Different Numbers of Long-Pulse 1064-nm Nd-YAG Laser Treatments for Onychomycosis: A Pilot Study.

PURPOSE: To examine the benefits of different numbers of 1064-nm Nd-YAG laser treatments in patients with onychomycosis. METHODS: This was a pilot study of patients with onychomycosis who were divided into three groups: four treatment sessions (group A), eight sessions (group B), and 12 sessions (group C). Only infected nails of degrees II-III (Scoring Clinical Index for Onychomycosis) were included. Treatment was given once a week using a long-pulse Nd-YAG 1064-nm laser. Patients were followed at 8, 16, and 24 weeks after the first treatment. Side effects were recorded. RESULTS: Treatments were completed for 442 nails in 102 patients. The efficacy rates at 8, 16, and 24 weeks were 35.5%, 38.7%, and 37.4% for group A; 31.4%, 41.7%, and 44.0% for group B; and 27.7%, 50.0%, and 55.4% for group C, respectively. There was a significant difference in the efficacy rate at 24 weeks (P = 0.016) between groups A and C, but not for groups A vs. B, or for groups B vs. C. No difference in the efficacy rate at 8 or 16 weeks was observed among the three groups. In all three groups, the efficacy was better for degree II nails than for degree III nails (all P = 0.016) between groups A and C, but not for groups A vs. B, or for groups B vs. C. No difference in the efficacy rate at 8 or 16 weeks was observed among the three groups. In all three groups, the efficacy was better for degree II nails than for degree III nails (all. CONCLUSIONS: The 1064-nm Nd-YAG laser had clinical benefits against onychomycosis. Higher numbers of treatments provided better long-term (24-week) benefits, but had no impact on the short-term outcomes. The efficacy of laser treatment on degree II onychomycosis was better than for degree III.

Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd:YAG 1064-nm Laser Combined with Itraconazole.

BACKGROUND: Onychomycosis is a fungal infection of the nail plate and subungual area. In this study, we examined the efficacy of laser treatment using self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser combined with oral medication. METHODS: Self-controlled strategies were followed in this study. The patients received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG 1064-nm laser treatment at the nails of the unilateral limb once a week for a total of four times. A total of 84 affected nails were divided into Group A (mild to moderate) and Group B (severe) according to disease severity. Affected nails with the same Scoring Clinical Index for Onychomycosis scores were selected to compare the therapeutic effects of the pure medication treatment group and the combination treatment group with a 24-week follow-up period. RESULTS: In Group A, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%, respectively, while those in the combination treatment group were 100%, 95.2%, and 90.5%, respectively. The differences between groups were not significant (8th week: χ2 = 4.421, P> 0.05; 16th week: χ2 = 2.043, P> 0.05; 24th week: χ2 = 0.00, P > 0.05). In Group B, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%, respectively, while those in the combination treatment group were 95.2%, 90.5%, and 100%, respectively. The differences between groups at the 8th and 24th weeks of follow-up were statistically significant (8th week: χ2 = 6.929, P< 0.05; 24th week: χ2 = 13.125, P < 0.05). CONCLUSIONS: For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.

Prognostic value of microRNA-10b overexpression in peripheral blood mononuclear cells of nonsmall-cell lung cancer patients.

We examined microRNA (miRNA)-10b expression in peripheral blood mononuclear cells (PBMCs) of nonsmall-cell lung cancer (NSCLC) patients for its clinical value. A group of 74 patients confirmed with NSCLC were recruited as case group and 52 healthy volunteers as control group. PBMCs were isolated from all subjects, and miRNA-10b expression level in these cells was measured by reverse transcription quantitative real-time polymerase chain reaction (qRT-PCR). The correlation between miRNA-10b expression levels and the clinical and pathological characteristics of NSCLC was obtained. The miRNA-10b expression level in NSCLS patients is markedly higher than control subjects (P < 0.01). Analysis of receiver operating characteristic (ROC) curve estimated the peak diagnostic sensitivity of miRNA-10b at 86.5 % and specificity at 76.9 %. NSCLC patients were divided into high expression group (64 patients) and low expression group (10 patients). Further analysis showed that miRNA-10b expression levels in PBMCs correlated with lymph node metastasis, distant metastasis, and TNM classification (all P < 0.05). The 5-year survival rate in high expression group was significantly lower than low expression group (P = 0.017). Multivariate analysis by Cox regression model showed that high miRNA-10b expression, age >60 years, lymph node and distant metastases, and stage III-IV carcinoma were risk factors for poor prognosis in NSCLC patients (all P < 0.05). MiRNA-10b expression levels in PBMCs can distinguish NSCLC patients from cancer-free subjects with a high sensitivity and specificity, suggesting that miRNA-10b expression in PBMCs is a valuable diagnostic and prognostic marker in NSCLC.

Clinical isolates of Mycobacterium abscessus in Guangzhou area most possibly from the environmental infection showed variable susceptibility.

BACKGROUND: Mycobacterium abscessus (M. abscessus) can cause a variety of human infections, involving the lung, skin and soft tissues, and is generally believed to be acquired from environmental sources. The aim of this study was to investigate the molecular diversity and antibiotic susceptibility of M. abscessus isolates as the basis for strategies to improve control and management of infection. METHODS: Seventy M. abscessus isolates from patients attending the Guangzhou Thoracic Hospital were identified from 2003 to 2005 by biochemical tests, gas chromatography, polymerase chain reaction (PCR)-restriction analysis (PRA) of heat shock protein gene hsp65, and sequencing of the quinolone resistance determining regions (QRDRs) of gyrA. Susceptibilities to six antibiotics were determined by micro-broth dilution. Isolates were genotyped using randomly amplified polymorphic DNA (RAPD) analysis. RESULTS: Most isolates (63/70; 90%) were susceptible to amikacin but rates of susceptibility to other antibiotics varied from moderate, clarithromycin (60%) and imipenem (43%), to low for ciprofloxacin and ofloxacin (3%), and 87% of isolates had intermediate susceptibility to cefoxitin. RAPD analysis showed that the 70 clinical isolates displayed 69 unique RAPD patterns. CONCLUSIONS: The high genetic diversity of isolates suggests that they are not transmitted from person to person but, presumably, are acquired independently from environmental sources. M. abscessus isolates displayed variable levels of susceptibility to all antibiotics tested, other than amikacin, indicating a need for routine susceptibility testing to guide treatment.

Effects of laser irradiation on Trichophyton rubrum growth and ultrastructure.

BACKGROUND: Trichophyton rubrum (T. rubrum) is the most common causative agent of dermatophytosis worldwide. In this study, we examined the effect of laser irradiation on the growth and morphology of T. rubrum. METHODS: Colonies of T. rubrum were isolated (one colony per plate), and randomly assigned to 5 treatment groups: Q-switched 694 nm ruby laser treatment, long-pulsed Nd:YAG 1064 nm laser treatment, intense pulsed light (IPL) treatment, 308 nm excimer laser treatment and the blank control group without treatment. Standardized photographs were obtained from grown-up fungal plates prior to treatment. Colonies were then exposed to various wavelengths and fluences of laser light. To compare the growth of colonies, they were re-photographed under identical conditions three and six days post-treatment. To investigate the morphology of T. rubrum, scanning electron microscope (SEM) and transmission electron microscope (TEM) images were obtained from specimens exposed to 24 hours of laser treatment. RESULTS: Growth of T. rubrum colonies was significantly inhibited following irradiation by 694 nm Q-switched and 1064 nm long-pulsed Nd:YAG lasers. Other treatments exerted little or no effect. Q-switched laser irradiation exerted a stronger growth inhibitory effect than long-pulsed Nd:YAG laser irradiation. Following treatment by the Q-switched ruby laser system, T. rubrum hyphae became shrunken and deflated, and SEM images revealed rough, fractured hyphal surfaces, punctured with small destructive holes. TEM images showed that the hyphae were degenerating, as evidenced by the irregular shape of hyphae, rough and loose cell wall, and obscure cytoplasmic texture. Initially high electron density structure was visible in the cell; later, low-density structure appeared as a result of cytoplasmic dissolution. In contrast, the blank control group showed no obvious changes in morphology. CONCLUSION: The Q-switched 694 nm ruby laser treatment significantly inhibits the growth and changes the morphology of T. rubrum.

Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis.

BACKGROUND: Recent research shows that lasers can inhibit fungal growth and that Nd:YAG 1064-nm lasers can penetrate as deep as the lower nail plate. The aim of this study was to observe the effect of a long-pulse Nd:YAG 1064-nm laser on 154 nails of 33 patients with clinically and mycologically proven onychomycosis. METHODS: Thirty-three patients with 154 nails affected by onychomycosis were randomly assigned to two groups, with the 154 nails divided into three sub-groups (II degree, III degree, and IV degree) according to the Scoring Clinical Index of Onychomycosis. The 15 patients (78 nails) in group 1 were given eight sessions with a one-week interval, and the 18 patients (76 nails) in group 2 were given four sessions with a one-week interval. RESULTS: In group 1, the effective rates at 8 weeks, 16 weeks, and 24 weeks were 63%, 62%, and 51%, respectively, and the effective rates in group 2 were 68%, 67%, and 53% respectively. The treatment effect was not significantly different between any sub-group pair (P > 0.05). CONCLUSIONS: Long pulse Nd:YAG 1064-nm laser was effective for onychomycosis. It is a simple and effective method without significant complications or side effects and is expected to become an alternative or replacement therapy for onychomycosis.

Modulation of tropoelastin and fibrillin-1 by infrared radiation in human skin in vivo.

BACKGROUND: The heat produced by exposure to infrared radiation (IR) has been demonstrated to modulate the expression of tropoelastin and fibrillin-1, the two main components of elastic fibers in human skin in vivo. However, the effect of IR range of radiations on tropoelastin and fibrillin-1 expression has not been thoroughly investigated. METHODS: Eighteen volunteers were enrolled in this study involving three trials. Time-dependent, dose-dependent and cumulative effects of IR were investigated, respectively. Tropoelastin and fibrillin-1 expression was measured by immunohistochemical staining on skin biopsy samples from volunteers. In addition, we also measured tropoelastin mRNA expression by a real-time RT-polymerase chain reaction. RESULTS: A single dose of IR (2 minimal heating dose) induced a time-dependent increase in tropoelastin expression at the protein level. An inverse correlation was found between the alterations of tropoelastin and fibrillin-1. Furthermore, IR was found to increase tropoelastin expression in a dose-dependent manner at both the mRNA and the protein level. Repeated low doses of IR increased tropoelastin expression and decreased fibrillin-1 expression at the protein level in the dermis. Meanwhile, the number of both fibers along the dermal-epidermal junction was increased. CONCLUSION: IR can alter the expression of tropoelastin and fibrillin-1, which may result in abnormal elastic fiber formation.