Several therapeutic effects of photobiomodultion (PBM) on variable mucosal lesions of the upper aerodigestive tract has been reported. However, the biomodulatory effect of PBM are rarely reported on tracheostomy and tracheal fenestration, which has been increased with the spread of coronavirus disease (COVID-19). In this study, we developed a translaryngeal PBM therapy by using a basket-integrated diffusing applicator (BIDA) to ameliorate the wound healing of fenestrated tracheostoma after surgery. Tracheostomy was performed by using an electrocautery unit (Bovie) to develop an in vivo porcine model of fenestrated tracheostoma with impaired wounds. A 635 nm laser light (200 mW/cm2 for 3 min, 36 J/cm2) was applied to the wounds by using BIDA once daily for five days. BIDA was inserted in tracheostomy tube and emitted homogeneous circumferential light into the fenestrated wound without thermal damage. Control highly induced fibrotic expressions of alpha-smooth muscle actin and type-1 collagen with acute inflammation. In contrast, PBM reduced the expressions up to less than 82% of control. Histological scores presented that PBM significantly decreased acute inflammation and overgranulation to two-thirds of control with a small portion of abscess. In addition, a substantial difference in the lumen area was observed between the control and PBM due to the thickened wall. The current study demonstrated that the proposed PBM therapy could ameliorate the impaired wound healing of fenestrated tracheostoma as a result of modulated inflammation and fibrotic responses. Therefore, the translaryngeal PBM with BIDA can be an effective adjuvant therapy for managing the fenestrated wound after tracheostomy.
Tracheal stenosis or granuloma is one of the most frequent complications after tracheostomy as a result of inflammatory, traumatic and fibrotic responses. Recently, multidisciplinary treatment has been used for tracheal stenosis and granuloma such as bronchoscopy, balloon dilation and tracheal surgeries. However, current treatments have risk of morbidity and may worsen the situation with high recurrence rate. The purpose of this study is to develop a novel combined treatment of photobiomodulation (PBM) and phlorotannin (PT) to prevent stenosis and granuloma formation after tracheal injury. The therapeutic effect of the combined treatment was evaluated on transforming growth factor (TGF)-beta-stimulated human tracheal fibroblasts and the developed tracheostomy rodent models. A 405 nm wavelength light was applied for PBM in a continuous-wave mode after treatment with Ecklonia cava-derived PT. MTT assay and western blot analysis showed that 12 J/cm2 of PBM and 100 µg/ml of PT were hardly cytotoxic (less than 20%). The combined treatment significantly inhibited cell migration and suppressed the expressions of alpha-smooth muscle actin and type-1 collagen via the downregulation of SMAD 2/3 and MAPK signaling pathways. Moreover, the proposed combined treatment showed promoted healing of tracheal fenestration wounds by modulating inflammation and overexpressed fibrotic activities on the developed tracheostomy rodent models. Therefore, the combination of PBM and PT demonstrates therapeutic potential for preventing tracheal stenosis and granuloma after tracheostomy.
Tracheal stomal stenosis is the most common complication that exists in patients after tracheostomy and prolonged intubation due to inflammatory and fibrotic responses. Various surgical techniques, such as Y-V and two circular incisions, have been attempted to minimize the stenosis. However, the current incision methods still have a risk of infection related to the enlarged stoma. The aim of this study is to develop a novel combined treatment of photobiomodulation (PBM) and phlorotannin (PT) to prevent the stenosis after tracheostomy. The therapeutic effect of the combined treatment was evaluated in tracheal fibroblast and the tracheostomy-developed rodent models. A 405 nm wavelength light was applied for PBM in a continuous-wave mode after treatment with Ecklonia cava-derived PT. MTT assay and western blot analysis showed that 12 J/cm2 of PBM and 100 μg/ml of PT were an insignificant cytotoxicity (less than 20%). The combined treatment significantly inhibited cell migration (51.7%) and suppressed the expressions of alpha-smooth muscle actin (38.3%) and type-1 collagen (54.2%) due to the downregulation of SMAD 2/3 and MAPK signalling pathways. In vivo tests confirmed that control group showed obstruction by tissue granulation in the incised tissue seven days after tracheostomy, whereas the combined group still maintained the stoma with minimal fibrosis. The current study demonstrated that PT-combined PBM could minimize the tracheal stomal stenosis in fibrotic conditions as a result of modulated fibrotic responses. Therefore, the combination of PBM and PT can warrant an effective prevention of the tracheal stomal stenosis post-tracheostomy.
Although several intraoperative methods to localize parathyroid gland(PG) were introduced, their clinical application has been limited. Thus, the current solution has been based on visual inspection of the surgeon. Recently, we reported excellent results (PPV = 100%, n=16) of Near infrared and infrared imaging technique for identifying surgically exposed PGs (JCEM, 2016). However, it is more important to predict the location of PGs before they are exposed to the naked eye. We investigated the feasibility of PG mapping (navigation) with NIR autofluorescence imaging to localize unexposed PGs. Seventy PGs from 38 thyroidectomy patients were enrolled in this prospective study. NIR imaging was taken at the areas where PGs were predicted to exist. We named the procedure as Parathyroid Navigation. The parathyroid navigation was photographed in three stages. Stage P1, taking images at pre-identification by the naked eye, step P2, at post-identification, and step P3, at removed specimens. Of 69 PGs identified, 64 (92.8%) were found at P1, 4 (5.8%) at P2, and 1 (1.4%) at P3. Even when PGs were covered by connective or fat tissues, NIR navigation at step P1 showed the sensitivity (92.75 %), specificity (100 %), PPV (100 %), NPV (16.66 %), accuracy (92.85 %). Five PGs of step P1 negative were identified at step P2 and P3 revealing 100% of total accuracy rate. The average parathyroid/background ratio was 4.78. These results suggest the concept of parathyroid navigation is feasible. We believe surgeons can get benefits of preserving parathyroid gland with the use of our NIR imaging method.
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