Browsing by Author "Shen, Jen-Hsiang"

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A quantitative real-time assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot
(2016-11-01)
Chang, Chang-Cheng
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Chen, Men-Yen
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Shen, Jen-Hsiang
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Lin, Yen Bin
;
Hsu, Wen-Wei
Buerger exercise can improve the peripheral circulation of lower extremities. However, the evidence and a quantitative assessment of skin perfusion immediately after this exercise in patients with diabetes feet are still rare. We recruited 30 patients with unilateral or bilateral diabetic ulcerated feet in Chang Gung Memorial Hospital, Chia-Yi Branch, from October 2012 to December 2013. Real-time dorsal foot skin perfusion pressures (SPPs) before and after Buerger exercise were measured and analyzed. In addition, the severity of ischemia and the presence of ulcers before exercise were also stratified. A total of 30 patients with a mean age of 63.4 +/- 13.7 years old were enrolled in this study. Their mean duration of diabetes was 13.6 +/- 8.2 years. Among them, 26 patients had unilateral and 4 patients had bilateral diabetes foot ulcers. Of the 34 wounded feet, 23 (68%) and 9 (27%) feet were classified as Wagner class II and III, respectively. The real-time SPP measurement indicated that Buerger exercise significantly increased the level of SPP by more than 10mmHg (n=46, 58.3 vs 70.0mmHg, P<0.001). In terms of pre-exercise dorsal foot circulation condition, the results showed that Buerger exercise increased the level of SPP in severe ischemia (n=5, 22.1 vs 37.3 mm Hg, P=0.043), moderate ischemia (n=14, 42.2 vs 64.4 mm Hg, P=0.001), and borderline-normal (n=7, 52.9 vs 65.4 mm Hg, P=0.028) groups, respectively. However, the 20 feet with SPP levels more than 60 mm Hg were not improved significantly after exercise (n=20, 58.3 vs 71.5 mm Hg, P=0.239). As to the presence of ulcers, Buerger exercise increased the level of SPP in either unwounded feet (n=12, 58.5 vs 66.0 mm Hg, P=0.012) or wounded feet (n=34, 58.3 vs 71.5 mm Hg, P<0.001). The majority of the ulcers was either completely healed (9/34=27%) or still improving (14/34=41%). This study quantitatively demonstrates the evidence of dorsal foot peripheral circulation improvement after Buerger exercise in patients with diabetes.
Combined vitamin C sonophoresis and neodymium-doped yttrium aluminum garnet (NdYAG) laser for facial hyperpigmentation: An outcome observation study in Asian patients
(2016-09-10)
Chen, Yu-Tsung
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Chang, Chang-Cheng
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Hsu, Cherng-Ru
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Shen, Jen-Hsiang
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Shih, Chao-Jen
Background: The neodymium-doped yttrium aluminum garnet (NdYAG) laser therapy has been a popular technique for facial rejuvenation but certain adverse effects like post-inflammatory hyperpigmentation are issues of concern to Asian patients. Aims: To assess the outcome following combined treatment with vitamin C sonophoresis and NdYAG laser, in selected cases of facial hyperpigmentation. Methods: Twenty three women with dyschromia or melasma who had undergone five sessions of Q-switched NdYAG laser therapy followed by transdermal delivery of vitamin C via sonophoresis were selected after a retrospective review of case records. The objective and subjective clinical outcomes and the side effects, including erythema, scaling, pruritus, dryness and post-inflammatory hyperpigmentation were evaluated. Results: In both objective or subjective outcomes, 91.3% (21/23) of the patients showed an excellent or better outcome, while 8.7% (2/23) showed no change. A majority of the patients (73.9%, 17/23) experienced no post-inflammatory hyperpigmentation or had slight post-inflammatory hyperpigmentation which quickly resolved within 1 week. Only one (4.3%) patient had extreme post-inflammatory hyperpigmentation which lasted for over a month. Limitations: This was a retrospective study without a control group; a comparative study with a control group (patients treated with the laser alone, without vitamin C sonopheresis) is needed to determine the difference in the outcome. Conclusion: The use of vitamin C sonophoresis along with NdYAG laser may reduce the incidence of adverse effects in Asian patients. Patients experienced obvious improvement in hyperpigmentation and had lower chances of experiencing extreme or severe post-inflammatory hyperpigmentation.
The Application of Wireless Near Infrared Spectroscopy on Detecting Peripheral Circulation in Patients With Diabetes Foot Ulcer When Doing Buerger's Exercise
(2017-09-01)
Chen, Min-Ling
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Lin, Bor-Shyh
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Su, Cheng-Wei
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Lin, Yen-Bin
;
Chen, Mei-Yen
Background and Objectives: The majority of patients with diabetes foot ulcer have peripheral arterial disease. The technique of near infrared spectroscopy (NIRS) used to monitor the dorsal foot blood circulation condition is by measuring the absorption differences between oxyhemoglobin and deoxy-hemoglobin. Study Designs/Materials and Methods: Patients with diabetic foot ulcer (DFU) treated in our wound care center were divided into two sub-groups based on the Duplex ultrasound or angiography. Patients with peripheral arterial disease (PAD) and non-peripheral arterial disease were divided into group A1 and A2, respectively. We applied wireless NIRS on patients' dorsal foot to assess the peripheral circulation by continuously detect the signal penetrating the tissue while patients were asked to do Buerger's exercise. The same procedure was also repeated on 15 healthy participants as control group B. Results: From January to August 2015, 30 patients with DFU (Group A) were enrolled in the study, 9 patients in Group A1 and 21 patients in Group A2. Tissue concentration of oxygenated hemoglobin (HbO2) in each group varied in a similar trend among five stages of Buerger's exercise. HbO2 concentration increases at post-exercise stages in all groups (P = 0.006 in Group A1, P = 0.223 in Group A2, P = 0.03 in Group B), however, there were significant difference in both pre-and postexercise stages (P = 0.001 and P = 0.01, respectively) between Group A and B. Moreover, significant differences (P = 0.0009) of HbO2 were also found between Group A1 and A2 in pre-exercise status, but no significant difference (P = 0.294) was found in postexercise status. Similar results were also found in total hemoglobin (Hb) concentration analyses. Conclusions: Buerger's exercise could increase peripheral HbO2 and totalHb circulation in patients with diabetes foot ulcer. The NIRS could continuously and quantitatively monitor real-time peripheral circulation inpostural changes and is novel to rehabilitation program. A larger scale study to prove the accuracy of NIRS system in detecting peripheral circulation could be worthwhile.(C) 2017 Wiley Periodicals, Inc.
Using a Low Fluence Q-Switched 532/1064-nm Nd:YAG Laser for Facial Skin Depigmentation in Asian Patients Outcome and Complication Profile Analysis
(2016-08)
Shen, Jen-Hsiang
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Chang, Chang-Cheng
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Chen, Yu-Tsung
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Hsih, Chao-Jen
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Huang, Hsin
Background and Objectives: Low fluence Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are widely applied for facial depigmentation. Nonetheless, few reports analyze the general outcome, complications, of single and combined therapy of 532/1064-nm Nd: YAG lasers in Asian patients with Fitzpatrick type IV skin. Study Design/Materials and Methods: We retrospectively reviewed all consecutive patients who completed 5 consecutive sessions at 1-month intervals of treatment with 1064-nm (spot size: 5-7 mm, 1.5-2.0 J/cm(2)) or combined with 532-nm (spot size, 2-3 mm; 0.5-1.5 J/cm(2)) Nd: YAG laser (Laseroptek, Korea) from October 2011 to March 2013. The patients, laser surgeon, and 3 blinded reviewers assessed the outcomes and complications. Improvement was graded as follows: 1, 0%-25%; 2, 26%-50%; 3, 51%-75%; 4, 76-90%; and 5, greater than 90%. Postinflammatory hyperpigmentation (PIH) was documented according to the severity (1, slight; 2, moderate; 3, severe; and 4, extreme). Other post-laser side effects were also documented (eg, scaling, dryness, erythema, and pruritus). Results: Four male patients and 37 female patients were included with a mean age of 38.5 years (SD, 10.1 years). There were no significant differences on patients\', surgeon\'s, or blinded reviewers\' improvement gradings. (4.11 +/- 0.62 vs 4.30 +/- 0.46, P = 0.54; 3.88 +/- 0.66 vs 3.89 +/- 0.31, P = 0.50; 3.30 +/- 0.69 vs 3.74 +/- 0.38, P = 0.34). Transient minor side effect occurred as follows: erythema in 9 (22%), pruritus in 7 (17%), dryness in 6 (15%), and scaling in 6 (15%). There was no risk difference in these side effects between groups. The PIH scores were slight in 10 patients (4 in single and 6 in combined), severe in 4 (3 in single and 1 in combined), and extreme in 1 (single therapy). The PIH incidence also did not differ (33.3%, 35.3%; P = 0.58). Conclusions: We reported satisfactory outcomes after low-fluence Q-switched sole 1064-nmor combined 532/1064-nm therapy. The outcome and complication profiles did not differ between the groups. The PIH incidence was not low, but usually transient. The incidence of severe or extreme PIH was rare.