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Int. J. Mol. Sci. 2016, 17, 309 9 of 10 Light, Shenzhen, China) model BL-PL 1203-18W, in which each panel is 18 W; (5) the red LED lamp often used for conventional PDT (Photocure ASA, Oslo, Norway) model Aktilite CL 128 140 W. 3.2. Exploratory Investigation Five healthy volunteers of Scandinavian origin were included in the study (mean age 46, range 27–72). On each volunteer three circular skin fields, two fields on one arm and one field on the other arm, with a diameter of 5 cm (19.6 cm2) were identified. The borders of each field were marked with a black non-fluorescent marker using a template. One of the fields on each arm was chosen for treatment. The remaining field was chosen as a control field. Both inner and outer arm were used. The control field was always placed on the same site near by the treatment field. In order to imitate skin lesions all fields were initially tape stripped 10 times (Lyreco Budget clear sticky tape, Marly, France). An excess of MAL 16% cream (Metvix®, Galderma, Lausanne, Switzerland) was applied on all fields. These were covered with a light-impermeable occlusive dressing. After 30 min. the dressing was removed from the two treatment fields, which were then illuminated for two hours with different lamps. Immediately after the two hours the light-impermeable dressing was removed from the control field and excess cream wiped off. All the fields were then illuminated with the red LED lamp with a total light dose of 37 J/cm2 over 8 min—the same illumination as used during conventional PDT. PpIX fluorescence yields were measured in all three fields just before and after this illumination. PpIX fluorescence was measured non-invasively using a handheld fluorescence photometer (FluoDerm, DiaMedico, Gentofte, Denmark) [13]. The photometer illuminates a skin area with a diameter of 4 cm with blue light (400–420 nm light-emitting diodes) matching the Soret band of PpIX at 407 nm. The corresponding red PpIX fluorescence intensity at 633 nm is also detected. Measurements were performed in arbitrary Fluoderm Units. For each field the difference between the two fluorescence measurements was determined. This figure expressed how much PpIX had been accumulated over the preceding 180 min, adjusted for the autofluorescence of the skin. Only the difference in fluorescence yield was analyzed and presented. The skin temperature was measured with a infrared thermometer RS 1327 (RS Components Ltd., Northants, UK). 3.3. Greenhouse The greenhouse is constructed of one layer window glass with acrylic at the very top (Figure 5). A UV dosimeter [14] was continuously measuring ambient UV while the spectroradiometric measurements were performed outside and inside the greenhouse to verify that the ambient light did not change during the measurements. The timespan between the measurements was less than 10 min, so it can be assumed that the solar spectrum did not change. The effect of the greenhouse glass was calculated by comparing the two spectroradiometric measurements. 4. Conclusions We found that among the lamps described here, halogen light (overhead and slide projector) was the best “indoor daylight lamp” for PDT treatment. Four of the five light sources were able to photobleach the PpIX produced in the skin completely. Furthermore, we found that the greenhouse is suitable for daylight PDT when the weather is cold, windy or wet since it filters out only 25%–30% of the daylight. Depending on the geographical location, the greenhouse can be used in the months when the intensity of the daylight is high enough but the weather is too cold for patients to be outside (e.g., between April and October in Denmark). Acknowledgments: We thank photographer Nis Kentorp for helping with the pictures. Also thanks to nuclear physicist Preben Loftager for input regarding the experimental section. Author Contributions: Catharina M. Lerche and Jakob Heydenreich performed the measurements; Ida M. Heerfordt performed the experiment with the healthy volunteers; Catharina M. Lerche wrote the manuscript; Hans Christian Wulf contributed to the planning of the project, to the interpretation of the results, and to the discussion.PDF Image | Alternatives to Outdoor Daylight for Photodynamic Therapy
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