Comparison of corneal biomechanics in Sjogren's syndrome and non-Sjogren's syndrome dry eyes by Scheimpflug based device

AIM：To compare the corneal biomechanics of Sj？gren＇s syndrome（SS） and non-SS dry eyes with Corneal Visualization Scheimpflug Technology（CorV is ST）.METHODS：Corneal biomechanics and tear film parameters, namely the Schirmer I test value, tear film break-up time（TBUT） and corneal staining score（CSS） were detected in 34 eyes of 34 dry eye patients with SS（SSDE group） and 34 dry eye subjects without SS（NSSDE group） using CorV is ST. The differences of the above parameters between the two groups were examined, and the relationship between corneal biomechanics and tear film parameters were observed. RESULTS：The differences in age, sex, intraocular pressure（IOP） and central corneal thickness（CCT） were not significant between the two groups（P〉0.05）. The tear film parameters had significant differences between the SSDE group and NSSDE group（all P〈0.05）. Patients in the SSDE group had significantly lower A1-time and HC-time, but higher DA（P=0.01, 0.02, and 0.02, respectively） compared with the NSSDE group. In the SSDE group, DA was negatively correlated with TBUT（rho=-0.38, P=0.03）; HC-time was negatively correlated with CSS（rho=-0.43, P=0.02）. In the NSSDE group, HC-time was again negatively correlated with CSS（rho=-0.39, P=0.02）.CONCLUSION：There are differences in corneal biomechanical properties between SSDE and NSSDE. The cornea of SSDE tends to show less ＂stiffness＂, as seen by a significantly shorter A1-time and HC-time, but larger DA, compared with the cornea of NSSDE. Biomechanical parameters can be influenced by different tear film parameters in both groups.

Evaluation of axial length/total corneal refractive power ratio as a potential marker for ocular diagnosis of Marfan’s syndrome in children

AIM:To investigate whether the axial length(AL)/total corneal refractive power(TCRP)ratio is a sensitive and simple factor that can be used for the early diagnosis of Marfan’s syndrome(MFS)in children.METHODS:The relationship between the AL/TCRP ratio and the diagnosis of MFS for 192 eyes in 97 children were evaluate.The biological characteristics,including age,sex,AL,and TCRP,were collected from medical records.Receiver operating characteristic(ROC)curve analysis was performed to investigate whether the AL/TCRP ratio effectively distinguishes MFS from other subjects.The Youden index was used to re-divide the whole population into two groups according to an AL/TCRP ratio of 0.59.RESULTS:Of 96 subjects(mean age 7.46±3.28 y)evaluated,56(110 eyes)had a definite diagnosis of MFS in childhood based on the revised Ghent criteria,41(82 eyes)with diagnosis of congenital ectopia lentis(EL)were included as a control group.AL was negatively correlated with TCRP,with a linear regression coefficient of-0.36(R2=0.08).A significant correlation was found between age and the AL/TCRP ratio(P=0.023).ROC curve analysis showed that the AL/TCRP ratio distinguished MFS from the other patients at a threshold of 0.59.MFS patients were present in 24/58(41.38%)patients with an AL/TCRP ratio of≤0.59 and in 34/39(87.18%)patients with an AL/TCRP ratio of>0.59.CONCLUSION:An AL/TCRP ratio of>0.59 is significantly associated with the risk of MFS.The AL/TCRP ratio should be measured as a promising marker for the prognosis of children MFS.Changes in the AL/TCRP ratio should be monitored over time.

Structural and functional characteristics of microbiota in oropharynx of sub-healthy children with gastrointestinal heat retention syndrome differentiated by traditional Chinese medicine

Objective:To explore the structural and functional characteristics of microbiota in oropharynx of subhealthy children with gastrointestinal heat retention syndrome(GHRS)differentiated by traditional Chinese medicine,and screen the biometric operational taxonomic units(OTUs)to assist the clinical diagnosis.Methods:We recruited children according to the“GHRS diagnostic scale”,collected their oropharyngeal swabs,and sequenced the 16 SrDNA V4 region.We described the bacterial structure with alpha-indexes,beta-distances,and relative abundances;moreover,we screened the differential genera/OTUs with Wilcoxon rank-sum test,Metagenome Seq analysis,and linear discriminant analysis effect size(LEf Se)analysis,in which biometric OTUs were selected to construct the receiver operating characteristic curve to verify the diagnostic value.The bacterial function was predicted with Kyoto Encyclopedia of Genes and Genomes pathways according to 16S rDNA gene by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States.Results:The study population was composed of 10 children with GHRS and 10 healthy control children.GHRS children were more likely to overeat(gluttony,P=.033).Alpha-indexes,such as Sobs,abundancebased coverage estimator,Bootstrap,and Qstat,were significantly higher in the GHRS group,while betadistances did not exhibit any significant intergroup differences.There were 9 differently distributed nonpredominant genera between the groups in Wilcoxon rank-sum test,as well as 13 non-predominant genera in Metagenome Seq analysis and 3 non-predominant OTUs in LEfSe analysis.OTU44 and OTU196 were used to construct the receiver operating characteristic curve,and the area under curve was 0.92.Predicted functions showed that pathways related to oxidative phosphorylation and carbon metabolism were enriched in healthy control samples,while the pathway related to renin secretion was remarkably enriched in GHRS samples.Conclusion:Unique oropharyngeal microbial structure and function were identified in GHRS children.OTU44 and OTU196 were specific OTUs,which could be used as biomarkers of GHRS to assist clinical diagnosis.

Gastrointestinal microbiome and primary Sjogren’s syndrome: a review of the literature and conclusions

The recognition of the profound impact of the human gastrointestinal microbiome(GM) on human autoimmune diseases has gradually increased thanks to deeper research efforts. As a systemic autoimmune disease, primary Sjogren’s syndrome(pSS) cannot be completely cured. Human studies have revealed that GM species and diversity are altered in patients with p SS compared with healthy individuals. Animal studies have provided possible mechanisms for the association between pSS and GM. The potential role of GM in pSS is exerted through several mechanisms. GM dysbiosis leads to increased intestinal permeability, which increases the risk of GM antigen exposure and activates specific autoreactive T lymphocytes via “molecular mimicry”. In addition, GM antigen exposure and intestinal immune tolerance loss caused by GM dysbiosis together induce chronic local gut mucosal inflammation, which deteriorates to systemic chronic non-specific inflammation with the circulation of pro-inflammatory lymphocytes and cytokines. These factors eventually activate autoreactive B lymphocytes and lead to pSS. If GM plays a key role in the pathogenesis of pSS, clarifying the underlying mechanisms will be helpful for the development of new therapies targeting GM for dry eye associated with pSS. This review summarizes the latest knowledge about the relationship between GM and p SS,with the aim of contributing to future research and to the development of new clinical applications.

Visual resolution under photopic and mesopic conditions in patients with Sjogren's syndrome

AIM:To focus on different visual resolution tasks under photopic and mesopic conditions in Sjogren’s syndrome patients compared to age-matched healthy controls.METHODS:The visual resolution measurements included high and low visual acuities and contrast sensitivity functions.These tests were conducted under photopic and then mesopic conditions.Twenty-one Sjögren’s syndrome patients and 21 aged-matched healthy volunteers completed all the measurements in this study.RESULTS:Sjogren’s syndrome patients have greater impairment in contrast sensitivity than standardized visual acuity.This reduction was significant under the mesopic condition.Also,Sjogren’s syndrome patients treated with pilocarpine suffer more than patients without pilocarpine treatment under low light conditions.CONCLUSION:Sjogren’s syndrome patients shows greater impairment in different visual resolution tasks due to dry eye symptoms.

Oral Candidiasis in Sjgoren's Syndrome：Prevalence，Clinical Features，and Treatment

This paper reports the diagnosis of 65 patients with Sjogren′s Syndrome. Among these patients, 20 patients(30.77%) were complicated with oral candidiasis. The twenty patients were treated by topical nystatin smearing, 2% sodium bicarbonate solution rinsing, and transfer factor injecting for about 2 months. The soreness, erythema, unpleasant feeling, angular cheilitis in mouths significantly diminished or completely disappeared, following two months treatments. The good results have been kept 6 months after follow up. However, dry mouth and atrophic changes, though showed no furture development, the therapeutic response was not significant.

Corneal sensitivity,ocular surface health and tear film stability after punctal plug therapy of aqueous deficient dry eye

AIM： To evaluate the effect of punctal occlusion using thermosensitive（smart plug） versus silicone plug for management of aqueous deficient dry eye on cornea sensitivity, ocular surface health and tear film stability.METHODS： A comparative prospective interventiona case study included 45 patients with bilateral severe form of aqueous deficient dry eye. In each patient, the smar plug was inserted in the lower punctum of the right eye which was considered as study group 1 and silicone plug was inserted in the lower punctum of the left eye o the same patient which was considered as study group2. All patients were subjected to careful history taking and questionnaire for subjective assessment of severity of symptoms. Corneal sensitivity, corneal fluorescein rose bengal staining, Schirmer＇s I test, tear film break up time and conjunctival impression cytology were performed pre and 1, 3 and 6mo post plug insertion.RESULTS： A statistically significant improvement in subjective and objective manifestations occurred following treatment with both types of plugs（P 〈0.01）The thermosensitive plug caused significant overal improvement, decrease in frequency of application o tear substitutes and improvement of conjunctiva impression cytology parameters in the inserted side（P 〈0.01）. Canaliculitis was reported in two eyes（4.4% following punctal occlusion using thermosensitive plug（study group 1）. Spontaneous plug loss occurred in 21eyes（46.6%） in the silicone plug group（study group 2）.CONCLUSION： Improvement of subjective and objective manifestations of aqueous deficient dry eye occurs following punctal plug occlusion. Thermosensitive plug has good patient＇s compliance with fewer complications and lower rates of loss compared to the silicone plug.

Association between orofacial granulomatosis and Crohn's disease in children:Systematic review

AIM: To review pediatric cases of orofacial granulomatosis (OFG), report disease characteristics, and explore the association between OFG and Crohn’s disease.

Topical biological agents targeting cytokines for the treatment of dry eye disease

Because inflammation plays a key role in the pathogenesis of dry eye disease and Sjogren's syndrome, topical anti-inflammatory agents such as corticosteroids and cyclosporine A have been used to treat inflammation of the ocular surface and lacrimal gland. Systemic biological agents that target specific immune molecules or cells such as tumor necrosis factor(TNF)-α, interferone-α, interleukin(IL)-1, IL-6, or B cells have been used in an attempt to treat Sjogren's syndrome. However, the efficacy of systemic biological agents, other than B-cell targeting agents, has not yet been confirmed in Sjogren's syndrome. Several studies have recently evaluated the efficacy of topical administration of biological agents targeting cytokines in the treatment of dry eye disease. Topical blockade of IL-1 by using IL-1 receptor antagonist could ameliorate clinical signs and inflammation of experimental dry eye. Using a mouse model of desiccating stress-induced dry eye, we have demonstrated that topical application of a TNF-α blocking agent, infliximab, could improve tear production and ocular surface irregularity, decrease inflammatory cytokines and Th-1 CD4+ cells on the ocular surface, and increase gobletcell density in the conjunctiva. Although controversy still remains, the use of topical biological agents targeting inflammatory cytokines may be a promising therapy for human dry eye disease.

Portal hypertensive biliopathy: A single center experience and literature review

Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging mo-dalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.

基于罗森尔塔效应的童趣化护理在肾病综合征患儿中的应用

目的:探讨基于罗森尔塔效应的童趣化护理在肾病综合征患儿中的应用效果。方法:将2022年1月1日~2023年1月31日收治的112例肾病综合征患儿按随机数字表法分为对照组和研究组各56例,对照组行常规护理,研究组在此基础上实施基于罗森尔塔效应的童趣化护理;比较两组心理状况、应对方式[采用简易应对方式问卷(SCQC)]、治疗依从性及社交焦虑情况[采用儿童社交焦虑量表(SASC)]。结果:干预后,研究组心理状况各项评分、SASC评分均低于对照组(P<0.05),治疗依从性高于对照组(P<0.05);干预后,研究组积极应对方式评分高于对照组(P<0.05),消极应对方式评分低于对照组(P<0.05)。结论:基于罗森尔塔效应的童趣化护理能够有效改善肾病综合征患儿的心理状况、社交焦虑情况,提高患儿治疗依从性,使患儿以更积极的态度去面对疾病。

Observation on the Curative Effect of Acupuncture on Child Tourette＇s Syndrome

To investigate the efficacy of earth-reinforcing and wood-reducing acupuncture tbr child Tourette＇s syndrome. Methods： Forty-five children with Yourette＇s syndrome were randomly allocated, according to a random number table, into an acupuncture group （23 cases） and a Western medicine group （22 cases）. Points Zhongwan （CV 12） and Siguan were selected in co-operation with acupuncture of other routine points in the acupuncture group. Haloperidol was orally administered for routine treatment in the Western medicine group. Results： The cure rate was 65.2% in the acupuncture group and 31.8% in the Western medicine group. There was a significant difference in cure rate between the two groups （P〈0.05）. Conclusion： Earth-reinforcing and wood-reducing acupuncture has an exact curative effect on child Tourette＇s syndrome.

Tourette综合征伴发行为问题的初步研究

目的 探讨Tourette综合征 (TS)伴发的行为问题及与抽动严重程度的关系。方法 采用CBCL和YGTSS对 6 9例TS患儿和 6 9例对照组儿童进行评估 ,比较CBCL得分 ,并就TS的抽动严重程度与行为问题的关系进行相关和多元回归分析。结果 TS组社会能力各分量表分及总分低于对照组 (P <0 0 1) ,TS组存在广泛的行为问题 (P <0 0 1) ;抽动症状严重组的违纪、思维、外向性行为问题和行为问题总分明显高于轻度组 (P <0 0 5 ) ;抽动严重程度与患儿的学校情况和社会能力成负相关 (P <0 0 5 ) ;与社交、思维、注意、违纪、攻击性、外向性和行为问题总分成正相关 (P <0 0 1)。结论 TS患儿伴发有广泛的行为问题 。

清肺口服液治疗小儿病毒性肺炎58例疗效观察

目的 :评价清肺口服液 (南京中医药大学附属医院院内制剂 )治疗小儿病毒性肺炎痰热闭肺证的有效性。方法 :选择 87例符合小儿病毒性肺炎痰热闭肺证诊断标准的患儿 ,按随机化原则分为试验组 (5 8例 )和对照组 (2 9例 ) ,分别给予清肺口服液、利巴韦林注射液治疗 ,观察疗程为 1 0天。 结果 :试验组患儿痊愈 5 0例 (86 .2 1 % ) ,显效 5例 (8.6 2 % ) ;对照组患儿痊愈 1 5例 (5 1 .72 % ) ,显效 1 4例 (4 8.2 8% ) ,经秩和检验P <0 .0 0 0 1 ,试验组疗效显著优于对照组。咳嗽、肺部湿啰音、Ｘ线全胸片等指标好转情况 ,试验组优于对照组。发热、气促等指标好转情况 ,两组疗效无显著性差异。 结论

《小儿维生素D缺乏性佝偻病中医诊疗指南》中医证型的德尔菲法评价及分析

目的:评价和筛选中医儿科专家对《小儿维生素D缺乏性佝偻病中医诊疗指南》中医证型标准的集中程度与协调程度,制定科学实用的《小儿维生素D缺乏性佝偻病中医诊疗指南》的中医证型标准。方法:采用德尔菲(Delphi)法,根据文献研究的结果制订《小儿维生素D缺乏性佝偻病中医诊疗指南专家问卷调查表》及专家回馈意见先后制订三轮问卷,向全国40余位家发送问卷调查,对问卷进行统计分析。结果:两次问卷调查分别回收有效问卷为35份与36份,专家积极系数分别为77.8%和92.3%,制定出《小儿维生素D缺乏性佝偻病中医诊疗指南》的证型,专家对其中指标意见的集中程度与协调程度较高。结论:专家的积极水平及专业水平均较高,分布地区广,具有代表性,故肺脾气虚证、脾虚肝旺证、肾精亏损证3证定为该病的证型基本得到专家的认可,但存在有不同的意见,有待于进一步优化。

电子鼻咽喉镜研究鼾症儿童上气道结构

目的用电子鼻咽喉镜研究鼾症儿童上气道结构和气道塌陷性。方法 79例阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿(轻度36例,中重度43例),41例原发性打鼾(primary snoring,PS)和45例对照组行电子鼻咽喉镜检查,比较各组腺样体占后鼻孔的比例(ANR)及各咽腔塌陷程度,同时将ANR、咽腔塌陷度与呼吸暂停低通气指数(apnea hyponea index,AHI)行相关分析。结果 4组患儿ANR、咽腔塌陷度比较差异有统计学意义(P均<0.05),鼾症组ANR两两比较示中重度OSAHS组最大(P<0.05),轻度其次,PS组最小(P<0.05),咽腔塌陷度中重度最大(P<0.05),轻度OSAHS组与PS组比较,差异无统计学意义(P>0.05),相关分析示ANR、腭咽腔前后径、腭咽腔塌陷度、舌咽腔左右径、舌咽腔塌陷度与AHI呈正相关;腭咽腔左右径、舌咽腔前后径塌陷度与AHI无相关关系。结论 ANR、咽腔易塌陷性增强与OSAHS病情严重程度有关,电子鼻咽喉镜结合Müller's检查在鼾症儿童上气道形态学研究中有一定价值,能反映腺样体堵塞程度及咽腔顺应性。

针灸治疗小儿抽动-秽语综合征15例

目的：运用针灸疗法对小儿抽动-秽语综合征进行治疗,观察针灸治疗小儿抽动-秽语综合征的疗效。方法：所选择的病例都是严格按照诊断标准诊断为小儿抽动-秽语综合征患儿,并且均选用中医经络理论选择相应的穴位进行针灸疗法进行治疗。治疗期间停止服用相应的治疗药物及其他疗法,以便作自身对照。治疗10天为1个疗程,连续治疗2个疗程,随访了3个月-1年。结果：15例患儿治愈8例,显效2例,好转2例,无效3例,随访1年无复发,总有效率80%。结论：针灸治疗小儿抽动-秽语综合征疗效确切,是一种较为理想的治疗方法。

小儿肺炎中医辨证规范研究问题与认识

针对目前辨证规范化研究中关键环节存在的若干问题,提出关于小儿肺炎中医辨证规范研究的问题和认识。认为建立完善小儿肺炎的中医临床辨证规范,应遵循病证规范的基本原则。需解决的具体问题包括全面澄清和处理小儿肺炎各证所属症状体征之间的逻辑关系、小儿肺炎各证所属症状的分级问题、症状体征轻重程度测量方法、舌象诊断的客观化和标准化等。

张士卿教授治疗小儿多发性抽动症的经验

张士卿教授认为小儿多发性抽动症大多是由先天不足、病后脾胃虚弱或情志失调,导致肝肾阴血不足,肝郁化火,肝风内动,阴阳失调所致。治疗以《时病论》清离定巽法为主,配合导痰汤、逍遥散加减化裁,同时注重饮食和情志调摄,每获效验。

小儿反复呼吸道感染证治初探

回顾了近五年对小儿反复呼吸道感染的中医证治的相关文献 ,从病因病机、预防治疗等不同角度和层次对此进行探讨。结果显示 ,诸虚、外邪、瘀血及脏腑功能失衡等均可导致本病发生 ,以气虚、阴虚、肺脾两虚等最为多见 ;本虚标实 ,湿邪阻滞 ,气机失调等是本病的重要发病机制 ;辨证施治仍占有主导地位 ,单方、外治法及中成药也有广泛应用 ,中西医结合防治是治疗的趋势所在。但总体而言 ,中医学尚缺乏对本病的系统的理论指导体系。