A randomized split-face clinical trial of conventional vs indoor-daylight photodynamic therapy for the treatment of multiple actinic keratosis of the face and scalp and photoaging

BACKGROUND

Recently, indoor daylight photodynamic therapy (idl-PDT) has been developed; however, its efficacy and tolerability remain to be assessed.

OBJECTIVE

This is a not-inferiority study to compare treatment outcomes of cPDT with a red LED lamp and idlPDT with a polychromatic white LED lamp in adult patients affected by symmetrical AKs of face and/or scalp.

METHODS

In this comparative, intra-patient, split-face, randomized clinical trial forty-three adult patients were enrolled. Two contralateral and symmetrical target areas of the face and/or scalp harboring at least 5 AKs were selected and randomized 1:1 to treatment with cPDT and idlPDT. The AKs number and cumulative area were assessed at baseline (T0). Efficacy and cosmetic outcome were assessed 3 months after treatment (T1).

RESULTS

Total AKs number and area reduced significantly with both idlPDT (p < .0001) and cPDT (p < .0001) in comparison to baseline. cPDT was more painful (p < .0001) and induced a more severe inflammation (p < .0001). Twenty-nine patients (70.7%) gave their overall preference to idlPDT (p < .001).

CONCLUSION

idlPDT may represent an alternative treatment protocol to cPDT for in-office treatment of AKs patients with better tolerability and a not inferior efficacy.

Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment

PURPOSE

Intensity-modulated radiation therapy (IMRT) is the state-of-the-art treatment for patients with malignant pleural mesothelioma (MPM). The goal of this work was to assess whether intensity-modulated proton therapy (IMPT) could further improve the dosimetric results allowed by IMRT.

PATIENTS AND METHODS

We re-planned 7 MPM cases using both photons and protons, by carrying out IMRT and IMPT plans. For both techniques, conventional dose comparisons and normal tissue complication probability (NTCP) analysis were performed. In 3 cases, additional IMPT plans were generated with different beam dimensions.

RESULTS

IMPT allowed a slight improvement in target coverage and clear advantages in dose conformity (p < 0.001) and dose homogeneity (p = 0.01). Better organ at risk (OAR) sparing was obtained with IMPT, in particular for the liver (D(mean) reduction of 9.5 Gy, p = 0.001) and ipsilateral kidney (V(20) reduction of 58%, p = 0.001), together with a very large reduction of mean dose for the contralateral lung (0.2 Gy vs 6.1 Gy, p = 0.0001). NTCP values for the liver showed a systematic superiority of IMPT with respect to IMRT for both the esophagus (average NTCP 14% vs. 30.5%) and the ipsilateral kidney (p = 0.001). Concerning plans obtained with different spot dimensions, a slight loss of target coverage was observed along with sigma increase, while maintaining OAR irradiation always under planning constraints.

CONCLUSION

Results suggest that IMPT allows better OAR sparing with respect to IMRT, mainly for the liver, ipsilateral kidney, and contralateral lung. The use of a spot dimension larger than 3 × 3 mm (up to 9 × 9 mm) does not compromise dosimetric results and allows a shorter delivery time.

Intraoral fluoride releasing device: a new clinical therapy for dentine sensitivity

BACKGROUND

Dentinal sensitivity (DS) occurs frequently in adult populations in western countries. The purpose of this work was to assess the effectiveness of a new intraoral fluoride releasing device (IFRD) in reducing the level of pain in patients with primary or postsurgical dentine sensitivity.

METHODS

A total of 49 individuals were selected for this study, 15 of whom had post-periodontal surgery dentine sensitivity and 34 with primary sensitivity. An IFRD was applied to 39, while 10 received a placebo device. All individuals in the control group suffered from primary sensitivity. The IFRD used in this study consists of sodium fluoride encased in an acrylic polymer which releases fluoride at a rate of approximately 0.04 mg/day. All patients were asked to rinse with cold water (10 degrees C) and to indicate the level of pain on a 0 to 10 visual analog scale, 0 equalling "no pain" and 10 "maximum bearable pain." All subjects were evaluated once a week during 4 months. Statistical analysis of dentine sensitivity was performed as a univariate study, in relation to the main factors: age, gender, and primary sensitivity or postsurgical etiology.

RESULTS

Symptoms decreased dramatically in all treated patients. The level of sensitivity did not change during the first week after IFRD application, but decreased significantly within the fourth week and remained absent through the duration of the treatment (P <0.01). Difference in sensitivity with respect to different etiology was significant only after 4 weeks (P= 0.01), while there was no statistical difference with respect to age or gender.

CONCLUSIONS

This paper is an initial study to evaluate the effectiveness of the IFRD. The method is fast, painless, inexpensive, and it appears to be suitable as a routine treatment. The presented data support the conclusions at this stage and warrant more comprehensive evaluation.

Stomatognathic function in juvenile rheumatoid arthritis and in developmental open-bite subjects

Patients affected with juvenile rheumatoid arthritis present clear radiological alterations of the condyles of the temporomandibular joint (TMJ) due to the inflammatory process, with a prevalence ranging from 17 percent to 63 percent. This work is a comparison between a group of subjects with juvenile rheumatoid arthritis presenting signs and symptoms of TMT dysfunction and a group of the same age not suffering from any rheumatic morbidity, but presenting an open bite > 3 mm. The aim is to verify whether the open bite can induce an alteration in mandibular function comparable to that observed in juvenile rheumatoid arthritis. Statistically significant difference is found in the juvenile rheumatoid arthritis group only regarding spontaneous and provoked muscle pain and the lateral opening deviations of the mouth, but mostly the two groups seem alike and present the same stomatognathic pattern.

An electrical model of biological tissues undergoing hyperaemia

Tissue hyperaemia is a physiological consequence of the temperature increase that follows, for example, the absorption of electromagnetic or ultrasound power in clinical diathermy. Diathermy, as well as other physical therapies (for example massotherapy), affects the local blood content of tissues through various mechanisms (vasoconstriction/dilatation, opening/closing of precapillary sphincters). A method for evaluating hyperaemia in superficial and medium-depth tissues has been recently proposed, which is based on four-electrode impedance measurements. A microcirculation model has also been developed to describe the hyperaemic effects of local diathermic therapy. This paper describes an electrical model of the tissues in hyperaemic conditions which allows us to correlate electrical impedance measurements to microcirculation modifications.

Hyperaemia evaluation in clinical diathermy by four-electrode impedance measurements

The four-electrode electrical impedance measurement technique is proposed for the evaluation of the hyperaemia variation in tissues treated by diathermic therapy. An impedance meter suitable for such measurements is described, and an electrical model of the heated tissues, concerning the impedance variation during diathermy and its relation with hyperaemia, is presented. The occurrence of the substantial contribution of blood to the overall transverse impedance is demonstrated by comparing the experimental results with those arising from a 2D electrical/thermal model of the treated tissues. A two-admittance model is proposed to explain the electrical behaviour of the tissues treated by diathermy. The model allows us to separate the impedance violation due to the temperature dependence of tissue conductivity from that due to the change of tissue blood content. The results of preliminary measurements of tissue impedance on healthy volunteers treated by electromagnetic diathermy are presented and discussed, showing the feasibility of impedance detection of hyperaemia variations inside tissues.

[Correlations between urinary prostaglandins, placental hormones and prolactin in the first pregnancy trimester]

In the first weeks of pregnancy there is a significant increase of vasodilatator prostaglandins in maternal blood. This increase could be in a cause-effect relation with the increase of progesterone, BHCG and HPRL typical of the first phase of pregnancy. Blood samples of 12 normotensive women reveal that there is not a correlation between placental hormons, HPRL and the increase of prostaglandins, but these hormones seem to offer an important control on other more complex biochemical mechanisms that cause the increase of vasodilator prostaglandins.

Reduced excretion of vasodilator prostaglandins in preeclampsia

The role of prostaglandin (PG) system in preeclampsia (pre-E) was investigated. Urinary excretion of PGE2,6-keto PGF1 alpha,2,3 dinor 6-keto PGF1 alpha, TxB2 and 2,3-dinor-TxB2 and kallikrein were determined in 10 normotensive pregnant women and 14 with pre-E. 6-keto PGF1 alpha and 2,3-dinor 6-keto PGF1 alpha (the main renal and extrarenal metabolites of vasodilator PGI2) and PGE2 excretion was lower in pre-E. TxB2 metabolites in urine were similar in the two groups of women. Our data are consistent with the hypothesis of an imbalance between vasodilator and vasoconstrictor PGs in pre-E.