A nomogram to predict anal condyloma acuminatum recurrence in HIV-negative patients following photodynamic therapy: A decade-long retrospective clinical study at a single tertiary hospital.

BACKGROUND: Anal condyloma acuminatum (CA) is marked by its thorny treatment and high recurrence rate. Although 5-aminolevulinic acid photodynamic therapy (ALA-PDT) demonstrates significant efficacy and safety in treating anal CA, it does not completely prevent recurrence. This study aimed to develop and validate a nomogram model in predicting the risk of relapse in HIV-negative patients with anal CA following treatment with ALA-PDT. METHODS: A retrospective analysis was conducted on patients diagnosed with anal CA who received combined CO2 laser vaporization and ALA-PDT between January 2013 and May 2023. Patients were divided into recurrence and non-recurrence groups. A nomogram was developed based on factors showing statistical significance in multivariable logistic regression analysis. The discriminative ability and clinical utility of the nomogram were assessed via ROC curves and decision curve analysis, with internal validation performed through bootstrap resampling. RESULTS: Among the 176 patients included, 33 (18.75 %) experienced recurrence, while 143 did not. Independent predictors for recurrence included HPV types, history of anal intercourse, and the number of CO2 laser treatments received. Incorporating these predictors, the nomogram demonstrated a superior diagnostic performance (area under the curve = 0.881, 95 % CI: 0.818-0.935) and a significant net benefit in decision curve analysis. CONCLUSIONS: The nomogram accurately predicts the risk of recurrence in HIV-negative patients with anal CA following ALA-PDT. It offers a valuable tool for guiding preoperative clinical decision-making and establishing personalized treatment strategies to minimize the risk of relapse.

Protective autophagy enhances antistress ability through AMPK/ULK1 signaling pathway in human immortalized keratinocytes.

Keratinocytes, located in the outermost layer of human skin, are pivotal cells to resist environmental damage. Cellular autophagy plays a critical role in eliminating damaged organelles and maintaining skin cell homeostasis. Low-dose 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) has been demonstrated to enhance skin's antistress ability; however, the regulatory mechanisms of autophagy in keratinocytes remain unclear. In this study, we treated immortalized human keratinocytes (HaCaT cells) with low-dose ALA-PDT (0.5 mmol/L, 3 J/cm2). Through RNA-sequencing analysis, we identified that low-dose ALA-PDT modulated autophagy-related pathways in keratinocytes and pinpointed Unc-51-like kinase 1 (ULK1) as a key gene involved. Western blot results revealed that low-dose ALA-PDT treatment upregulated the expression of autophagy-related proteins Beclin-1 and LC3-II/LC3-I ratio. Notably, low-dose ALA-PDT regulated autophagy by inducing an appropriate level of reactive oxygen species (ROS), transiently reducing mitochondrial membrane potential, and decreasing adenosine triphosphate production; all these processes functioned on the AMP-activated protein kinase (AMPK)/ULK1 pathway to activate autophagy. Finally, we simulated external environmental damage using ultraviolet B (UVB) at a dose of 60 mJ/cm2 and observed that low-dose ALA-PDT mitigated UVB-induced cell apoptosis; however, this protective effect was reversed when using the autophagy inhibitor 3-methyladenine. Overall, these findings highlight how low-dose ALA-PDT enhances antistress ability in HaCaT cells through controlling ROS generation and activating the AMPK/ULK1 pathway to arouse cellular autophagy.

Spatial and temporal patterns of above- and below- ground biomass over the Tibet Plateau grasslands and their sensitivity to climate change.

The sensitivity of grassland above- (AGB, gC m-2) and below-ground biomass (BGB, gC m-2) to climate has been shown to be significant on the Tibetan Plateau, however, the spatial patterns and sensitivity of biomass with altitudinal change needs to be quantitated. In this study, large data sets of AGB and BGB during the peak growth season, and the corresponding geographical and climate conditions in the grasslands of the Tibetan Plateau between 2001 and 2020 were analyzed, and modelled using a Cubist regression trees algorithm. The mean values for AGB and BGB were 61.3 and 1304.3 gC m-2, respectively, for the whole region over the two decades. There was a significant change in spatial AGB of 64.8 % on the Plateau (P < 0.05, with areas where AGB increased being twice as large as areas where AGB decreased), while BGB did not change significantly in majority the of the region (≥ 90.1 %, P > 0.05). In general, the areas where AGB showed positive partial correlations with precipitation were larger than the areas where AGB had positive correlations with temperature (P < 0.05). However, these trends varied depending on the climatic conditions: in the wetter regions, temperature had a greater effect on the size of the areas with positive AGB responses than precipitation (P < 0.05), while precipitation had a greater effect on the size of areas with positive BGB changes than temperature (P < 0.05). In the drier areas, however, precipitation affected the AGB response significantly compared to temperature (P < 0.05), while temperature influenced the BGB response greater than precipitation (P < 0.05). The response and sensitivity of grassland biomass to temperature and precipitation varied according to the altitude of the Plateau: the response and sensitivity were stronger and more sensitive at medium altitudes, and weak at the higher or lower altitudes. Likely, this phenomenon was resulted from the natural selection of plants to maintain the efficient use of resources during un-favourable and stressed conditions for maximum plant development and growth. These findings will help assess the ecological consequences of global climate change for the grasslands of the Tibetan Plateau, particularly in those regions with highly variable altitudes.

Efficacy and safety of fractional microneedle radiofrequency for atrophic acne scars: A real-world clinical study of 126 patients.

OBJECTIVE: To analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting. METHODS: The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars. RESULTS: A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%-100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400-500 ms) (OR = 52.6, p < 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomes compared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatment and one case experienced hyperpigmentation, both of which resolved within 1-3 months after appropriate management. CONCLUSION: FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.

Sleep quality correlates with effectiveness of ultrapulse fractional CO2 laser in the treatment of facial atrophic acne scars.

Ultrapulse fractional CO2 laser is effective for acne atrophic scars. Whether this effectiveness is affected by sleep quality remains unclear. Aiming to investigate the relationship between sleep quality and postoperative effectiveness, a retrospective clinical study was conducted, enrolling 83 patients with atrophic acne scar. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI) questionnaire at 3 months after the end of the first treatment. The ECCA (échelle d'évaluation clinique des cicatrices d'acné) scale was used to evaluate the clinical effectiveness before and at 3 months after treatment. The patients were divided into a mild to moderate improvement group and a good to excellent improvement group, based on whether they achieved a 50% ECCA improvement rate. PSQI score was higher in the mild and moderate improvement group than in the good to excellent improvement group (7.6 ± 4.5 vs 3.8 ± 1.7, p < 0.001). Multivariate logistic regression showed that both PSQI score (odds ratio = 0.6 [95% CI = 0.5-0.8], p < 0.001) and scar type were correlated with postfractional CO2 laser effectiveness. Pearson correlation analysis suggested that PSQI score was negatively correlated with ECCA decline score (r = -0.6139, p < 0.0001). Receiver operating characteristic curve analysis showed that PSQI score (area under the curve = 0.759) and scar type (area under the curve = 0.737) were all closely correlated with postoperative effectiveness, without statistical difference between their accuracies (p = 0.647). Decision curve analysis demonstrated that both PSQI score and scar type correlated with postoperative effectiveness. Our results demonstrated that sleep quality correlates with the postoperative effectiveness of ultrapulse fractional CO2 laser in the treatment of atrophic acne scars.

Tissue RNA Sequencing Reveals Novel Biomarkers Associated with Postoperative Keloid Recurrence.

Keloids can be resected through surgery, but they may still recur. The purpose of this study was to explore the biomarkers to predict the postoperative recurrence of keloids. Patients who underwent surgical treatment and postoperative superficial X-ray radiation between January 2019 and December 2020 were recruited with clinical data and keloid samples for RNA-seq. By screening differentially expressed genes (DEGs) between postoperative recurrent and non-recurrent sample groups and constructing a co-expression network via the weighted gene co-expression network analysis (WGCNA), an immunity-related module was chosen for subsequent analysis. By constructing a DEG co-expression network and using the Molecular Complex Detection (MCODE) algorithm, five hub genes were identified in the key module. Receiver Operating Characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the five combined hub genes was 0.776. The result of qRT-PCR showed that CHI3L1, IL1RN, MMP7, TNFAIP3, and TNFAIP6 were upregulated in the recurrent group with statistical significance (p < 0.05). Immune infiltration analysis showed that mast cells, macrophages, and T cells were the major components of the keloid immune microenvironment. This study provides potential biomarkers for predicting keloid recurrence and offers insights into genetic targets for recurrence prevention.

"Multiple Mode Procedures" of Ultra-Pulse Fractional CO2 Laser: A Novel Treatment Modality of Facial Atrophic Acne Scars.

BACKGROUND AND AIM: Fractional CO2 laser is therapeutic for acne atrophic scar, but its effect usually is limited after multiple sessions, with occasional adverse reactions. This study aimed to evaluate the efficacy and safety of a new modality combining ultra-pulse CO2 laser and fractional CO2 laser (multiple mode procedures [MMP]) in the treatment of acne atrophic scars. METHOD: From December 2017 to January 2023, a total of 103 patients with facial acne atrophic scars treated with MMP technique were retrospectively analyzed. MMP was performed for 1-4 sessions with an interval of approximately three months. Based on photographs taken before and after treatment, overall atrophic scar improvement was assessed according to the ECCA grading scale, the modified Manchester Scar Scale and the 4-point Global Assessment Scale (GAS). The safety was evaluated by the degree of pain during treatment and postoperative adverse reactions. RESULTS: All the 103 patients received treatment and completed follow-up, with an average of two sessions. The mean ECCA score decreased from 162.7 to 93.1 with statistically significant difference (p < 0.001). The mean GAS score increased by an average of 2.3 ± 0.9. The GAS improvement more evident for "boxcar" atrophic scars (2.7 ± 0.8) than for "rolling" (2.3 ± 0.8) and "icepick" scars (1.7 ± 0.8) (p < 0.001). The average improvement scores for color, distortion and texture were 2.0 ± 0.9, 2.2 ± 0.9 and 2.3 ± 0.8, respectively. The mean pain score during treatment was 3.9 ± 0.8, and the mean duration of erythema was 30.7 ± 3.5 days. Only three patients developed hyperpigmentation at the treated site within a few months. DISCUSSION: Ultra-pulse CO2 fractional laser MMP technique can effectively improve the condition of facial atrophic acne scars with limited adverse reactions.

Different responses of alpine plants to natural climate change reduced coexistence through phenological niche overlap.

Plant phenology is the bridge between climate change and ecosystem functions. Time coordination of interspecific and intraspecific phenology changes overlap or separate can be regarded as an important characteristic of species coexistence. To confirm the hypothesis that plant phenological niche promotes species coexistence, three key alpine plants, Kobresia humilis (sedge), Stipa purpurea (grass), and Astragalus laxmannii (forb) were investigated in this study in the Qinghai-Tibet Plateau. Phenological niches represented as the duration of green up-flowering, flowering-fruiting, and fruiting-withering by 2-day intervals for phenological dynamics of three key alpine plants from 1997 to 2016. We found the role of precipitation on regulating the phenological niches of alpine plants was highlighted in the context of climate warming. The response of the intraspecific phenological niche of the three species to temperature and precipitation is different, and the phenological niche of Kobresia humilis and Stipa purpurea was separate, especially in the green up-flowering. But the overlapping degree of interspecific phenological niche of the three species has continued to increase in the past 20 years, reducing possibility of species coexistence. Our findings have profound implications for understanding the adaptation strategies of key alpine plants to climate change in the dimension of phenological niche.

Peripheral blood CD4+ T cell count predicts recurrence of condyloma acuminatum after photodynamic therapy in HIV-positive patients.

BACKGROUND: Few studies have reported postoperative relapse of condyloma acuminatum (CA) after 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in human immunodeficiency virus (HIV) positive patients. METHODS: The clinical data of HIV-positive CA patients treated with ALA-PDT from October 2018 to December 2019 were analyzed retrospectively. Univariate and multivariate Cox regression was used to analyze the variables related to postoperative recurrence. Pearson correlation test was employed to analyze the correlation between CD4+ T cell count and postoperative recurrence rate. Kaplan-Meier method was used to compare the CA recurrence after ALA-PDT in low CD4 group and high CD4 group. RESULTS: A total of 38 HIV-positive patients with CA were included in the study. Among them, 26 patients experienced CA recurrence within 6 months, and the recurrence rate was 68.4%. CD4+ T cell count was 187.0 (79.0-596.0) cells/µl in relapsed patients and 406.0 (89.0-612.0) cells/µl in non-relapsed patients, showing a statistically significant difference (p = .005). Pearson correlation coefficient analysis revealed a negative correlation between CD4+ T cell count and postoperative recurrence rate (p = .005, r = -.443). Univariate regression analysis showed that CD4+ T cell count was correlated with postoperative recurrence, hazard ratio (HR) was 0.99 [95% Confidence interval (CI) = 0.99-1.0, p = .012]. Multivariate Cox regression analysis showed that with the low CD4+ T cell count as the reference, the high CD4+ T cell count was negatively correlated with postoperative recurrence (HR = 0.09, 95% CI 0.01-0.87, p = .038). CONCLUSIONS: Peripheral blood CD4+ T cell count can predict the CA recurrence rate after ALA-PDT in HIV-positive patients.

Spatial Autocorrelation Analysis of Land Use and Ecosystem Service Value in the Huangshui River Basin at the Grid Scale.

The Huangshui River Basin is one of the most densely populated areas on the Qinghai-Tibet Plateau and is characterized by a high level of human activity. The contradiction between ecological protection and socioeconomic development has become increasingly prominent; determining how to achieve the balanced and coordinated development of the Huangshui River Basin is an important task. Thus, this study used the Google Earth Engine (GEE) cloud-computing platform and Sentinel-1/2 data, supplemented with an ALOS digital elevation model (ALOS DEM) and field survey data, and combined a remote sensing classification method, grid method, and ecosystem service value (ESV) evaluation method to study the spatial correlation and interaction between land use (LU) and ESV in the Huangshui River Basin. The following results were obtained: (1) on the GEE platform, Sentinel-1/2 active and passive remote sensing data, combined with the gradient tree-boosting algorithm, can efficiently produce highly accurate LU data with a spatial resolution of 10 m in the Huangshui River Basin; the overall accuracy (OA) reached 88%. (2) The total ESV in the Huangshui River Basin in 2020 was CNY 33.18 billion (USD 4867.2 million), of which woodland and grassland were the main contributors to ESV. In the Huangshui River Basin, the LU type, LU degree, and ESV have significant positive spatial correlations, with urban and agricultural areas showing an H-H agglomeration in terms of LU degree, with woodlands, grasslands, reservoirs, and wetlands showing an H-H agglomeration in terms of ESV. (3) There is a significant negative spatial correlation between the LU degree and ESV in the Huangshui River Basin, indicating that the enhancement of the LU degree in the basin could have a negative spatial spillover effect on the ESV of surrounding areas. Thus, green development should be the future direction of progress in the Huangshui River Basin, i.e., while maintaining and expanding the land for ecological protection and restoration, and the LU structure should be actively adjusted to ensure ecological security and coordinated and sustainable socioeconomic development in the Basin.

Fractional microneedle radiofrequency treatment for enlarged facial pores: A real-world retrospective observational study on 75 patients.

OBJECTIVE: This study aimed to analyze the clinical results and influencing factors of the fractional microneedle radiofrequency (FMR) treatment for enlarged facial pores on different facial sites. METHODS: The clinical data of patients with enlarged facial pores who underwent FMR treatment from January 2019 to December 2020 were collected. The efficacy and complications of FMR for enlarged pores in different facial areas were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to explore the clinical factors related to the efficacy of FMR after the first treatment session. RESULTS: Totally, 75 patients with enlarged facial pores were included (full-face FMR for 45, nasal FMR for 58, frontal FMR for 45, and cheek FMR for 72 patients). All patients received more than one treatment session, two patients received five treatment sessions, and the mean number of FMR session was 1.7. The moderate to excellent improvement rates in patients with nasal, frontal and cheek enlarged pores after the first session were 13.8%, 8.9%, and 11.1%, respectively. The improvement rate rose with the increasing number of treatment sessions. Multivariate logistic regression analysis revealed that long pulse-width (300 ms) was positively associated with clinical efficacy after the first session (OR = 22.4, 95% CI [2.0-250.4], p = 0.012), compared with the short pulse-width group (100-200 ms). The main adverse effects after FMR were transient pain, erythema, and edema. A minority of patients developed acneiform eruption. CONCLUSION: This study confirms that FMR is safe and effective in improving enlarged facial pores. The pulse width is associated with the improvement of nasal enlarged pores.

Air or soil temperature matters the responses of alpine plants in biomass accumulation to climate warming.

Climate change has substantially affected plant phenology and growth on the Qinghai-Tibetan Plateau (QTP), while it remains unclear how plant phenology and growth impact the plant biomass under climate change. We used long-term data (from 1997 to 2017) for four plants, Stipa purpurea, Artemisia scoparia, Kobresia humilis and Astragalus laxmannii in the alpine meadow to examine the relationships among multiple climate factors, vegetative growth, reproductive growth, intrinsic growth rate and biomass. The order of returning to green determines the growth strategies of different plants, the earliest plants to green (p < 0.05) (e.g., Stipa purpurea and Artemisia scoparia) would choose the strategy of vegetative growth (p < 0.05); the earlier plants (p < 0.05) (e.g., Kobresia humilis) would be regulated by both vegetative growth and reproductive growth (p < 0.05); while the latest plant to green (p < 0.05) such as Astragalus laxmannii, would choose intrinsic growth rate rather than growing season (P < 0.05). Temperature was the most important drivers for key phenological phases and growth patterns of four species, different factors play a role in different stages of the growth period, i.e., in the early and late stage is the soil temperature, while in the middle stage is the average temperature or the maximum temperature, and all the optimum thresholds were >30 day. These findings provide the in-situ evidences of long-term changes in phenology and its associated growth on the biomass of alpine plants on the QTP in the era of climate change.

Exosome-mediated miR-4655-3p contributes to UV radiation-induced bystander effects.

Radiation-induced bystander effects (RIBEs) refer to a series of reactions displaying in nonirradiated cells triggered by signals from irradiated cells. Though bystander effects induced by ionizing radiation have been well studied, there are still limited data on ultraviolet(UV) induced bystander effects(UV-RIBEs). Studies have verified that exosomes, acting as a new tool of intercellular communication, participate in ionizing radiation-induced bystander effect. The purpose of what we studied was to explore the function of exosomes in UV-RIBEs, and seeking the relevant mechanism. Human skin fibroblasts (HSFs) were exposed to a single dose of ultraviolet A (UVA) radiation (20 J/cm2) or ultraviolet B (UVB) radiation (60 mJ/cm2), respectively. Exosomes were isolated from the culture medium of HSFs by differential ultracentrifugation. Three endpoints relevant to potodamage were used in the evaluation of UV-RIBEs, which including the cell proliferation, oxidative damage, and apoptosis. Our results showed that exosomes from UV-irradiated cells contributed to UV-RIBEs. The expression of miR-4655-3p in exosomes increased after UV radiation and exosomes assisted in the transportation of miR-4655-3p between cells. The upregulation of miR-4655-3p enhanced the UV-RIBEs in the bystander cells. MiR-4655-3p restrained the expression of E2F2 through direct binding to its 3'-UTR. In addition, E2F2 contributed to the cell proliferation and decreased oxidative damage of HSFs. To sum up that exosomal miR-4655-3p plays a crucial role in UV-RIBEs and this function mentioned partially related to the inhibition of E2F2.

Keloid Biomarkers and Their Correlation With Immune Infiltration.

Objective: This work aimed to verify the candidate biomarkers for keloid disorder (KD), and analyze the role of immune cell infiltration (ICI) in the pathology of keloid disorder. Methods: The keloid-related datasets (GSE44270 and GSE145725) were retrieved from the Gene Expression Omnibus (GEO). Then, differential expressed genes (DEGs) were identified by using the "limma" R package. Support vector machine-recursive feature elimination (SVM-RFE) and LASSO logistic regression were utilized for screening candidate biomarkers of KD. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic power of candidate biomarkers. The candidate biomarkers were further verified through qRT-PCR of keloid lesions and the matched healthy skin tissue collected from eight cases. In addition, ICI in keloid lesions was estimated through single-sample gene-set enrichment analysis (ssGSEA). Finally, the potential drugs to the treatment of KD were predicted in the Connectivity Map Database (CMAP). Results: A total of 406 DEGs were identified between keloid lesion and healthy skin samples. Among them, STC2 (AUC = 0.919), SDC4 (AUC = 0.970), DAAM1 (AUC = 0.966), and NOX4 (AUC = 0.949) were identified as potential biomarkers through the SVM-RFE, LASSO analysis and ROC analysis. The differential expressions of SDC4, DAAM1, and NOX4 were further verified in collected eight samples by qRT-PCR experiment. ICI analysis result showed a positive correlation of DAAM1 expression with monocytes and mast cells, SDC4 with effector memory CD4+ T cells, STC2 with T follicular helper cells, and NOX4 with central memory CD8+ T cells. Finally, a total of 13 candidate small molecule drugs were predicted for keloids treatment in CMAP drug database. Conclusion: We identified four genes that may serve as potential biomarkers for KD development and revealed that ICI might play a critical role in the pathogenesis of KD.

Efficacy and adverse reactions of fractional CO2 laser for atrophic acne scars and related clinical factors: A retrospective study on 121 patients.

OBJECTIVE: This study was performed to analyze the efficacy, adverse reactions of fractional CO2  laser for atrophic acne scars, and related clinical factors. METHODS: The clinical data of 121 patients with atrophic acne scars treated with ultra-pulsed fractional CO2  laser in the Cosmetic Dermatology from August 2014 to March 2020 were retrospectively analyzed. The efficacy and adverse reactions of atrophic acne scar after fractional CO2  laser therapy were statistically analyzed. The clinical factors related to efficacy and adverse reactions after the first therapy session were analyzed by multivariate logistic regression. RESULTS: A total of 121 patients received 206 sessions of fractional CO2  laser therapy, with an average of 1.7 sessions. Moderate to excellent improvement rate reached 50.4% after the first session. Multivariate logistic regression analysis indicated that rolling scars responded better to fractional CO2  laser treatment than icepick scars (OR = 7.3, 95% CI [1.2, 43.4], p = 0.029), and scar improvement was more significant in the high-energy laser group than in the low-energy laser group (OR = 10.9, 95% CI [1.1, 106.8], p = 0.041). The main adverse reactions after fractional laser surgery were pigmentation, skin sensitivity, persistent erythema, and acneiform eruption. Multivariate logistic analysis revealed that the longer the scar duration, the higher incidence of postoperative adverse reactions (OR = 1.3, 95% CI [1.1, 1.5], p = 0.008). Compared with icepick scars, rolling scars (OR = 10.4, 95% CI [2.3, 47.7], p = 0.003) and boxcar scars (OR = 12.0, 95% CI [3.3, 44.0], p < 0.001) had higher risk of developing adverse reactions. The incidence of postoperative adverse reactions was also higher in the combined mode group (DeepFX mode + ActiveFX mode) than in the single-mode group (OR = 7.8, 95% CI [2.4, 25.5], p < 0.001). CONCLUSION: Fractional CO2 laser was effective in the treatment of atrophic acne scars, without serious adverse reactions. Scar type and laser energy were independent clinical factors affecting its efficacy. Scar course, scar type, and fractional laser mode were independent clinical factors affecting its adverse reactions.

A novel nomogram based on a retrospective study of 346 patients to predict the recurrence risk of condyloma acuminatum after 5-aminolevulinic acid photodynamic therapy.

Condyloma acuminatum (CA) is a sexually transmitted disease caused by human papillomavirus (HPV) often with high recurrence rate after treatment. This study aimed to construct and evaluate a nomogram model containing three clinical parameters to predict the recurrence risk of CA after 5-aminolevulinic acid photodynamic therapy (ALA-PDT). A predictive model was established based on a training cohort of 346 CA patients treated with ALA-PDT between January 2013 and July 2018. A validation cohort of 123 CA patients was recruited from August 2018 to December 2019. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize the clinical feature selection. A nomogram predicting the recurrence of CA after ALA-PDT was constructed based on the predictors identified by LASSO regression. C-index and area under the curve (AUC) values were used to evaluate the discrimination. Calibration was evaluated with a calibration curve. The net benefit was performed via decision curve analysis (DCA). In the training cohort, 55 (15.89%) patients experienced recurrences after ALA-PDT. Predictors selected by LASSO regression were concomitant human immunodeficiency virus (HIV) infection [Hazard ratio (HR) = 4.4; 95% confidence interval (CI), 2.5-7.9; p < 0.001], skin and mucosa as affected area (HR = 1.7; 95% CI, 0.9-3.1; p = 0.109), and more than one time of CO2 laser therapy (HR = 6.3; 95% CI, 2.8-13.9; p < 0.001). The nomogram showed a good performance in predicting recurrence as the C-indexes were 0.843 (95% CI, 0.799-0.887) in the training cohort, and 0.831 (95% CI, 0.727-0.934) in the validation cohort. The AUCs of the nomogram were 0.85 in training and 0.8 in validation. DCA confirmed the nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 5%. This nomogram can provide individualized prediction for the recurrence risk of CA in patients treated by ALA-PDT.

Effects of surgery on survival of patients aged 75 years or older with Merkel cell carcinoma.

OBJECTIVE: To investigate whether surgery improves prognosis in elderly patients with Merkel cell carcinoma (MCC). MATERIALS/METHODS: Data of all patients with MCC diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Differences in baseline characteristics were analyzed among the age groups (75-80, 80-85, and ≥85 years). Multivariate Cox proportional hazards analysis was used to assess the effects of each variable on patient outcomes. The Kaplan-Meier curves were employed to evaluate MCC overall survival (OS) and MCC-specific survival (MSS). RESULTS: A total of 1156 of patients with MCC met the inclusion and exclusion criteria. The surgery rate decreased with age (75-80, 80-85, and ≥85 years were 93.3%, 91.1%, and 88.7%, respectively; p = 0.082). Multivariate Cox proportional hazards analysis showed that the OS of patients in the 80-85 years group (hazard ratio [HR] = 1.39; 95% confidence interval [CI] = 1.14-1.70; p = 0.001) and the ≥85 years group (HR = 2.18; 95% CI = 1.80-2.63; p < 0.0001) was worse than that in the 75-80 years group. Compared with the non-surgery groups, the HR for the surgery group was 0.75 for OS (95% CI = 0.56-1.00; p = 0.048) and 0.73 for MSS (95% CI = 0.48-1.10; p = 0.130). Subgroup analyses showed that patients aged ≥85 years undergoing surgery had better OS (HR = 0.65; 95% CI = 0.45-0.95; p = 0.024). CONCLUSIONS: MCC patients aged 75 years and older would benefit from surgical resection. However, surgical resection should be performed cautiously, and larger prospective clinical trials are needed to further verify these findings.

[Characteristics of grassland degradation and its relationship with climate factors on Qinghai-Tibetan Plateau, China]. / é’è—é«˜åŽŸè‰åœ°é€€åŒ–ç‰¹å¾åŠå ¶ä¸Žæ°”å€™å› å­çš„å ³ç³».

Understanding the distribution, characteristics, and changing trend and persistence of grassland degradation and revealing its mechanism on the Qinghai-Tibetan Plateau can provide scientific basis for effective grassland management and conservation. We selected grassland coverage as the remote sensing monitoring index to establish the remote sensing monitoring and evaluation index system of grassland degradation and evaluate grassland degradation during 2016 to 2020 on the Qinghai-Tibet Plateau. The changing trend and persistence of grassland coverage were analyzed using linear regression and Hurst index analysis on a long time series scale (1982-2020). The partial correlation analysis was used to examine the influence of climate on grassland degradation. The results showed that grassland degradation reached 24.3% during 2016 to 2020, which was mainly light and moderate degradation, and largely distributed in low altitude and high fractional vegetation cover areas. From 1982 to 2020, grassland coverage tended to increase in the north, west and southwest, and decreased in the east and center of the Qinghai-Tibetan Plateau. The Hurst index of grassland coverage was less than 0.5 in 98.1% of the total grassland, indicating grassland coverage showed negatively persistent. The partial correlation coefficient between grassland coverage and precipitation (0.096) was higher than that of temperature (-0.033). About 16.0% area was dominated by temperature, which was mainly distributed in the central and southeast. About 12.2% area was dominated by precipitation, which was distributed in the northeast and west of the Qinghai-Tibetan Plateau.