Dual-Fields Rotational Total Skin Electron Therapy: Investigation and Implementation

Purpose: To present a protocol of a dual-field rotational (DFR) total skin electron therapy (TSET) and to provide an assessment of clinical implementation, dosimetry properties, and skin dose evaluation. Methods and Materials: The DFR-TSET combined the Stanford 6-field and McGill rotational methods. Dual 6 MeV electron beams in high dose total skin electron mode were used for DFR-TSET on a commercial linac. Beam profiles and dosimetric properties were measured using solid phantoms. The dose rate at expanded source-to-surface distance (SSD) was a combination of static rate and rotational rate. In vivo dosimetry of patient skin was performed on patients’ skin using film, metal oxide semiconductor field-effect transistors (MOSFET), and optically stimulated luminescent dosimeters (OSLD). Results: Dual field rotational total skin electron therapy exhibited good (≤±10%) uniformity in the beam profiles in the vertical direction at an extended SSD of 332 cm with a gantry angulation of ±20˚ deviated from the horizontal direction. In-vivo measurements confirmed acceptable uniformity of the patients’ total body surfaces and revealed anatomically self-blocked or shielded areas where underdosing occurred. Conclusions: The clinical implementation of DFR-TSET effectively utilizes the special mode on a linac. This technique provides short beam-on times, uniform dose distribution, large treatment field, and reduced dose of x-ray contamination to the patients. In-vivo measurements indicate satisfactory delivery and dose uniformity of the prescribed dose. Electron boost fields are recommended at normal SSDs to address underdosed areas.

Observation on Therapeutic Effect of Lotus Needle Cupping Therapy for Removing Blood Stasis in Zhuang Medicine on PHN and Its Influ-ence on Inflammatory Mediators

[Objectives]To observe the clinical effect of the lotus needle cupping therapy for removing blood stasis in Zhuang medicine in treating PHNand its influence on inflammatory factors.[Methods]96 patients with PHN were randomly divided into three groups:lotus nee-dle cupping therapy group,TCM surrounding acupuncture group and gabapentin group.Venous blood and acupoint blood were collected at 0,21 and 42 d of treatment,and the expression levels of 5-HT,SP and CGRPinflammatory mediators were detected before and after treatment.The changes of VAS scores before,during and after treatment and the clinical efficacy were observed.[Results]The total effective rate of the lotus needle cupping group was 87.50%,which was better than that of the TCM acupuncture group(81.25%)and the gabapentin group(62.50%);after treatment,the VAS scores and the expression of inflammatory mediators in the three groups of patients were lower than those before treatment,and the decrease was more significant in the treatment group(P<0.05).[Conclusions]The lotus needle cupping therapy for removing blood stasis in Zhuang medicine is effective in treating PHN,and its mechanism is to reduce the release of inflammatory media-tors,reduce hyperalgesia,relieve pain and improve the quality of life of patients.

Application of negative pressure wound therapy after skin grafting in the treatment of skin cancer:A case report

BACKGROUND Skin cancer is a common malignant tumor in dermatology.A large area must be excised to ensure a negative incisal margin on huge frontotemporal skin cancer,and it is difficult to treat the wound.In the past,treatment with skin grafting and pressure dressing was easy to cause complications such as wound infections,subcutaneous effusion,skin necrosis,and contracture.Negative pressure wound therapy(NPWT)has been applied to treat huge frontotemporal skin cancer.CASE SUMMARY Herein,we report the case of a 92-year-old woman with huge frontotemporal skin cancer.The patient presented to the surgery department complaining of ruptured bleeding and pain in a right frontal mass.The tumor was pathologically diagnosed as highly differentiated squamous cell carcinoma.The patient underwent skin cancer surgery and skin grafting,after which NPWT was used.She did not experience a relapse during the three-year follow-up period.CONCLUSION NPWT is of great clinical value in the postoperative treatment of skin cancer.It is not only inexpensive but also can effectively reduce the risk of surgical effusion,infection,and flap necrosis.

The Effects of Cupping Therapy on Skin’s Biomechanical Properties in Wistar Rats

Cupping therapy has been widely used for clinical treatment of soft tissue lesions. The current study investigated the effects of cupping therapy on biomechanical properties of the skin in Wistar rats. 20 rats were divided into two groups: 10 in experimental and 10 in control group. Either the right or the left lower quadrants of the lumbar regions in the experimental group underwent 10 minutes daily cupping therapy for 12 days. The skin stiffness and ultimate tensile strength of all the rats were measured using tensiometer. The skin stiffness and ultimate tensile strength were decreased significantly in cupping side of the experimental group as compared with the non-cupping side and the control group. There were no significant differences between the non-cupping side of the experimental group and the control group. In conclusion, cupping therapy can be useful as a treatment method to reduce the skin stiffness and ultimate tensile strength.

Commissioning and Optimization of a Total Skin Electron Therapy Technique Using a High Dose Rate Electron Facility

Total skin electron therapy (TSET) is used for the treatment of Mycosis Fungoides. Several tech-niques have been developed, in order to achieve homogeneous dose distribution over the complete body surface. To implement a TSET technique, one has to optimize a variety of parameters. Monte Carlo simulation of TSET can facilitate this optimization. The aim of this study was to commission and optimize a TSET technique using the 4 and 6 MeV electron and the high dose rate facility on the Elekta Precise accelerator. The EGS4nrc/BEAMnrc Monte Carlo code was used. The beam data were calculated and measured at two different scoring planes for a single beam. The Model was validated by comparing the simulation with measurements. Two different vertical angles were used to obtain a uniform dose. The angle was optimized for best dose uniformity. The Rando phantom is placed on a rotating platform and rotates 60 degrees apart to facilitate the six patient position orientations. The doses delivered in a phantom by complete treatment were measured with Kodak EDR2 films and TLDs. The dose distribution varied among various scanning directions by 2 - 3 mm and 3 - 4 mm for 4 and 6 MeV respectively. The composite percentage depth dose of all six dual fields for the 4 and 6 MeV yielded an R80 of ~4 mm and ~6 mm, respectively. Dose uniformity was ±6% for 4 MeV and ±5% for 6 MeV. The bremsstrahlung contamination was 0.9% - 1.3%. Good agreements were found with published literature and inline with international protocols.

Analysis of Interferential Current Therapy-Induced Skin Changes in Healthy Korean Men

We examined the changes in numerous skin conditions before and after the ap-plication of interferential current therapy to various regions of healthy male bodies. In this study, we assessed the differences in the skin’s sebum, moisture levels, pores, wrinkles, pigmentation, and elasticity on the shoulders, lower back, and the knees of Korean males in their 20s. A total of 30 healthy males were in-cluded in the study. We used a skin diagnosis meter as a device for measuring the state of the skin. A statistical difference was found when comparing the pre- and post-measurement values in regards to the moisture levels, wrinkles, and pig-mentation. In the correlation analysis results, the sebum and pigmentation, moisture levels and wrinkles, moisture levels and pigmentation, and moisture levels and elasticity were all positively correlated, respectively. The results of this study partially suggest that a change in skin condition is associated with ex-ternal stimulation. The study also found that the effects of the application of in-terferential current therapy on the various skin conditions may differ depending on the region of the body that the application is conducted as well.

Effects of Micro Vibration Therapy Nursing Care on Muscle Hardness and Skin Blood Flow: A Pre/Post Group Comparison Study

Purpose: The purpose of this study was to investigate the effects of Micro Vibrational therapy (MVT) on muscle stiffness and blood flow in the skin before and after Micro Vibrational therapy in healthy subjects in order to scientifically verify the effects of MVT. Methods: Micro Vibrational therapy is nurse care use in Japan. It was performed on the backs of 30 subjects (8 males and 22 females) in their 20 s to 50 s according to the eligibility criteria. The resting state before implementation was set as the baseline for the control group, and after 30 seconds of MVT was set as the intervention group. The effects of the MVT were statistically analyzed by these factors and subjective sensation by Visual Analog Scale. Results: The muscle hardness of the area where the MVT was applied for 30 seconds decreased to 29.54 (SD 5.04) after the application, compared to 30.45 (SD 5.05) before. A corresponding t-test showed a significant difference (p = 0.019). Skin blood flow increased from a median of 0.76 (variance 0.062) before to a median of 0.86 (variance 0.16) after the procedure. The Wilcoxon rank test showed a significant difference (p = 0.000). Circulatory response was confirmed by SBP, DBP, and HR. SBP of 108.6 mmHg (SD 14.8) before the study decreased to 105.7 mmHg (SD 15.0) after the study, and DBP of 65.6 mmHg (SD 11.1) before the study decreased to 62.7 mmHg (SD 11.8) after the study. HR decreased from 71.6 beats per minute (SD 10.3) before to 69.2 beats per minute (SD 11.7) after. There was a significant difference in all cardiovascular indices (p < 0.05). VAS (pain, stiffness, and fatigue) was significantly decreased after MVT (p < 0.05). Conclusion: Micro Vibrational therapy tended to decrease muscle hardness and increase skin blood flow even in the short time of 30 seconds. The results suggest that local vibration stimulation is not likely to cause a sudden increase in blood pressure or pulse rate fluctuation. These results suggest that hand vibration nursing care may be applicable to acute patients with unstable circulatory conditions.

Hyperbaric Oxygen Therapy of Ischemic Cranial Skin Flap: Case Report and Review of the Literature

Hyperbaric Oxygen Therapy (HBOT) is a medical procedure and therapeutic modality that utilizes 100% oxygen. HBOT has been used various medical conditions such as progressive necrotizing fasciitis, peripheral arterial insufficiency, and diabetic wounds of the lower extremities. The case report reported here describes the usage of HBOT as an adjunctive “rescue” measure to salvage a patient’s cranioplasty scalp flap after flap ischemia was noted 2 days post-operatively. Patient is a 54 year-old caucasian female who presented to our facility with symptoms of a left MCA infarct. CT and MRI of her brain revealed a left MCA infarct with hemorrhagic stroke with significant cerebral edema, and midline shift. She was taken to the operating room for a left decompressive hemi-craniectomy. She had cranioplasty utilizing native bone flap delayed fashion. She had wound infection after cranioplasty which required removal of native bone. After appropriate treatment for infection, she had cranioplasty utilizing prosthetic Biomet implant. Post-cranioplasty, patient developed ischemic cranial flap. This was recognized within 48 hrs and HBOT was implemented. She has a successful rescue of the ischemic cranial flap after she received 14 consecutive treatments over two weeks. In our knowledge, this is the first successful treatment of HBOT reported after prosthetic cranioplasty for scalp flap ischemia.

Clinical Efficacy and Adverse Reactions of Photodynamic Therapy in the Treatment of Malignant Skin Tumors and Precancerous Skin Diseases

The purpose of the study was to investigate the efficacy and safety of photodynamic therapy in the treatment of malignant skin tumors and precancerous skin diseases.First of all,100 patients with malignant skin tumor and pre-cancer skin disease admitted to our hospital from January 20,2018 to September 18,2018 were selected,and all of them adopted photodynamic therapy.The 100 patients included 40 cases of basal cell carcinoma,14 cases of squamous cell carcinoma,7 cases of proliferative erythema,9 cases of Bowen’s disease and 39 cases of solar keratosis.Among the 100 patients,77 cases had excellent curative effect,18 cases had good effect and 5 cases had poor effect,and the overall effective rate was 95%(95/100).After 6 months of follow-up,5 cases of basal cell carcinoma,2 cases of squamous cell carcinoma,0 cases of proliferative erythra,1 case of Bowen’s disease and 3 cases of solar keratosis recurred,with an overall recurrence rate of 14%(14/100).The adverse reactions of pruritus were 90%(90/100),81%(81/100),90%(90/100)and 3%(3/100).Therefore,the application of photodynamic therapy in the treatment of malignant skin tumors and precancerous skin diseases is not only effective,but also safe and not easy to relapse.

Clinical Study of Aminolevulinic Acid-mediated Acid Photodynamic Therapy Combined with Surgical Therapy of Skin Malignant Tumor

The purpose of the study was to analyze the effects of aminolevulinic acid-mediated photodynamic therapy(ALA-PDT)combined with surgery and its prognostic implications.Firstly,70 cases of skin malignant tumors admitted to the dermatology department of our hospital from January 2017 to December 2018 were selected and divided into observation group and control group according to the random number table,with 35 patients in each group.Observation group adopted the ALA-PDT combined with surgery therapy,and control group adopted surgery therapy.Two groups of patients were last follow-up to December 2019.The results showed that the total effective rate of clinical treatment in the observation group was significantly higher than that in the control group(P<0.05),indicating that based on the basis of conventional surgical treatment,combined use of ALA-PDT can effectively improve the clinical therapeutic effect and better promote the patient’s health recovery.Therefore,combined with surgical treatment,ALA-PDT can improve the clinical efficacy of skin malignant tumors with fewer adverse reactions,high safety,low recurrence rate and ideal long-term prognosis.

The impact of intensity modulated radiotherapy on the skin dose for deep seated tumors

Objective: The purpose of this study was to investigate the impact of intensity modulated radiotherapy (IMRT) on surface doses for brain, abdomen and pelvis deep located tumors treated with 6 MV photon and to evaluate the skin dose calculation accuracy of the XIO 4.04 treatment planning system. Methods: More investigations for the influences of IMRT on skin doses would increase its applications for many treatment sites. Measuring skin doses in real treatment situations would reduce the uncertainty of skin dose prediction. In this work a pediatric human phantom was covered by a layer of 1 mm bolus at three treatment sites and thermoluminescent dosimeter (TLD) chips were inserted into the bolus at each treatment site before CT scan. Two different treatment plans [three-dimensional conformal radiation therapy (3DCRT) and IMRT] for each treatment sites were performed on XIO 4.04 treatment planning system using superposition algorism. Results: The results showed that the surface doses for 3DCRT were higher than the surface doses in IMRT by 1.6%, 2.5% and 3.2% for brain, abdomen and pelvis sites respectively. There was good agreement between measured and calculated surface doses, where the calculated surface dose was 15.5% for brain tumor calculated with 3DCRT whereas the measured surface dose was 12.1%. For abdomen site the calculated surface dose for IMRT treatment plan was 16.5% whereas the measured surface dose was 12.6%. Conclusion: The skin dose in IMRT for deep seated tumors is lower than that in 3DCRT which is another advantage for the IMRT. The TLD readings showed that the difference between the calculated and measured point dose is negligible. The superposition calculation algorism of the XIO 4.04 treatment planning system modeled the superficial dose well.

Clinical Effect of Photodynamic Therapy Combined Cryotherapy on Nonmelanoma Skin Cancer

The purpose of this study was to investigate the clinical efficacy of photodynamic combined freezing in patients with non-melanoma skin cancer(NMSC).First,according to the treatment regimen,96 patients with NMSC were divided into study group(n=50)and control group(n=46).The control group was treated with 5-amino-ketovalic acid photodynamic therapy(ALAPDT),while the study group was treated with ala-PDT combined with cryotherapy.Visual analogue scale(VAS)scores,visual satisfaction,clinical efficacy,adverse reactions,and progression-free survival were compared between the two groups.The results showed that VAS score in the study group was slightly higher than that in the control group,but the difference was not statistically significant(P>0.05).The appearance satisfaction and total effective rate of patients in the study group were higher than those in the control group,and the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the study group was slightly higher than that in the control group,but the difference was not statistically significant(P>0.05).3 years progressionfree survival time and 3 years progression-free survival rate were compared between the two groups,and the difference was not statistically significant(P>0.05).Therefore,the combination of PDT and cryotherapy for non-melanoma skin cancer has a good clinical effect,which is conducive to the recovery of skin lesions,high patient satisfaction,fewer adverse reactions,and longer progression-free survival.In addition,the combined therapy can provide a new treatment idea for non-melanoma skin cancer patients who are not suitable for surgical treatment.

Clinical Efficacy of Plasma Exchange Therapy for Treatment of Autoimmune Bullous Skin Disease

Objective:To investigate the clinical efficacy of plasma exchange therapy for autoimmune bullous skin disease.Methods:Fifty patients with autoimmune bullous skin disease enrolled in our hospital from January 2018 to January 2019 were selected.The patients were grouped by treatment method:25 control group patients were given conventional hormone therapy,while 25 experimental group patients were treated with plasma exchange therapy;efficacy of treatment was compared between two groups of patients.Results:Initial dose,maximum dose,and cumulative dose of glucocorticoids were lower in experimental group patients than those in control group(P<0.05).Incidence of complication was lower in experimental group patients than those in control group(P<0.05);the difference was significant.There was no significant difference in short-term efficacy between the two groups(P>0.05).Conclusion:The application of plasma exchange therapy was effective for treatment of autoimmune bullous skin disease.It could reduce dosage amount of glucocorticoids and incidence of complications;its application can be promoted.

Effects of hyperbaric oxygen therapy on 32 cases of full-thickness skin grafting for the repair of defects on the hand and foot

Full-thickness skin grafting is one of the most commonly used repair methods for skin defects. It has the advantage of wear-resistant with less scar hyperplasia and less difficult to operate with no symptoms. Hyperbaric oxygen was used in this study after full-thickness skin grafting from September 2012 to August 2016 to achieve the best effect of skin survival after surgery.

The Physical and Clinical Aspects of Radiation Therapy in Skin Cancer and Subcutaneous Tissue Neoplasm

Cancers, malignant melanoma and sarcomas of the skin represent the most common group of malignancies in humans. The main treatment method of almost all skin cancers and subcutaneous tissue tumours is surgery, which consists of complete removal of a neoplastic lesion, with an adequate margin of healthy tissue. Radiotherapy plays an adjuvant role in this process, meaning complementing of the surgical procedure. This study compared four methods of irradiation treatment of cancer located in the skin or in subcutaneous tissues: contact brachytherapy, conventional orthovoltage therapy, electron beam conformal teleradiotherapy and IMRT dynamically shaped photonic beams conformal teleradiotherapy. In order to compare the methods and techniques of surface radiotherapy, following specific objectives were formulated. At the beginning in order to compare the scopes of the absorbed doses at different tissue depths, an analysis of parameters describing particular beams or radiation source has been performed—the curves for the absorbed-dose depth drop-offs. Doses distribution in tissue-like phantoms stimulating homogeneous cuboidal tissue block has been determined. A quality comparison of dose distribution in 2D and 3D treatment planning system for contact brachytherapy application has been made. The dose distribution for electron beam in the system has been determined. Conformal plannings for electron beam treatment, contact brachytherapy applicator treatment and 4 photon beams treatment optimized in IMRT technology have been performed. Dose distribution has been performed for the irradiated female patient within the well chest—the target included the recurrence area in the post-operative scar. The radiation therapy with X-rays has actually been completely eliminated from skin cancer and subcutaneous tissue radiotherapy by the electrons generated in linear accelerators, contact brachytherapy HDR and by high-energy photons used in conformal techniques, ex. IMRT. It is because the residual dose beyond the target is the highest for single X-ray beam. Although in brachytherapy HDR a rapid dose drop-off is observed, 5 cm from its normalization level for the target the residual radiation remains at the level of several percent. So, both X-rays beam radiation and brachytherapy in skin cancer treatment is connected with the administration of the dose with a high gradient in the health tissues. The dose distribution for photon conformal techniques IMRT or for electron radiation looks different. There with the dose normalization at the level of 90% or 85% we deal with the dose layer, the division does not exceed 15% of heterogeneity.

Therapeutic role of growth factors in treating diabetic wound

Wounds in diabetic patients,especially diabetic foot ulcers,are more difficult to heal compared with normal wounds and can easily deteriorate,leading to amputation.Common treatments cannot heal diabetic wounds or control their many complications.Growth factors are found to play important roles in regulating complex diabetic wound healing.Different growth factors such as transforming growth factor beta 1,insulin-like growth factor,and vascular endothelial growth factor play different roles in diabetic wound healing.This implies that a therapeutic modality modulating different growth factors to suit wound healing can significantly improve the treatment of diabetic wounds.Further,some current treatments have been shown to promote the healing of diabetic wounds by modulating specific growth factors.The purpose of this study was to discuss the role played by each growth factor in therapeutic approaches so as to stimulate further therapeutic thinking.

Development of tacrolimus-loaded transfersomes for deeper skin penetration enhancement and therapeutic effect improvement in vivo

The aims of this study were to prepare novel transfersomes(TFs)for tacrolimus to treat atopic dermatitis,and to observe the therapeutic effects on mice atopic dermatitis,as compared to commercial tacrolimus ointment(Protopic
)and liposomes-gel.Different kinds of surfactantsdsodium cholate,Tween 80 and Span 80 were investigated to prepare TFs respectively.TFs-Tween 80 was selected as the optimal carrier owing to the best deformability and the highest drug retentions.Entrapment efficiency and diameter were also evaluated.The optimized TFs were further made into gel and in vitro drug release of TFs-gel after 24 h was higher than the commercial ointment.Cumulative drug release from TFs-gel after 12 h in vitro was 37.6%.The optimized TFs-gel illustrated remarkably highest drug skin retentions when compared with liposomes-gel and commercial ointment in vivo skin retention experiments.The amounts of tacrolimus in epidermis and dermis from TFsgel were 3.8 times and 4.2 times respectively as much as ointment,while liposomes-gel was only 1.7 times and 1.4 times respectively as compared to ointment.Topical application of TFs-gel displayed the best therapeutic effect on mice atopic dermatitis induced by repeated topical application of 2,4-dinitrofluorobenzene.Thus TFs displayed superior performance and effective skin target for topical delivery of tacrolimus.

Biomedical overview of melanin.1.Updating melanin biology and chemistry,physico-chemical properties,melanoma tumors,and photothermal therapy

Melanins(eumelanin,pheomelanin,and allomelanin)represent a very,if not themost,important group of biological pigments.Their biological roles are multiple,from photoprotection to antioxidant activity,heavy metal disposal or the myriad uses of color in organisms across all Phyla.In the first part of this review,eumelanin biology and some chemical aspects will be presented,as well as key physico-chemical features that make this biological pigment so interesting.The principal characteristics of the melanocyte,the melanin-synthesizing cell in mammals,will also be introduced.Transformed melanocytes are the cause of one of the most devastating known cancers:the malignant melanoma.Epidemiology and molecular signaling aspects will be presented next,as well as the principal advances in promising oncotherapies designed and applied for the treatment of melanoma.In particular,on account of the photo-physical properties of melanin,special details will be provided regarding the use of photothermal therapy for melanoma treatment.

Non-invasive physical therapy as salvage measure for ischemic skin flap:A literature review

This review focuses on the available evidence regarding the molecular mechanisms and treatment potential of several non-surgical physical therapies for managing flap ischemia to propose a non-invasive,economical,and simple treatment to improve flap survival.A review of the literature was conducted on the topics of various non-invasive methods for the treatment of ischemic necrosis of the distal end of the flap between 1988 and 2019.A total of 52 published studies were reviewed on the applications of hyperbaric oxygen therapy,electrical stimulation therapy,heat stress pretreatment,phototherapy,and vibration therapy to manage skin flap necrosis.The underlying molecular mechanisms of these physical therapies on revitalizing the dying skin flaps were discussed and preliminary clinical uses of these therapies to salvage the necrotic skin flaps were pooled and summarized for clarifying the safety and feasibility of these methods.Various physical therapy regimens have been ushered to manage necrotic development in cutaneous flaps.With the refinement of these new technologies and enhancement of related basic science research on vascular revitalization,the prevention and treatment of flap ischemia will enter a new era.

Hyperbaric oxygen therapy for skin flap blood flow disorder: a case report

A female patient at the age of 17 received dilator implant on the right part of her face to prepare skin flap for her facial scar.The skin flap was in good conditions before scar cutting,but showed poor blood circulation after being transferred.Hyperbaric oxygen therapy was given at 0.2 MPa(2ATA) in double pure oxygen cabins for 90 min every day for 10 d.The skin flap showed in sound viability and sound blood circulation after the treatment.Hyperbaric oxygen therapy can be used to treat blood circulation disorder in transferred skin flap.