AIM: To investigate the efficacy of lacrimal duct laser dacryoplasty combined with intubation and postoperative meibomian gland treatment in patients with chronic dacryocystitis complicated by meibomian gland dysfunction.METHODS: Data were collected from 128 patients with chronic dacryocystitis complicated by meibomian gland dysfunction treated at Xi'an No.1 Hospital from March 2021 to December 2022. All patients underwent lacrimal duct laser dacryoplasty combined with intubation. Postoperatively, those patients were randomly divided into two groups: group A(64 cases, without meibomian gland treatment)and group B(64 cases, with meibomian gland treatment). The lacrimal intubation was removed at 3 mo after surgery to evaluate the patency rate of lacrimal irrigation. Additionally, changes in the ocular surface disease index(OSDI)score, non-invasive tear film break-up time, tear meniscus height, conjunctival hyperemia analysis, meibomian gland analysis, tear lipid layer thickness, tear ferning test, and conjunctival impression cytology were compared between the two groups.RESULTS: The lacrimal irrigation patency rates in the group A and group B were 78.1% and 81.2% respectively, with no statistically significant difference between the two groups(P>0.05); compared with the group A, group B showed a significant extension in non-invasive tear breakup time at 3 mo after surgery, and the OSDI score, conjunctival hyperemia analysis, tear ferning test and conjunctival impression cytology grading were all significantly decreased(all P<0.05), while there was no significant difference in tear meniscus height, tear lipid layer thickness and meibomian gland loss score between the two groups(all P>0.05).CONCLUSION: Comprehensive treatment for patients with chronic dacryocystitis combined with meibomian gland dysfunction have improved patients' comfort, tear film stability, and reduces local inflammatory response. It is important to simultaneously address ocular surface microenvironment abnormalities during surgical treatment to achieve satisfactory efficacy.

Objective: The research was aimed at exploring the effects of mandelic acid on the proliferation , apoptosis and migration of H1299 lung adenocarcinoma (LUAD) cells and the related molecular mechanisms. Methods: CCK⁃8 was used to detect changes in the proliferation ability of H1299 cells;Hoechst 33258/PI double⁃staining assay was used to analyze the apoptosis of H1299 cells;Transwell and migration assays were used to analyze changes in the invasive and migration ability of H1299 cells;Western blot was used to detect the expression of proliferation ,apoptosis and migration⁃related pathway proteins. Results : Different concentrations of mandelic acid inhibited the proliferation viability and invasion and migration ability of H1299 cells (P < 0. 05) . Mandelic acid induced high expression of bax and cl⁃caspase⁃3 and low expression of p ⁃stat3 in proliferation and apoptosis pathways (P < 0. 05) .In addition , it inhibited the expression of MMP⁃9 and Vimentin proteins ,which were related to invasion and migration (P < 0. 01) . Conclusion Mandelic acid inhibited the proliferation of H1299 LUAD cells and elevated the level of apoptosis , and molecular biological mechanism might be closely related to the decreased activation of stat3 and activation of bax/caspase⁃3 signaling axis. The inhibition of invasive and migrational ability of H1299 cells induced by mandelic acid was associated with the decreased expression of MMP⁃9 and Vimentin proteins.

Objective:To investigate the mid-term clinical outcomes of selective column arthrodesis based on the three-column theory in the treatment of malunion of Lisfranc injury.Methods:The 28 patients with malunion of Lisfranc injury were analyzed retrospectively who had been treated by selective column arthrodesis at Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine from January 2011 to January 2020.They were 18 males and 10 females, with an average age of 37.2 years(from 18 to 65 years). Twelve left and 16 right sides were affected. According to Myerson's three-column classification, one case was medial column injury (type A), 4 ones middle column injury (type B), 7 ones medial plus middle columns injury and 16 ones three-column injury. Medial column arthrodesis was conducted in 7, middle column arthrodesis in 4 and medial plus middle columns arthrodesis in 17. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were compared between preoperation and the last follow-up to evaluate the improvements in foot function and pain. The operation-related complications were recorded.Results:All patients were followed up for an average of 35.6 months (from 18 to 60 months). The AOFAS midfoot score increased from 43.1±4.1 at pre-operation to 84.1± 7.4 at the last follow-up and the VAS score decreased from 5.7±1.3 at pre-operation to 2.0±0.9 at the last follow-up (both P<0.001). The wounds healed in 28 patients, 3 of whom had postoperative wound exudation but responded to dressing change. There were no such complications as injury to the deep peroneal nerve or deep venous thrombosis. The internal fixation was removed in 5 patients at about one year after arthrodesis. Conclusion:Selective column arthrodesis based on the three-column theory can result in satisfactory med-term clinical outcomes in the treatment of malunion of Lisfranc injury.

Objective:To explore effects of the specialist nurse training program of based on the context, input, process, product (CIPP) evaluation model in the training of junior nurses in the Department of Otolaryngology.Methods:From April 2018 to May 2020, convenience sampling method was used to select 80 specialist nurses who received training in the Shandong ENT Hospital as research objects. A total of 40 nurses who received traditional training from April 2018 to March 2019 were divided into a control group. From April 2019 to May 2020, 40 nurses who were trained in a specialist nurse training program based on the CIPP evaluation model were divided into observation groups. This study compared nurses' core competence and training qualification rate.Results:After training, the core competence score of observation group was higher than that of control group, and the difference was statistically significant ( P<0.05) . The training qualification rate of observation group and control group was 92.50% (37/40) and 70.00% (28/40) respectively, also with a statistical difference ( P<0.05) . Conclusions:The training program for specialist nurses based on the CIPP evaluation model can improve the theoretical knowledge and practical ability of nurses, and then improve the quality of clinical care, and promote the long-term development of the hospital, which is worthy of promotion.

Objective: To learn the population,virus status and viral types of hantavirus（HV）hosts in Tiantai County of Zhejiang Province from 2011 to 2018,and to provide evidence for hemorrhagic fever with renal syndrome（HFRS）control. Methods: Rodents in Tiantai County were captured by night trapping method. After the species and age of rodents were identified,the composition of rodent species,dominant species and density of rodents were analyzed. The lungs and blood of rodents were sampled to detect the antigen and antibody of HV by immunofluorescence method. The HV antigen-positive lung samples were detected by RT-PCR with specific primers of HV S fragment,then HV was isolated and identified by inoculating Vero-E6 cells. Results: The average rodent density in Tiantai County from 2011 to 2018 was 4.44%. The rodent density in the field and residential areas were 4.94% and 2.23%,respectively. Ten species of rodents were identified,with Apodemus agrarius dominant in the field and Rattus norvegicus in the residential areas. Sixty-seven lung samples were HV antigen positive（4.13%）,one from Rattus norvegicus and the other sixty-six from Apodemus agrarius. Seventy-nine blood samples were HV antibody positive（4.86%）,all from Apodemus agrarius. Thirty-four HV antigen-positive lung samples were positive（50.75%）after RT-PCR amplification. Twenty-two strains of virus were isolated and all of them were from Apodemus agrarius,including twenty-one strains of Hantaan type（HTN）and one strain of Seoul type（SEO）. Conclusion In Tiantai County,Apodemus agrarius is the main source of HFRS infection;the main epidemic type of HV is HTN and SEO is first found in Apodemus agrarius.

Objective: By investigating the genotype and evolutionary variation of hantavirus (HV) in Tiantai county, a national surveillance site for hemorrhagic fever with renal syndrome (HFRS) was set in Zhejiang province, from 2011 to 2018, to reveal the molecular epidemiological characteristics of hantavirus (HV) in Tiantai. Methods: Total RNA was extracted from ultrasound treated HV antigen- positive rat lung samples in Tiantai from 2011 to 2018. After cDNA was prepared, nested PCR was used to amplify partial sequence of M fragments by using specific primers of HV. The sequences of HV in Tiantai from 2011 to 2018 were compared with other known HV sequences in order to identify the genotype and analyze the evolution and variation of the virus. Results: In 67 HV antigen-positive lung specimens, 31 were positive in nested PCR amplification with type-specific primers, including 30 Hantaan virus (HTNV) positive samples, 1 Seoul virus (SEOV) positive sample, and all the 31 samples were from Apodemus agrarius. The phylogenetic tree based on partial M segment was divided into monophyletic group, 30 strains were distributed in HTNV group and 1 was in SEOV group. The HTNV strain Tiantai T2018-130 was independently in one branch, sharing 84.8%-87.9% homology with other strains both at home and abroad, including 29 strains in HTNV group in Tiantai. The other 29 HTNV strains in Tiantai showed closer relationship. The SEOV strain T2016-31 from Apodemus agrarius showed closer relationship with previous strains of SEOV, Tiantai ZT71, ZT10 and Z37 strains of Wenzhou, Zhejiang province. Conclusions HTNV, the main genotype of HV in Tiantai of Zhejiang province, showed obvious geographic clustering, but the strain T2018-130 was distinct from the others in Tiantai. Meanwhile, by sequence analysis, we confirmed that The SEOV strain T2016-31 existed in in Apodemus agrarius, indicating there was a phenomenon of "spillover" between virus and host in SEOV evolution.

Objective The ammonia level in air and heavy metals in drinking water were explored in a cynomolgus monkey feedlot. Methods Air ammonia from different communities and feeding patterns of cynomolgus monkeys were collected at three time-points per day and determined by Nessler's reagent spectrophotometry. Inductively coupled plasma mass spectrometry was applied to detect the level of heavy metals in drinking water from 5 different sampling sites in the feedlot,incluing the outlet of underground water,the water tank,both monkey cages equipped with PVC or iron pipes and sewage lagoon,respectively. Results Air ammonia levels in quarantine inspection flock cages(0.59 ± 0.03 mg/m3)were significantly higher than in the cages of both reproductive flock(0.34 ± 0.03 mg/m3)and sale flock(0.27 ± 0.04 mg/m3). The ammonia level in air in different feeding patterns ranks as following:cage rearing of quarantine inspection flock(0.59 ± 0.03 mg/m3)>cage rearing of reproductive flock(0.48 ± 0.02 mg/m3)>captive bleeding of sale flock(0.30 ± 0.02 mg/m3)>cage rearing of sale flock(0.25 ± 0.01 mg/m3)> captive bleeding of reproductive flock(0.22 ± 0.02 mg/m3). The air ammonia concentrations of both former flocks were statistically higher than the latter three flocks. The highest air ammonia level among different flocks and feeding patterns occurred in the morning, before waste discharge clean-up. The iron concentration in drinking water in the cages equipped with iron pipes was higher than Chinese drinking water standard. Conclusions The air ammonia level was lower than the Chinese air quality standard. The iron concentration in drinking water in the cages equipped with iron pipes was higher than the Chinese drinking water standard.

Objective To study the influence of SCNIA intronic mutations in mRNA splicing in febrile seizures related epilepsy,and investigate the association between splicing changes and genotype-phenotype-inheritance pattern.Methods Molecular cloning of 5 SCN1A intronic mutations was performed in patients with partial epilepsy with antecedent febrile seizures plus (PEFS+) and Dravet syndrome (DS) through constructing mutant and wild-type plasmids of pTragetE2-3-4-5 and E24-25-26 by using Minigene splicing assay,and the in vitro expressions in HENK293 cells were detected.The mRNA splicing changes were analyzed qualitatively and quantitatively by reverse transcription (RT)-PCR and real time quantitative (q)-PCR.Results (1) Using RT-PCR,DS mutants presented a whole exon skipping without significant remain of normal mRNA transcripts,while PEFS+ mutants showed partial exon skipping or intronic insertion with coexistence of normal and aberrant mRNA transcripts.(2) Statistical differences were found between relative quantity (RQ) of aberrant and normal mRNA in PEFS+ mutant (c.473+5G＞A:4.92％±1.05％ and 6.10％±0.21％;c.473+5G＞C:7.97％±1.12％ and 3.94％ ±1.25％) and that in DS mutant (c.602+1G＞A:60.51％±1.81％ and 0.060％±0.022％,P＜0.05);similarly,there were statistical differences between relative RQ of normal and aberrant mRNA in PEFS+ mutant c.4853-25T＞A (71.22％±11.92％ and 7.38％±1.61％) and that in DS mutant c.4853-1G＞C (0.08％±0.01％ and 22.11％±2.83％,P＜0.05).Conclusion The position and difference of splicing patterns of SCNIA intronic mutations are potential molecular pathogenesis for phenotypic difference of febrile seizures related epilepsy.

Objective To explore the value of contrast-enhanced ultrasound in the diagnosis and classification of traumatic spleen rupture , as compared with enhanced CT. Methods The manifestations of contrast-enhanced ultrasound on surgically or clinically confirmed spleen rupture in 40 patients were retrospectively analyzed. The performance of contrast-enhanced ultrasound on diagnosis and classification was compared with that of enhanced CT. Results For 40 patients with traumatic spleen rupture , the of accuracy of enhanced CT and contrast-enhanced imaging in the diagnosis of traumatic spleen rupture was 97.5%, with no significant statistical differences (chi-square = 0, P = 1). On contrast-enhanced ultrasound examination, 14 patients were diagnosed as true splenic rupture , 9 as subcapsular spleen rupture , and 16 as central splenicrupture, with a accuracy rate of 92.5% (37/40); and accuracy rate for enhanced CT was 90.0% (36/40), there was no significant statistical difference (chi-square = 1.97, P > 0.05). Conclusions Contrast-enhanced and enhanced CT have good consistency in the diagnosis and classification of traumatic spleen rupture. Contrast-enhanced ultrasound can accurately determine the scope and degree of spleen damage , resulting in more accurate classification; and it has values in the diagnosis of traumatic spleen rupture and choice of therapies.

Objective To comparatively evaluate the effects of a recombinant Mtb protein ESAT 6-CFP10 ( rESAT6-CFP10 ) and a purified protein derivative ( PPD ) as skin test reagents in guinea pigs . Methods Guinea pigs were sensitized with different Mycobacteria species .After sensitization , all guinea pigs were intradermally injected with rESAT6-CFP10 and PPD.At 48 h after the injection, the size of ery-thema at injection sites was measured by using a double-blind method .For guinea pigs sensitized with viable Mtb, the size of erythema at injection sites were measured at 24 h after the injection .The positive conversion rates of skin test with rESAT 6-CFP10 and PPD were calculated .Results The results of PPD skin test were positive in all guinea pigs sensitized with viable Mtb , killed Mtb and BCG with erythema diameters of (11.4 ±0.9) mm, (11.8±1.1) mm and (13.2±0.8) mm, respectively.Positive skin test with rESAT6-CFP10 was only observed in guinea pigs infected by viable Mtb-showing erythema diameters of (13.7±5.7) mm. The skin test with rESAT6-CFP10 was negative in guinea pigs sensitized by killed Mtb-and vaccinated by BCG.The skin tests by using rESAT6-CFP10 and PPD were performed on randomly selected guinea pigs at ninth day after infection by Mycobacterium tuberculosis H37Rv.At the 2nd week, totally 24 selected guinea pigs showed positive skin test results with rESAT6-CFP10 (24/24) with erythema diameters of (19.9± 3.0) mm, while only 15 out of 24 had positive PPD skin test with erythema diameters of (6.1±5.5) mm. At the 4th week, all guinea pigs showed positive PPD skin test (3/3) with erythema diameters of (12.7± 2.5) mm.Conclusion The skin test by using recombinant ESAT 6-CFP10 protein can effectively distin-guish viable Mtb infection from BCG vaccination and killed Mtb sensitization , which is a more suitable anti-gen than PPD for the early diagnosis of Mtb infection .