New lasers and light sources - old and new risks?
May,
2017
Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices - in the context of laser-assisted drug delivery - have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have…
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
[Nonviral sexually transmitted infections-epidemiology, clinical manifestations, diagnostic workup, therapy : Part 3: Treponemes, Gardnerella and trichomonads].
Feb,
2017
In Germany, the reported syphilis prevalence has increased continuously since 2010, with a total of 6834 syphilis cases being reported in 2015. The largest increase of reported syphilis occurred in men who have sex with men (MSM). The antibiotic agent of choice for treatment of syphilis is still penicillin. There are no penicillin-resistant Treponema pallidum strains. Alternatives are ceftriaxone and doxycycline. In Germany, azithromycin is not approved for treatment of syphilis; however, therapy failures are increasingly reported. Bacterial vaginosis is accompanied by vaginal discharge. The vaginal secretion exhibits an increased pH value higher than 4.5. Clinical symptoms are pruritus, burning, and the characteristic amine odor. The probability for bacterial vaginosis is highest in women with higher numbers of sexual partners, unmarried women, early first sexual intercourse, in commercial female sex workers, and those women who regularly apply vaginal douches. The main pathogen of bacterial vaginosis is Gardnerella vaginalis. For oral therapy metronidazole is given, alternatively clindamycin; the latter should be applied additionally as topical agent. Trichomoniasis is considered as the nonviral sexually transmitted infection with the highest prevalence worldwide. Other than direct microscopic detection of the protozoa (trophozoites) in vaginal secretion or urine, PCR has been approved as the diagnostic method with the highest sensitivity. Oral metronidazole represents the therapy of choice in trichomoniasis. read more
Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete
[Non-viral sexually transmitted infections - Epidemiology, clinical manifestations, diagnostics and therapy : Part 1: Gonococci].
Jan,
2017
Approximately 1 million people are infected per day worldwide by one or more sexually transmitted infections (STI) as estimated by the World Health Organization (WHO). Gonorrhoea represents an almost exclusively sexually transmitted infection, which predominantly affects mucous membranes of the genitourinary tract. Extragenital localization of infections is also possible, e. g. in the anorectal region. Currently, only syphilis and human immunodeficiency virus (HIV) are notifiable diseases according to the Infection Protection Act in Germany. In Saxony, an extended registration ordinance according to the German Infection Protection Act is in force, which means that besides syphilis the laboratory detection of Neisseria gonorrhoeae, Chlamydia trachomatis and genital mycoplasms are also notifiable infections. In particular, beginning in 2009 in Saxony a spectacular increase of registered infections due to N. gonorrhoeae was observed and in 2015 altogether 824 infections due to N. gonorrhoeae were reported. Alarming is the increase in resistance of N. gonorrhoeae against penicillin, doxycycline, ciprofloxacin and recently also against azithromycin and third generation cephalosporins. The so-called superbug of N. gonorrhoeae, which originated in Japan with multidrug resistance against most of the currently available oral antibiotics, has now arrived in Europe. Intramuscular or intravenous injection of ceftriaxone plus oral azithromycin, each given as single dose is the standard therapy for gonorrhoea. read more
Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete
Nicotinamide phosphoribosyltransferase production in human spermatozoa is influenced by maturation stage.
11,
2016
High amounts of nicotinamide phosphoribosyltransferase (NAMPT) were found in human seminal plasma. This enzyme influences energy metabolism and apoptosis and is essential for the regulation of cellular nicotinamide adenine dinucleotide (NAD) levels in somatic cells. NAD is required as a co-substrate for dehydrogenases, which are potentially important for spermatogenesis. The functional significance of intra- and extracellular NAMPT in human reproduction, however, has not been defined yet. The objectives of the study were therefore to determine NAMPT protein expression in human spermatozoa and testes, the secretion of NAMPT by spermatozoa depending on their maturation stage and the impact of NAMPT enzymatic function on sperm viability, motility, fertilisation capacity and induction of apoptosis. Firstly, we detected NAMPT protein in different cell types of human testes. NAMPT protein was also detected in spermatozoa, with significantly higher amounts in immature than in mature ejaculated spermatozoa. Additionally, NAD levels were significantly higher in immature than in mature spermatozoa. Secondly, NAMPT was released into the supernatant of human spermatozoa, with significantly higher NAMPT levels in supernatant of immature spermatozoa compared with mature cells. Finally, the specific inhibition of the enzyme by FK866 did not influence motility, capacitation or apoptosis signalling. In summary, NAMPT is produced in human spermatozoa in a maturation-dependent manner. read more
Andrology
The Future of Fractional Lasers.
Jun,
2016
Recent insights to the potential of fractional skin treatments have established standard laser procedures to treat aged, sun-damaged skin and scars. On top of this, the concept has been extended to fibrosing conditions, to remove foreign bodies and to treat inflammatory skin diseases. The biggest potential, however, is foreseen with the option of a contact-free temporary opening of the epidermal barrier (TOR, German: gate) to promote new and intensified treatment regimen. To date these concepts are predominantly experimental, although first clinical studies already show a better response rate if actinic keratoses are treated by fractional laser-intensified photodynamic therapy (PDT) in comparison to the conventional PDT. Possible risks may arise due to the fact that fractional laser home devices are at hand. Used in conjunction with topicals of all origins, toxic and allergic reactions may occur. Principles of current fractional laser interventions are presented as facts while visions are given as future indications. read more
Facial plastic surgery : FPS
Ablative fractional laser alters biodistribution of ingenol mebutate in the skin.
Aug,
2015
Topically applied ingenol mebutate (IngMeb) is approved for field-treatment of actinic keratosis and is currently being investigated for treatment of non-melanoma skin cancer (NMSC). Ablative fractional lasers (AFXLs) generate microscopic ablation zones (MAZs) in the skin, which may help induce a deep penetration needed for effective treatment of NMSC. Using Franz diffusion cells, uptake and bio-distribution were investigated over 21 h in intact (n = 9) and AFXL-exposed porcine skin (n = 58). A 2940-nm fractional Er:YAG laser generated intraepidermal (11.2 mJ/MAZ; 66 μm deep, 177 μm wide) and intradermal (128 mJ/MAZ; 570 μm deep, 262 wide) MAZ's with 16, 97, and 195 MAZs/cm(2). Surface ablation densities corresponded to 0.5, 2.5, and 5 % for intraepidermal MAZs, and corresponded to 1, 5, and 10.5 % for intradermal MAZs. Liquid-chromatography-mass-spectrometry quantified deposition of IngMeb in stratum corneum, epidermis, dermis, and receiver chamber. In intact skin, IngMeb readily penetrated to the epidermal layer (1,314 ng, 41 % of the applied IngMeb), while dermal deposition was limited (508 ng, 16 %). In AFXL-exposed skin, a profound dermal deposition of IngMeb was achieved, while less accumulated in SC and epidermis. Uptake depended entirely on laser density; increasing coverage from 0 % to 0.5 %, 1 %, 2.5 %, 5 %, and 10.5 % enhanced dermal uptake 1.6-, 2.1-, 3.1-, 3.4-, and 3.9-fold, respectively (p < 0.0001). Channel depth did not influence drug uptake; at 5 % density, dermal deposition with intraepidermal and intradermal MAZs was analogous (1801 vs. 1744; p = 0.447). In conclusion, IngMeb readily distributes to superficial layers of intact skin, whereas dermal uptake is limited. Independent of channel depth, AFXL enhances dermal drug deposition, providing for customized topical delivery and potential use of IngMeb for treatment of NMSC. read more
Archives of dermatological research
Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy.
May,
2015
Treatment of dermatophyte infections is based on the clinical picture and mycological detection of the causative pathogen. Based on the appropriate indication, onychomycosis can be treated topically using an antimycotic nail lacquer. Atraumatic nail abrasion with 40 % urea ointment has a beneficial effect on healing. Continuous treatment of onychomycosis with terbinafine represents the most effective systemic therapy. Terbinafine or itraconazole are the safest and most effective antimycotic agents for the treatment of onychomycosis in children. For laser therapy of onychomycosis, only a few studies on clinical efficacy are available. Regarding tinea capitis, targeted species-specific therapy of dermatophytosis of the scalp is currently recommended. Terbinafine, yet also itraconazole and fluconazole, are effective in tinea capitis caused by Trichophyton species. Microsporum infections of the scalp are preferably treated with griseofulvin, alternatively with itraconazole or fluconazole. Terbinafine is less effective. Candidal intertrigo are topically treated with nystatin, but azoles or ciclopirox olamine are also suitable candidates. Systemically, fluconazole or itraconazole are used. Topical and systemic antimycotics are equivalent forms of therapy in acute vulvovaginal mycosis. Fluconazole is the drug of choice in chronic recurrent vulvovaginal mycosis caused by Candida albicans. Ketoconazole shows very good efficacy in tinea versicolor. With respect to systemic treatment of severe and widespread tinea versicolor, itraconazole is the drug of choice. read more
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
Changes of murine sperm phospholipid composition during epididymal maturation determined by MALDI-TOF mass spectrometry.
Aug,
2014
After leaving the testis, spermatozoa undergo several important steps of biochemical maturation during the passage through the epididymis, increasing their motility and fertilizing ability. These changes comprise (among others) the modification of the phospholipid composition of the sperm membrane. This process is thought to be important for the achievement of motility and fertilizing capacity. The lipids of the sperm membrane are characterized by a significant content of unsaturated fatty acyl residues, resulting in a high sensitivity against oxidative stress. This is evidenced by the appearance of lysolipids, for example, lysophosphatidylcholine, which acts like a detergent and is normally present in only very small amounts in biological membranes. The epididymis represents a tubular system comprising three main parts (caput, corpus, and cauda), through which the spermatozoa are consecutively transported undergoing distinct maturation stages. Using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, we established three striking differences in the lipid composition of murine spermatozoa from the different epididymal regions: in comparison to the caput sperm, sperm from the cauda are characterized by (1) a higher degree of unsaturation (PC 18:0/22:5 and 18:0/22:6 vs. 18:0/20:4 and 18:0/18:1), (2) an enhanced plasmalogen content, and (3) an enhanced content of lysolipids. These changes are likely to be of physiological relevance and potentially useful as diagnostic markers of sperm maturation and acquisition of motility. read more
Theriogenology
[Infections of finger and toe nails due to fungi and bacteria].
Apr,
2014
Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing. read more
Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete
A MALDI MS investigation of the lysophosphatidylcholine/phosphatidylcholine ratio in human spermatozoa and erythrocytes as a useful fertility marker.
Mar,
2014
The human spermatozoa membrane is characterized by a unique fatty acyl composition with significant amounts of highly unsaturated fatty acids, particularly docosahexaenoic acid (22:6), whereby phosphatidylcholine (PtdCho) (16:0/22:6) is the most abundant glycerophospholipid. The large amount of highly unsaturated fatty acyl residues is crucial for the fluidity of the membrane and, therefore, the successful fertilization process. Consequently, however, the spermatozoa are very sensitive to reactive oxygen species (ROS) that are generated under conditions of "oxidative stress" and key players in many pathological conditions. Lipid oxidation of the sperm membrane is accompanied by the loss of the oxidatively modified unsaturated residue (normally in the sn-2 position) and the generation of saturated lysophosphatidylcholine (LysoPtdCho). Although other lysolipids are also generated, LysoPtdCho is the "marker" lipid of choice due to the high abundance of PtdCho. In particular, obesity (body mass index >30 kg/m(2)) is characterized by increased ROS generation and negatively affects the reproductive potential. We will show here that the LysoPtdCho/PtdCho ratio can be easily determined by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). The data found do correlate with clinical markers of sperm quality. A very interesting aspect is that the LysoPtdCho/PtdCho ratios determined in the spermatozoa extracts correlate with the LysoPtdCho/PtdCho values determined in the organic extracts of erythrocytes. Thus, there is no absolute need for a sperm investigation, but an estimation of the fertilizing ability of the corresponding male could be also made directly from the blood which is more readily available than the spermatozoa. read more
Lipids
Heat profiles of laser-irradiated nails.
Jan,
2014
Onychomycosis is a worldwide problem with no tendency for self-healing, and existing systemic treatments achieve disease-free nails in only 35 to 76% of cases. Recently, treatment of nail fungus with a near-infrared laser has been introduced. It is assumed that fungal eradication is mediated by local heat. To investigate if laser treatment has the potential to eradicate fungal hyphae and arthrospores, laser heat application and propagation needs to be studied in detail. This study aimed to measure nail temperatures using real-time videothermography during laser irradiation. Treatment was performed using 808- and 980-nm linear scanning diode lasers developed for hair removal, enabling contact-free homogeneous irradiation of a human nail plate in one pass. Average and peak temperatures increased pass by pass, while the laser beam moved along the nail plates. The achieved mean peak temperatures (808 nm: 74.1 to 112.4°C, 980 nm: 45.8 to 53.5°C), as well as the elevation of average temperatures (808 nm: 29.5 to 38.2°C, 980 nm: 27.1 to 32.6°C) were associated with pain that was equivalent to that of hair removal procedures and was not significantly different for various wavelengths. The linear scanning laser devices provide the benefits of contact-free homogeneous heating of the human nail while ensuring adequate temperature rises. read more
Journal of biomedical optics
Long-term efficacy of linear-scanning 808 nm diode laser for hair removal compared to a scanned alexandrite laser.
Jan,
2014
Alexandrite and diode lasers are commonly used for hair removal. To date, the available spot sizes and repetition rates are defining factors in terms of penetration depth, treatment speed, and efficacy. Still, larger treatment areas and faster systems are desirable. To compare the efficacy, tolerability, and subject satisfaction of a continuously linear-scanning 808 nm diode laser with an alexandrite 755 nm laser for axillary hair removal. read more
Lasers in surgery and medicine
Basic diagnostics in andrology.
Sep,
2013
Basic andrological diagnosis consists of taking the patient's medical history and the couple's history as well as performing a physical examination including genital ultrasound, spermiogram, and hormonal analysis. If needed, a testicular biopsy and genetic testing may also be performed. Recent studies have shown the effect of lifestyle factors on male fertility. Thus, the patient history and clinical/andrological examinations have been broadened to include information on metabolic disorders like obesity and diabetes mellitus. The biggest changes occurred with the publication of the fifth edition of the WHO laboratory manual in 2010 and the introduction of a section on semen analysis in the German Medical Association guidelines (RiliBÄK). The reference values for almost all spermiogram parameters were adapted in an evidence-based approach using worldwide prospective population studies. For central parameters such as sperm motility and morphology, the assessment criteria were changed. New independent markers such as sperm DNA fragmentation rate are now routinely used in clinical diagnosis. For German andrological laboratories, there are now mandatory quality assurance measures for semen analysis (in the German "Rili-BÄK" guidelines). These include duplicate testing of all standard semen parameters and inter-laboratory comparison at regular intervals. read more
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
Progeroid laminopathy with restrictive dermopathy-like features caused by an isodisomic LMNA mutation p.R435C.
Jun,
2013
The clinical course of a female patient affected by a progeroid syndrome with Restrictive Dermopathy (RD)-like features was followed up. Besides missing hairiness, stagnating weight and growth, RD-like features including progressive skin swelling and solidification, acrocontractures, osteolysis and muscular hypotension were observed until the patient died at the age of 11 months. A homozygousLMNA mutation c.1303C>T (p.R435C) was found by Sanger sequencing. Haplotyping revealed a partial uniparental disomy of chromosome 1 (1q21.3 to 1q23.1) including the LMNA gene. In contrast to reported RD patients with LMNA mutations, LMNA p.R435C is not located at the cleavage site necessary for processing of prelamin A by ZMPSTE24 and leads to a distinct phenotype combining clinical features of Restrictive Dermopathy, Mandibuloacral Dysplasia and Hutchinson-Gilford Progeria. Functionally, LMNA p.R435C is associated with increasing DNA double strand breaks and decreased recruitment of P53 binding protein 1 (53BP1) to DNA-damage sites indicating delayed DNA repair. The follow-up of the complete clinical course in the patient combined with functional studies showed for the first time that a progressive loss of lamin A rather than abnormal accumulation of prelamin A species could be a pathophysiological mechanism in progeroid laminopathies, which leads to DNA repair deficiency accompanied by advancing tissue degeneration. read more
Aging
Age-dependent inhibin B concentration in relation to FSH and semen sample qualities: a study in 2448 men.
Mar,
2013
Inhibin B is an important serum marker of spermatogenesis, whereas sensitivity and predicting power for the spermatogenic situation at several ages are under debate. We performed a retrospective analysis of data from 2448 men who attended our University-based male infertility clinic to evaluate inhibin B in relation to age and semen sample qualities in comparison with FSH. Moreover, the range of inhibin B in 82 nonobstructive azoospermic patients was correlated with the sperm retrieval in testicular sperm extraction procedures. Inhibin B correlated with FSH (Spearman rank correlation (R)=-0.50; P<0.00001). Inhibin B and inhibin B/FSH ratio (IFR) showed an inverse U-shaped dependence on age, whereas FSH showed a U-shaped dependence on age (optimum 20-40 years). However, in men with normal spermiograms inhibin B concentrations did not differ between age groups. Their levels of inhibin B amounted to 130.5, 54.5-247 ng/l (median, 10th-90th precentile), and of IFR to 38.3, 12.5-104.8 (median, 10th-90th percentile), which might be taken as the reference range. Using the 10th percentile of IFR, correct classification in normal or pathological semen groups was achieved in 99.1%. The percentage of aniline blue-negative spermatozoa, i.e. mature spermatozoa with protamines, did not correlate with FSH (P>0.05) but with inhibin B (R=0.15, P<0.001). The probability of retrieving testicular spermatozoa decreased with declining inhibin B: <20 ng/l sperm could never be found. Our results from a large group of men with a wide spectrum of semen qualities allow estimating reference values for inhibin B and IFR. Inhibin B and especially the IFR are more sensitive markers of male infertility than FSH alone. read more
Reproduction (Cambridge, England)
Enhanced lysophosphatidylcholine and sphingomyelin contents are characteristic of spermatozoa from obese men-A MALDI mass spectrometric study.
Dec,
2012
The lipids of human spermatozoa are characterized by unique fatty acyl compositions, i.e. considerable amounts of highly unsaturated, in particular docosahexaenoyl (22:6) fatty acyl residues. This makes spermatozoa very sensitive to oxidation. It has already been shown that the most abundant lipid of sperm, phosphatidylcholine (PC), is converted into lysophosphatidylcholine (LPC) under conditions of oxidative stress, and, thus, the PC/LPC ratio may be used as a measure of sperm quality. However, direct correlations between the PC/LPC ratios and certain pathologies are so far missing. We will show here for the first time (by using matrix-assisted laser desorption and ionization time-of-flight (MALDI-TOF) mass spectrometry (MS)) that sperm from obese donors (BMI>35kg/m(2)) are characterized by (a) a significantly increased LPC as well as (b) an increased sphingomyelin content. This does exclusively hold true for the lipid extracts of the spermatozoa but is not valid for the related seminal fluids. read more
Chemistry and physics of lipids
Sperm apoptosis signalling in diabetic men.
Sep,
2012
Male patients with diabetes type I and type II present more frequently with subfertility. On a subcellular level, increased apoptosis signalling and the rate of DNA fragmentation have an impact on sperm fertilizing capacity. The aim of this study was to evaluate apoptosis signalling and the role of DNA fragmentation in sperm of patients with diabetes type I and type II to gain further insight into the pathophysiology of diabetes-related subfertility in men. Semen specimens collected from 18 healthy fertile donors and 27 donors with diabetes type I (n=13) or type II (n=14) were prepared via density gradient centrifugation. High- and low-density sperm subpopulations were assessed for apoptosis markers (disrupted transmembrane mitochondrial potential, activated caspase 3) and reactive oxygen species, as well as DNA fragmentation, by flow cytometry. The results show that ejaculates of diabetic men contain significantly (P<0.05) higher concentrations of spermatozoa with disrupted transmembrane mitochondrial potential, activated caspase 3, reactive oxygen species and fragmented DNA when compared with healthy fertile donors. The effect is more pronounced in men with diabetes type II. All measured parameters were inversely correlated with the sperm fertilizing potential, indicating a possible mechanism of subfertility in diabetic men. Diabetes mellitus can affect male fertility. Earlier studies have proved reduced sperm motility and lower DNA integrity in germ cells of diabetic patients. It was postulated that higher levels of oxidative stress may contribute to this findings. However, until now the pathophysiology of diabetes-related male subfertility is not fully understood. Our study showed for the first time that apoptosis signalling, measured by disrupted transmembrane mitochondrial potential and activated caspase 3, is significantly increased in sperm from males with diabetes type-I and type-II. Particularly, a disrupted transmembrane mitochondrial potential contributes to the reduced sperm motility. Together with the increased presence of intracellular reactive oxygen species and higher levels of sperm DNA fragmentation, several subcellular factors are now available to explain subfertility in diabetic males. read more
Reproductive biomedicine online
Lysophospholipids: potential markers of diseases and infertility?
Jan,
2012
The in vivo concentration of lysophospholipids (LPL) such as lysophosphatidylcholine (LPC) increases under different pathological conditions and, thus, LPL attract nowadays considerable diagnostic and pharmacological interest. LPL are particularly interesting because they possess pro- and anti-inflammatory properties and can be generated by two completely different pathways: either by the influence of (a) phospholipases and (b) different reactive oxygen species (ROS) that are generated in significant amounts under inflammatory conditions. This review provides a summary of the mechanisms by which LPL can be generated under in vitro and in vivo conditions. The focus will be on lysophosphatidylcholine (LPC) because this LPL is most abundant among all LPL and was, thus, most intensively studied so far. Additionally, biochemical, chromatographic and spectroscopic methods of LPL and LPC determinations will be discussed. Finally, the effects of LPL as signaling molecules and their roles in different pathologies such as infertility, cancer, atherosclerosis or inflammatory diseases are discussed. Special emphasis will be on the role of LPL in reproduction failures related to poor semen quality and, in that context, the potential role of LPC as a disease-indicative molecule. read more
Mini reviews in medicinal chemistry
