Three-step irradiance schedule versus two-step irradiance schedule for pain control during topical 5-aminolevulinic acid-photodynamic therapy of facial acne in Chinese patients: A prospective randomized comparative study.

BACKGROUND: A two-step irradiance schedule has been found to be useful for pain control during photodynamic therapy (PDT) on nonmelanotic skin cancer and condyloma acuminatum. OBJECTIVES: To evaluate the efficacy of a new three-step irradiance schedule derived from the psychological "peak-end rule" and two-step irradiance schedule in relieving pain during 5-aminolevulinic acid PDT (ALA-PDT) on acne. METHODS: A total of 90 moderate to severe acne patients were enrolled in our study and randomly divided into two groups with a ratio of 1:1. They were treated by a light-emitting diode light source of 633 ± 10 nm after being incubated with 5% ALA for an hour using a two-step or three-step irradiance schedule, respectively. The total irradiance intensity was 84 J/cm2 of each session and the treatment interval was 2 weeks. Pain was recorded 30 min after each PDT using a visual analog scale (VAS). Follow-up was done at baseline and 2 weeks after each treatment. The numbers of lesions were counted after the third treatment through the pictures taken before and all the side effects were recorded at each follow-up visit. RESULTS: Eighty-seven subjects completed the total three treatments (44 cases in Group A and 43 cases in Group B). The average VAS of Group B (1.61 ± 0.67) was significantly lower than that of Group A (3.14 ± 0.67), with a difference of 1.52 ± 0.08 (p < 0.0001) between them. Both groups received a similar effective rate after the total three sessions (88.64% vs. 88.37%, p > 0.05). CONCLUSIONS: The new three-step irradiance method could relieve pain during ALA-PDT more significantly than the two-step schedule with a similar effective rate.

A prospective study of the effect of fire micro-needling plus 5% topical ALA-PDT for the treatment of dissecting cellulitis of the scalp.

BACKGROUND: Different therapies have been used for dissecting cellulitis of the scalp (DCS) with poor results. Topical 5-aminolaevulinic acid photodynamic therapy (ALA-PDT) is effective for many inflammatory skin diseases. OBJECTIVES: To evaluate the efficacy and safety of fire micro-needling plus 5% ALA-PDT on DCS. METHODS: Forty-two male DCS patients were enrolled and treated by four sessions of fire micro-needling plus 5% ALA-PDT (occlusion time: 3 h, 100 mW/cm2 for 20-32 min, 633 ± 10 nm LED) with an interval of 1-2 weeks. The reduction of lesions was evaluated at each follow-up visit. The patients` symptoms were evaluated by Dermatology Life Quality Index (DLQI). All of the side effects were recorded. RESULTS: Forty-one DCS patients finished the treatments and the marked effective rate (MER) reached 65.85%. Ten patients (24.39%) were cured and 17 patients (41.46%) achieved excellent improvement. The median of lesion numbers decreased significantly from 25 to 7 (p < 0.001) with DLQI from 13 to 2 (p < 0.001). Although all the ten cured patients had a relapse during the 12-month follow-up, 5/10 patients had a remission of more than 6 months. All the patients tolerated PDT well with mild adverse effects. CONCLUSIONS: Fire micro-needling plus 5% ALA-PDT is effective for Chinese male DCS patients without the need to take systemic drugs.

Pancreatic Stenting Reduces Post-ERCP Pancreatitis and Biliary Sepsis in High-Risk Patients: A Randomized, Controlled Study.

Background. Endoscopic retrograde cholangiopancreatography (ERCP) is an established treatment modality for bile duct disorders, but patients have a risk of post-ERCP pancreatitis (PEP) and biliary sepsis. Aim. To evaluate the effectiveness and safety of pancreatic stent for prophylaxis of PEP and biliary sepsis in high-risk patients with complicating common bile duct (CBD) disorders. Methods. Two hundred and six patients with complicating confirmed or suspected CBD disorders were randomly assigned to receive ERCP with pancreatic stenting (experimental group) or without stenting (control group). Primary outcome measure was frequency of PEP, and secondary outcome measures included operative time, blood loss, postoperative recovery times, and other ERCP-associated morbidities. Results. Baseline age, sex, CBD etiology, concomitant medical/surgical conditions, cannulation difficulty, and ERCP success were comparable between the two groups (all P > 0.05). Compared to the control group, the experimental group had a significantly lower frequency of PEP (7.7% versus 17.7%, P < 0.05) and positive bile microbial culture (40.4% versus 62.7%, P < 0.05). However, the two groups were similar in operative time, blood loss, postoperative recovery times, and other ERCP-associated morbidities (all P > 0.05). Conclusions. Pancreatic stenting can reduce the occurrence of PEP and biliary sepsis in high-risk patients with complicating CBD disorders but does not increase other ERCP-associated morbidities. This trial is registered with the Chinese Clinical Trial Registry (registration identifier ChiCTR-OCH-14005134).

[Therapeutic effects of curcumin treatment on hepatic fibrosis].

OBJECTIVE: To investigate the therapeutic effects and mechanisms of curcumin treatment on hepatic fibrosis. METHODS: A model of hepatic fibrosis was established using carbon tetrachloride intraperitoneal injections in rats. Curcumin was administered to one group of the model rats (curcumin group) and the other rats were used as controls (control group). Serum levels of ALT, AST, HA, LN, PCIII, and NO were measured, and Hyp, MDA, and SOD in liver tissues were measured. Liver tissue slides were stained with HE and Masson staining to study the pathological changes in the livers. Grades of hepatic fibrosis were evaluated according to a semiquantitative scoring system. RESULTS: In the curcumin group, serum levels of ALT, AST, NO, HA, LN, PCIII, MDA, and Hyp, were (218.50+/-48.89) U/L, (376.60+/-79.13) U/L, (47.96+/-6.53) micromol/L, (289.96+/-60.43) mg/L, (107.35+/-27.24) mg/L, (148.95+/-28.63) microg/L, (236.10+/-30.54) nmol/g, (478.40+/-75.74) microg/g and all were lower than those of the control group (693.75+/-117.57) U/L, (892.50+/-105.69) U/L, (70.95+/-10.23) micromol/L, (468.22+/-93.45) mg/L, (346.44+/-75.08) mg/L, (279.82+/-54.00) microg/L, (402.25+/-39.16) nmol/g, and (752.50+/-77.62) microg/g. The differences were significant. In the curcumin group, the level of SOD (90.39+/-21.23) in the liver tissues was significantly higher than that of the control group (46.52+/-20.01). The hepatic fibrosis scores in the curcumin group were significantly lower than those of the control group. These effects were dose-dependent. CONCLUSIONS: Curcumin reduces rat hepatic fibrosis. Anti-peroxidation and regulation of collagen metabolism in liver tissues may be involved in the therapeutic effectiveness of curcumin on hepatic fibrosis.