Dry eye disease in systemic lupus erythematosus: a cross sectional study

AIM:To explore ocular surface manifestations of dry eye disease(DED)and its influencing factors in systemic lupus erythematosus(SLE)patients.METHODS:Ophthalmological examinations were conducted in SLE patients(n=43)and controls(n=41),including Ocular Surface Disease Index(OSDI),objective scatter index(OSI),tear meniscus height(TMH),lipid layer thickness(LLT),non-invasive Keratograph tear breakup time(NIKBUT),corneal fluorescein score(CFS),Schirmer I test.DED was diagnosed according to the Tear Film and Ocular Surface Society Dry Eye Workshop II Criteria.SLE patients were further divided into DED group and non-DED group,the disease activity,clinical manifestations and laboratory investigations were compared between the two groups.The disease activity was evaluated by Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI-2K).Receiver operative characteristic(ROC)curve and multiplefactor binary logistic regression were performed.RESULTS:SLE patients showed higher OSDI[9.1(2.8-15.9)vs 6.3(2.2-7.5),P=0.035],higher OSI[1.67(1.09-2.60)vs 0.96(0.87-1.60),P=0.001],higher CFS[1(0-2)vs 0(0-1),P=0.001],lower LLT[65(42-100)vs 100(79.5-100),P=0.010],and lower NIKBUT[8.03(4.02-9.73)vs 9.67(5.26-12.71),P=0.030]than controls.The 32.6%of SLE patients had DED,which was higher than 12.2%of healthy controls.DED group showed higher SLEDAI-2K score[9.7±6.1 vs 5.4±3.4,P=0.025],higher anti-cardiolipin antibody(ACL)[8.7(3.5-13.2)vs 3.6(2.0-6.9),P=0.035],and higher proportion of patients with cutaneous eruption[42.9%vs 6.9%,P=0.015]than non-DED group.According to multiple-factor binary logistic regression analysis,the SLEDAI-2K score(OR=1.194,P=0.041)and cutaneous eruption(OR=7.094,P=0.045)could be consider as risk factors for DED in SLE patients.The ROC curve of the combined factors including age,disease duration,SLEDAI-2K score,ACL,and cutaneous eruption was analyzed,with a sensitivity of 0.786,a specificity of 0.793,and an area under curve of 0.820.CONCLUSION:Ocular surface affection is frequent in SLE patients,and patients with high disease activity and cutaneous eruption show increased risk of DED.

Non-spherical symmetry development of underwater shock waves created by laser-induced breakdown

As a controllable alternative to cavitation collapse-induced shock waves,numerous cavitation studies on laser-induced breakdown have been carried out in hydromechanics.When the laser focusing region is not spherical,the shock waves caused by laser breakdown also exhibit non-spherical symmetry propagation.Recently,some researchers have proposed the linear superposition theory based on the far field measurement data to explain this asymmetry,assuming that it is essentially the linear superposition of multiple wave fronts caused by multiple points of laser-induced breakdown that leads to the asymmetric propagation of shock waves.In this study,measurements of shock wave propagation processes with different breakdown energies are carried out based on a nanosecond resolution photogrammetry system,and the propagation velocities of shock waves in different directions are directly measured using a double exposure technique on a single frame.In the experiment,the velocity of the shock wave at the beginning of the breakdown was measured up to nearly 4000 m/s.The early shock wave front was ellipsoidal,and the propagation velocity in the laser incident direction was generally slower than that in the perpendicular direction,decaying to the speed of sound in water within 1000 ns after the breakdown,and the wave front gradually approached to a circle.The variability of the shock wave front pressure ratio in the laser propagation direction and the vertical direction implies that the linear superposition theory applicable to the far field is not applicable to the near field.There may be more complex mechanism for the near-field shock wave propagation process.

A case of Quebec platelet disorder with interstitial pneumonia

To the Editor:The a activity of fbrinolytic enzymes is complex.Abnormal bleeding can be caused by over-expression of plasminogen activators or a lack of fibrinolysis inhibitor.Quebec platelet disorder(QPD),an autosomal dominant disorder,with increased gene expression of PLAU encoding.urokinase plasminogen activator(u-PA),causes a gain-of-function abnormality in fibrinolysis.Tissue plasminogen activator(t-PA)exists in various tissues and clls.When pulmonary interstitial cells are damaged,t-PA can be released and promote the activation of plasminogen,The interstitial pulmonary fibrosis(IPF)can cause vascular injury and leakage of t-PA,resulting in their elevation in alveoli,Patients can present with fibrinolytic system abnormalities,and anti-fbrinolyt-ic therapy combined with glucocorticoids can effectively prolong the survival time.