AIM: To explore the clinical features, diagnosis and treatment experience and the distribution characteristics of pathogenic microorganisms of primary canaliculitis, and provide reference for its diagnosis and treatment. METHODS: Retrospective clinical study. A total of 119 cases(120 eyes)diagnosed as primary canaliculitis in the department of ophthalmology of Wuxi No.2 People's Hospital from June 2019 to February 2023 were included. The treatment methods were mainly divided into conservative treatment(removing canaliculus stones through lacrimal punctum combined with injecting antibiotic eye ointment into the tube)and surgical treatment. The inspection methods of pathogenic microorganisms included secretion smear microscopy and microbial culture.RESULTS: Primary canaliculitis was more common in middle-aged and older female, mainly manifested by long-term red eye and increased secretion; however, the majority was not accompanied by tearing. Totally, 118 cases(99.2%)had monocular disease, while 63 cases(63 eyes; 52.5%)had inferior lacrimal canaliculus disease. Laboratory examination: Among 119 cases(120 eyes), 4 cases(4 eyes)did not undergo laboratory examination, and the other 115 cases(116 eyes)were as follows: Gram staining microscopy of secretion smear showed that Actinomyces were detected in 102 cases(103 eyes; 88.8%), while no fungus was detected; Microbial culture: 85 cases(86 eyes; 74.1%)were positive for bacterial culture. A total of 111 bacterial strains were cultured, which contained 26 types of bacteria. Among them, 32 strains were aerobic(28.8%); 26 strains were anaerobic(23.4%); and 53 strains were facultative anaerobic(47.7%). The most common bacteria were streptococcus(20 strains), staphylococcus(13 strains), Propionibacterium(10 strains), and capnocytophaga(10 strains). Only 4 cases(4 eyes; 3.4%)of microbial cultures were positive for Actinomyces. Fungus was negative in all microbial cultures. Treatment: Of the 119 cases(120 eyes), 114 cases(115 eyes; 95.8%)were cured by conservative treatment of removing lacrimal canaliculus stones through lacrimal punctum and intracanalicular ointment infiltration(IOI), while 5 cases(5 eyes)were not effective in conservative treatment; however, all of them were cured after surgical treatment, and the cure rate for primary canaliculitis was 100.0%.CONCLUSION: The incidence of primary canaliculitis is low, and it is prevalent in middle-aged and older female. Single lacrimal canaliculus is more common, which could be missed and misdiagnosed in clinic. Actinomyces is the major pathogen observed mostly in mixed infections, with heterogeneous strains, mainly anaerobic or facultative anaerobic bacteria. Streptococcus and Staphylococcus are the most common whereas fungal canaliculitis is rare. The cure rate of primary canaliculitis is high after diagnosis, and IOI method is recommended as the initial treatment of canaliculitis.

Objective To explore the microstructural changes in white matter(WM)fibers of patients with post-stroke depression(PSD)by using automated fiber quantification(AFQ)and the relationship between changes in fibers and the Hamilton depression scale(HAMD).Methods The HAMD and MRI data were collected from stroke patients with a single anterior circulation infarction at 1-month follow-up.AFQ was used to extract the main fibers and calculate the fractional anisotropy(FA)of each node in each fiber.The difference of node FA in each fiber between groups and correlations between altered node FA and HAMD were then evaluated.Results Data were collected from 8 patients with PSD and 18 patients without PSD(non-PSD).Compared with that in non-PSD,the node FA in the callosum,left inferior longitudinal fasciculus,and uncinate fasciculus were significantly decreased in patients with PSD(P<0.05).The altered node FA values in the corpus callosum forceps minor(r=-0.418,P=0.047)and left uncinate fasciculus(r=-0.467,P=0.029)were negatively related to HAMD in patients with PSD.Conclusions AFQ can precisely measure the segmental microstructural damage of nerve fiber bundles in patients with PSD,of which segmental microstructural damage of the corpus callosum forceps and hook tracts is associated with the severity of depression.

Objective? To explore the effects of family participation in the respiratory rehabilitation of the patients with chronic obstructive pulmonary disease (COPD) in terms of their treatment compliance and outcomes. Methods? Totally 80 COPD patients admitted in The First Affiliated Hospital of Guangzhou Medical University from March 2016 to August 2017 were selected and divided into the control group (n=40) and the observation group (n=40) according to the random number table. Patients in the control group received conventional respiratory rehabilitation intervention, while the patients had their family members participated in the rehabilitation process in the observation group. Treatment compliance and effects were compared between the two groups. Results? The compliance of the observation group totaled 97.50%, while that of the control group totaled 87.50% (χ2=7.207, P＜ 0.05). After 3 months' intervention, the walking distance within 6 min of the observation group was (278.72±45.89) m; the PEF pred% was (93.46±13.47)%; and FEV1% was (87.42±14.71)%, better than those of the control group (t=4.127,7.156,3.859;P＜ 0.05). Conclusions? Family participation in respiratory rehabilitation process can improve the compliance of COPD patients significantly, thus improve the treatment effects, which is worth promoting in clinical practice.

OBJECTIVE:To study the protective effect of fingolimod on renal ischemia reperfusion injury (RIRI) model mice and its mechanism.METHODS:A total of 60 mice were randomly divided into sham operation group,model group,fingolimod group (1 mg/kg) and fingolimod+wortmannin group [fingolimod 1 mg/kg+phosphatidylinositol 3-kinase (PI3K) specific blocker wortmarmin 1.4 mg/kg],with 15 mice in each group.Except for sham operation group,RIRI model was induced in other 3 groups,and those model mice were given relevant medicine via caudal vein at once 24 h before surgery.Serum of mice were collected in each group after 24 h perfusion.Serum levels of Scr and BUN were measured by automatic biochemical analyzer.The pathological changes of renal tissue were observed under light microscope.The protein expression of intercellular cell adhesion molecule-1 (ICAM-1),monocyte chemoattractant protein-1 (MCP-1) and phosphorylated protein kinase B (p-Akt) in renal tissue were measured by Western blot assay.RESULTS:Compared with sham operation group,the serum levels of Scr and BUN in model group were increased significantly (P＜0.01).Pathological changes were found in the kidney,and RIRI led to widespread renal tubular epithelial cell injury,apoptosis and inflammatory cells infiltration.The protein expression of ICAM-1 and MCP-1 in renal tissue were increased significantly (P＜0.01),the protein expression of p-Akt was increased slightly (P＞0.05).Compared with model group,other indexes of fingolimod group were improved significantly (P＜0.01) except that the protein expression of p-Akt in renal tissue was increased significantly (P＜0.01).Compared with fingolimod group,above indexes of fingolimod+wortmannin group were reversed (P＜0.05 or P＜0.01).CONCLUSIONS:Fingolimod can obviously ameliorate renal injury induced by RIRI in mice,the mechanism of which may be associated with the activation of PI3K/Akt signaling pathway.

Objective To verify the validity of standard air cushion inflation method, and to explore the relationship between patients' body mass index (BMI) and the optimal air cushion inflation pressure. Methods A total of 90 orthopedic patients who were treated in Liangxiang Hospital of Fangshan District in Beijing from June 2017 to March 2018 were randomly divided into experimental group and control group, with 45 cases in each group. The control group used air cushion bed routinely according to the experience of nurses, while the observation group used standard air cushion bed inflation method according to previous research. Comparing the skin pressure and the feeling of using the mattress softness and hardness between the two groups, and analyzing the relationship between the pressure value of the mattress and the BMI of the patients in the observation group, the regression equation was obtained.Results The local skin redness rate of the observation group was 4.4％, 2.2％ and 4.4％ after 2, 48 and 72 hours of using air cushion mattress, which was lower than that of the control group 22.2％, 31.1％ and 33.3％. The result was statistically significant (P<0.01). Within 72 hours, the satisfaction degree of the observation group was higher than that of the control group, and the difference was statistically significant (P < 0.05). The BMI of the patients in the observation group was linearly correlated with the optimal air cushion pressure (R2=0.962). The air cushion pressure (kpa)=3.835+BMI×0.379. Conclusions Reasonable adjustment of the pressure of the air cushion bed can improve the effect of using air cushion bed. The method of adjusting the pressure of the air cushion bed based on patient BMI is convenient for nurses to master and operate.

Objective To study the clinical features and possible pathogenesis of acute ischemic stroke in renal cell cancer patients. Methods The clinical data from in-hospital patients with renal cell cancer who developed acute ischemic stroke were collected, including the patients with renal cell cancer who developed acute ischemic stroke during anti-cancer therapies and those patients with acute ischemic stroke who were firstly diagnosed to have renal cell cancer during anti-stroke therapies between January 2003 and December 2015. Results A total of 2516 patients with renal cell cancer were screened, and there were 36 patients (1.43%) with acute ischemic stroke. Out of the 36 patients, there were 29 men (80.56%) and 7 women (19.44%). Their age ranged from 45 to 68 years, with a average age of (65.11 ± 14.77) years. Eight patients (22.22%) had some conventional cardiovascular risk factors, while the other 28 patients (77.78%) had no such risk factors. Magnetic resonance imaging (MRI) scans at the acute stage of ischemic stroke were carried out for all these patients. Based on the diffusion weighted imaging (DWI) of MRI, 8 patients (22.22%) had single lesion and 28 patients (77.78%) had multiple lesions in different arterial territories in their brains. The pathological types of renal cell cancer were:suprarenal epithelioma (18 patients, 50.00%), papillary cell carcinoma (12 patients, 33.33%) and chromophobe renal cell carcinoma (6 patients, 16.67%). Metastases were found 10 patients (27.78%) out of the 36 patients. Blood biochemical examination showed that 28 patients had elevated plasma D-dimer level, 22 patients had elevated plasma cancer antigen (CA)125 level, and 17 patients had elevated plasma carcinoembryonic antigen (CEA) levels. Conclusions It is suggested that the renal cell cancer associated stroke is characterized by lacking of traditional risk factors and having multiple lesions in brain;and that the elevated plasma D-dimer, CA125 and CEA levels may lead to hypercoagulable state and lead to ischemic stroke eventually .

Objective To study the relationship between tubomanometry(TMM) and tympanograms before and after the treatment of otitis media with effusion(OME) in children,and to evaluate the function of tubomanometry in forecasting the prognosis of OME.Methods Data from 66 patients(98 ears) were collected before and after one to four weeks treatment,all the patients received tympanometry and tubomanometry ETS,recorded eustachian tube scores(ETS) and tympanogram types.Results Before treatment,there were significant differences between the ETS of normal ears and sick ears,also between ETS of type B tympanograms and type C.There was significant difference between ETS before and after treatment,but not between the ETS of type B tympanograms and type C after treatment.The increased ETS value of type B tympanograms was higher than type C with a significant difference.There was a significant difference between the ETS of the effective group and the invalid group before and after treatment,whether type B tympanograms or type C.Conclusion Eustachian tube scores increased after treatment,and the functions of eustachian tube were improved in children of otitis media with effusion.Before treatment,the ETS of type B tympanograrns was lower than type C,indicating a poorer function of eustachian tube.After treatment,the increased ETS value of type B tympanograms was more than type C.Tubomanometry could forecast the prognosis of otitis media with effusion in children.

Objective To investigate the difference of apparent diffusion coefficients (ADCs) changes in three major salivary glands after gustatory stimulation using two different stimuli. Methods Thirty healthy volunteers were examined with a 1.5 T MR unit. A diffusion-weighted MR imaging (MR DWI) sequence was performed once at rest and continuously repeated 13 times after gustatory stimulation using a commercially available lemon juice and vitamin C tablets in the same volunteer by using self-controlled method. The subsequence of two stimuli was random. In addition, the salivary flow rates at rest and after stimulation were measured. Characteristics and differences in ADCs curves of three salivary glands before and after stimulation between two stimuli were analyzed. Comparison of maximum ADCs, maximum ADCs increase rates (IRs) and times to maximum ADCs(Tmax) between two stimuli was performed by using independent-samples t test. Correlation analysis between rest salivary flow rates and rest ADCs, the maximum salivary flow rates and ADCs after stimulation, the maximum salivary flow IRs and ADC IRs after stimulation were performed by using Pearson correlation test. Results In lemon juice stimulation group, the mean ADCs mostly showed a steady increase to peak values during the first DW MRI scan after stimulation in all glands, followed by a gradually decrease fluctuating slightly around the baseline values. In vitamin C stimulation group, the mean ADCs were significantly increased in all glands during the first DW MRI scan after stimulation, followed by a gradual upward trend till peak values. In lemon juice stimulation group, the mean Tmax of submandibular and sublingual glands[(184±122)s, (345±232)s, respectively] were significantly earlier than those[(454 ± 301)s, (528 ± 297)s, respectively] in vitamin C stimulation group (t=-3.517 and-2.548 respectively, P<0.01 for all). The mean maximum ADCs of three glands in lemon juice stimulation group[(1.05 ± 0.12) × 10-3 mm2/s, (1.22 ± 0.10) × 10-3 mm2/s and (1.26 ± 0.21) × 10-3 mm2/s, respectively] were all lower than those in vitamin C stimulation group[(1.13±0.13) ×10-3 mm2/s, (1.32±0.25) × 10-3 mm2/s and (1.57 ± 0.36) × 10-3 mm2/s, respectively], and the differences in parotid and sublingual glands between two groups were significant(t=-2.894 and-3.681 respectively, P<0.01 for all). The mean maximum ADC IRs of three glands in lemon juice stimulation group[(11.35±4.07)%, (8.81±5.40)%, (34.08±21.66)%, respectively] were significantly lower than those[(17.80 ± 12.72)%, (18.16 ± 18.93)%, (67.49 ± 46.04)% , respectively] in vitamin C stimulation group (t=-2.252,-2.330 and-3.432 respectively, P<0.05 for all) . In two groups, the mean maximum ADC IRs of parotid and submandibular gland were all significantly lower than sublingual gland (t=-5.994 and-6.443 respectively, P<0.01 for all). No correlation was observed between ADCs and salivary flow rates, ADC IRs and salivary flow rate IRs in two groups (P>0.05). Conclusion MR DWI with transient stimulation using lemon juice is more stable for evaluating the physiologic changes of salivary glands in vivo.

Objective To investigate the clinical application of scalp skin grafts in reconstruction of external auditory meatus in congenital aural atresia.Methods We conducted a retrospective study on 85 patients of congenital aural atresia,all of whom were unilateral,operated from March of 2008 to December of 2010 in ENT department of the Sun Yat-Sen Memorial Hospital.The patients enrolled in the study were between 6 to 37 years old (median age 12 years),55 male and 30 female.Scalp surface graft in ipsilateral temporal region was harvested to cover the bony external auditory meatus.Results All of these scalp split-thickness skin grafts survived without necrosis,no restenosis was found in these external auditory meatus.Neither scar nor alopecia was found in the skin-harvesting region,and hairs grew well.Granulations occurred in 27 cases in the first to sixth month posteroperatively,20 cases recovered after local treatment.In the first year,30 cases obtained hearing improvement more than 15 dB,36 cases gained more than 25 dB and 19 cases gained more than 35 dB.Totally 8 patients were lost in the 4 to 5 years of follow-up,70 cases (70/77,90.9％) developed new external auditory meatus,7 cases (7/77,9.1％) suffered from stenosis in different degrees,but no atresia was found in these patients.Conclusion Scalp split-thickness skin grafts has significant clinical advantage in meatoplasty of congenital aural atresia.