Photodynamische Therapie (PDT) und wassergefiltertes Infrarot A (wIRA) bei Patienten mit therapierefraktären vulgären Hand- und Fußwarzen

Background: Common warts (verrucae vulgares) are human papilloma virus (HPV) infections with a high incidence and prevalence, most often affecting hands and feet, being able to impair quality of life. About 30 different therapeutic regimens described in literature reveal a lack of a single striking strategy. Recent publications showed positive results of photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) in the treatment of HPV-induced skin diseases, especially warts, using visible light (VIS) to stimulate an absorption band of endogenously formed protoporphyrin IX. Additional experiences adding waterfiltered infrared A (wIRA) during 5-ALA-PDT revealed positive effects. Aim of the study: First prospective randomised controlled blind study including PDT and wIRA in the treatment of recalcitrant common hand and foot warts. Comparison of "5-ALA cream (ALA) vs. placebo cream (PLC)" and "irradiation with visible light and wIRA (VIS+wIRA) vs. irradiation with visible light alone (VIS)". Methods: Pre-treatment with keratolysis (salicylic acid) and curettage. PDT treatment: topical application of 5-ALA (Medac) in "unguentum emulsificans aquosum" vs. placebo; irradiation: combination of VIS and a large amount of wIRA (Hydrosun® radiator type 501, 4 mm water cuvette, waterfiltered spectrum 590-1400 nm, contact-free, typically painless) vs. VIS alone. Post-treatment with retinoic acid ointment. One to three therapy cycles every 3 weeks. Main variable of interest: "Percent change of total wart area of each patient over the time" (18 weeks). Global judgement by patient and by physician and subjective rating of feeling/pain (visual analogue scales). 80 patients with therapy-resistant common hand and foot warts were assigned randomly into one of the four therapy groups with comparable numbers of warts at comparable sites in all groups. Results: The individual total wart area decreased during 18 weeks in group 1 (ALA+VIS+wIRA) and in group 2 (PLC+VIS+wIRA) significantly more than in both groups without wIRA (group 3 (ALA+VIS) and 4 (PLC+VIS)): medians and interquartile ranges: -94% (-100%/-84%) vs. -99% (-100%/-71%) vs. -47% (-75%/0%) vs. -73% (-92%/-27%). After 18 weeks the two groups with wIRA differed remarkably from the two groups without wIRA: 42% vs. 7% completely cured patients; 72% vs. 34% vanished warts. Global judgement by patient and by physician and subjective rating of feeling was much better in the two groups with wIRA than in the two groups without wIRA. Conclusions: The above described complete treatment scheme of hand and foot warts (keratolysis, curettage, PDT treatment, irradiation with VIS+wIRA, retinoic acid ointment; three therapy cycles every 3 weeks) proved to be effective. Within this treatment scheme wIRA as non-invasive and painless treatment modality revealed to be an important, effective factor, while photodynamic therapy with 5-ALA in the described form did not contribute recognisably - neither alone (without wIRA) nor in combination with wIRA - to a clinical improvement. For future treatment of warts an even improved scheme is proposed: one treatment cycle (keratolysis, curettage, wIRA, without PDT) once a week for six to nine weeks. © 2004 Fuchs et al; licensee German Medical Science. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL : http://www.egms.de/en/gms/volume2.shtmlHintergrund: Vulgäre Warzen (Verrucae vulgares) sind humane Papillomvirus-Infektionen (HPV) mit einer hohen Inzidenz und Prävalenz, die am häufigsten Hände und Füße befallen und die in der Lage sind, die Lebensqualität zu beeinträchtigen. Etwa 30 in der Literatur beschriebene Therapieverfahren zeugen von einem Mangel an einer einzigen überzeugenden Strategie. Jüngste Veröffentlichungen zeigten positive Ergebnisse der Photodynamischen Therapie (PDT) mit 5-Aminolävulinsäure (5-ALA) in der Therapie von HPV-induzierten Hautkrankheiten, besonders Warzen, wobei sichtbares Licht (VIS) verwendet wird, um ein Absorptionsband des endogen aus 5-ALA gebildeten Protoporphyrin IX zu stimulieren. Weitere Erfahrungen, wassergefiltertes Infrarot A (wIRA) während der 5-ALA-PDT zusätzlich anzuwenden, offenbarten positive Wirkungen. Ziel der Untersuchung: Erste prospektive randomisierte kontrollierte Blind-Studie, die PDT und wIRA in die Behandlung von therapierefraktären vulgären Hand- und Fußwarzen einbezieht. Vergleich von "5-ALA-Salbe (ALA) vs. Placebo-Salbe (PLC)" und "Bestrahlung mit sichtbarem Licht und wIRA (VIS+wIRA) vs. Bestrahlung mit sichtbarem Licht allein (VIS)". Methoden: Vorbehandlung mit Keratolyse (Salizylsäure) und Kürettage. Photodynamische Therapie (PDT): topische Applikation von 5-ALA (Medac) in "Unguentum emulsificans aquosum" vs. Placebo; Bestrahlung: Kombination von sichtbarem Licht (VIS) und einem hohen Maß an wassergefiltertem Infrarot A (wIRA) (Hydrosun®-Strahler Typ 501, 4 mm Wasserküvette, wassergefiltertes Spektrum 590-1400 nm, kontaktfrei, typischerweise schmerzlos) vs. sichtbares Licht (VIS) allein. Nachbehandlung mit Vitamin-A-Säure-Salbe. Ein bis drei Therapiezyklen im Abstand von 3 Wochen. Hauptzielvariable: "Prozentuale Änderung der Gesamtwarzenfläche jedes Patienten über die Zeit" (18 Wochen). Globales Urteil von Patient und von Arzt sowie subjektive Einschätzung von Empfindung/Schmerz (visuelle Analogskalen). 80 Patienten mit therapierefraktären vulgären Hand- und Fußwarzen wurden randomisiert einer der vier Behandlungsgruppen (mit vergleichbarer Anzahl an Warzen in vergleichbaren Lokalisationen in allen Gruppen) zugeteilt. Ergebnisse: Die individuelle Gesamtwarzenfläche nahm während 18 Wochen in Gruppe 1 (ALA+VIS+wIRA) und in Gruppe 2 (PLC+VIS+wIRA) signifikant mehr als in den beiden Gruppen ohne wIRA (Gruppe 3 (ALA+VIS) und 4 (PLC+VIS)) ab: Mediane und Interquartil-Spannen: -94% (-100%/-84%) vs. -99% (-100%/-71%) vs. -47% (-75%/0%) vs. -73% (-92%/-27%). Nach 18 Wochen unterschieden sich die zwei Gruppen mit wIRA deutlich von den zwei Gruppen ohne wIRA: 42% vs. 7% komplett geheilte Patienten; 72% vs. 34% völlig verschwundene Warzen. Das globale Urteil von Patient und von Arzt und die subjektive Einschätzung des Empfindens waren in den zwei Gruppen mit wIRA viel besser als in den zwei Gruppen ohne wIRA. Folgerungen: Das oben beschriebene vollständige Therapieschema von Hand- und Fußwarzen (Keratolyse, Kürettage, Photodynamische Therapie, Bestrahlung mit VIS+wIRA, Vitamin-A-Säure-Salbe; drei Therapiezyklen im Abstand von 3 Wochen) erwies sich als effektiv. Innerhalb des Therapieschemas zeigte sich wIRA - als nicht-invasive und schmerzlose Therapiemodalität - als ein wichtiger, effektiver Faktor, während die Photodynamische Therapie mit 5-ALA in der beschriebenen Form nicht erkennbar - weder alleine (ohne wIRA) noch in Kombination mit wIRA - zu einer klinischen Verbesserung beitrug. Für die zukünftige Behandlung von Warzen wird ein weiter verbessertes Schema vorgeschlagen: ein Therapiezyklus (Keratolyse, Kürettage, wIRA, ohne PDT) einmal pro Woche für sechs bis neun Wochen

Fused filament fabrication: Comparison of methods for determining the interfacial strength of single welded tracks

The mechanical properties of plastic-based additively manufactured specimens have been widely discussed. However, there is still no standard that can be used to determine properties such as the interfacial strength of adjacent tracks and also to exclude the influence of varying manufacturing conditions. In this paper, a proposal is made to determine the interfacial strength using specimens with only one track within a layer. For this purpose, so-called single-wall specimens of polylactide were characterised under tensile load and the interfacial area between the adjacent layers was determined using three methods. It turned out that the determination of the interfacial area via the fracture surface is the most accurate method for determining the interfacial strength. The measured interfacial strengths were compared with the bulk material strength and it was found that the bulk material strength can be achieved under optimal conditions in the FFF process. It was also observed that with increasing nozzle temperature, the simultaneous printing of specimens influences the interfacial strength. To conclude, this method allows to measure the interfacial strength without superimposing the influence of voids. However, for example, the interfacial strength within a layer cannot be determined

Keratinocyte and Fibroblast Wound Healing In Vitro Is Repressed by Non-Optimal Conditions but the Reparative Potential Can Be Improved by Water-Filtered Infrared A

It is a general goal to improve wound healing, especially of chronic wounds. As light therapy has gained increasing attention, the positive influence on healing progression of water-filtered infrared A (wIRA), a special form of thermal radiation, has been investigated and compared to the detrimental effects of UV-B irradiation on wound closure in vitro. Models of keratinocyte and fibroblast scratches help to elucidate effects on epithelial and dermal healing. This study further used the simulation of non-optimal settings such as S. aureus infection, chronic inflammation, and anti-inflammatory conditions to determine how these affect scratch wound progression and whether wIRA treatment can improve healing. Gene expression analysis for cytokines ( IL1A , IL6 , CXCL8 ), growth ( TGFB1 , PDGFC ) and transcription factors ( NFKB1 , TP53 ), heat shock proteins ( HSP90AA1 , HSPA1A , HSPD1 ), keratinocyte desmogleins ( DSG1 , DSG3 ), and fibroblast collagen ( COL1A1 , COL3A1 ) was performed. Keratinocyte and fibroblast wound healing under non-optimal conditions was found to be distinctly reduced in vitro. wIRA treatment could counteract the inflammatory response in infected keratinocytes as well as under chronic inflammatory conditions by decreasing pro-inflammatory cytokine gene expression and improve wound healing. In contrast, in the anti-inflammatory setting, wIRA radiation could re-initiate the acute inflammatory response necessary after injury to stimulate the regenerative processes and advance scratch closure

Development of an Injection Molding Process for Long Glass Fiber-Reinforced Phenolic Resins

Glass fiber-reinforced phenolic resins are well suited to substitute aluminum die-cast materials. They meet the high thermomechanical and chemical demands that are typically found in combustion engine and electric drive train applications. An injection molding process development for further improving their mechanical properties by increasing the glass fiber length in the molded part was conducted. A novel screw mixing element was developed to improve the homogenization of the long fibers in the phenolic resin. The process operation with the mixing element is a balance between the desired mixing action, an undesired preliminary curing of the phenolic resin, and the reduction of the fiber length. The highest mixing energy input leads to a reduction of the initial fiber length L(0) = 5000 μm to a weighted average fiber length of L(p) = 571 μm in the molded part. This is an improvement over L(p) = 285 μm for a short fiber-reinforced resin under comparable processing conditions. The mechanical characterization shows that for the long fiber-reinforced materials, the benefit of the increased homogeneity outweighs the disadvantages of the reduced fiber length. This is evident from the increase in tensile strength from σ(m) = 21 MPa to σ(m) = 57 MPa between the lowest and the highest mixing energy input parameter settings

Compounding of short fiber reinforced phenolic resin by using specific mechanical energy input as a process control parameter

For a newly developed thermoset injection molding process, glass fiber-reinforced phenolic molding compounds with fiber contents between 0 wt% and 60 wt% were compounded. To achieve a comparable remaining heat of the reaction in all compound formulations, the specific mechanical energy input (SME) during the twin-screw extruder compounding process was used as a control parameter. By adjusting the extruder screw speed and the material throughput, a constant SME into the resin was targeted. Validation measurements using differential scanning calorimetry showed that the remaining heat of the reaction was higher for the molding compounds with low glass fiber contents. It was concluded that the SME was not the only influencing factor on the resin crosslinking progress during the compounding. The material temperature and the residence time changed with the screw speed and throughput, and most likely influenced the curing. However, the SME was one of the major influence factors, and can serve as an at-line control parameter for reactive compounding processes. The mechanical characterization of the test specimens revealed a linear improvement in tensile strength up to a fiber content of 40–50 wt%. The unnotched Charpy impact strength at a 0° orientation reached a plateau at fiber fractions of approximately 45 wt%

Development of an injection molding process for long glass fiber-reinforced phenolic resins

Glass fiber-reinforced phenolic resins are well suited to substitute aluminum die-cast materials. They meet the high thermomechanical and chemical demands that are typically found in combustion engine and electric drive train applications. An injection molding process development for further improving their mechanical properties by increasing the glass fiber length in the molded part was conducted. A novel screw mixing element was developed to improve the homogenization of the long fibers in the phenolic resin. The process operation with the mixing element is a balance between the desired mixing action, an undesired preliminary curing of the phenolic resin, and the reduction of the fiber length. The highest mixing energy input leads to a reduction of the initial fiber length L0 = 5000 μm to a weighted average fiber length of Lp = 571 μm in the molded part. This is an improvement over Lp = 285 μm for a short fiber-reinforced resin under comparable processing conditions. The mechanical characterization shows that for the long fiber-reinforced materials, the benefit of the increased homogeneity outweighs the disadvantages of the reduced fiber length. This is evident from the increase in tensile strength from σm = 21 MPa to σm = 57 MPa between the lowest and the highest mixing energy input parameter settings

On visualisation scaling, subeigenvectors and Kleene stars in max algebra

The purpose of this paper is to investigate the interplay arising between max algebra, convexity and scaling problems. The latter, which have been studied in nonnegative matrix theory, are strongly related to max algebra. One problem is strict visualisation scaling, which means finding, for a given nonnegative matrix A, a diagonal matrix X such that all elements of X^{-1}AX are less than or equal to the maximum cycle geometric mean of A, with strict inequality for the entries which do not lie on critical cycles. In this paper such scalings are described by means of the max-algebraic subeigenvectors and Kleene stars of nonnegative matrices as well as by some concepts of convex geometry.Comment: 22 page

Chandra Observation of an X-ray Flare at Saturn: Evidence for Direct Solar Control on Saturn's Disk X-ray Emissions

Saturn was observed by Chandra ACIS-S on 20 and 26-27 January 2004 for one full Saturn rotation (10.7 hr) at each epoch. We report here the first observation of an X-ray flare from Saturn's non-auroral (low-latitude) disk, which is seen in direct response to an M6-class flare emanating from a sunspot that was clearly visible from both Saturn and Earth. Saturn's disk X-ray emissions are found to be variable on time scales of hours to weeks to months, and correlated with solar F10.7 cm flux. Unlike Jupiter, X-rays from Saturn's polar (auroral) region have characteristics similar to those from its disk. This report, combined with earlier studies, establishes that disk X-ray emissions of the giant planets Saturn and Jupiter are directly regulated by processes happening on the Sun. We suggest that these emissions could be monitored to study X-ray flaring from solar active regions when they are on the far side and not visible to Near-Earth space weather satellites.Comment: Total 12 pages including 4 figure

Application of a Tensor Interpolation Method on the Determination of Fiber Orientation Tensors From Computed Tomography Images

When investigating the mechanical behavior of fiber-reinforced polymers, fiber orientation plays a decisive role concerning anisotropy. Fiber orientation distributions are typically measured in the form of fiber orientation tensors. In order to measure orientation tensors, computed tomography scans and consecutive image processing methods have become one of the leading non-destructive testing methods. The conflict between scan resolution and sample size limits the volume that can be scanned. To obtain the fiber orientation behavior across an entire plate, a direct interpolation of orientation tensors computed from CT scans of smaller volumes at selected coordinates of the plate is implemented. Rather than a component-based interpolation, the authors chose a decomposition and reassembly method interpolating shape and orientation of the tensors separately. While this approach has been implemented and used for e.g. diffusion tensors in medical imaging, the authors consider the application to sparse but measured CT-based data to be a novelty