Use of osmotically active agents to alter optical properties of tissue: effects on the detected fluorescence signal measured through skin

Optical clearing of tissues: Issues of antimicrobial phototherapy and drug delivery

This review presents principles and novelties in the field of tissue optical clearing (TOC) technology, as well as application for optical monitoring of drug delivery and effective antimicrobial phototherapy. TOC is based on altering the optical properties of tissue through the introduction of immersion optical cleaning agents (OCA), which impregnate the tissue of interest. We also analyze various methods and kinetics of delivery of photodynamic agents, nanoantibiotics and their mixtures with OCAs into the tissue depth in the context of antimicrobial and antifungal phototherapy. In vitro and in vivo studies of antimicrobial phototherapies, such as photodynamic, photothermal plasmonic and photocatalytic, are summarized, and the prospects of a new TOC technology for effective killing of pathogens are discussed.

Impact of optical clearing on ex vivo human skin optical properties characterized by spatially resolved multimodal spectroscopy

A spatially resolved multimodal spectroscopic device was used on a two-layered "hybrid" model made of ex vivo skin and fluorescent gel to investigate the effect of skin optical clearing on the depth sensitivity of optical spectroscopy. Time kinetics of fluorescence and diffuse reflectance spectra were acquired in four experimental conditions: with optical clearing agent (OCA) 1 made of polyethylene glycol 400 (PEG-400), propylene glycol and sucrose; with OCA 2 made of PEG-400 and dimethyl sulfoxide (DMSO); with saline solution as control and a "dry" condition. An increase in the gel fluorescence back reflected intensity was measured after optical clearing. Effect of OCA 2 turned out to be stronger than that of OCA 1, possibly due to DMSO impact on the stratum corneum keratin conformation. Complementary experimental results showed increased light transmittance through the skin and confirmed that the improvement in the depth sensitivity of the multimodal spectroscopic approach is related not only to the dehydration and refractive indices matching due to optical clearing, but also to the mechanical compression of tissues caused by the application of the spectroscopic probe.

Spatially-Resolved Multiply-Excited Autofluorescence and Diffuse Reflectance Spectroscopy: SpectroLive Medical Device for Skin In Vivo Optical Biopsy

This contribution presents the development of an optical spectroscopy device, called SpectroLive, that allows spatially-resolved multiply-excited autofluorescence and diffuse reflectance measurements. Besides describing the device, this study aims at presenting the metrological and safety regulation validations performed towards its aimed application to skin carcinoma in vivo diagnosis. This device is made of six light sources and four spectrometers for detection of the back-scattered intensity spectra collected through an optical probe (made of several optical fibers) featuring four source-to-detector separations (from 400 to 1000 µm). In order to be allowed by the French authorities to be evaluated in clinics, the SpectroLive device was successfully checked for electromagnetic compatibility and electrical and photobiological safety. In order to process spectra, spectral correction and metrological calibration were implemented in the post-processing software. Finally, we characterized the device’s sensitivity to autofluorescence detection: excitation light irradiance at the optical probe tip in contact with skin surface ranges from 2 to 11 W/m², depending on the light source. Such irradiances combined to sensitive detectors allow the device to acquire a full spectroscopic sequence within 6 s which is a short enough duration to be compatible with optical-guided surgery. All these results about sensitivity and safety make the SpectroLive device mature enough to be evaluated through a clinical trial that aims at evaluating its diagnostic accuracy for skin carcinoma diagnosis.

Investigating the optical clearing effects of 50% glycerol in ex vivo human skin by harmonic generation microscopy

Imaging depth and quality of optical microscopy can be enhanced by optical clearing. Here we investigate the optical clearing of the ex vivo human skin by 50% glycerol topical application, which is allowed for cosmetic usage. Harmonic generation microscopy, by combining second and third harmonic generation (THG) modalities, was utilized to examine the clearing effect. The THG image intensity is sensitive to the improved optical homogeneity after optical clearing, and the second harmonic generation (SHG) image intensity in the dermis could serve as a beacon to confirm the reduction of the scattering in the epidermis layer. As a result, our study supports the OC effect through 50% glycerol topical application. Our study further indicates the critical role of stratum corneum shrinkage for the observed SHG and THG signal recovery.

Tissue clearing and its applications in neuroscience

State-of-the-art tissue-clearing methods provide subcellular-level optical access to intact tissues from individual organs and even to some entire mammals. When combined with light-sheet microscopy and automated approaches to image analysis, existing tissue-clearing methods can speed up and may reduce the cost of conventional histology by several orders of magnitude. In addition, tissue-clearing chemistry allows whole-organ antibody labelling, which can be applied even to thick human tissues. By combining the most powerful labelling, clearing, imaging and data-analysis tools, scientists are extracting structural and functional cellular and subcellular information on complex mammalian bodies and large human specimens at an accelerated pace. The rapid generation of terabyte-scale imaging data furthermore creates a high demand for efficient computational approaches that tackle challenges in large-scale data analysis and management. In this Review, we discuss how tissue-clearing methods could provide an unbiased, system-level view of mammalian bodies and human specimens and discuss future opportunities for the use of these methods in human neuroscience.

First Use of Optical Coherence Tomography on In Vivo Inflammatory Acne-Like Lesions: A Murine Model

BACKGROUND AND OBJECTIVES

Successful outcomes of clinical studies for acne vulgaris depend greatly on achieving statistically significant reduction in acne lesion count and improvement in Investigator's Global Assessment score of the investigational drug product against its vehicle control. To date, there has not been a validated preclinical acne model to evaluate investigational drug products in order to improve the probability of clinical success. An inflammatory acne-like lesion mouse model developed in-house has previously been used for clinical guidance in our drug development program. In this study, we aim to implement and assess the adequacy of swept-source optical coherence tomography (SS-OCT) in quantifying the dynamic changes in inflammatory acne-like lesions.

STUDY DESIGN/MATERIALS AND METHODS

Live Propionibacterium acnes bacteria were injected intradermally resulting in inflammatory acne-like lesions. Topical 1% and 2% minocycline gels were applied to the lesions in separate groups once daily for 2 weeks and compared with vehicle and untreated control groups. The growth of these lesions was monitored and measured with a ruler (height)/microcaliper (width)-an approach previously developed, and with SS-OCT. The reliability of the two methods were assessed. Acquired OCT images across the apex of these inflammatory lesions were statistically analyzed for lesion volume reduction from baseline as well as between the treatment groups and the control groups.

RESULTS

The OCT technique allowed for reliable lesion volume analysis with varying conic profiles. After 14 days of topical minocycline treatments (1%, 2% minocycline), statistically significant reduction in lesion volume (P ≤ 0.05) based on OCT image analysis was observed compared with untreated and vehicle control groups as well as compared with baseline measurements. Under the right conditions, some morphological aspects of the P. acnes injection site were discernible within the skin in images captured with OCT.

CONCLUSIONS

We demonstrated the first use of SS-OCT in evaluating in vivo inflammatory acne-like lesions in a murine model. Our findings support the use of OCT in assessing lesion size and evolution of P. acnes injection sites non-invasively in preclinical in vivo studies, which could potentially lead to more consistent and predictable outcomes in clinical development. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Methods for Optical Skin Clearing in Molecular Optical Imaging in Dermatology

This short review describes recent progress in using optical clearing (OC) technique in skin studies. Optical clearing is an efficient tool for enhancing the probing depth and data quality in multiphoton microscopy and Raman spectroscopy. Here, we discuss the main mechanisms of OC, its safety, advantages, and limitations. The data on the OC effect on the skin water content are presented. It was demonstrated that 70% glycerol and 100% Omnipaque^TM 300 reduce the water content in the skin. Both OC agents (OCAs) significantly affect the strongly bound and weakly bound water. However, Omnipaque^TM 300 causes considerably less skin dehydration than glycerol. In addition, the results of examination of the OC effect on autofluorescence in two-photon excitation and background fluorescence in Raman scattering at different skin depths are presented. It is shown that Omnipaque^TM 300 is a promising OCA due to its ability to reduce background fluorescence in the upper skin layers. The possibility of multimodal imaging combining optical methods and OC technique is discussed.

Ultrafast optical clearing method for three-dimensional imaging with cellular resolution

Optical clearing is a versatile approach to improve imaging quality and depth of optical microscopy by reducing scattered light. However, conventional optical clearing methods are restricted in the efficiency-first applications due to unsatisfied time consumption, irreversible tissue deformation, and fluorescence quenching. Here, we developed an ultrafast optical clearing method (FOCM) with simple protocols and common reagents to overcome these limitations. The results show that FOCM can rapidly clarify 300-µm-thick brain slices within 2 min. Besides, the tissue linear expansion can be well controlled by only a 2.12% increase, meanwhile the fluorescence signals of GFP can be preserved up to 86% even after 11 d. By using FOCM, we successfully built the detailed 3D nerve cells model and showed the connection between neuron, astrocyte, and blood vessel. When applied to 3D imaging analysis, we found that the foot shock and morphine stimulation induced distinct c-fos pattern in the paraventricular nucleus of the hypothalamus (PVH). Therefore, FOCM has the potential to be a widely used sample mounting media for biological optical imaging.

Recent progress in tissue optical clearing for spectroscopic application

This paper aims to review recent progress in optical clearing of the skin and over naturally turbid biological tissues and blood using this technique in vivo and in vitro with multiphoton microscopy, confocal Raman microscopy, confocal microscopy, NIR spectroscopy, optical coherence tomography, and laser speckle contrast imaging. Basic principles of the technique, its safety, advantages and limitations are discussed. The application of optical clearing agent on a tissue allows for controlling the optical properties of tissue. Optical clearing-induced reduction of tissue scattering significantly facilitates the observation of deep-located tissue regions, at the same time improving the resolution and image contrast for a variety of optical imaging methods suitable for clinical applications, such as diagnostics and laser treatment of skin diseases, mucosal tumor imaging, laser disruption of pathological abnormalities, etc.

Seeing through Musculoskeletal Tissues: Improving In Situ Imaging of Bone and the Lacunar Canalicular System through Optical Clearing

In situ, cells of the musculoskeletal system reside within complex and often interconnected 3-D environments. Key to better understanding how 3-D tissue and cellular environments regulate musculoskeletal physiology, homeostasis, and health is the use of robust methodologies for directly visualizing cell-cell and cell-matrix architecture in situ. However, the use of standard optical imaging techniques is often of limited utility in deep imaging of intact musculoskeletal tissues due to the highly scattering nature of biological tissues. Drawing inspiration from recent developments in the deep-tissue imaging field, we describe the application of immersion based optical clearing techniques, which utilize the principle of refractive index (RI) matching between the clearing/mounting media and tissue under observation, to improve the deep, in situ imaging of musculoskeletal tissues. To date, few optical clearing techniques have been applied specifically to musculoskeletal tissues, and a systematic comparison of the clearing ability of optical clearing agents in musculoskeletal tissues has yet to be fully demonstrated. In this study we tested the ability of eight different aqueous and non-aqueous clearing agents, with RIs ranging from 1.45 to 1.56, to optically clear murine knee joints and cortical bone. We demonstrated and quantified the ability of these optical clearing agents to clear musculoskeletal tissues and improve both macro- and micro-scale imaging of musculoskeletal tissue across several imaging modalities (stereomicroscopy, spectroscopy, and one-, and two-photon confocal microscopy) and investigational techniques (dynamic bone labeling and en bloc tissue staining). Based upon these findings we believe that optical clearing, in combination with advanced imaging techniques, has the potential to complement classical musculoskeletal analysis techniques; opening the door for improved in situ investigation and quantification of musculoskeletal tissues.

Effect of mechanical optical clearing on near-infrared spectroscopy

Near-infrared Spectroscopy (NIRS) is a broadly utilized technology with many emerging applications including clinical diagnostics, sports medicine, and functional neuroimaging, to name a few. For functional brain imaging NIR light is delivered at multiple wavelengths through the scalp and skull to the brain to enable spatial oximetry measurements. Dynamic changes in brain oxygenation are highly correlated with neural stimulation, activation, and function. Unfortunately, NIRS is currently limited by its low spatial resolution, shallow penetration depth, and, perhaps most importantly, signal corruption due to light interactions with superficial non-target tissues such as scalp and skull. In response to these issues, we have combined the non-invasive and rapidly reversible method of mechanical tissue optical clearing (MOC) with a commercially available NIRS system. MOC utilizes a compressive loading force on tissue, causing the lateral displacement of blood and water, while simultaneously thinning the tissue. A MOC-NIRS Breath Hold Test displayed a ∼3.5-fold decrease in the time-averaged standard deviation between channels, consequentially promoting greater channel agreement. A Skin Pinch Test was implemented to negate brain and muscle activity from affecting the recorded signal. These results displayed a 2.5-3.0 fold increase in raw signal amplitude. Existing NIRS instrumentation has been further integrated within a custom helmet device to provide a uniform force distribution across the NIRS sensor array. These results showed a gradual decrease in time-averaged standard deviation among channels with an increase in applied pressure. Through these experiments, and the development of the MOC-NIRS helmet device, MOC appears to provide enhancement of NIRS technology beyond its current limitations.

Optical properties of mouse brain tissue after optical clearing with FocusClear™

Fluorescence microscopy is commonly used to investigate disease progression in biological tissues. Biological tissues, however, are strongly scattering in the visible wavelengths, limiting the application of fluorescence microscopy to superficial (<200µm) regions. Optical clearing, which involves incubation of the tissue in a chemical bath, reduces the optical scattering in tissue, resulting in increased tissue transparency and optical imaging depth. The goal of this study was to determine the time- and wavelength-resolved dynamics of the optical scattering properties of rodent brain after optical clearing with FocusClear™. Light transmittance and reflectance of 1-mm mouse brain sections were measured using an integrating sphere before and after optical clearing and the inverse adding doubling algorithm used to determine tissue optical scattering. The degree of optical clearing was quantified by calculating the optical clearing potential (OCP), and the effects of differing OCP were demonstrated using the optical histology method, which combines tissue optical clearing with optical imaging to visualize the microvasculature. We observed increased tissue transparency with longer optical clearing time and an analogous increase in OCP. Furthermore, OCP did not vary substantially between 400 and 1000 nm for increasing optical clearing durations, suggesting that optical histology can improve ex vivo visualization of several fluorescent probes.

Evaluation of ultrasound and glucose synergy effect on the optical clearing and light penetration for human colon tissue using SD-OCT

Topical application optical clearing agents (OCAs) can effectively enhance the tissue optical clearing on the human colon tissue, which has been demonstrated in our previous studies. Nevertheless, the strong light scattering still limits the diffusion rate of OCAs and penetration depth of light into the tissue. In this study, in order to further increase the diffusion of the OCA of glucose into tissue, we employ a method to improve the glucose permeability and light penetration with ultrasound (sonophoretic delivery, SP) and glucose (G) synergy on human normal and cancerous colon tissues in vitro, which was measured and quantified with spectral-domain optical coherence tomography (SD-OCT) technology. To evaluate the effect of ultrasound mediation, the percentages of OCT signal enhancement (PSE) and 1/e light-penetration depth were calculated for G alone and ultrasound-G treatments. The PSE was calculated at approximately 313 μm from the sample tissue surface. For normal and cancerous colon tissues the PSE were about 91.1 ± 10.6% and 65.3% ± 12.3% with 30% G/SP, but for the 30% G alone treatment it was about 78.6 ± 11.2% and 54.5% ± 9.3%, respectively. The max value of 1/e light-penetration depth for normal colon tissue was 0.47 ± 0.02 mm with 30% G alone and 0.60 ± 0.05 mm (p < 0.05)with 30% G/SP synergy. However, for the cancerous colon tissue the max value was 0.45 ± 0.01 mm and 0.57 ± 0.03 mm (p < 0.05), respectively. The obtained permeability coefficients showed a significant enhancement with ultrasound mediation. The mean permeability coefficients of 30% G/SP in normal and cancerous colon tissues were (6.3 ± 0.16) × 10(-6) cm/s and (12.1 ± 0.34) × 10(-6) cm/s (p < 0.05), respectively. These preliminary experiments showed that ultrasound can effectively enhance the tissue optical clearing and glucose diffusion rate as well as increase the light-penetration depth into biotissues.

Optical clearing agent perfusion enhancement via combination of microneedle poration, heating and pneumatic pressure

BACKGROUND AND OBJECTIVE

Optical clearing agents (OCAs) have shown promise for increasing the penetration depth of biomedical lasers by temporarily decreasing optical scattering within the skin. However, their translation to the clinic has been constrained by lack of practical means for effectively perfusing OCA within target tissues in vivo. The objective of this study was to address this limitation through combination of a variety of techniques to enhance OCA perfusion, including heating of OCA, microneedling and/or application of pneumatic pressure over the skin surface being treated (vacuum and/or positive pressure). While some of these techniques have been explored by others independently, the current study represents the first to explore their use together.

STUDY DESIGN/MATERIALS AND METHODS

Propylene glycol (PG) OCA, either at room-temperature or heated to 45°C, was topically applied to hydrated, body temperature ex vivo porcine skin, in conjunction with various combinations of microneedling pre-treatment (0.2 mm length microneedles, performed prior to OCA application), vacuum pre-treatment (17-50 kPa, performed prior to OCA application), and positive pressure post-treatment (35-172 kPa, performed after OCA application). The effectiveness of OCA perfusion was characterized via measurements of transmittance, reduced scattering coefficient, and penetration depth at a number of medically-relevant laser wavelengths across the visible spectrum.

RESULTS

Topical application of room-temperature (RT) PG led to an increase in transmittance across the visible spectrum of up to 21% relative to untreated skin. However, only modest increases were observed with addition of various combinations of microneedling pre-treatment, vacuum pre-treatment, and positive pressure post-treatment. Conversely, when heated PG was used in conjunction with these techniques, we observed significant increases in transmittance. Using an optimal PG perfusion enhancement protocol consisting of 45°C heated PG + microneedle pre-treatment + 35 kPa vacuum pre-treatment + 103 kPa positive pressure post-treatment, we observed up to 68% increase in transmittance relative to untreated skin, and up to 46% increase relative to topical RT PG application alone. Using the optimal PG perfusion enhancement protocol, we also observed up to 30% decrease in reduced scattering coefficient relative to untreated skin, and up to 20% decrease relative to topical RT PG alone. Finally, using the optimal protocol, we observed up to 25% increase in penetration depth relative to untreated skin, and up to 23% increase relative to topical RT PG alone.

CONCLUSIONS

The combination of heated PG, microneedling pre-treatment, vacuum pre-treatment, and positive pressure-post treatment were observed to significantly enhance the perfusion of topically applied PG. Although further studies are required to evaluate the efficacy of combined perfusion enhancement techniques in vivo, the current results suggest promise for facilitating the translation of OCAs to the clinic.

Transparent nanocrystalline yttria-stabilized-zirconia calvarium prosthesis

Laser-based diagnostics and therapeutics show promise for many neurological disorders. However, the poor transparency of cranial bone (calvaria) limits the spatial resolution and interaction depth that can be achieved, thus constraining opportunity in this regard. Herein, we report preliminary results from efforts seeking to address this limitation through use of novel transparent cranial implants made from nanocrystalline yttria-stabilized zirconia (nc-YSZ). Using optical coherence tomography (OCT) imaging of underlying brain in an acute murine model, we show that signal strength is improved when imaging through nc-YSZ implants relative to native cranium. As such, this provides initial evidence supporting the feasibility of nc-YSZ as a transparent cranial implant material. Furthermore, it represents a crucial first step towards realization of an innovative new concept we are developing, which seeks to eventually provide a clinically-viable means for optically accessing the brain, on-demand, over large areas, and on a chronically-recurring basis, without need for repeated craniectomies.

FROM THE CLINICAL EDITOR

In this study, transparent nanocrystalline yttria-stabilized-zirconia is used as an experimental "cranium prosthesis" material, enabling the replacement of segments of cranial bone with a material that allows for optical access to the brain on a recurrent basis using optical imaging methods such as OCT.

Optical histology: a method to visualize microvasculature in thick tissue sections of mouse brain

BACKGROUND

The microvasculature is the network of blood vessels involved in delivering nutrients and gases necessary for tissue survival. Study of the microvasculature often involves immunohistological methods. While useful for visualizing microvasculature at the µm scale in specific regions of interest, immunohistology is not well suited to visualize the global microvascular architecture in an organ. Hence, use of immunohistology precludes visualization of the entire microvasculature of an organ, and thus impedes study of global changes in the microvasculature that occur in concert with changes in tissue due to various disease states. Therefore, there is a critical need for a simple, relatively rapid technique that will facilitate visualization of the microvascular network of an entire tissue.

METHODOLOGY/PRINCIPAL FINDINGS

The systemic vasculature of a mouse is stained with the fluorescent lipophilic dye DiI using a method called "vessel painting". The brain, or other organ of interest, is harvested and fixed in 4% paraformaldehyde. The organ is then sliced into 1 mm sections and optically cleared, or made transparent, using FocusClear, a proprietary optical clearing agent. After optical clearing, the DiI-labeled tissue microvasculature is imaged using confocal fluorescence microscopy and adjacent image stacks tiled together to produce a depth-encoded map of the microvasculature in the tissue slice. We demonstrated that the use of optical clearing enhances both the tissue imaging depth and the estimate of the vascular density. Using our "optical histology" technique, we visualized microvasculature in the mouse brain to a depth of 850 µm.

CONCLUSIONS/SIGNIFICANCE

Presented here are maps of the microvasculature in 1 mm thick slices of mouse brain. Using combined optical clearing and optical imaging techniques, we devised a methodology to enhance the visualization of the microvasculature in thick tissues. We believe this technique could potentially be used to generate a three-dimensional map of the microvasculature in an entire organ.

Imaging of skin microvessels with optical coherence tomography: potential uses in port wine stains

The knowledge of vascular structures of port wine stains (PWSs) may be useful to select treatment doses and improve therapeutic efficacy. Biopsies are impractical to implement, therefore, it is necessary to develop non-invasive techniques for morphological evaluation. This study aimed to evaluate the application of a novel optical coherence tomography (OCT) system to characterize the vascular structures of PWSs. First, OCT images were obtained from the skin of healthy rabbit ears and compared with the histopathological images. Second, OCT was used to document the differences between PWS lesions and contralateral normal skin; the size and depth of the vascular structures of two clinical types of PWSs were measured and statistically analyzed. The dermal blood vessels of healthy rabbit ears were clearly distinguished from other tissue. There was no statistical difference between the vascular diameter or depth measured by OCT images and histopathological sections (P>0.05). The OCT images of the PWSs could be distinguished from normal skin. There was no statistical difference in the depth of vessels between the purple-type and the proliferative-type PWSs (P>0.05), while there was statistical difference in the diameter of vessels between them (P<0.01). Therefore, OCT is a promising, real-time, in vivo and non-invasive tool with which to characterize the vascular structures of PWSs.

Mechanical tissue optical clearing technique increases imaging resolution and contrast through ex vivo porcine skin

BACKGROUND AND OBJECTIVES

Mechanical tissue optical clearing permits light delivery deeper into turbid tissue, which may improve current optical diagnostics and laser-based therapeutic techniques. We investigated the effects of localized compression on brightfield imaging through ex vivo porcine skin by evaluating resolution and contrast of a target positioned beneath native, mechanically compressed, or chemically cleared specimens. We also evaluated the effects of indentation on dynamic tissue thickness and light transmission.

STUDY DESIGN/METHODS

A 5 mm diameter, hemispherically tipped, manual load transducer was used to compress specimens using 2-44 N for 60 seconds. Chemically cleared specimens were immersed for 1 hour in glycerol or dimethyl sulfoxide. A USAF 1951 resolution target was positioned beneath specimens and imaged using brightfield microscopy. Resolution and contrast of target features were analyzed. In separate experiments, a mechanical test instrument was used to compress and hold specimens at a final thickness while measuring applied load and light transmission.

RESULTS

Image intensity profiles showed that while uncompressed skin did not allow resolution of any target, localized compression allowed maximum resolution up to a line width of 173 ± 21 µm. Mechanical clearing achieved up to four times higher maximum resolution and 2-3 times higher contrast sensitivity than chemical immersion. Resolving capability was highly correlated with compressive tissue strain. Light transmission increased during tissue compression, but also increased while holding final thickness constant.

CONCLUSION

Localized compression is an effective technique for increasing resolution and contrast of target features through tissue and may improve light-based diagnostics. Thickness reduction and other mechanisms appear to contribute to this effect.

Quantification of glucose diffusion in human lung tissues by using Fourier domain optical coherence tomography

In this study, we report permeability coefficients of 30% glucose diffusion by the optical coherence tomography signal slope (OCTSS) method in four kinds of human lung tissue in vitro: normal lung tissue, benign granulomatosis lung tissue, squamous cell carcinoma and adenocarcinoma tumor. To quantify the permeability coefficient of the agent, the monitored region was 80 μm thickness at a tissue depth of ca 230 μm from the surface. The permeability coefficients of 30% glucose from 10 independent experiments were averaged and found to be (1.35 ± 0.13) × 10(-5) cm s(-1) from the normal lung tissue, (1.78 ± 0.21) × 10(-5) cm s(-1) from the benign granulomatosis lung tissue, (2.88 ± 0.19) × 10(-5) cm s(-1) from the adenocarcinoma tumor and (3.53 ± 0.25) × 10(-5) cm s(-1) from the squamous cell carcinoma, respectively. It could be clearly seen that the permeability coefficients of 30% glucose increase ca 32%, 113% and 162% in the benign granulomatosis, adenocarcinoma tumor and squamous cell carcinoma of human lung tissue compared with that from the normal lung tissue, respectively. Therefore, we inferred from this pilot study that the OCT imaging is a feasible method to distinguish normal and cancer lung tissue.

Laser tattoo removal: a review

BACKGROUND

Tattoos have played an important role in human culture for thousands of years, and they remain popular today. The development of quality-switched (QS) lasers has revolutionized the removal of unwanted tattoos.

OBJECTIVES

To thoroughly review the literature on laser tattoo removal pertaining to its history, its theoretical basis, the various devices used, potential adverse effects, and future developments.

MATERIAL AND METHODS

An extensive literature review of publications related to tattoo removal was conducted.

RESULTS

Reports exist demonstrating the efficacy of laser removal of different tattoo types, including professional, amateur, traumatic, cosmetic, and medical. The literature supports the use of different QS lasers for removal of tattoos. Some colors have a more-complete response using particular wavelengths.

CONCLUSION

QS lasers can effectively and safely remove different types of unwanted tattoos.

Effect of Localized Mechanical Indentation on Skin Water Content Evaluated Using OCT

The highly disordered refractive index distribution in skin causes multiple scattering of incident light and limits optical imaging and therapeutic depth. We hypothesize that localized mechanical compression reduces scattering by expulsing unbound water from the dermal collagen matrix, increasing protein concentration and decreasing the number of index mismatch interfaces between tissue constituents. A swept-source optical coherence tomography (OCT) system was used to assess changes in thickness and group refractive index in ex vivo porcine skin, as well as changes in signal intensity profile when imaging in vivo human skin. Compression of ex vivo porcine skin resulted in an effective strain of −58.5%, an increase in refractive index from 1.39 to 1.50, and a decrease in water volume fraction from 0.66 to 0.20. In vivo OCT signal intensity increased by 1.5 dB at a depth of 1 mm, possibly due to transport of water away from the compressed regions. These finding suggest that local compression could be used to enhance light-based diagnostic and therapeutic techniques.

Changes in morphology and optical properties of sclera and choroidal layers due to hyperosmotic agent

Light scattering in the normally white sclera prevents diagnostic imaging or delivery of a focused laser beam to a target in the underlying choroid layer. In this study, we examine optical clearing of the sclera and changes in blood flow resulting from the application of glycerol to the sclera of rabbits. Recovery dynamics are monitored after the application of saline. The speed of clearing for injection delivery is compared to the direct application of glycerol through an incision in the conjunctiva. Although, the same volume of glycerol was applied, the sclera cleared much faster (5 to 10 s) with the topical application of glycerol compared to the injection method (3 min). In addition, the direct topical application of glycerol spreads over a larger area in the sclera than the latter method. A diffuse optical spectroscopy system provided spectral analysis of the remitted light every two minutes during clearing and rehydration. Comparison of measurements to those obtained from phantoms with various absorption and scattering properties provided estimates of the absorption coefficient and reduced scattering coefficient of rabbit eye tissue.

Application of an optical clearing agent during noninvasive laser coagulation of the canine vas deferens

Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to scrotal skin to reduce laser power necessary for successful noninvasive laser vasectomy and eliminate scrotal skin burns. A mixture of dimethyl sulfoxide and glycerol was noninvasively delivered into scrotal skin using a pneumatic jet device. Near-infrared laser radiation was delivered in conjunction with cryogen spray cooling to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify strength of vas closure. A 30-min application of OCA improved skin transparency by 26+/-3%, reducing average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP=291+/-31 mmHg) to 7.0 W with OCA (BP=292+/-19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82+/-28 mmHg) significantly below typical ejaculation pressures (136+/-29 mmHg). Application of an OCA reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by approximately 25%. This technique may result in use of a less expensive laser and eliminate the formation of scrotal skin burns during the procedure.

ASSESSMENT OF TISSUE OPTICAL CLEARING AS A FUNCTION OF GLUCOSE CONCENTRATION USING OPTICAL COHERENCE TOMOGRAPHY

One of the major challenges in imaging biological tissues using optical techniques, such as optical coherence tomography (OCT), is the lack of light penetration due to highly turbid structures within the tissue. Optical clearing techniques enable the biological samples to be more optically homogeneous, allowing for deeper penetration of light into the tissue. This study investigates the effect of optical clearing utilizing various concentrations of glucose solution (10%, 30%, and 50%) on porcine skin. A gold-plated mirror was imaged beneath the tissue and percentage clearing was determined by monitoring the change in reflected light intensity from the mirror over time. The ratio of percentage clearing per tissue thickness for 10%, 30% and 50% glucose was determined to be 4.7 ± 1.6% mm(-1) (n = 6), 10.6 ± 2.0% mm(-1) (n = 7) and 21.8 ± 2.2% mm(-1) (n = 5), respectively. It was concluded that while higher glucose concentration has the highest optical clearing effect, a suitable concentration should be chosen for the purpose of clearing, considering the osmotic stress on the tissue sample.

Revisiting optical clearing with dimethyl sulfoxide (DMSO)

Functional optical characterization of disease progression and response to therapy suffers from loss of spatial resolution and imaging depth due to scattering. Here we report on the ability of dimethyl sulfoxide (DMSO) alone to reduce the optical scattering of skin. We observed a threefold reduction in the scattering of skin with topical DMSO application. With an in vivo window chamber model, we observed a threefold increase in light transmittance through the preparation and enhanced visualization of subsurface microvasculature. Collectively, our data demonstrate the potential of DMSO alone to mitigate effects of scattering, which we expect will improve molecular imaging studies.

Dermal scatter reduction in human skin: a method using controlled application of glycerol

BACKGROUND AND OBJECTIVE

Previous studies in a hairless Guinea pig model showed that transdermal application of glycerol effected a temporary reduction in dermal scatter of light. This study focuses on the application of this protocol on human patients.

STUDY DESIGN/MATERIALS AND METHODS

After stratum corneal removal, glycerol was applied to human subjects using a low pressure transdermal application device. Optical coherence tomography imaging showed increased intensity of radiation reaching deeper regions in the skin and photographs showed enhanced visualization of dermal structures.

RESULTS/CONCLUSION

Topically applied glycerol increased light penetration of in vivo corneal-stripped skin. This minimally invasive approach to temporary dermal scatter reduction has the potential to improve the efficacy of light-based diagnostic or therapeutic devices.

Following dimethyl sulfoxide skin optical clearing dynamics with quantitative nonlinear multimodal microscopy

Second-harmonic generation (SHG) imaging is combined with coherent anti-Stokes Raman scattering (CARS) microscopy to follow the process of optical clearing in human skin ex vivo using dimethyl sulfoxide (DMSO) as the optical clearing agent. SHG imaging revealed that DMSO introduces morphological changes to the collagen I matrix. By carefully measuring the dynamic tissue attenuation of the coherent nonlinear signal, using CARS reference signals during the clearing process, it is found that DMSO reduces the overall SHG response from dermal collagen. Evidence is provided for a role of DMSO in compromising the structure of collagen fibers, associated with a reduction of the tissue's scattering properties.

Mechanical tissue optical clearing devices: enhancement of light penetration in ex vivo porcine skin and adipose tissue

BACKGROUND AND OBJECTIVE

The complex morphological structure of tissue and associated variations in the indices of refraction of components therein, provides a highly scattering medium for visible and near-infrared wavelengths of light. Tissue optical clearing permits delivery of light deeper into tissue, potentially improving the capabilities of various light-based therapeutic techniques, such as adipose tissue removal or reshaping.

STUDY DESIGN/MATERIALS AND METHODS

We report results of a study to evaluate effectiveness of novel mechanical tissue optical clearing devices (TOCD) using white light photography and infrared imaging radiometry (IIR). The TOCD consists of a pin array and vacuum pressure source applied directly to the skin surface. IIR images recorded light absorption and temperature increase of ex vivo porcine skin and adipose during laser irradiation (980 and 1,210 nm) before and after TOCD application.

RESULTS

White light photographic images of in vivo human skin demonstrated localized compression and altered visual appearance, indicative of water and blood movement in skin. White light photographic images also showed increased visible light transport through regions of ex vivo porcine skin compressed by TOCD pins. Rate of heating in sub-dermal adipose regions beneath TOCD pins was twofold higher following TOCD application.

CONCLUSIONS

Results of our study suggest that mechanical optical clearing may provide a means to deliver increased light fluence to dermal and adipose tissues.

Vascular effects of photodynamic and pulsed dye laser therapy protocols

BACKGROUND AND OBJECTIVE

Pulsed dye laser (PDL) treatment of cutaneous vascular lesions is associated with variable and unpredictable efficacy. Thus, alternative treatment modalities are needed. Previous in vitro and in vivo studies have demonstrated enhanced selective vascular destruction with benzoporphyrin derivative (BPD) monoacid ring A photodynamic therapy (PDT) followed immediately by PDL irradiation (PDT+PDL). Here, we evaluate PDT alone, PDL alone, and PDT+PDL protocols using an optimized in vivo rodent dorsal window chamber model.

STUDY DESIGN/MATERIALS AND METHODS

A dorsal window chamber was surgically installed on male Golden Syrian hamsters. BPD solution was administered intravenously via a jugular venous catheter. Evaluated interventions included: (1) Control (no BPD, no light); (2) Control (BPD, no light); (3) PDT alone (lambda = 576 nm; 25, 50, 75, or 96 J/cm2 radiant exposure; 15 minutes post-BPD injection); (4) PDL alone at 7 J/cm2 (585 nm, 1.5 milliseconds pulse duration, 7 mm spot); and (5) PDT (25 or 75 J/cm2)+PDL (7 J/cm2). Laser speckle imaging was used to monitor blood flow dynamics before, immediately after, and 1, 3, and 5 days post-intervention.

RESULTS

Perfusion reduction on day 1 post-intervention was achieved with PDT>50 J/cm2, PDL alone, and PDT+PDL. However, by day 5 post-intervention, recovery of flow was observed with PDT alone at 50 J/cm2 (-15.1%) and PDL alone (+215%). PDT (75 J/cm2)+PDL resulted in the greatest prolonged reduction in vascular perfusion (-99.8%).

CONCLUSIONS

Our in vivo data suggest that the PDT+PDL therapeutic protocol can result in enhanced and persistent vascular shutdown compared to PDT or PDL alone. The PDT+PDL approach has potential for considerable superficial vascular destruction and should be considered as a treatment modality for cutaneous vascular lesions. Monitoring of blood flow changes for as long as possible is crucial for accurate assessment of light-based vascular interventions.

Optical clearing of the skin for near-infrared fluorescence image-guided surgery

Near-infrared (NIR) light penetrates relatively deep into skin, but its usefulness for biomedical imaging is constrained by high scattering of living tissue. Previous studies have suggested that treatment with hyperosmotic "clearing" agents might change the optical properties of tissue, resulting in improved photon transport and reduced scatter. Since this would have a profound impact on image-guided surgery, we seek to quantify the magnitude of the optical clearing effect in living subjects. A custom NIR imaging system is used to perform sentinel lymph node mapping and superficial perforator angiography in vivo on 35-kg pigs in the presence or absence of glycerol or polypropylene glycol:polyethylene glycol (PPG:PEG) pretreatment of skin. Ex-vivo, NIR fluorescent standards are placed at a fixed distance beneath sections of excised porcine skin, either preserved in saline or stored dry, then treated or not treated with glycerol. Fluorescence intensity through the skin is quantified and analyzed statistically. Surprisingly, the expected increase in intensity is not measurable either in vivo or ex vivo, unless the skin is previously dried. Histological evaluation shows a morphological difference only in stratum corneum, with this difference being negligible in living tissue. In conclusion, topically applied hyperosmotic agents are ineffective for image-guided surgery of living subjects.

Glycerol and the skin: holistic approach to its origin and functions

Glycerol is a trihydroxy alcohol that has been included for many years in topical dermatological preparations. In addition, endogenous glycerol plays a role in skin hydration, cutaneous elasticity and epidermal barrier repair. The aquaporin-3 transport channel and lipid metabolism in the pilosebaceous unit have been evidenced as potential pathways for endogenous delivery of glycerol and for its metabolism in the skin. Multiple effects of glycerol on the skin have been reported. The diverse actions of the polyol glycerol on the epidermis include improvement of stratum corneum hydration, skin barrier function and skin mechanical properties, inhibition of the stratum corneum lipid phase transition, protection against irritating stimuli, enhancement of desmosomal degradation, and acceleration of wound-healing processes. Even an antimicrobial effect has been demonstrated. Topical application of glycerol-containing products improves skin properties in diseases characterized by xerosis and impaired epidermal barrier function, such as atopic dermatitis. The increase of epidermal hydration by glycerol is critical in skin conditions aggravated by dry and cold environmental conditions, e.g. winter xerosis. This paper provides a review on effects of glycerol on the skin, the mechanisms of its action, and the potential applications of glycerol in dermatology.

Feasibility of sonophoretic delivery for effective skin optical clearing

In an attempt to find a noninvasive way to improve the efficacy of skin optical clearing with topical application of optical clearing agents (OCA), we exploited the effect of ultrasound on optical clearing of intact skin in vitro Changes in optical transmittance and diffuse reflectance of the porcine skin under different treatment procedures were measured by a UV/Vis/NIR spectrophotometer. Clearing capability of glycerol or propylene glycol was much improved with the simultaneous application of ultrasound with a frequency of 1 MHz and a power of 0.75 W over a 3-cm probe. Light transmittance at 470 and 1276 nm increased by 112%-128% and 54%-65%, respectively. The most significant effect was seen where skin was treated with the combination of ultrasound and the chemical enhancer azone, resulting in a 2.3-fold increase of optical clearing at 1276 nm. We demonstrate the feasibility of using sonophoretic delivery methods to improve skin optical clearing with topical application of OCA.

Differential permeability rate and percent clearing of glucose in different regions in rabbit sclera

Imaging of biological tissues with optical coherence tomography (OCT) poses a great interest for its capability to noninvasively outline subsurface microstructures within tissues. However, a major limitation for many optical imaging techniques is inadequate depth penetration of light in turbid media, which is bounded to just a few millimeters. There have been several attempts to improve light penetration depth in biological tissues, including application of different tissue optical clearing methods. In this study, an aqueous solution of glucose (40%) is added to rabbit sclera in vitro, where depth-resolved permeability coefficients and optical clearing are calculated with OCT. The permeability rate in regions in the upper 80- to 100-microm region is found to be different from that of regions in the deeper 100-microm region: (6.01+/-0.37)x10(-6) cmsec and (2.84+/-0.68)x10(-5) cmsec, respectively. A difference in percent clearing is also noted. Optical clearing of the upper region is about 10% and increased to 17 to 22% in the one beneath. These results demonstrate the capability of OCT-based methods to not only measure the diffusion rate and optical clearing of a tissue, but also its ability of functional differentiation between layers of epithelial tissues.

Optical clearing of human skin: comparative study of permeability and dehydration of intact and photothermally perforated skin

Accelerated diffusion of water and hyperosmotic optical clearing agents is studied as a result of enhanced epidermal permeability. A lattice of microzones (islets) of damage in stratum corneum is induced using a flash-lamp applique system. An optical clearing agent composed of 88% glycerol in aqueous solution is used for all experiments. Research of skin dehydration and glycerol delivery through epidermis at both intact and perforated stratum corneum is presented. The dehydration process induced by both stimuli of evaporation and osmotic agent action is studied by weight measurements. Dynamics of refractive index alteration of both glycerol solution and water during their interaction with skin samples is monitored. The amounts of water escaping from skin through the stratum corneum, due to hyperosmotic-agent action, and glycerol penetrating through the skin sample, are estimated. The results show that the proposed method allows for effective transepidermal water loss and delivery of optical clearing agents.

Influence of alcohols on the optical clearing effect of skin in vitro

The optical clearing technique has shown great potential in improving light penetration into biotissues. Among various optical clearing agents (OCAs) under study, the hydroxyl-terminated agents induce the highest optical clearing effect of skin, but the exact mechanism of optical clearing is still unclear. In consideration of several probable factors, such as the number of hydroxyl groups, the refractive index, and the molecular weight, we investigate the optical clearing effect of porcine skin after applying six alcohols to the epidermis and saline to the dermis. The dynamical transmission intensity of porcine skin is monitored by an integrating sphere system, and the thickness of skin samples is measured before and after experiments. The results show that the transmittance of skin increases significantly, but there is no significant change in thickness after the treatment of OCAs. The optical clearing effect of skin induced by alcohols is related to the number of hydroxyl groups. The refractive index or molecular weight of optical clearing agents does not correlate with the degree of optical clearing effect for a 60-min time interval of measurement. However, the behavior of skin transmittance after 60 min needs to be further investigated.

Short-term and long-term effects of optical clearing agents on blood vessels in chick chorioallantoic membrane

The tissue optical clearing technique shows great potential in optical diagnosis and therapy. However, short-term and long-term effects of optical clearing agents on blood vessels, which are relevant to the safety of clinical applications, have not been clarified. We used laser speckle contrast imaging to monitor the changes in blood vessels in chick chorioallantoic membrane (CAM) after application of glycerol or glucose. The changes in morphology of vessels and blood flow velocity were measured. Long-term effects on blood vessels were investigated by observing the function and the development of blood vessels. The results show that glycerol reduces the local blood flow velocity and constricts and even blocks vessels quickly. At 2 days, the blood flow velocity is recovered to different extents, and new blood vessels develop but are fewer in number. Glucose induces slow changes in blood flow or vessels. However, most blood vessels are blocked, and no new blood vessel develops at 2 days. The effects depend on the dosage of agents, including volume and concentration, and decrease with the dosage of agents. Therefore, short-term effects of glucose on blood vessels are slighter than those of glycerol, but long-term effects of glucose are greater.

Photochemical cross-linking for collagen-based scaffolds: a study on optical properties, mechanical properties, stability, and hematocompatibility

Collagen presents an attractive biomaterial for tissue engineering because of its excellent biocompatibility and negligible immunogenicity. However, some intrinsic features related to the mechanical stability and thrombogenicity limit its applications in orthopedic and vascular tissue engineering. Photochemical cross-linking is an emerging technique able to stabilize tissue grafts and improve the physicochemical properties of collagen-based structures. However, other important properties of collagen-based structures and the effect of processing parameters on these properties have not been explored. In this study, we aim to investigate the dose dependence of tensile and swelling properties on two parameters, namely, laser energy fluence and rose Bengal photosensitizer concentration. We also study the compression properties using cyclic compression test, long-term stability using subcutaneous implantation, and hematocompatibility using platelets adhesion test, of cross-linked collagen structures. Moreover, because limited optical penetration in turbid media is the major obstacle for light-based techniques, we also characterize the optical properties, which partially determine the effective optical penetration depth in collagen gel samples, during photochemical cross-linking. Laser energy fluence and rose Bengal concentration are important parameters affecting the cross-linking efficiency, which was characterized as the mechanical and the swelling properties, in a dose-dependent manner. Under the experimental conditions in this study, the peak fluence was 12.5 J/cm2 and the minimal rose Bengal concentration for effective cross-linking was >0.00008% (0.786 micromol). Photochemical cross-linking also enhanced the compression strength and long-term stability of collagen structures without compromising the tissue compatibility. Furthermore, photochemical cross-linking reduced platelet adhesion and abolished fibrin mesh formation, thereby improving the hematocompatibility of collagen structures. These results suggest the feasibility of using the photochemically cross-linked collagen structures for orthopedic and vascular tissue engineering. Finally, the effective optical penetration depth in collagen gel samples is wavelength and rose Bengal concentration dependent, and was approximately 12 mm at 514 nm at 0.001% (9.825 micromol), the rose Bengal concentration mostly used in this study.

Correlation between collagen solubility and skin optical clearing using sugars

BACKGROUND AND OBJECTIVE

Light scattering from collagen within skin limits light-based therapeutics while increasing the risk of epidermal thermal injury. Specific chemicals show the ability to reduce light scattering by reversibly altering the optical properties of skin. This study examines the correlation between collagen solubility and the optical clearing potential (OCP) of sugars and sugar-alcohols using in vitro rodent skin.

MATERIALS AND METHODS

Collagen solubility in dextrose, fructose, sucrose, and sorbitol was measured using near-UV spectroscopy. Light transmittance, reflectance, and rodent skin thickness were measured (giving skin reduced scattering coefficient) before and after exposure of the dermal surface to sugars and sugar-alcohols. OCP was calculated as the ratio of reduced scattering coefficients before and after exposures.

RESULTS

Dextrose, fructose, sucrose, and sorbitol had at least twice the collagen solubility and twice the OCP as compared to glycerol. In general, collagen solubility correlated with each agent's ability to optically clear rodent skin.

CONCLUSION

These results demonstrate that sugar and sugar-alcohol interaction with collagen are a primary event in tissue optical clearing.