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Current Opinion in Critical Care Aug 2024Sleep and circadian disruption (SCD) are associated with worse outcomes in the ICU population. We discuss sleep, circadian physiology, the role of light in circadian... (Review)
Review
PURPOSE OF REVIEW
Sleep and circadian disruption (SCD) are associated with worse outcomes in the ICU population. We discuss sleep, circadian physiology, the role of light in circadian entrainment and its possible role in treating SCD, with special attention to the use of light therapies and ICU design.
RECENT FINDINGS
The American Thoracic Society recently published an official research statement highlighting key areas required to define and treat ICU SCD. Recent literature has been predominantly observational, describing how both critical illness and the ICU environment might impair normal sleep and impact circadian rhythm. Emerging consensus guidance outlines the need for standardized light metrics in clinical trials investigating effects of light therapies. A recent proof-of-concept randomized controlled trial (RCT) showed improvement in delirium incidence and circadian alignment from ICU room redesign that included a dynamic lighting system (DLS).
SUMMARY
Further investigation is needed to define the optimal physical properties of light therapy in the ICU environment as well as timing and duration of light treatments. Work in this area will inform future circadian-promoting design, as well as multicomponent nonpharmacological protocols, to mitigate ICU SCD with the objective of improving patient outcomes.
Topics: Humans; Critical Illness; Circadian Rhythm; Phototherapy; Intensive Care Units; Critical Care; Sleep; Sleep Disorders, Circadian Rhythm; Delirium
PubMed: 38841914
DOI: 10.1097/MCC.0000000000001163 -
Biomaterials Oct 2023Photoimmunotherapy has been acknowledged to be an unprecedented strategy to obtain significantly improved cancer treatment efficacy. In this regard, the exploitation of...
Photoimmunotherapy has been acknowledged to be an unprecedented strategy to obtain significantly improved cancer treatment efficacy. In this regard, the exploitation of high-performance multimodal phototheranostic agents is highly desired. Apart from tailoring electron donors, acceptor engineering is gradually rising as a deliberate approach in this field. Herein, we rationally designed a family of aggregation-induced emission (AIE)-active compounds with the same donors but different acceptors based on the acceptor engineering. Through finely adjusting the functional groups on electron acceptors, the electron affinity of electron acceptors and the conformation of the compounds were simultaneously modulated. It was found that one of the molecules (named DCTIC), bearing a moderately electrophilic electron acceptor and the best planarity, exhibited optimal phototheranostic properties in terms of light-harvesting ability, fluorescence emission, reactive oxygen species (ROS) production, and photothermal performance. For the purpose of amplified therapeutic outcomes, DCTIC was fabricated into tumor and mitochondria dual-targeted DCTIC nanoparticles (NPs), which afforded good performance in the fluorescence/photoacoustic/photothermal trimodal imaging-guided photodynamic/photothermal-synergized cancer immunotherapy with the combination of programmed cell death protein-1 (PD-1) antibody. Not only the primary tumors were totally eradicated, but efficient growth inhibition of distant tumors was also realized.
Topics: Humans; Photochemotherapy; Phototherapy; Neoplasms; Nanoparticles; Immunotherapy; Mitochondria; Theranostic Nanomedicine; Oxidants; Multimodal Imaging; Cell Line, Tumor
PubMed: 37579564
DOI: 10.1016/j.biomaterials.2023.122276 -
Materials Horizons Oct 2023With their distinctive physicochemical features, nanoparticles have gained recognition as effective multifunctional tools for biomedical applications, with designs and... (Review)
Review
With their distinctive physicochemical features, nanoparticles have gained recognition as effective multifunctional tools for biomedical applications, with designs and compositions tailored for specific uses. Notably, magnetic nanoparticles stand out as first-in-class examples of multiple modalities provided by the iron-based composition. They have long been exploited as contrast agents for magnetic resonance imaging (MRI) or as anti-cancer agents generating therapeutic hyperthermia through high-frequency magnetic field application, known as magnetic hyperthermia (MHT). This review focuses on two more recent applications in oncology using iron-based nanomaterials: photothermal therapy (PTT) and ferroptosis. In PTT, the iron oxide core responds to a near-infrared (NIR) excitation and generates heat in its surrounding area, rivaling the efficiency of plasmonic gold-standard nanoparticles. This opens up the possibility of a dual MHT + PTT approach using a single nanomaterial. Moreover, the iron composition of magnetic nanoparticles can be harnessed as a chemotherapeutic asset. Degradation in the intracellular environment triggers the release of iron ions, which can stimulate the production of reactive oxygen species (ROS) and induce cancer cell death through ferroptosis. Consequently, this review emphasizes these emerging physical and chemical approaches for anti-cancer therapy facilitated by magnetic nanoparticles, combining all-in-one functionalities.
Topics: Phototherapy; Hyperthermia, Induced; Magnetite Nanoparticles; Photochemotherapy; Iron
PubMed: 37740347
DOI: 10.1039/d3mh00831b -
F1000Research 2022Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the... (Review)
Review
BACKGROUND
Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia.
METHODS
Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline.
RESULTS
The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal.
CONCLUSIONS
The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.
Topics: Infant, Newborn; Humans; Child; Indonesia; Hyperbilirubinemia, Neonatal; Jaundice, Neonatal; Phototherapy; Bilirubin
PubMed: 38025296
DOI: 10.12688/f1000research.110550.2 -
Photodermatology, Photoimmunology &... Jul 2024Phototherapy has emerged as a safe yet effective form of treatment of atopic dermatitis (AD). Few studies have been done to evaluate the efficacy of phototherapy in...
BACKGROUND/PURPOSE
Phototherapy has emerged as a safe yet effective form of treatment of atopic dermatitis (AD). Few studies have been done to evaluate the efficacy of phototherapy in Asian children. The aim of this study was to review the phototherapy experience in a cohort of Asian pediatric patients with AD at a tertiary dermatologic center in Singapore.
METHODS
A retrospective study of patients 18 years and below with AD who had undergone phototherapy at KK Women's and Children's Hospital, Singapore, over a 4-year period was performed.
RESULTS
Sixty-two patients were identified, between ages 4 and 16 years (mean age 11 years) at the time of commencement of phototherapy. Thirty-five (60%) patients were males and 23 (40%) were females. Most patients had moderate to severe disease, with 60.3% of the patients with an initial body surface area (BSA) involvement of 31%-60% and 13.8% of the patients with an initial BSA involvement of 61%-90%. For patients who had undergone narrowband ultraviolet B (NBUVB) and combined ultraviolet A (UVA) and NBUVB phototherapy, the mean reduction of the Eczema Area and Severity Index (EASI) scores were 11.4 and 7.9, respectively. Common side effects experienced include xerosis, pruritus, erythema, and pain. Other reasons for cessation of therapy in the NBUVB group included time commitment difficulty (9.3%), hyperactivity (2.3%), and claustrophobia (2.3%). Two patients that had photochemotherapy (psoralen + UVA) [PUVA] suffered from post-UVA burns requiring cessation of treatment. More than half of the patients (56.9%) treated with phototherapy experienced treatment success with improvement in Investigator Global Assessment and EASI scores. 86.2% of the patients had good compliance to the treatment regime, 12% had poor-compliance, and 3.4% were lost to follow-up.
CONCLUSION
Phototherapy is a useful treatment adjunct for moderate to severe AD in Asian children.
Topics: Humans; Dermatitis, Atopic; Child; Female; Adolescent; Male; Singapore; Child, Preschool; Retrospective Studies; Phototherapy; Ultraviolet Therapy
PubMed: 38874329
DOI: 10.1111/phpp.12986 -
Journal of Affective Disorders Apr 2024The purpose of this study was to assess the potential effectiveness of several mainstream therapies, including phototherapy, antidepressants, cognitive-behavioral... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this study was to assess the potential effectiveness of several mainstream therapies, including phototherapy, antidepressants, cognitive-behavioral therapy, and negative ion generators, in the treatment of Seasonal Affective Disorder (SAD).
METHODS
A systematic search of PubMed, Embase, Cochrane, and WOS databases was conducted from January 1975 to December 3, 2022. Randomized controlled trials meeting predefined selection criteria for the treatment of SAD using mainstream therapeutic approaches were identified. After reviewing abstracts, data were synthesized and categorized based on the type of intervention and the targeted disorder.
RESULTS
A total of 21 randomized controlled trials, involving 1037 participants, were included. The standardized mean difference of depression scores and corresponding 95 % confidence intervals were calculated to assess the efficacy of phototherapy for Seasonal Affective Disorder. The meta-analysis revealed that phototherapy was significantly more effective than other intervention groups or control therapies, with an effect size of 4.64(2.38,7.03). Subgroup analysis demonstrated that no factors could explain the significant heterogeneity observed. Phototherapy exhibited statistically significant mild to moderate therapeutic effects in alleviating depressive symptoms and can be considered as a clinical therapy for treating Seasonal Affective Disorder. However, the quality of evidence remains low, and further well-designed, larger sample size, and high-quality studies are needed to confirm the efficacy of phototherapy in treating Seasonal Affective Disorder.
CONCLUSION
In conclusion, our systematic review and meta-analysis indicate that bright light therapy is a promising first-line non-pharmacological treatment for Seasonal Affective Disorder (SAD), showing significant improvement in mood symptoms compared to placebo. The findings support the use of bright light therapy as an effective and well-tolerated intervention for SAD. However, further large-scale, multicenter randomized controlled trials with long-term follow-up are needed to assess the long-term efficacy and safety of different treatment approaches for SAD.
Topics: Humans; Seasonal Affective Disorder; Network Meta-Analysis; Phototherapy; Antidepressive Agents; Cognitive Behavioral Therapy; Multicenter Studies as Topic
PubMed: 38220102
DOI: 10.1016/j.jad.2024.01.028 -
JAMA Pediatrics Jun 2024
Topics: Humans; Infant, Newborn; Phototherapy; Jaundice, Neonatal; Documentation
PubMed: 38619845
DOI: 10.1001/jamapediatrics.2024.0558 -
Hu Li Za Zhi the Journal of Nursing Dec 2023Patients with dementia often display related sleep disturbance, depression, and behavioral and psychological symptoms, which are traditionally managed through the use of...
Patients with dementia often display related sleep disturbance, depression, and behavioral and psychological symptoms, which are traditionally managed through the use of antipsychotic medications or physical restraint. However, these management interventions can have negative effects on the physical and psychological health of patients. The results of several meta-analyses suggest non-pharmacological interventions, including light therapy, should be used for the first-line management of these dementia symptoms. Light therapy uses artificial light to compensate for insufficient light exposure during the daytime and to help patients with dementia properly regulate their circadian rhythms. Sleep disturbance and depression in those with dementia may be effectively relieved through the application of light therapy. Nurses should assess the needs and symptoms of patients with dementia and consider applying light therapy as a complementary care intervention to improve quality of care.
Topics: Humans; Phototherapy; Circadian Rhythm; Mental Health; Physical Examination; Sleep Wake Disorders; Dementia
PubMed: 37981880
DOI: 10.6224/JN.202312_70(6).04 -
PloS One 2023Phototherapy is the most common treatment modality of neonatal hyperbilirubinemia. We aimed to evaluate the therapeutic effect of oral Ursodeoxycholic Acid (UDCA) on... (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation of therapeutic effect of oral Ursodeoxycholic Acid on indirect hyperbilirubinemia in term neonates undergoing phototherapy: A randomized controlled clinical trial.
INTRODUCTION AND AIMS
Phototherapy is the most common treatment modality of neonatal hyperbilirubinemia. We aimed to evaluate the therapeutic effect of oral Ursodeoxycholic Acid (UDCA) on indirect hyperbilirubinemia in term neonates undergoing phototherapy.
MATERIALS AND METHODS
This randomized controlled clinical trial was performed on 106 full-term neonates with jaundice who were admitted to the neonatal ward of 17 Shahrivar Hospital in Rasht, Iran. The neonates were randomly assigned to two groups of intervention (10 mg/kg UDCA+phototherapy) and control (phototherapy alone). Total serum bilirubin (TSB) was measured at the time of admission, during first 12, 24, and 48 hours after admission and at the time of discharge. The duration of hospitalization and side effects were also assessed in both groups. IBM SPSS Statistics for Windows, version 20 was used to analyze the data.
RESULTS
Results showed that in the intervention group, 28 (52.8%) of neonates were boys with the mean age of 5.1±1.25 days. While, in the control group 29 (54.7%) of them were boys with the mean age of 5.19±2.26 days. Bilirubin levels in both groups decreased significantly after hospitalization (at 12, 24 and 48 hours) (P <0.001). The mean of bilirubin at 12, 24 and 48 hours in the intervention and control groups were 17.1, 13.2, 10.2 mg / dl and 17.1, 14.2 and 11.3 mg / dl, respectively. At the time of discharge, TSB in the former compared to the latter group was significantly reduced (7.74± 1.39 vs. 8.67±1.35) (P = 0.001). In addition, the duration of hospitalization was considerably shorter in the intervention compared to the control group (P = 0.038) and no side effects were observed.
CONCLUSIONS
Administering UDCA plus phototherapy reduced TSB and length of hospital stay with proper safety and efficacy. Therefore, it seems that this combination can be an appropriate treatment modality in neonatal hyperbilirubinemia.
Topics: Male; Infant, Newborn; Humans; Female; Ursodeoxycholic Acid; Hyperbilirubinemia, Neonatal; Jaundice; Bilirubin; Phototherapy
PubMed: 38085723
DOI: 10.1371/journal.pone.0273516 -
Advanced Science (Weinheim,... Feb 2024Near-infrared (NIR) light is well-suited for the optical imaging and wireless phototherapy of malignant diseases because of its deep tissue penetration, low... (Review)
Review
Near-infrared (NIR) light is well-suited for the optical imaging and wireless phototherapy of malignant diseases because of its deep tissue penetration, low autofluorescence, weak tissue scattering, and non-invasiveness. Rare earth nanoparticles (RENPs) are promising NIR-responsive materials, owing to their excellent physical and chemical properties. The 4f electron subshell of lanthanides, the main group of rare earth elements, has rich energy-level structures. This facilitates broad-spectrum light-to-light conversion and the conversion of light to other forms of energy, such as thermal and chemical energies. In addition, the abundant loadable and modifiable sites on the surface offer favorable conditions for the functional expansion of RENPs. In this review, the authors systematically discuss the main processes and mechanisms underlying the response of RENPs to NIR light and summarize recent advances in their applications in optical imaging, photothermal therapy, photodynamic therapy, photoimmunotherapy, optogenetics, and light-responsive drug release. Finally, the challenges and opportunities for the application of RENPs in optical imaging and wireless phototherapy under NIR activation are considered.
Topics: Humans; Phototherapy; Nanoparticles; Photochemotherapy; Neoplasms; Optical Imaging
PubMed: 37946706
DOI: 10.1002/advs.202305308