Health Scienzaefede

There are many different mattresses that can be brought today all at a small fortune that aren't necessarily offering the comfort you may need. Some mattresses either offer a large amount of comfort offering a soft pillow like mattress, often not containing springs that may be extremely comforting but nonetheless may not be very supportive or necessarily healthy for your body. These types of mattresses often can cause long-term pain and dis-comfort, as they do not correctly support your spine or any other large bones that could become mis-shaped or less flexible. With spring made mattresses they do offer the correct support however they do not offer a large amount of comfort. These types of mattresses could have a worse effect if you are bed ridden of if you suffer from painful backs or necks, they could effectively make the pain worse and sometimes unbearable to live with.

With memory foam mattresses the mattress is made from the carefully developed memory foam, which reacts to body temperature. The way in which it reacts is that when a person lays on the mattress the foam actually moulds round the shape of the body allowing certain parts of the body to move in anyway they want without having as much pressure applied to them. The mattress offers a fine line between support and comfort and cleverly enables the bones and joints to not seize up because the mattress id still firm even when soft. These mattresses are fire retardant and don't need much maintaining as they are not made with springs that can rust, they also are repellent against dust mites so as not too deteriorate over a long period of time. These mattresses have also become readily available to the general public and are priced a between £200 and £400 depending on which size or depth of memory foam you need. Memory foam mattresses are all in all, extremely comforting and supportive and can last for a long time, making them a long-term investment. They are well worth the money and can be highly recommended by doctors and chiropractors ensuring to keep you in the best of health.

One of the most recent new technologies developed in cutaneous laser therapy has been the use of fractionated beams of light for photoregeneration.
The Fraxel from Reliant is a 1550nm fiber laser. This was the original clinical device in this field first introduced in 2003.The laser delivers microscopic columns of laser light closely and uniformly aligned. Tiny columns of injury are termed microscopic treatment zones (MTZ). The operator can adjust the energy of the laser and the density of the MTZ.

Intelligent Optical TrackingTM technology is used for consistent MTZ pattern. The laser needed a tracking device (a proprietary blue dye applied to the skin before treatment) and topical anaesthesia was necessary. A new upgrade is now available with a lighter handpiece and higher power. This device can be used in the treatment of rhytides, acne scarring, photorejuvenation and melasma.
Alternative fractional technologies are now available:
Palomar have marketed theLux1540 Fractional Handpiece with an Er:glass laser.
Each pulse delivers an array of focused ‘microbeams'. Skin is cooled through the handpiece tip. This can also used with an infrared handpiece for tissue tightening.

Cynosure offers the Affirm 1440nm Nd: YAG laser with CAPTM technology.
A Combined Apex Pulse (CAP) delivers discrete areas of high and low level light intensity. SmartCool cold air-cooling is used with the laser. There is minimal discomfort, and no tracking device is needed.

The Pixel is a 2940nm Erb:YAG laser with fractional ablative technology from Alma. 49 or 81 pixels are available in a spot 11x11mm. Minimal discomfort ensues with no need for a tracking device. Most recently fractionated CO2 lasers have shown great promise.

Experience to date suggests that fractionated devices are an exciting new development which may offer some of the advantages of ablative laser techniques with minimized adverse effects because of the unique way of delivering the light.

Fractional resurfacing
C02 and Er:YAG lasers have traditionally been used in ablative resurfacing
procedures. They target tissue water and non-specifically ablate layers of skin to varying depths. Significant improvements can be obtained with these lasers in the treatment of scars (including those from acne vulgaris), cutaneous growths and photodamaged skin. However, recovery can be protracted and several side effects are recognized, including dyspigmentation, scarring and prolonged
erythema. A new laser technology, fractional photothermolysis, has recently been introduced to specifically overcome the drawbacks of conventional resurfacing.

Instead of producing one beam that causes uniform thermal damage to
tissue in its path (as with conventional resurfacing lasers), the output from
fractional resurfacing devices consists of thousands of microscopic columns,
which each produce thermal damage to a small volume of tissue). As ablation is
non-confluent, the risk of scarring is reduced and recovery is rapid, with
epidermal healing taking only 24 hours by means of keratinocyte migration.
Side effects last 24 to 48 hours, and consist mainly of erythema and oedema. The procedure can be performed under topical anaesthesia with slight discomfort.

Although promising, this technology is still in its infancy and optimum treatment frequency and parameters remain to be defined. The original fractionated laser Fraxel (Reliant Technologies, Mountain View, CA, USA) was a non ablative technique, interest is increasing in the delivery of ablative wavelengths in this way with fractionated Er:YAG and CO2 laser sources.

Pneumatic suction devices
Pneumatic suction devices are a recent enhancement to existing lasers and IPLs. A negative pressure is applied to the skin before the light pulse is delivered. This gently pulls and stretches the skin so as to thin the epidermis, reduce the density of epidermal melanin and bring the dermis closer to the light source. As a result, lower energies are required, and there is theoretically a lower propensity for side effects. The vacuum also activates sensory fibres, thereby reducing the transmission of pain and treatment becomes more comfortable. Negative pressure may also increase the volume of dermal vessels.

Expanded vessels concentrate laser energy better as they contain more blood this may be of assistance in treating therapy resistant lesions such as PWS. Pneumatic suction devices may be integrated into the laser or IPL handpiece (e.g. Aesthera PPx, Pleasanton, CA, USA) or as a separate attachment that can be used with existing systems (e.g. Inolase, Candela Corp, Boston, USA). Investigative clinical uses include hair removal, acne and analgesia in various procedures.

Optical clearing agents
A significant proportion of the light emitted by lasers is scattered by the epidermis. Non-human and laboratory data have shown that hyperosmotic chemicals such as glycerol and propylene glycol enhance penetration of light to dermal targets by reducing scattering in the epidermis. This has the potential of improving the efficacy of lasers and reducing unwanted epidermal injury. Optical clearing agents are currently impractical to use in the clinical context, and refinements in the epidermal delivery mechanism of these agents are awaited.

Much of the research relating to the effects of the PDL on scars has been led by Dr Tina Alster in Washington, DC. She noted (Alster et al, 1993) that the PDL was able to alter argon laser-induced scars, which are often erythematous and hypertrophic. By using optical profilometry measurements she demonstrated a trend toward more normal skin texture as well as reduction in observed erythema. This work was extended to the treatment of erythematous and hypertrophic scars (Alster and Williams, 1995) using objective measurements; clinical appearance (colour and height), surface texture, skin pliability and pruritus could all be improved.

It is not known how the PDL improves the appearance of hypertrophic and keloidal scars. Microvascular damage may effect collagen or collagenase activity within the scar. Thermal damage to abnormal collagen within the hypertrophic scar may allow remodelling, and reduction in endothelial cell volume can affect type V collagen, which is increased in hypertrophic scars (Hering et al, 1983). Mast cell alterations after laser irradiation may also be of importance.

Although established hypertrophic scars can respond to treatment, early treatment of scars within the first months might prevent hypertrophy in individuals who are keloid-prone. I have certainly seen the benefits of early PDL treatment of excised recurrent keloids (Smith, Lanigan and Murison, unpublished observations). In a group of 11 patients treated in this way, none had a recurrent keloidal scar. Treatment at 6.5-7.5Jcm2 with a 5mm spot or 6-6.75Jcm2 with a 7mm spot is usually used. Treatment is repeated at 6- to 8- weekly intervals depending on clinical response. Keloidal scars require multiple treatments and the response is unpredictable. There may be additional benefits from using newer PDL with wavelengths of 590 or 595 nm but there is no published work to confirm this.

Alster's work has been confirmed by Dierickx et al (1995), who treated 15 patients with erythematous/hypertrophic scars and obtained an average improvement of 77% after an average of 1.8 treatments. Goldman and Fitzpatrick (1995) also treated 48 patients with similar laser parameters. Scars less than 1 year old did better than those more than 1 year old and facial scars did better there was an 88% average improvements, with total resolution in 20% after 4.4 treatments. Similar results were also seen in erythematous and hypertrophic facial acne scars by Alster and McMeekin (1996). Combinations of CO2¬ and PDL treatment of hypertrophic non-erythematous scars have also shown additional benefit of the PDL compared to the CO2 laser alone (Alster et al, 1998).

For persistent scars combinations of intralesional corticosteroid injections, steroid impregnated tapes and laser therapy may be necessary (Sawcer et al, 1998).

More recent work by Manuskiatti et al (2001) showed improvement in scarring following treatment with the pulsed dye laser at varying fluences of 3, 5 and 7 Jcm-2. There was a trend for lower fluences to show most improvement and multiple treatments were required.

Two studies have compared the effects of pulsed dye laser treatment with other treatment modalities, particularly intralesional steroids. Alster (2003) compared pulsed dye laser treatment alone with laser therapy combined with intralesional corticosteroid treatment. Both treatment arms produced improvement in scars and there was no significant difference between the two treatments. Manuskiatti and Fitzpatrick (2002) compared scar treatment with intralesional corticosteroids alone or combined with 5-fluorouracil or 5-fluorouracil alone or the pulsed dye laser using fluences of 5 Jcm-2. All treatment areas were improved compared to baseline, there was no significant difference in treatment outcome compared to method of treatment. The highest risk of adverse sequelae occurred in the corticosteroid intralesional group. They concluded that treatment with intralesional corticosteroid alone or in combination with 5-fluorouracil or 5-fluorouracil alone and pulsed dye laser treatment are comparable.

Other studies however, have failed to demonstrate substantial effects of the pulsed dye laser on scars (Allison et al 2003; Paquet 2001; Whittenberg et al 1999;). Paquet assessed laser treated scars using remittance spectroscopy. Although a discrete decrease in redness of the scars was reported clinically this was not confirmed by objective data. Whittenberg et al, in a prospective single blind randomized controlled study compared laser treatment with silicon gel sheeting and controls. Although there was an overall reduction in blood volume and flow and scar pruritis over time, there were no differences detected between the treatment arms and the control groups. Allison et al, treating old and new scars with the pulsed dye laser with fluences of 5 to 6 Jcm-2 were unable to demonstrate any statistical differences between treatment and control by photographic assessments nor surface profile measurements. However, they did notice a significant improvement in scar pruritis in the active group compared with the controlled group.

In conclusion, there are now multiple studies assessing the effects of the pulsed dye laser in the treatment of scars. Although results are conflicting, particularly when controlled studies are performed, it would appear that in some cases laser therapy can be beneficial in the treatment for scars. It is likely that redness and pruritis are the two parameters that are most likely to significantly improve with this treatment.