. Descriptive analysis was used for demographics and paired t test for statistical analysis. Significance was set at p = 0.05. RESULTS: Four hundred and ten patients and 2,337 rib fractures were analyzed. Average age was 55.6(±20.6); 70.5% were male; median Injury Severity Score was 16 (interquartile range, 9-22) and chest Abbreviated Injury Scale score was 3 (interquartile range, 3-3). For all descriptive categories, radiologists consistently underappreciated the severity of rib fracture displacement compared with surgeon assessment and severity of displacement was not mentioned for 35% of rib fractures. The mean score provided by the radiologist was 1.58 (±0.63) versus 1.78 (±0.51) by the surgeon (p < 0.001). Radiologists missed 138 (5.9%) rib fractures on initial CT. The sensitivity of the radiologist to identify a severely displaced rib fracture was 54.9% with specificity of 79.9%. CONCLUSION: Discrepancy exists between radiologist and surgeon regarding rib fracture description on chest CT as radiologists routinely underappreciate fracture severity. Surgeons need to evaluate CT scans themselves to appropriately decide management strategies and SSRF indications. LEVEL OF EVIDENCE: Prognostic/Diagnostic Test, level III.