Evaluation of the efficacy of transarterial chemoembolization combined with microwave ablation followed by adjuvant therapy in patients with hepatocellular carcinoma.

Objective: This study aimed to explore the efficacy of transarterial chemoembolization (TACE) combined with microwave ablation (MWA) adjuvant to lenvatinib and anti-PD-1 antibodies for patients with hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 67 patients with HCC treated at our hospital between October 2018 and May 2022 was conducted. All patients underwent a combination of TACE and MWA. Among them, 29 received postoperative treatment with molecular-targeted agents, like lenvatinib, along with anti-PD-1 antibodies such as sindilizumab, karelizumab, or tirilizumab. The remaining 38 patients did not receive postoperative systemic therapies, like targeted or immunotherapy. The survival and prognosis of all patients were analyzed. Results: Nine patients in the observation group and 29 patients in the control group experienced recurrence, and the median progression-free survival 1 (PFS1) was not reached 'Not Applicable'(NA) and 17.05 months (P=0.035), respectively. Failure to combine adjuvant therapy was identified as an independent risk factor for tumor recurrence, and the observation group had a 0.245 times lower risk of recurrence compared to that in the control group (P=0.005). Multivariable Cox regression analysis confirmed that the maximum tumor size, and tumor number were risk factors for tumor recurrence. Patients with a large maximum tumor size had a 1.519 times higher risk of recurrence compared to those with a small maximum tumor size (P=0.006), and patients with a large number of tumors had a 5.978 times higher risk of recurrence compared to those with a small number of tumors (P=0.02). The median PFS2 of the two groups was 11.795 and 21.257 months, respectively, though not statistically significant (P=0.955). However, there was a disparity in the percentage of BCLC stages associated with recurrence between the two groups. In the observation group approximately 22.22% of patients progressed to stage C, while in the control group, this proportion was 34.48%. The observation group exhibited a lower risk of distant metastasis compared to the control group. Conclusion: Adjuvant treatment of HCC following TACE combined with MWA improved PFS and achieved better clinical outcomes compared to that with TACE combined with MWA alone.

Novel exosome-related risk signature as prognostic biomarkers in glioblastoma.

Exosomes are progressively being detected as an indicator for the diagnosis and prognosis of cancer in clinical settings. Many clinical trials have confirmed the impact of exosomes on tumor growth, particularly in anti-tumor immunity and immunosuppression of exosomes. Therefore, we developed a risk score based on genes found in glioblastoma-derived exosomes. In this study, we used the TCGA dataset as the training queue and GSE13041, GSE43378, GSE4412, and CGGA datasets as the external validation queue. Based on machine algorithms and bioinformatics methods, an exosome-generalized risk score was established. We found that the risk score could independently predict the prognosis of patients with glioma, and there were significant differences in the outcomes of patients in the high- and low-risk groups. Univariate and multivariate analyses showed that risk score is a valid predictive biomarker for gliomas. Two immunotherapy datasets, IMvigor210 and GSE78220, were obtained from previous studies. A high-risk score showed a significant association with multiple immunomodulators that could act on cancer immune evasion. The exosome-related risk score could predict the effectiveness of anti-PD-1 immunotherapy. Moreover, we compared the sensitivity of patients with high- and low-risk scores to various anti-cancer drugs and found that patients with high-risk scores had better responses to a variety of anti-cancer drugs. The risk-scoring model established in this study provides a useful tool to predict the total survival time of patients with glioma and guide immunotherapy.

Immune Cell Infiltration and Relevant Gene Signatures in the Tumor Microenvironment that Significantly Associates With the Prognosis of Patients With Breast Cancer.

Breast cancer is the most common malignancy and the leading cause of cancer-related deaths in women. Recent studies have investigated the prognostic value of the tumor microenvironment (TME)-related genes in breast cancer. The purpose of this research is to identify the immune-associated prognostic signature for breast cancer evaluate the probability of their prognostic value and compare the current staging system. In this study, we comprehensively evaluated the infiltration patterns of TME in 1,077 breast cancer patients downloaded from TCGA by applying the ssGSEA method to the transcriptome of these patients. Thus, generated two groups of immune cell infiltration. Based on two groups of low infiltration and high infiltration immune cell groups, 983 common differentially expressed genes were found using the limma algorithm. In addition, studying potential mechanisms, the GSEA method was used to indicate some pathways with remarkable enrichment in two clusters of immune cell infiltration. Finally, the seven immune-associated hub genes with survival as prognostic signatures were identified by using univariate Cox, survival, and LASSO analyses and constructed a TME score. The prognostic value of the TME score was self-validated in the TCGA cohort and further validated in an external independent set from METABRIC and GEO database by time-dependent survival receiver operation. Univariate and multivariate analyses of clinicopathological characteristics indicated that the TME score was an independent prognostic factor. In conclusion, the proposed TME score model should be considered as a prognostic factor, similar to the current TNM stage, and the seven immune-related genes can be a valuable potential biomarker for breast cancer.

TGFBI gene mutation in a Chinese pedigree with Reis-Bücklers corneal dystrophy.

PURPOSE: To characterize the molecular defects in the TGFBI gene in a Chinese family with Reis-Bücklers corneal dystrophy (RBCD), and to study the relationship between the gene mutations and the clinical manifestations. METHODS: Four generations of this family with RBCD were enrolled in the study. In addition to ophthalmic and histopathological examinations, polymerase chain reaction (PCR) amplification and analysis of nucleotide sequencing of exons 4, 12, 14 of TGFBI were performed. RESULTS: The clinical manifestations of the disease were characterized by geographic opacities in the subepithelial layers and anterior stroma of the cornea. Confocal microscopy images of the cornea showed focal hyper-reflective materials deposited in the subepithelium and anterior stroma. It was confirmed by histopathology that Bowman's membrane was mainly replaced by extracellular fibril material, which extended downwards into the superficial corneal stroma. Molecular genetic analysis revealed a single heterozygous G>T change at nucleotide 124 in exon 4 of TGFBI in all members (22) of the pedigree affected with RBCD, but not in the unaffected members. CONCLUSIONS: A p.Arg124Leu mutation of the TGFBI gene was detected in this Chinese pedigree with Reis-Bücklers corneal dystrophy. The phenotype of Reis-Bücklers corneal dystrophy in this family belongs to the geographic type. The molecular genetic studies combined with histopathology may be useful for the accurate diagnosis of this type of corneal dystrophy.

Epidemiology of pterygium in aged rural population of Beijing, China.

BACKGROUND: Pterygium is a common ophthalmic disease and an important public health problem. It may be affected by many factors such as age, gender, ultraviolet radiation exposure, and time spent outdoors. This study aimed to investigate the prevalence of pterygium and evaluate the risk factors for the development of pterygium in the aged rural population of Beijing. METHODS: The investigation is a population-based cross-sectional study. Participants from 198 villages of 13 suburban districts, aged 55 - 85 years old, were invited to complete a medical record, and 37 067 individuals were taken external ocular and fundus photos at Beijing ocular disease survey in 2008-2009. The information was uploaded by Internet and diagnosed with stages and grades by ophthalmological specialists. The prevalence, stages and grades of pterygia were observed. RESULTS: Of the 37 067 individuals, 1395 (3.76%) had pterygium. There was a significantly higher prevalence in male (5.13%) than in female (3.17%, P = 0.000). The prevalence rate increased obviously with ages (chi(2) = 7.939, P = 0.019) in rural Beijing. The average prevalence of 5.91% in Daxing and Fangshan districts with low latitude and low precipitation was significantly higher than that in Miyun and Huairou districts with high latitude and deep precipitation (3.17%, P = 0.000). The majority of the pterygia (43.5%) were in active stage and 46.5% pterygia involved pupil area corneas. CONCLUSIONS: There is a statistically significant association between latitude and precipitation of habitation region and pterygium formation. Solar radiation, especially ultraviolet exposure represents a significant environment hazard to pterygium development.

[Morphological characteristics in corneal smear of acanthamoeba keratitis].

OBJECTIVE: To study the morphological characteristics in corneal smear of acanthamoeba keratitis. METHODS: Experimental study. From May 1991 to December 2007, in Department of Microbiology, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, 159 cases with acanthamoeba keratitis were analyzed for the laboratory results and clinical data. Giemsa's stained smear and wet-mount preparation of 159 cases were observed, all the results of cytology be photographed as the records. RESULTS: Among the 159 cases with acanthamoeba keratitis, 131 patients (82.4%) were positive on smear, and 110 cases (69.2%) were positive in culture of amoeba. The detection positive rate of smear was apparently higher than culture. Typical trophozoites, pre-encystment trophozoites, mature cysts and empty cysts could be observed by smear. So it is an important method for the clinical diagnosis. The edema and dissolved corneal epithelial cells, exudate cells, arthrospores or chlamydoconidium of mycelial fungus, vacuoles, lipid droplet and medicine crystallization should be differentiated with the pathogen. The movement of trophozoites could mainly be observed through wet-mount preparation. CONCLUSION: The detection of typical features of trophozoites, pre-encystment trophozoites, mature cysts and empty cysts by corneal smear is important for the etiological diagnosis of acanthamoeba keratitis.

Effect of topical application of terbinafine on fungal keratitis.

BACKGROUND: Fungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0.25% terbinafine eye drops comparing with 5% natamycin suspension on fungal keratitis. METHODS: A retrospective clinical trial was performed on 90 patients presenting with direct smear and/or culture positive fungal keratitis at Beijing Tongren Hospital, Beijing, China from January 2006 to May 2008. Corneal ulcers were categorized as mild or severe. Forty-five patients were treated with topical terbinafine and the next 45 cases received topical natamycin hourly. RESULTS: Filamentous fungi were found in corneal scrapings among all 90 cases. Fungal cultures were positive in 64 patients (71%). Species of Fusarium and Aspergillus were the principal isolates. Forty (89%) patients showed favorable response to terbinafine, while forty-two (93%) patients exhibited favorable response to natamycin (P > 0.05). The mean course of treatment was significantly showed in the terbinafine treatment group than natamycin group ((26.5 +/- 11.2) days versus (19.3 +/- 6.4) days; P < 0.05). In terbinafine group, twenty patients with ulcers smaller than 4 mm had favorable outcome, while 20 of 25 patients with ulcers more than 4 mm in diameter had favorable response (P < 0.05). Twenty-seven patients with depth of infiltration less than half of stroma thickness had favorable response to terbinafine, while 13 of 18 patients with depth of infiltration more than half of stroma responded to terbinafine. This difference was statistically significant (P < 0.05). CONCLUSIONS: Our findings suggest that topical terbinafine is an effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases with smaller and shallower ulcers. Its mean duration of treatment was longer than natamycin.

[Ultrastructure study of pathogen of acanthamoeba keratitis].

OBJECTIVE: To observe the ultrastructure of the strains of acanthamoeba isolated from acanthamoeba keratitis (AK), the morphologic changes of acanthamoeba after culture with 0.02% chlorhexidine, and ultrastructure characteristics of acanthamoeba in corneal tissue of AK. METHODS: It was a experimental study. The ultrastructure of acanthamoeba strains cultured with 0.02% chlorhexidine was observed with scanning electron microscope (SEM). The excited cornea tissues from AK were observed with transmission electron microscope (TEM). RESULTS: Cultured acanthamoeba trophozoites were approximately 15 - 45 microm in diameter, appeared irregularly round or oval in shape, with rough surface and intrusion of cytoplasm. The trophozoite propagated by ways of binary division. The acanthamoeba cysts were approximately 10 - 25 microm in diameter, round in shape and with a plica-like surface. The acanthamoeba could change from trophozoite to cyst. The amoeba emerging through ostioles could turn into trophozoite and left an empty cyst. After cultured with 0.02% chlorhexidine for 24 hours, the trophozoite and cyst collapsed and distorted. However, after clinical treatment with 0.02% chlorhexidine, only the cysts could be seen in corneal tissue of AK. Ecto-and endo-cystic walls were preserved, but the cytoplasma was aggregated and the sub-cytoarchitecture were degenerated or disappeared. DISCUSSION Chlorhexidine at a concentration of 0.02% kills acanthamoeba trophozoites and cysts in vitro. Chlorhexidine (0.02%) also kills trophozoites and inhibits the activity of cysts in corneal tissues. However, it should be noticed that the inactive cysts can stay in the cornea for a long time and may cause an immuno-pathologic inflammation of the cornea.

Infectious keratitis related to orthokeratology.

PURPOSE: To report 28 cases of infectious keratitis related to orthokeratology lens overnight wear in China. METHODS: From March 2000 to August 2001, 28 cases of infectious keratitis related to overnight orthokeratology lens wear were diagnosed in Beijing Institute of Ophthalmology. These were retrospectively reviewed with regard to the pathogens isolated, duration of wear, the time since onset of symptoms, and age. Cultures of corneal scrapes for bacteria, fungus and Acanthamoeba were performed in all of the 28 cases. RESULTS: All cases were students, including 10 males and 18 females, average age was 16 years (range 10-21 years). The duration of orthokeratology overnight wearing was from 2 weeks to 2 years. Uncorrected visual acuity (UCVA) on initial examination in our institute was from 20/200 to light perception. Of 28 isolates, 24 were culture positive (including 11 bacteria, 11 Acanthamoeba and two fungi), and four were culture negative. In two of the four culture negative cases, Acanthamoeba cysts were detected in the corneal stroma with the confocal microscope. Acanthamoeba and Pseudomonas aeruginosa accounted for 75% (21 of 28) of the cases of infectious keratitis. CONCLUSION: Infectious keratitis is a severe complication associated with overnight orthokeratology lens wear. Ophthalmologists should pay more attention to this complication in practice.

Acanthamoeba keratitis: clinical characteristics and management.

OBJECTIVE: To review the clinical characteristics, treatment, and outcome of patients with Acanthamoeba keratitis (AK). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty consecutive patients with AK were referred to the Beijing Tongren Hospital, Capital University of Medical Science, China. METHODS: Retrospective analysis of medical records from 20 consecutive patients with AK between December 1, 1997 and March 30, 2003. Risk factors, laboratory investigations, clinical manifestations, treatments, and outcomes were analyzed. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) at the end of follow-up. RESULTS: Of the 20 patients presented in this series, 12 patients were students and 6 were farmers. Risk factors included contact lens wear (12/20) and trauma (6/20). Corneal ulceration, diffuse stromal infiltration, and ring infiltration were the main clinical manifestations. The diagnosis of all patients was based on the laboratory investigation. Smear and culture positive specimens were 19 of 20 and 12 of 20, respectively. Images of cysts were demonstrated with confocal microscopy in 4 patients. Treatment was combined instillation of chlorhexidine (0.02%), neomycin (0.5%), metronidazole (0.4%), and/or lesion cauterization with chlorhexidine (1%), and corneal lesion debridement. The mean duration of therapy was 70 days (range, 18-150 days). Nineteen lesions healed with scar formation. The BCVA was better or equal to 20/100 in 7 eyes. CONCLUSIONS: Early diagnosis of AK is the key challenge in clinical practice. The combined use of antiacanthamoeba agents, debridement, and cauterization may be a best choice of treatment for patients who are diagnosed early in the course of their disease.

Microbiological analysis of chronic dacryocystitis.

AIMS: To investigate the microbiology of specimens from patients with chronic dacryocystitis. METHODS: A total of 100 samples were obtained from the contents of the lacrimal duct in 91 consecutive patients with chronic dacryocystitis, including nine bilateral cases. These samples were cultured for aerobic and anaerobic bacteria and fungi with a routine microbiological technique. Positive cultured isolates were identified. RESULTS: A total of 180 strains were isolated from the 85 bacterial samples, including 150 strains of aerobic bacteria and 30 strains of anaerobic bacteria. Fungi were found in eight samples and actinomyces in three samples. The bacterial species that were most frequently found were Staphylococcus species, representing 34.5% of all strains, followed by Corynebacterium diphtheroides (15.5%). The sensitivity tests revealed that levo-ofloxacin and amikacin were the most effective antibiotics. CONCLUSIONS: Gram positive cocci was the predominant pathogen of chronic dacryocystitis. Levo-ofloxacin and amikacin had the best effect in vitro.

[Molecular characteristics of Acanthamoeba strains from keratitis patients].

OBJECTIVE: To study the molecular characteristics of Acanthamoeba strains isolated from keratitis patients. METHODS: Twenty six Acanthamoeba strains were isolated from corneal ulcers between 1994 and 2002. Partial genome DNA sequences of all strains of Acanthamoeba were amplified using PCR and then the PCR products were sequenced. The partial DNA sequences were analyzed by software Clustal X and MEGA2. The results of Acanthamoeba obtained from Beijing Tongren Hospital were compared with strains from other countries and districts. RESULTS: Of 26 Acanthamoeba strains isolated from the patients, 25 (96%) were 18S rDNA (Rns) genotype T4 and one (4%) was T3. These results were similar to those obtained from other countries and districts. CONCLUSIONS: According to the Rns genotype classification criterion, most of Acanthamoeba strains isolated from keratitis patients in Beijing are genotype T4 and only few of these strains are genotype T3. The Acanthamoeba infecting the cornea might belong to the specific 18S rDNA genotype.

Identification of 18S ribosomal DNA genotype of Acanthamoeba from patients with keratitis in North China.

PURPOSE: To identify the genotype of 18S ribosomal RNA gene (18S rDNA, Rns) of the Acanthamoeba strains isolated from patients with keratitis in northern China. METHODS: The genus-specific primers JDP1 and JDP2 were used for the amplification of the amplimer ASA.S1. With DNA PCR and sequencing, Rns genotypes were identified according to the DF3 sequence variances. RESULTS: Of all 26 DF3 sequences obtained from the 26 Acanthamoeba strains, 18 were unique (69.2%). Of those, 17 were Rns genotype T4 and one was Rns genotype T3. CONCLUSIONS: Most Acanthamoeba strains isolated from keratitis in northern China were Rns genotype T4. The results are in agreement with recent results in the literature.

Etiological analysis on ocular fungal infection in the period of 1989 - 2000.

BACKGROUND: This study was to review the distribution and shifting trend of fungal of culture specimens isolated from eyes of patients at the Beijing Institute of Ophthalmology, Tongren Hospital, Beijing, China. METHODS: The fungal culture-positive rate, the distribution and change of isolates of 2609 specimens collected in a 12-year period (1989 - 2000) were retrospectively analyzed. RESULTS: In 775 positive cultures, 707 specimens (91.2%) were from the cornea, 22 (2.8%) from the conjunctiva, 15 (1.9%) from the anterior chamber, 9 (1.2%) from the vitreous body, 3 (0.4%) from the lacrimal sac, and 19 (2.5%) from other parts of the eye. The average culture-positive rate was 29.7%. The ratio of the positive cultures in the first half year (from January to June) to those in the second half (from July to December) was 1:2.1. The main genus cultured was Fusarium sp (58.7%), followed by Aspergirum sp (16.8%). The percentage of Fusarium sp was increased from 53.6% (1989 - 1994) to 60.2% (1995 - 2000), whereas the percentage of Aspergirum sp was decreased from 22.3% (1989 - 1994) to 15.1% (1995 - 2000). CONCLUSIONS: Fusaruim sp is one of the most predominant pathogens of ocular fungal infection in northern China and its incidence tends to increase, but that of Aspergirum sp to decrease. It is very important to recognize the distribution and shifting trend of pathogenic fungi in the diagnosis, prevention and treatment of fungal keratitis.

[In vitro fluoroquinolone resistance in ocular bacterial isolates].

OBJECTIVE: To assess the in vitro resistance of ocular bacterial isolates to fluoroquinolone that are commonly used in the treatment of ocular infection. METHODS: Ocular bacterial isolates (n = 347) from Beijing Institute of Ophthalmology were tested for their resistance to ofloxacin, ciprofloxacin and norfloxacin. In vitro susceptibility testing was determined by the Kirby-Bauer disk diffusion method. RESULTS: The total number of ocular bacterial isolates was 347 from January, 1999 to December, 2000 including gram-positive cocci 192 (55.3%), gram-negative cocci 16 (4.6%), gram-positive bacilli 44 (12.7%), gram-negative bacilli 89 (25.7%), Nocardia 6 (1.7%). The percentage of resistance in total ocular bacterial isolates to ofloxacin, ciprofloxacin and norfloxacin was 28.5%, 25.9% and 34.9% respectively. The resistance of streptococcus species to ofloxacin (5.9%) and ciproloxacin (11.8%) was significantly lower than gentamycin (52.9%) and tobramycin (70.6%) (P < 0.01), and to norfloxacin (23.5%) was significantly lower than tobramycin (P < 0.01). Pseudomonas showed significantly lower resistance to ciprofloxacin (6%) ofloxacin (14.0%) and norfloxacin (14.0%) than gentamycin (42.0%) (P < 0.01 and P < 0.05). The percentage of resistance in staphylococcus species to norfloxacin (46.8%) was higher than gentamycin (30.8%) and tobramycin (27.6%) (P < 0.05 and P < 0.01 separately). The resistance of gram-positive bacilli to ofloxacin, ciproloxacin and norfloxacin. was equivalent (P > 0.05). CONCLUSIONS: The fluoroquinolones, ofloxacin and ciprofloxacin have higher overall in vitro efficacy on most of the ocular bacteria than gentamycin and tobramycin, but ofloxacin and ciprofloxacin are equivalent to gentamycin and tobramycin in efficacy against staphylococcus species.

Etiological analysis on the ocular fungal infection.

OBJECTIVE: To review the distribution and shifting trends of fungal culture specimens in Beijing Institute of Ophthalmology. METHODS: Retrospective analyses of the fungal culture positive rate, the distribution and change of isolates were performed on 2 609 specimens during a 12-year period (1989 - 2000). RESULTS: The number of positive cultures was 775 (707 from the cornea, 91.23%; 22 from the conjunctiva, 2.84%; 15 from anterior chamber, 1.94%; 9 from the vitreous body, 1.16%; 3 from lacrimal sac, 0.39% and 19 from other parts of eye, 2.45%). The average culture-positive rate was 29.70%. The average ratio of the positive cultures between the first half (from January to June) and the second half (from July to December) of the years was 1:2.1. The main genus cultured was Fusarium (58.71%), next was Aspergillus (16.8%). The percentage of Fusarium was increased (53.63% from 1989 through 1994 to 60.23% from 1995 through 2000), and the percentage Aspergillus was decreased (22.35% from 1989 through 1994 to 15.10% from 1995 through 2000). CONCLUSIONS: The Fusaruim is the predominant pathogens of ocular fungal infection in the northern part of China, its frequency was increased during this 12-year period, and meanwhile the frequency of the Aspergillus was decreased. It is very important to comprehend the distribution and shifting trends of pathogenic fungi continuously for diagnosis, prevention and treatment of fungal infectious ocular disease.

Etiological analysis on bacterial ocular disease in northern China (1989-1998).

OBJECTIVE: To review the distribution and trends of bacterial culture specimens in Beijing Institute of Ophthalmology. METHODS: A retrospective analysis of the bacterial culture-positive rate, the distribution of gram' s stain, and the distribution and change of isolates was performed on 4705 specimens during a 10-year period (1989- 1998). RESULTS: Positive cultures numbered 1339 of the 4705 specimens, with a positive rate of 28.6%. Gram-positive cocci constituted 55.6% of the total isolates, followed by gram-positive bacilli 13.1% . Gram-negative cocci accounted for 2.8%, and gram-negative bacilli 28.5% . In the positive bacteria cultures, coagulase-negative Staphylococcus (mainly Staphylococcous epidermidis) was the most common isolate (25.3%), and followed by Pseudomonas 18.8%, Micrococcus 11.7%, Cotynbaccterium 10.1%, and Staphylococcus aureus 8.2% . During the 10-year period, the overall frequency of gram-positive cocci appeared to increase with time while the frequency of gram-negative bacilli decreased. CONCLUSIONS: Gram-positive cocci and gram-negative bacilli are still the predominant pathogens of ocular infection in northern China. The frequency of the former increases annually whereas that of the latter decreases. It is important to comprehend the distribution and trends of ocular pathogenic bacteria for the diagnosis, prevention and treatment of bacterial infectious ocular disease.

[Distribution and shifting trends of the pathogens for bacterial keratitis].

OBJECTIVE: To study the distribution and shifting trends of corneal bacterial isolates from bacterial keratitis retrospectively. METHODS: The data of bacterial cultures of 2 220 corneal isolates from January, 1989 to December, 1998 were reviewed. RESULTS: During this 10-year period, 2 220 consecutive corneal cultures were obtained, and a positive-culture was recovered in 490 isolates, the positive rate being 22.1%. In the 490 positive-cultures, Gram-positive cocci and Gram-negative bacilli represented 51.0% and 39.4% respectively. Gram-positive bacilli was 9.2%. Pseudomonas aeruginosa was isolated the most commonly in the corneal isolates (32.2%), followed by coagulase-negative staphylococcus (18.6%). Streptococcus pneumoniae represented 12.0%. During this period, we documented a gradual increase in the number of Gram-positive cocci coupled with a decrease of the number of Gram-negative bacilli. CONCLUSION: Pseudomonas aeruginosa and coagulase-negative staphylococcus are the most common pathogens in bacterial keratitis in the north part of China. At present, the increased recovery of Gram-positive cocci and decreased of Gram-negative bacilli from keratitis isolates present an important challenge to the ophthalmology.

[The variance of pathogenic organisms of purulent ulcerative keratitis].

OBJECTIVE: To identify the variance of pathogens of purulent keratitis and their resistance patterns to antibiotics. METHODS: From January 1995 to October 2000, all patients with suspected infectious corneal ulcer were examined by bacterial, fungal and Acanthameoba culture. The results of microorganism-culture were compared with those in literature. RESULTS: Of the specimens in 1 430 cases, there were 790 cases (55.2%) with positive culture including bacterial isolates in 258 cases (18.0%), fungal isolates in 498 cases (34.8%) and parasites in 34 cases (2.4%). The Staphylococcus aureous and Pseudomonas aeruginosa that had markedly declined since 1980s represented 6.2% and 21.7% of bacterial isolates respectively. However, the opportunity organism such as Staphylococcus epidermidis represented 27.5%, a tendency of gradual increase. The most common fungal pathogen was fusarium spp that represented 64.5% of all positive fungal cultures, and Aspergillus spp (13.6%) occupied the second place. The resistance of the ocular bacteria to fluoroquinolones gradually increased. Although the Pseudomonas aeruginosa was resistant to gentamycin in 36.2%, it was almost no resistance to tobramycin (3.4%). The fusarium spp was shown to be resistant to a number of the anti-fungal agents, but it is sensitive to natamycin. CONCLUSION: The survey of pathogens in purulent ulcerative keratitis and their resistance patterns to antibiotics helps in clinical treatment.