Search

Coronavirus disease 2019 (COVID-19) is a new type of respiratory infectious disease that spreads among humans. People infected with COVID-19 present with severe acute respiratory symptoms, fever, cough, breathlessness and dyspnea, impaired physical conditions, kidney failure, and even death. Chest radiographs suggest diffuse inflammation in both lungs and show "white lung" changes. Patients may even experience multiple organ failures within a short period. The effects of general ventilator-assisted treatment are poor. While the application of extracorporeal membrane oxygenation (ECMO) for adjuvant therapy in COVID-19 patients may benefit, there is still a lack of clinical management experience to guide the treatment of the disease. Therefore, in this case, report, we describe the case of a COVID-19-infected patient who was managed with ECMO. During treatment, the patient's vital signs, biochemical indicators, and hemodynamic changes were closely monitored, with strengthening the operation of ECMO and mechanical ventilation, the patients bleeding, infection and other related complications were actively prevented and managed. After active treatment and careful management, the patient was successfully weaned from ECMO after 13 days. This report has summarized the management experience of a severe case with ECMO management, which can provide a reference for the diagnosis and treatment of severe COVID-19 patients in the future.

Linear psoriasis is an unusual type of psoriasis that was first reported in 19511 . It is characterized by the linear distribution of psoriatic lesions along the lines of Blaschko. Linear psoriasis is easily confused with linear lichen planus and inflammatory linear verrucous epidermal nevus2 . Histopathology can provide an accurate basis for its diagnosis; however, the involvement of invasive methods can lead to trauma.

BACKGROUND Laser therapies have brought dawn to refractory skin diseases, but also were accompanied by postlaser inflammation and skin barrier dysfunction. To recover skin function quickly, the research and development of active ingredients including β-glucan for postlaser repair have attracted much attention. AIMS To evaluate the efficacy and tolerance of skin care regimens containing β-glucan (Dermdoc®;Songyang Biotech) in repairing postlaser inflammation and skin barrier dysfunction after fractional laser therapy. METHODS A total of 20 patients with facial atrophic acne scars who accepted fractional laser therapy were recruited: 10 patients treated with ablative fractional CO2 laser and 10 patients treated with 1565nm nonablative fractional laser. Using the method of split-face vehicle-control study, the left half of the face was served as the treatment side and accepted skin care regimens, and the right half was control side accepted vehicle. Noninvasive bioinstrumentation of skin hydration index, transepidermal water loss (TEWL), and hemoglobin index (E value) was detected in the study. Standard digital photographs were taken at each visit. The skin tolerance and adverse effect were also evaluated by subject questionnaire. RESULTS Compared with the control side, the Hemoglobin index (E value) of the treatment side was improved more significantly on the 7th day (P

Fault is one of the common geological structures in coal mining, the concentrated development of several faults has changed the movement form and structure shape of overlying strata, which caused the instability of overburden strata easily and induced dynamic disasters. Taking the 10,416 working face of Yangliu coal mine as the research object, the plane numerical model of overburden structure with two faults (a reverse fault and a normal fault) was established by using UDEC numerical simulation software. The dip angle of normal fault is 50°, the dip angle of normal fault is 70°. The distances between the two faults are 30 m, 60 m, 90 m. The evolution characteristics of overburden structure in working face are studied respectively from hanging wall to footwall and from footwall to hanging wall, and the dynamic hazard law induced by the activation of different faults is analyzed. The results prove that: when the working face is mined from footwall to hanging wall, the overlying strata on the working surface form “trapezoid” and “triangle” structures. When the working face is mined from hanging wall to footwall, the overlying strata form the structure of “inverted trapezoid” and “inverted triangle”. The low-level fault activation caused by overburden movement is easy to induce dynamic response. Finally, the research results are verified by using the microseismic activity of 10,416 working face in Yangliu coal mine.

Background The World Health Organization End TB Strategy meant that compared with 2015 baseline, the reduction in pulmonary tuberculosis (PTB) incidence should be 20 and 50% in 2020 and 2025, respectively. The case number of PTB in China accounted for 9% of the global total in 2018, which ranked the second high in the world. From 2007 to 2019, 854 672 active PTB cases were registered and treated in Henan Province, China. This study was to assess whether the WHO milestones could be achieved in Henan Province. Methods The active PTB numbers in Henan Province from 2007 to 2019, registered in Chinese Tuberculosis Information Management System were analyzed to predict the active PTB registration rates in 2020 and 2025, which is conductive to early response measures to ensure the achievement of the WHO milestones. The time series model was created by monthly active PTB registration rates from 2007 to 2016, and the optimal model was verified by data from 2017 to 2019. The Ljung-Box Q statistic was used to evaluate the model. The statistically significant level is α = 0.05. Monthly active PTB registration rates and 95% confidence interval (CI) from 2020 to 2025 were predicted. Results High active PTB registration rates in March, April, May and June showed the seasonal variations. The exponential smoothing winter’s multiplication model was selected as the best-fitting model. The predicted values were approximately consistent with the observed ones from 2017 to 2019. The annual active PTB registration rates were predicted as 49.1 (95% CI: 36.2–62.0) per 100 000 population and 34.4 (95% CI: 18.6–50.2) per 100 000 population in 2020 and 2025, respectively. Compared with the active PTB registration rate in 2015, the reduction will reach 23.7% (95% CI, 3.2–44.1%) and 46.8% (95% CI, 21.4–72.1%) in 2020 and 2025, respectively. Conclusions The high active PTB registration rates in spring and early summer indicate that high risk of tuberculosis infection in late autumn and winter in Henan Province. Without regard to the CI, the first milestone of WHO End TB Strategy in 2020 will be achieved. However, the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province, China.

Desertification is the impoverishment of arid, semiarid, and some subhumid ecosystems. The assessment of global scale desertification vulnerability to climate change and human activity is important to help decision makers formulate the best strategies for land rehabilitation and combat global desertification in sensitive areas. There is no global desertification vulnerability map that considers both climate change and human activities. The main aim of this study was to construct a new index, the global desertification vulnerability index (GDVI), by combining climate change and human activity, provide another perspective on desertification vulnerability on a global scale, and project its future evolution. Using the probability density function of the GDVI, we classified desertification vulnerability into four classes: very high, high, medium, and low. The results of the analysis indicated that areas around deserts and barren land have a higher risk of desertification. Areas with a moderate, high, and very high desertification risk accounted for 13%, 7%, and 9% of the global area, respectively. Among the representative concentration pathways (RCPs), RCP8.5 projected that the area of moderate to very high desertification risk will increase by 23% by the end of this century. The areas where desertification risks are predicted to increase over time are mainly in Africa, North America, and the northern areas of China and India.

For the engineering application of manipulator grasping objects, mechanical arm occlusion and limited imaging angle produce various holes in the reconstructed 3D point clouds of objects. Acquiring a complete point cloud model of the grasped object plays a very important role in the subsequent task planning of the manipulator. This paper proposes a method with which to automatically detect and repair the holes in the 3D point cloud model of symmetrical objects grasped by the manipulator. With the established virtual camera coordinate system and boundary detection, repair and classification of holes, the closed boundaries for the nested holes were detected and classified into two kinds, which correspond to the mechanical claw holes caused by mechanical arm occlusion and the missing surface produced by limited imaging angle. These two kinds of holes were repaired based on surface reconstruction and object symmetry. Experiments on simulated and real point cloud models demonstrate that our approach outperforms the other state-of-the-art 3D point cloud hole repair algorithms.

Background Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. Methods The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. Results Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p Conclusions Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

Seborrheic keratosis (SK) is a common benign lesion in which malignancies like cutaneous squamous cell carcinoma (cSCC) can arise rarely. We report a case of an 81-year-old man who presented a well-demarcated reddish-brown plaque with central raised coarse nodules on the top of his head. Dermoscopy and reflectance confocal microscopy (RCM) showed the possibility of malignant transformation. cSCC was confirmed by histopathology and immunohistochemistry. Considering the fact of local low-risk cSCC within a large SK lesion, carbon dioxide (CO2) laser was used to treat the SK lesion, and reduce the thickness of local cSCC simultaneously. Three sessions of 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) were performed after CO2 laser. Finally, no atypical cells were found by multi-point biopsy after treatment, and follow-up was continued for one year. Therefore, malignant changes of SK are relatively uncommon, but should be suspected when abnormal appearance or symptoms occurred. ALA-PDT combined with CO2 is a safe, effective, and minimally invasive treatment for cSCC arising from a huge SK.

Chronic ultraviolet radiation exposure could induce photoaging, and even carcinogenesis. Dietary omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation has proved to alleviate photoaging and cutaneous carcinoma. Although the exact mechanism remains poorly elucidated, accumulated evidence suggests that the alleviation effect of n-3 PUFA for photoaging is a multifactorial procession characterized by different pathways. Here, we performed a whole-genome proteomics and lipidomics analyses using a self-constructed photoaging mouse model with n-3 PUFA or n-6 PUFA supplementation. Significant alleviation of photoaging was observed, and a total of 88 differentially expressed proteins and 152 differentially expressed lipids were identified in mice with n-3 PUFA supplementation. We found that n-3 PUFA may alleviate photoaging by upregulating Hmmr (hyaluronic acid receptor) expression, which can decrease Mmp9 expression, reducing collagen degradation. As most proteins were associated with lipogenesis and lipid metabolism, we further analyzed the lipidomics data, finding that most triglycerides (93%) showed a significant increase in the n-3 PUFA supplementation group. Our proteomics and lipidomics results indicate that the protective mechanism of n-3 PUFA for photoaging is complicated. Furthermore, the effect of elevated triglycerides by n-3 PUFA supplementation in counteracting skin photoaging cannot be ignored, which will become a new prime target in anti-photoaging.

Melanoma is a malignancy with poor prognosis. Its incidence rate has been on the rise and it poses high health and economic challenges to different populations. Photothermal therapy (PTT) served as an effective local therapy in treating various tumors, particularly cutaneous carcinoma like melanoma. To fully understand the mechanisms of tumor cell death induced by PTT, we investigated gene expression and immune cells compositions of B16-F10 tumors after PTT treatment. A total of 256 differentially expressed genes (DEGs) were identified, with 215 being downregulated and 41 upregulated by PTT. Functional annotation showed that most DEGs involved in immune response and inflammatory response. Immune cells compositions inference revealed changes in many immune cells including regulatory T cells, M2 macrophage and B cells after PTT treatment. Our results help delineate the mechanism of cell death at the transcriptional level triggered by non-invasive PTT treatment of melanoma without exogenous light absorbing agents.

Hereditary leukonychia (HL) is a rare nail dystrophy disease, and several different clinical manifestations and mutations in the phospholipase C δ 1 (PLCD1) gene have been reported. The present study reports on one Chinese family and one sporadic case of with HL. The family members exhibited an autosomal dominant pattern of inheritance with the involvement of all the fingers and toenails in all the patients. Of interest, most of the affected members had koilonychia during their childhood. Thus, the present study first used gene mapping with an aim to identify the pathogenic gene underlying koilonychia. Through genome-wide linkage analysis, the pathogenic area of koilonychia was identified on chromosome 3 with multipoint Log of Odds scores >2. A novel pathogenic mutation c.1384G>A (p.E462K) was identified in the PLCD1 gene in all the patients in the family, which confirmed the diagnosis of hereditary leukonychia. A novel mutation c.770G>A (p.R257H) was also detected in one sporadic case of leukonychia. On the basis of these findings and of previous studies, it is suggested that hereditary leukonychia may initially present as koilonychia, whereas hereditary koilonychia does not progress to leukonychia. Moreover, the present study identified two pathogenic variants of the PLCD1 associated with hereditary leukonychia, and highlights the significance of genetic diagnosis.

Non-invasively diagnosis of actinic keratoses (AK) is important for preventing cutaneous squamous cell carcinoma (cSCC). Optical coherence tomography (OCT) can be used to detect the cross-sectional skin micromorphology with sufficient resolution and imaging depth. It has the capability to reveal the changes in skin microstructure during the development of AK. Therefore, OCT can serve as a tool for diagnosing AK. This study explores the feasibility of OCT in evaluating the structural changes in mouse skin at the different stages following exposure to ultraviolet radiation. The performance of OCT is compared with histology, the gold standard in this context. The imaging results demonstrate that a wave-shaped irregular dermo-epidermal junction (DEJ), as well as the continuous thickening of the epidermis, are useful diagnostic parameters for diagnosing AK. Histological examinations confirm these observations. These findings emphasize the need for effective skin protection or medical treatment once changes in the DEJ and epidermis are detected. OCT shows strong potential for non-invasive evaluation of such changes and AK development, and can be used for the prevention of cSCC without the necessity of taking biopsies.

BackgroundNecroptosis is a newly recognized form of programmed cell death with characteristics of both necrosis and apoptosis. The role of necroptosis in hepatic damage during sepsis is poorly understood. In this study, we investigated the occurrence of necroptosis in hepatic damage, and its contribution to hepatic damage in a piglet model of lipopolysaccharide (LPS)-induced sepsis.MethodsTwo animal experiments were conducted. In trial 1, piglets were challenged with LPS and sacrificed at different time points after LPS challenge. In trial 2, piglets were pretreated with necrostatin-1, a specific inhibitor of necroptosis, prior to LPS challenge. Alterations in the hepatic structure and function, pro-inflammatory cytokine expression, and the necroptosis signaling pathway were investigated. Typical ultrastructural characteristics of cell necrosis was observed in the liver of LPS-challenged piglets.ResultsExpressions of critical components of necroptosis including kinases (RIP1, RIP3, and MLKL), mitochondrial proteins (PGAM5 and DRP1), and an intracellular damage-associated molecular pattern (HMGB1) were increased in the liver in a time-dependent manner, followed by hepatic inflammation, morphological damage, and dysfunction as manifested by elevated hepatic expression of IL-1β, IL-6 and TNF-α as well as increased serum AST and AKP activities and the AST/ALT ratio. Pretreatment with necrostatin-1 significantly reduced the expression of RIP1, RIP3 and MLKL as well as PGAM5, DRP1 and HMGB1, which subsequently led to obvious attenuation of hepatic inflammation and damage.ConclusionsOur study demonstrates that necroptosis occurs in the liver during sepsis and contributes to septic hepatic injury.

Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome characterized by (a) capillary malformations, such as port-wine stain (PWS), and (b) pigmented lesions, such as pigmented trichoepidermal nevus, cafe-au-lait spots, and dermal melanocytosis with or without systemic damage. Severe pruritus has not previously been reported among PPV patients. Here, we report a pediatric case of PPV with severe pruritus, which was refractory to various long-term oral antiallergic agents and topical tacrolimus but was temporarily responsive to hematoporphyrin monomethyl ether-mediated photodynamic therapy (HMME-PDT). HMME-PDT is the latest technology used in treating PWS following the basic principle of targeted photodynamic destruction of the vascular wall of the lesion. Furthermore, many studies have confirmed the safety and efficacy of HMME-PDT for PWS in both adults and children. Specific pathophysiologic mechanisms and treatment methods must be further explored to advance our understanding of the disease and improve the quality of life in PPV patients.

Background In 2005, China established an internet-based Tuberculosis Information Management System (TBIMS) to monitor changes in tuberculosis (TB). Many scholars have conducted epidemiological research using TBIMS; however, few studies assessing control strategies have been performed based on this platform data. Henan province is a high TB incidence area in China where, in addition to following the nationwide TB strategies, a series of local intervention combinations have been implemented. Objective Our study aims to evaluate the impact of nationwide TB intervention combinations on epidemiological changes and determine whether Henan province can achieve the World Health Organization’s (WHO) goal of reducing TB incidence by 50% and TB mortality by 75% by the year 2025. Methods We used descriptive statistical methods to show the spatial and temporal distribution of pulmonary tuberculosis (PTB) reported to the TBIMS database from 2005 to 2018, and logistic regression analysis was performed to identify the risk factors of bacteriological-positive TB. The dynamic compartmental model and Bayesian melding approach was adopted to estimate the burden of TB under the impact of different TB control policies. Results In total, 976,526 PTB cases were notified to the TBIMS in Henan in a period of 14 years. Although the overall incidence of PTB declined from 91.4/105 to 58.5/105, and the overall incidence of bacteriological-positive PTB declined from 44.5/105 to 14.7/105, the WHO’s 2025 goal could not be met. The distribution of high incidence and poverty-stricken counties were basically overlapped. Men, farmers and herdsmen (in rural areas), and subjects aged ≥60 years were more likely to develop bacteriological-positive PTB. The increasing treatment success for drug-susceptible tuberculosis and multidrug-resistant tuberculosis has not provided the desired reduction in incidence and mortality. Conclusions To achieve the targeted goal, while improving the cure rate of TB, new active (rather than passive) detection and intervention strategies should be formulated based on epidemiological characteristics in Henan province.

5-aminolevulinic acid photodynamic therapy (ALA-PDT) is not only the first-line treatment for actinic keratosis (AK), but also demonstrated to improve photoaging during AK field treatment. However, its long-term effect on photoaging remains elusive.To evaluate the long-term improvement effect of ALA-PDT on photoaging.The data of 10 patients with AK who received field-directed ALA-PDT on one side of the face and lesion-directed ALA-PDT on the other side were retrospectively reviewed. Their clinical photographs were evaluated with Global scores of photoaging (GSP) assessment independently by two dermatologists at baseline and 1 month, 6 months and 24 months after ALA-PDT.GSP evaluation was performed after 24 months of follow-up. Improvements in the fine line and mottled pigmentation were observed (p0.05). All the 10 patients achieved complete response of AK lesions and had no relapse during the 24-month follow-up period.A small sample size.Photoaging can be effectively alleviated in the long-term follow-up after ALA-PDT treatment for AK. The present study may inspire new treatment strategies for photoaging.

Background Pain is a major concern associated with conventional photodynamic therapy (C-PDT). Objective To evaluate the efficacy, pain and safety of modified photodynamic therapy(M-PDT) for the treatment of condylomata acuminata. Methods A prospective, randomized, self-controlled study was conducted. Warts were randomized to the M-PDT or C-PDT side. 5-aminolevulinic acid (ALA; 20%) was incubated for 3 h before patients were exposed to LED red light (100 J/cm2 ) on the C-PDT side and for 30 minutes before being exposed to LED red light (300 J/cm2 ) on the M-PDT side. Treatment was administered with 1-week interval for three weeks. The clearance rates were determined at one week and the recurrence rates at 4, 8, and 12 weeks after treatment. The pain and other side effects were also investigated. Results A total of 24 patients with condylomata acuminata were enrolled in this trial. Twenty patients completed the trial. The clearance rates were 98.17% in the M-PDT side and 98.20% in the C-PDT side(P > 0.05). The recurrence rates were 11.11% and 10.53% (P > 0.05). However, M-PDT was almost painless (mean score 0.3 ± 0.47, range 0∼1), which was significantly less than that on the C-PDT side (mean score 3.6 ± 0.94, range 0∼1) (P Conclusion The modified PDT is basically painless with similar efficacy to conventional PDT, which is a major breakthrough of pain management in PDT.

Background: The World Health Organization (WHO) End TB Strategy meant that compared with 2015 baseline, the reduction in pulmonary tuberculosis(PTB) incidence rate should be 20% and 50% in 2020 and 2025, respectively. The incidence number of PTB in China accounted for 9% of the global total in 2018, which ranked the second high in the world. From 2007 to 2019, 854,672active PTB cases were registered and treated in Henan Province, China. We need to assess whether the WHO milestones could be achieved in Henan Province. Methods: The active PTB numbers in Henan Province from 2007 to2019, registered in Chinese Tuberculosis Information Management System (CTIMS) were analyzed to predict the active PTB registration rates in 2020 and 2025, which is conductive to early response measures to ensure the achievement of the WHO milestones. The time series model was created by monthly active PTB registration rates from 2007 to 2016, and the optimal model was verified by data from 2017 to 2019. Monthly and annual active PTB registration rates and 95% confidence interval (CI) from 2020 to 2025 were predicted. Results: High active PTB registration rates in March, April, May and June showed the seasonal variations. The exponential smoothing winter’s multiplication model was selected as the best-fitting model. The predicted values were approximately consistent with the observed ones from 2017 to 2019. The annual active PTB registration rates were predicted as 49.2 (95% CI: 36.0-62.5) and 34.3 (95% CI: 17.7-50.8) per 100 ,000 population in 2020 and 2025 , respectively. Compared with the active PTB registration rate in 2015, the reduction will reach 23.7% (95% CI: 3.1%-44.2%) and 46.9% (95% CI: 21.3%-72.5%) in 2020 and 2025, respectively. Conclusions: The high active PTB registration rates in spring and early summer indicates that high risk of tuberculosis infection in late autumn and winter in Henan Province. Without regard to the confidence interval, the first milestone of WHO End TB Strategy in 2020 will be achieved. However, the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province, China. Trial registration: Not applicable

This study aimed to develop and validate a risk score for early prediction of venous thromboembolism (VTE) in patients with lung cancer. A total of 827 patients with lung cancer from February 2013 to February 2018 in our hospital were retrospectively analyzed. Demographic and clinicopathological variables independently correlated to VTE were applied to develop the risk score in the development group while examined in the validation group. The regression coefficients of multivariable logistic regression test were applied to assign a risk score system. The incidence of VTE was 12.3%, 12.7%, and 11.8% in all patients, in the development and validation groups, respectively. The 496 patients in the development group were classified into 3 groups: low risk (scores ≤3), moderate risk (scores 4-5), and high risk (scores ≥6). The risk of VTE was significantly and positively related to the risk scores in both development and validation groups. The risk score system aided proper stratification of patients with either high or low risk of VTE in the development and validation groups ( c statistic = 0.819 and 0.827, respectively). This risk score system based on the factors with most significant correlation showed good predictive ability and is potentially useful for predicting VTE in patients with lung cancer. However, it was developed and validated by a retrospective analysis and has significant limitations, and a prospective validation with all the classic variables assessing the thrombotic risk is needed for a solid conclusion.

Background There is no standard method to remove facial verruca plana and achieve better cosmetic effects. The present study is the first study to use intense pulsed light (IPL) as photothermal therapy (PTT) combined with intra-gluteal injection of bacillus calmette-guerin polysaccharide nucleic acid (BCG-PSN), which function as immunotherapy, contracting a new type of clinically available laser immunotherapy (LIT) for the treatment of facial verruca plana. The aim of this study was to evaluate the efficacy, cosmetic outcome, and adverse reactions of IPL combined with BCG-PSN for facial verruca plana. Methods Twenty-three patients with facial verruca plana were treated with IPL (560-nm filter, 15–17 J/cm2) and all patients were given intra-gluteal injections of BCG-PSN twice a week for 8 weeks combined with IPL once a month in two times. The clinical responses, recurrences, adverse reactions, and rejuvenation outcomes were evaluated. Results A complete and excellent response was noted in 17 patients (74%). Of the 676 treated warts, 548 were eradicated and the overall clearance rate was 81%. No patient relapsed during the 20-week follow-up. No obvious adverse reactions was observed. Almost all patients showed an improvement in skin texture after IPL treatment Conclusion We conclude that a novel LIT based on BCG-PSN and IPL for the treatment of facial verruca plana proved to be a well-tolerated and effective treatment modality. This novel LIT can clear skin lesions and achieve a very good cosmetic effect.

Laser immunotherapy is a new anti-cancer therapy combining photothermal therapy and immunostimulation. It can eliminate the tumours by damaging tumour cells directly and promoting the release of damage-associated molecular patterns (DAMPs) to enhance tumour immunogenicity. The aim of this study was to investigate the thermal effects of laser immunotherapy and to evaluate the effectiveness and safety of laser immunotherapy for cutaneous squamous cell carcinoma (cSCC).The cell viability and the DAMPs productions of heat-treated cSCC A431 cells in different temperatures were investigated. Laser immunotherapy with the optimal thermal effect for DAMPs production was performed on SKH-1 mice bearing ultraviolet-induced cSCC and a patient suffering from a large refractory cSCC.The temperature in the range of 45-50 °C killing half of A431 cells had an optimal thermal effect for the productions of DAMPs. The thermal effect could be further enhanced by local application of imiquimod, an immunoadjuvant. Laser immunotherapy eliminated most tumours and improved the survival rate of the ultraviolet-induced cSCC-bearing SKH-1 mice (p 0.05). The patient with cSCC treated by laser immunotherapy experienced a significant tumour reduction after laser immunotherapy increased the amounts of infiltrating lymphocytes in the tumour. No obviously adverse effect was observed in the mice experiment or in the clinical application.Our results strongly indicate that laser immunotherapy with optimal thermal effects is an effective and safe treatment modality for cSCC.

Background and objectives Androgenetic alopecia (AGA) is one of the most common hair loss disorders. Treatment options for AGA are limited . New therapies for AGA are clinically needed. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is widely applied in diseases involving the pilosebaceous unit. However, limited research has explored the efficacy of ALA-PDT in treating alopecia. Some studies reported hair regrowth after PDT in alopecia areata patients, but the efficacy of ALA-PDT on AGA remains unclear. The objective of this study is to evaluate the efficacy and safety of ALA-PDT for the treatment of AGA. Methods A randomized, placebo-controlled, split-scalp clinical study was conducted. Subjects with AGA received six sessions of 5% ALA-PDT on one half of their scalp and the red-light therapy on the other half. The treatments were applied every two weeks for six sessions on each subject. Results There were 7 subjects enrolled in this study. No significant difference in hair density was observed between the red-light treatment and ALA-PDT treatment. The hair density in the ALA-PDT treated half of the scalp significantly decreased 1 week after the treatment, then it increased, and no statistical difference was found at 12 weeks after the last treatment compared to the baseline. There was no significant improvement in hair growth according to a 7-point scale and the subjects’ self-assessments. The main adverse effects in ALA-PDT treatment were mild edema and tolerable pain, and no adverse effect was observed in red-light treatment. Conclusions 6 sessions of 5% ALA-PDT did not increase the hair growth of AGA patients, but slightly suppressed the sebum secretion on the scalp. The adverse effects of ALA-PDT were mild, which indicated safety and tolerability of this treatment.

To investigate the interference effects of building groups with flat roofs on snow load, a modified Eulerian-Eulerian model was proposed and verified by three typical cases. Based on the verified model, the impact of wind velocity on snow distribution on an isolated building with a flat roof was discussed first, and then a series of CFD simulations were carried out to investigate the snow distribution on building groups with the regular and staggered arrangement. The results showed that the amount of snow on the isolated building decreases significantly with the increase of wind velocity. The critical building density of the building group with the regular and staggered arrangement is about 0.25, above which the interference effects of the building groups on snow load are not significant. The interference effects of the building groups with the staggered arrangement on snow load are weaker than that of the building group with the regular arrangement.

Basal cell carcinoma (BCC) is a common non-melanoma skin malignancy arising in sun exposure area. Patients with multiple BCCs have a high-risk factor for recurrence and are very difficult to treat with current methods. 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) treat superficial type of BCCs with superior efficacy and an excellent cosmetic result, but deep tumor success is limited. Herein, a case of numerous nodular BCCs scattered on the face and head, which was treated with the combination of topical curettage and modified ALA-PDT is reported. Curettage was to rapidly scalp away nodular tumors and contributed to ALA transdermal depth to the tumor base. Modified ALA-PDT as an advanced treatment was nearly painless and can cure multiple BCCs of face and head combing curettage.

5-aminolaevulinic acid photodynamic therapy (ALA-PDT) has emerged as a non-invasive treatment modality for premalignant and malignant skin lesions. It has the advantage of better tolerance and providing better cosmetic outcomes than conventional treatment methods. Herein, we report a patient who suffered from multiple cutaneous squamous cell carcinoma (cSCC) in situ and actinic keratosis (AK) scattered in the body's sun-exposed areas, which had led him to undergo multiple surgical resections since the age of 16. Next-generation sequencing-based on a targeted gene capture panel revealed compound heterozygous mutations c.G559A and c.G1389A in the TMC8 gene. Combined with the typical clinical manifestations and mutation analysis, the patient was diagnosed with Epidermodysplasia verruciformis (EV). Due to the multiple AK and cSCC in situ lesions, ALA-PDT was applied. After 8 courses of ALA-PDT all lesions were successfully cleared without causing any scarring. Therefore, the use of ALA-PDT treatment may constitute a very promising and effective therapeutic modality for multiple cSCC in situ and AK secondary to EV.

Background Squamous cell carcinoma (SCC) of the lip removed by surgery may cause lip dysfunction and scar. ALA-PDT (5-Aminolevulinic acid photodynamic therapy) is a minimally invasive treatment for superficial SCC in situ. However, few studies reported the use of topical ALA-PDT to manage lip SCC. Methods Between 2015 and 2017, 6 patients with Tis to T2 lip squamous cell carcinoma without evidence of lymph node spread, were treated with topical ALA-PDT at Shanghai Skin Disease Hospital. Clinical responses and side effect were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) at 1 month, 6 months, 12 months and 24 months after ALA-PDT. Results All of the 6 patients achieved complete response (CR) by 2–7 sessions of ALA-PDT. There was no relapse during 24 months follow up for 4 patients. Two out of 6 patients relapsed at 10 months and 20 months post PDT but achieved CR again by 1–3 more sessions of PDT. There was no functional or aesthetic problem. Conclusion Topical 5-Aminolevulinic acid photodynamic could be considered a potential alternative therapeutic option for early-stage lip squamous cell carcinoma without lymph node spread.

Epidermodysplasia verruciformis (EV) is a rare autosomal recessive disorder. Individuals with EV are more susceptible to the development of cutaneous neoplasia in sun-exposed regions. This disease should be closely observed for cutaneous squamous cell carcinoma (cSCC) or pre-cancerous lesions - if neoplasia is found, it should be removed. A 68-year-old woman with EV had a post-operative recurrent, invasive cSCC growing on her upper-left eyelid. Although the standard treatment for cSCC is surgical excision, it is challenging to reach the deepest regions. Herein, we reported a case of a recurrent, invasive cSCC effectively treated by a combination of non-invasive 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) and deep-penetrative holmium laser. The results were satisfactory without any adverse effects to the patient.

Intense pulsed light (IPL) is a good option for erythema and telangiectasia of rosacea. Demodex, which is light and heat sensitive, is an important risk of Rosacea. Sometimes, IPL can induce rosacea aggravation. Here, we show two cases of erythema rosacea aggravated as pustule in several hours after IPL. Both cases show high density of Demodex after IPL. Neither of them had photosensitivity, systemic disease, or any other contraindication for IPL. One of the patients received IPL again after Demodex infection relieved and this time there was no inflammation induction. We need to attract more attention to IPL-induced rosacea aggravation and latent Demodex infection may act as a cofactor.

Phototherapy, particularly photothermal therapy (PTT) and photodynamic therapy (PDT), has become a promising therapeutic technique for the treatment of skin cancers because of its minial invasiveness, high efficacy, and low side effects. Nevertheless, single modality therapy, either PTT or PDT, has limited clinical effectiveness in treating skin cancers. Thus, combined applications of PTT and PDT have been frequently reported; however, PTT and PDT often require their respective photoagents and excitation light sources, resulting in challenges in clinical transformation. In this study, to address these issues, we report the use of biocompatible gold nanoclusters Au25(Capt)18 for the concurrent PTT and PDT treatment of cutaneous squamous cell carcinoma (cSCC) using an 808 nm near-infrared (NIR) laser. Utilizing their high light-thermal conversion efficiency, potent generation of singlet oxygen, and strong photothermal stability, Au25(Capt)18 nanoclusters potentiated a significant proliferation suppression of cSCC XL50 cells in vitro and the inhibition of cSCC tumors on SKH-1 mice in vivo. In particular, under 808 nm light irradiation, the tumor-cell-killing contributions of PTT and PDT were estimated to be 28.86% and 71.14%, respectively, by using an ROS scavenger to quench the PDT effect. Tumor-infiltrating CD4+ T and CD8+ T cells were observed after one course of concurrent PTT and PDT. Preliminary toxicity studies indicated low adverse effects of the Au25(Capt)18 nanoclusters. Through this study, we report the use of a simple nanostructure for simultaneous PTT and PDT applications to effectively kill cSCC and to induce anti-tumor immune responses. Our study could lead to the development of effective photoagents for current, synergistic applications of different phototherapies with targeted immunological responses for the treatment of cancers.

Background Anal canal condylomata acuminata is a disease caused by the human papilloma virus. Conventional cauterizing laser treatment cannot achieve a satisfactory result owing to a high recurrence rate, and the application of 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) also has limitations in the anal canal. Holmium yttrium aluminum garnet (Ho: YAG) laser with fiber is found to be effective at removing canal lesions, and may create suitable conditions for ALA-PDT. We aim to investigate the feasibility of Ho: YAG laser combined with ALA-PDT and to explore a more optimal therapy in refractory anal canal condylomata. Methods Data of 37 patients with anal canal condylomata (number of warts≥ 10 lesions) from May 2017 to March 2019 were reviewed. In total 17 cases were treated with Ho: YAG laser plus ALA-PDT, and 20 patients treated with CO2 laser plus ALA-PDT were selected as control. Wart clearance and recurrence rates were evaluated as well as laser complications. Results Most warts (88.23 %) were removed after a session of Ho: YAG laser pretreatment. The average number of laser sessions required to clear all warts was 1.94 in the Ho: YAG laser plus ALA-PDT group. Meanwhile, no wound infections or defecation disfunctions were found. Ho: YAG laser with ALA-PDT could significantly reduce wart recurrence rates (17.6 %) in comparison with CO2 laser with ALA-PDT (55 %). Conclusions Ho: YAG laser combined with ALA-PDT raised the cure rate of refractory anal canal condylomata and has important guidance implications for clinical application.

Aiming at the shortcomings of low recognition rate and the cumbersome feature extraction of traditional machine learning methods during the process of controlling wheelchair with electroencephalography(EEG) signals, this paper presents a scheme for controlling intelligent wheelchair with multi-class motor imagery (MI) EEG based on deep learning framework. The representative model of deep learning deep belief network (DBN) was used to classify the MI EEG. Firstly, the improved OVO-CSP algorithm is used to extract the features of multi-class EEG. Then, five kinds of MI EEG signals are trained and classified by DBN. Finally, the comparison with traditional machine classification methods such as SVM and BP Neural Network proves the effectiveness and validity of the proposed method. The results show that the deep belief network can better extract the essential characteristics of multi-class EEG and improve the classification accuracy.

Dynamic compaction and geogrid reinforcement are two of the well-known methods used in improving the mechanical properties of fill foundations. In order to investigate their mutual restriction when used simultaneously and optimize the design parameters, model experiments and numerical simulations were conducted. First, three factors (embedded ratio of reinforced geogrid, number of reinforced layers and interval of reinforced layers) that are related to performance of reinforced geogrid were analyzed by model experiments with dynamic compaction. Then, orthogonal analysis was performed by numerical simulation (dynamic analysis in FLAC3D) to take into account five different elastic moduli and internal angle of friction along with the aforementioned three factors. Last, range analysis and variance analysis were performed on the orthogonal results to optimize the five factors by the calculated indicators. Additionally, linear regression analysis reflecting the relationships between five factors and four indicators was presented. The displacement field, compaction effect, earth pressure, and geogrid deformation of the reinforced soil under different combinations of the five factors were explored. Experiment and simulation results provide practical guides to the design of reinforced methods and a reference for the stability and deformation of other earth reinforcement projects under dynamic loads.

Background The identification of meaningful biomarkers of tuberculosis (TB) has potential to improve diagnosis, disease staging and prediction of treatment outcomes. It has been shown that active pulmonary TB (PTB) is associated with qualitative and quantitative changes in systemic immune profile, suggesting a chronic inflammatory imbalance. Here we characterized the profile of PTB and extrapulmonary TB (EPTB) in a prospective cohort study. Methods We measured a panel of 27 inflammatory cytokines, soluble receptors, and lipid mediators in peripheral blood from patients with PTB or EPTB from a prospective clinical study in China. Multidimensional analyses were performed to describe associations between plasma levels of biomarkers and different TB disease presentation profiles. Results Mycobacterium tuberculosis infection induced changes in both the expression and correlation profiles of plasma mediators of inflammation in patients with PTB compared to those with EPTB. Increases in mycobacterial loads in sputum smears were associated with rises in concentrations of several molecules involved in TB pathogenesis, such as IL-1β, IFN-α, IL-10 and PGF2α. Moreover, PTB patients presenting with severe disease exhibited a distinct inflammatory profile hallmarked by heightened levels of TNF-α, IL-1β, IL17, IL-18 and IL-27. Interestingly, while antitubercular treatment (ATT) resulted in early changes of plasma concentrations of markers in PTB, changes were delayed in EPTB patients. Exploratory analyses of the molecular degree of perturbation (MDP) of the inflammatory mediators before and during ATT suggested the occurrence of infection and/or treatment-induced long lasting “inflammatory imprinting” of biomarker profiles in TB. At 24 weeks post ATT commencement, markers underlying the observed increases in MDP scores were IL-27 in PTB and IL-1β in EPTB patients. Conclusion Our findings describe systemic and durable changes in the concentrations of inflammatory cytokines and lipid mediators in both PTB and EPTB and emphasize the role of M. tuberculosis bacterial burden and site of disease in modulating patient immune biomarkers.

Tuberculosis (TB) is a chronic inflammatory disease caused by Mycobacterium tuberculosis infection which causes tremendous morbidity and mortality worldwide. Clinical presentation of TB patients is very diverse and disease heterogeneity is associated with changes in biomarker signatures. Here, we compared at the molecular level the extent of individual inflammatory perturbation of plasma protein and lipid mediators associated with TB in patients in China versus India. We performed a cross-sectional study analyzing the overall degree of inflammatory perturbation in treatment-naïve pulmonary TB patients and uninfected individuals from India (TB: n = 97, healthy: n = 20) and China (TB: n = 100, healthy: n = 11). We employed the molecular degree of perturbation (MDP) adapted to plasma biomarkers to examine the overall changes in inflammation between these countries. M. tuberculosis infection caused a significant degree of molecular perturbation in patients from both countries, with higher perturbation detected in India. Interestingly, there were differences in biomarker perturbation patterns and the overall degree of inflammation. Patients with severe TB exhibited increased MDP values and Indian patients with this condition exhibited even higher degree of perturbation compared to Chinese patients. Network analyses identified IFN-α, IFN-β, IL-1RI and TNF-α as combined biomarkers that account for the overall molecular perturbation in the entire study population. Our results delineate the magnitude of the systemic inflammatory perturbation in pulmonary TB and reveal qualitative changes in inflammatory profiles between two countries with high disease prevalence.

Background 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) is a reliable treatment for actinic keratosis (AK), though the concentration of 20 % is applied in most ALA-PDT for the treatment of AK, it was found that 10 % ALA could achieve similar outcome during clinical practice. However, there are limited number of reports comparing the efficacy and the safety of ALA-PDT with different ALA doses when treating AK. Objectives This study was designed to compare the efficacy, the adverse effects and the costs of 10 % and 20 % ALA-PDT for AK treatment. Methods We reviewed the records of patients who had received ALA-PDT in our department between January 1, 2012, and April 30, 2017, the efficacy, the adverse effects were recorded, and the costs were analyzed. Follow-up data were collected until April 30, 2018. Results A total of 59 AK patients’ records were analyzed for the efficacy, the adverse events, the recurrence and the costs. All the AK lesions were tapped with plum-blossom needle as a pre-treatment before receiving ALA-PDT. There was no statistical difference between 10 % ALA-PDT and 20 % ALA-PDT in terms of efficacy and adverse events. In the 10 % ALA group, there was one recurrence out of 34 patients and in the 20 % group there were none. The average treatment cost of each lesion was significantly lower in 10 % ALA group than in 20 % ALA group. Conclusions 10 % ALA-PDT has similar efficacy and adverse effects as 20 % ALA-PDT with lower costs. Taken together, this supports the use of 10 % ALA-PDT in clinical practice.

BackgroundIn 2013, a tuberculosis (TB) outbreak occurred in a middle school in Henan province of China. An outbreak survey was carried out in the school.ObjectivesThis study was undertaken to investigate the detection rate of TB cases and those with strong Mantoux positive (SMP), defined as tuberculin skin test (TST) indurations of 15mm or larger and/or blisters, necrosis or lymphangitis, and to identify their risk factors.MethodsThe TST, chest x-ray/radiography, and TB-suspicious symptoms interview were used to screen for TB cases. Their diagnosis was made by sputum smear microscopy, liquid culture, computed tomography (CT), and diagnostic therapy if necessary. We retrospectively analyzed the outbreak survey data of 4082 students and 278 staff in the school. Logistic regression models were used to identify the risk factors associated with SMP and TB disease.ResultsApproximately 3.55% of students and 16.55% of staff were SMP. SMP rate in students was significantly lower than that in staff (pConclusionSame dormitory-floor, same classroom, same teaching-floor and same teaching-building with the index case were all risk factors for both TB infection and disease for students in the outbreak, and the closer the contact was with the index case, the higher the risk was observed. Attention should also be paid to students with TST indurations

• We encountered a case of mucosal leukoplakia with large lesions treated with repeated photodynamic therapy without significant improvement in the clinic, which we called “refractory large area mucosal leukoplakia”.

This study aims to provide a multiphase approach that could better consider the snow drifting development on a building roof and then apply it to the investigation of the snowdrift development on a long-span spherical roof. Firstly, the CFD prediction accuracy for the flow field and the snowdrift on a two-level step building is examined by comparing simulated results with that of a field measurement. The windward snowdrift caused by building's blocking effect and trajectories of snow particles under the action of aerodynamic force and gravity are both well reproduced by incorporating an additional source term and a slip term into the transport equations. Secondly, the prediction accuracy of the snowdrift formed on a spherical roof is confirmed through the comparison with a wind tunnel test. The snow slipping effect at the edge of the roof is also well reproduced by considering the angle of repose of the snow. Based the validated approach, the snowdrift characteristics on a long-span spherical roof are investigated under different inflow velocity conditions. Three kinds of distribution patterns, i.e., the full-span balanced distribution, half-span unbalanced distribution and transitional distribution between them, are observed. Furthermore, the predicted results correspond well with the resultant design codes developed by ISO 4355. Finally, the size effect of the building roof on snowdrifts is explored by simulating the snowdrift on the spherical roofs with different spans. It is found that the spherical roof would have to bear a larger snow load with the increasing roof span, namely, the long-span spherical roof has more risks due to the adverse snow load.

Squamous cell carcinoma (SCC) of thelip is conventionally treated by extended surgery or radiotherapy, which may cause deformities and dysfunction due to this special location. Topical 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) for SCC in situ is effective and non-invasive, and may preserve normal morphological structure. However, the effectiveness is limited by tumor size and depth due to the permeability of photosensitizer and penetration depth of the therapeutic light source. We successfully treated two cases of lip invasive SCC (tumor size is 22.4 mm × 16.1 mm × 11.9 mm and 23 mm × 15 mm × 5 mm) with superficial resection surgery to reduce tumor load and sequential ALA-PDT (20 % ALA, 3 h incubation, 200 J/cm2) to remove residual tumor. During the treatment, ultrasonography was used to monitor the tumor invasion depth and assess the therapeutic efficacy. Both cases showed tumor free at 12 months of follow-up. These two cases suggest that ALA-PDT combined with minimal invasive surgery is a viable treatment for special cases of lip SCC.

We used 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) combined with plum-blossom needle (PBN) on a 3.5 cm × 3.0 cm pretibial region to treat an elderly woman suffering from Bowen’s disease (BD). Before the application of ALA, the PBN was inserted 3–4 times vertically starting at 5 cm above the lesion. Then, 20 % 5-ALA cream was applied with an incubation time of 3.5 h. A semiconductor laser at a wavelength of 635 nm was used to illuminate the lesion at 100 J/cm2 using 60 mW/cm2. A total of three sessions of ALA-PDT were performed at 2−3-week intervals, thus removing the lesion of BD. However, a 1.5 cm × 1.0 cm ulceration occurred 2 weeks after the third session when the PBN was used. Therefore, PBN percussion or other methods for promoting ALA penetration should be carefully applied to avoid ulceration, especially on the sites with less subcutaneous tissue.

Objective: To explore the effects of 532 nm continuous laser combined with photodynamic therapy (PDT) versus 595 nm pulsed dye laser (PDL) on a chicken comb model of vascular malformation. Study design: Ninety adult male chickens were divided into three groups (A, B and C). One comb side of the chickens was taken randomly as the treatment side, and the other side as the self-control side. Group A was irradiated once with a 532 nm continuous laser after a single intravenous injection of hematoporphyrin monomethyl ether (HMME). In group B treatment side of combs was irradiated once with a 595 nm pulsed dye laser (PDL). In the control group C, the combs were treated neither with photosensitizer nor with irradiation. Results: Compared with the self-control sides, part of the treated combs were blanched after HMME-PDT while the histopathology showed an absence of erythrocytes and the vessel lumina were obliterated, leaving the normal overlying epidermis completely intact. At the same time selective destruction of the capillaries in the target area and obvious reduction of vascular vessel number were seen (ppp>0.05). Conclusion: In the chicken comb model it was shown that both 532 nm HMME-PDT and 595 nm PDL treatment could damage capillaries in the superficial dermis of combs. The 532 nm HMME-PDT had fewer side effects compared with 595 nm PDL, but the inefficiency rate of 532 nm HMME-PDT group was higher than the 595 nm PDL group. No significant difference was observed in the macroscopic and histopathological results of both groups (p>0.05).

Cutaneous granulomas caused by Candida guilliermondii are difficult to cure. In situ photoimmunotherapy (ISPI) is a novel method composed of local photothermal therapy and immunoadjuvant. In this study, ISPI was used the first time clinically for cutaneous granuloma caused by itraconazole-resistant C.guilliermondii. A 10-week cycle of ISPI was composed of (1) 5% imiquimod applied topically every other day and (2) irradiation of lesions with an 808-nm diode laser at Days 14, 28, 42, and 56. Here we report our first case. A patient was treated with ISPI for four cycles. After the treatment, the lesions were eliminated without recurrence during a 12-month follow-up. Our results demonstrate that ISPI can be used as an effective treatment modality for cutaneous fungal granuloma.

Kindler syndrome (KS) is a rare subtype of epidermolysis bullosa that is inherited in an autosomal recessive manner with mutations in FERMT1. A number of mutations in FERMT1 have been identified in KS. The current study reported a 33-year-old Chinese man who exhibited a wide variety of clinical features, including formation of blisters, photosensitivity, cutaneous atrophy and poikiloderma, telangiectasia of the face and neck, contracture of the end limbs, nail dystrophy, muscle, eye and oral damage, tympanitis, esophagus narrowing, pneumothorax and palmoplantar keratoderma. The patient's parents were healthy and the patient had no siblings or children. Peripheral blood was obtained from the patient, his parents and 100 controls, who were admitted to the Dermatology Clinic of Shanghai Skin Disease Hospital, Shanghai, China. A multi-gene panel test consisting of 541 genetic loci of monogenic hereditary diseases was performed. The results identified one novel homogenous mutation in the patient: c.1885_1901del (p.Val629fs) on exon 15 in FERMT1. The patient's parents exhibited heterogeneous identical mutations. This mutation was absent in the control group. The results of the multi-gene panel test were further verified by Sanger sequencing. Based on the clinical manifestations and genetic analysis, KS was diagnosed in the patient. The current study reported a Chinese case of KS with one novel mutation c.1885_1901del in FERMT1 and presented a brief summary of all pathogenic mutations in FERMT1 that have been reported in KS between 1984 and May 2020 via a PubMed literature search.

A 72-year old woman who has a history of refractory vulvar lichen sclerosus(VLS) was treated with ALA-PDT for 3 times every other week,then holmium laser and ALA-PDT were combined to treat the same areas at a time.Satisfactory result was noted without any unbearable adverse effects.The combination of holmium laser therapy and ALA-PDT may further improve the efficacy with good tolerance of VLS patients.