Canada has officially unveiled its first-ever lunar rover, marking a historic leap in the nation’s space exploration journey. Developed in collaboration between the Canadian Space Agency (CSA) and domestic tech firms, the rover is designed to explore the Moon’s surface, conduct scientific experiments, and test new technologies vital for future missions. The announcement represents Canada’s entry into lunar exploration, placing it among a select group of nations pursuing robotic and human presence beyond Earth. With its rover slated for launch later this decade, Canada is not only showcasing its technological capabilities but also signaling a bold commitment to space innovation and international cooperation.
A milestone in Canada’s space journey
The lunar rover project builds on Canada’s celebrated space legacy, best known for contributions like the Canadarm on NASA’s Space Shuttle and the International Space Station. By extending its robotics expertise to planetary exploration, Canada is now pushing into an entirely new frontier on the Moon. This step underscores the country’s ambition to play a stronger role in global space exploration at a time when interest in lunar missions is rapidly accelerating.Designed for the harsh conditions of the Moon, the rover will endure extreme temperatures, rugged terrain, and abrasive lunar dust. Its instruments will be tasked with analyzing soil composition, searching for water ice, and studying the impact of lunar dust on machinery. These findings could provide essential knowledge for sustaining human presence on the Moon, making the mission not just a symbolic achievement but a scientific necessity.
Partnerships, innovation, and future vision
Canada’s lunar rover is also a story of collaboration. The mission aligns with NASA’s Artemis program and other international partnerships, ensuring that Canada’s contribution has a direct role in advancing humanity’s broader return to the Moon. By focusing on polar exploration, the rover will gather data critical for long-term lunar habitation, supporting both robotic and human-led missions in the future.Beyond science and technology, officials emphasize the rover’s inspirational role at home. Canada’s first attempt at the Moon is expected to spark curiosity among young people, encourage careers in STEM fields, and energize innovation across industries. As a symbol of national pride, the rover demonstrates that Canada is ready to transform its space legacy into a bold vision for the future, from robotic arms orbiting Earth to a rover rolling on the Moon. The mission also highlights Canada’s growing role in international space collaborations and sets the stage for more ambitious extraterrestrial projects in the decades to come.
JD.com, Inc. (NASDAQ:JD) ranks among the best Asian stocks to buy. Citing increased food delivery spending projections, CFRA reduced its price target on JD.com, Inc. (NASDAQ:JD) from $37 to $36 on August 15 while retaining a Buy rating on the company’s shares.
The firm reduced its 2025/2026 earnings per ADS expectations to CNY11.11/CNY18.44 from CNY11.69/CNY19.41, citing higher investment in JD.com’s growing food delivery operation, which encountered 25 million daily orders by late June.
According to CFRA, JD.com’s revenue will likely rise by 20% in 2025 and 15% in 2026. This growth is expected to be fueled by the company’s rapid foray into the food delivery market, as well as e-commerce expansion bolstered by more affordable products, China’s expanded home appliance trade-in program, and government subsidies for electronics transactions.
JD.com, Inc. (NASDAQ:JD) is a leading Chinese e-commerce company that focuses on computers and other electronic products, all the while serving as a supply chain-focused technology provider. Using its logistics network, JD.com has established itself as a major player in China’s online retail market.
While we acknowledge the potential of JD as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you’re looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the best short-term AI stock.
READ NEXT: 10 Best Magic Formula Stocks for 2025 and 10 Best Retirement Stocks to Buy According to Hedge Funds.
Disclosure: None. This article is originally published at Insider Monkey.
Members of Pakistan’s lower house of parliament attend the National Assembly meeting in Islamabad on March 1, 2024. — X/@NAofPakistan
Decision taken in accordance with Imran Khan’s directives: Gohar
He says party will hold peaceful protest outside Parliament House.
Waqas Akram says MNAs will briefly attend, then boycott sessions.
ISLAMABAD: After submitting resignations from multiple parliamentary panels, the Pakistan Tehreek-e-Insaf (PTI) has now decided to boycott National Assembly (NA) sessions, The News reported on Tuesday.
The move, in line with the PTI founder Imran Khan’s directives, will see the party converge outside the Parliament House for informal proceedings.
The development comes against the backdrop of multiple disqualifications of PTI lawmakers, including former leader of the opposition in the NA and Senate Omar Ayub and Shibli Faraz, after the courts sentenced them in cases related to the May 9 riots — further exacerbating the former ruling party’s existing legal woes.
Announcing the decision, PTI Chairman Barrister Gohar Ali Khan said that the parliamentary party’s members fully support the decision and they would now be staging peaceful protest gatherings outside the Parliament House.
“Our members were disqualified, and we were not even allowed to speak. If we wanted to celebrate Independence Day, they did not allow us to do so either,” Gohar lamented while reflecting on PTI lawmakers’ disqualifications.
“We tried to present our demands in the assembly session in a democratic manner, but we were not allowed to speak,” the PTI chairman added.
When contacted, PTI Information Secretary Waqas Akram confirmed the development. But when asked, would the party lawmakers totally stay away from the session, he explained that the members would briefly attend each sitting and then come out in protest.
“Our members will hold assembly outside the Parliament,” he explained.
Meanwhile, NA Speaker Ayaz Sadiq has urged PTI-backed Sunni Ittehad Council (SIC) members to reconsider their decision to resign from the standing committees of the Lower House.
“I wish that they should remain part of the standing committees of the House,” Sadiq said while while chairing a meeting of the House Business Advisory Committee a day earlier.
Islamabad, Pakistan – When the foreign minister, Ishaq Dar, landed at Dhaka airport on a windswept, overcast morning on August 23, it was the first time in 13 years that such a senior Pakistani official had visited Bangladesh, which had broken from Pakistan 54 years ago.
Dar, who also serves as Pakistan’s deputy prime minister, struck an optimistic tone, calling the “historic” tour the start of “a new phase of our reinvigorated partnership”.
Acknowledging a thaw in bilateral relations, he pointed to the “significant progress” made over the past year.
“We must work together to create an environment where youth from Karachi to Chittagong, Quetta to Rajshahi, Peshawar to Sylhet and Lahore to Dhaka join hands to face challenges and realise their shared dreams,” Dar said, naming cities across both countries.
His visit symbolised a breakthrough after months of diplomatic and military engagements between Pakistan and Bangladesh. Relations have warmed rapidly since the August 2024 ouster of former Bangladeshi Prime Minister Sheikh Hasina, who was widely perceived as being close to India, and who was forced out by massive student-led protests.
But Masood Khalid, Pakistan’s former ambassador to China, cautioned that the past continues to complicate trust-building between the two nations.
“The new government of Bangladesh has responded positively to Pakistan’s gestures. Clearly, there were artificial barriers to close relations that have now been removed,” he told Al Jazeera.
What was now needed, he said, was a “framework for deeper engagement, where constructive dialogue can dispel misunderstandings”.
Military and diplomatic engagements intensify
While Pakistani Prime Minister Shehbaz Sharif met Nobel Laureate Muhammad Yunus, leader of Bangladesh’s interim government, twice last year, few analysts expected such a swift improvement in ties, or the regular, high-level exchanges that followed.
In January, Lieutenant General S M Kamr-ul-Hassan of the Bangladesh Army visited Islamabad to meet Pakistan’s army chief, General Asim Munir. In February, Bangladesh’s naval chief, Admiral Mohammad Nazmul Hassan, followed, and two months later, Pakistani Foreign Secretary Amna Baloch travelled to Dhaka.
Dar’s trip had been delayed by Pakistan’s four-day clash with India in May, but July saw Minister of Interior Mohsin Naqvi visiting Dhaka.
Dar’s eventual arrival in Dhaka in August coincided with that of Lieutenant General Muhammad Faizur Rahman, the quartermaster general of the Bangladesh Army in Pakistan, where he held talks with the chairman of the Pakistani Joint Chiefs of Staff Committee, General Sahir Shamshad Mirza.
Delwar Hossain, an international relations professor at the University of Dhaka, said that Pakistan’s “hasty efforts” to strengthen ties are strategic.
“Pakistan was trying to normalise relations even under the Hasina government. Now they see an opportunity to revive the bond they enjoyed in the post-1975 era,” he told Al Jazeera, referencing the period after the assassination of Sheikh Mujibur Rahman, Bangladesh’s founder and Hasina’s father.
Relations between Islamabad and Dhaka normalised under Ziaur Rahman, Bangladesh’s military chief-turned-president, who led the country from late 1975 until he, too, was assassinated in 1981.
“Regime change has historically created a binary of friendship and antagonism in Bangladesh’s ties with India and Pakistan. Pakistan may also want to exploit the current tensions in Bangladesh-India relations. This is a common diplomatic practice,” Hossain added.
Bangladesh’s war of independence legacy
For decades, Islamabad and New Delhi have viewed ties with Dhaka through the prism of their rivalry, a dynamic rooted in Bangladesh’s 1971 war of independence.
When Pakistan and India gained independence from Britain in 1947, Pakistan was created as a Muslim-majority state with two geographically separated wings.
The western wing, home to about 34 million people of diverse ethnicities, was seen as dominant. The eastern wing, East Pakistan — which would become Bangladesh — was more populous, with more than 42 million Bengali speakers. India stood between the two parts of Pakistan.
As grievances grew in the east, India supported the Bengali liberation struggle. Pakistan’s military and allied militias carried out atrocities, killing hundreds of thousands of people and allegedly raping an estimated 200,000 women.
With India’s military backing, Sheikh Mujibur Rahman and his Awami League party led Bangladesh to independence. He became the country’s founding president.
Hasina, who led Bangladesh for 16 years before her removal last year, is widely seen as close to India, where she has been living since last year.
Aizaz Chaudhry, Pakistan’s former foreign secretary, said that the shared grievances over India’s “regional hegemony” have spurred Islamabad and Dhaka to repair ties.
“Bangladeshis have experienced Indian hegemony, and we, in Pakistan, saw it in the May conflict. Both nations now understand the need for balance of power in South Asia,” he told Al Jazeera.
In May, India and Pakistan fought a brief but intense four-day aerial war after gunmen killed 26 people, mostly tourists, in an attack in Pahalgam, in Indian-administered Kashmir. India has blamed Pakistan for the attack, allegations that Islamabad rejects.
Shahab Enam Khan, the executive director of the Bangladesh Center for Indo-Pacific Affairs, described Dhaka’s relationship with New Delhi as “lukewarm”, despite India being a significant neighbour, but added that foreign policy is driven by economic imperatives.
“Anti-India sentiment is often exaggerated,” he said. “Bangladesh historically avoids viewing relations, especially with Pakistan, through a purely security or military lens, preferring economic and regional cooperation.”
China’s growing role
Regional dynamics are further complicated by China’s growing influence in South Asia. Beijing, a close ally of Islamabad, had strong relations with Hasina, who successfully juggled her friendship with India and China – though the two Asian giants are otherwise rivals.
Dhaka University’s Hossain said that China had managed to retain a significant presence in Bangladesh even after Hasina’s ouster. In March, Yunus visited Beijing, followed by Bangladesh Army chief General Waker-Uz-Zaman’s weeklong China trip in August.
“Bangladesh is considering buying 12 J-10C fighter jets to boost its air power,” he added, referring to Chinese-made planes that Pakistan also has, and that Islamabad used in the May conflict. China is also Pakistan’s closest strategic partner, and the source of both economic loans and investments as well as military equipment.
“These developments are bringing Dhaka and Islamabad closer, transforming ties into a strong partnership,” Hossain said.
Pakistani and Bangladeshi officials held several meetings during Dar’s visit to Dhaka in August [Handout/Pakistan’s Ministry of Foreign Affairs]
Trade, politics as countries seek partnership
Dar’s two-day visit to Bangladesh was packed with meetings, including talks with Yunus and Adviser for Foreign Affairs Touhid Hossain.
He also met leaders from a range of political parties, including the Bangladesh Nationalist Party (BNP), Jamaat-e-Islami (JI), and the student-led National Citizen Party (NCP), which spearheaded the protests that toppled Hasina.
Those meetings were particularly significant as Bangladesh is preparing for elections in early 2026, said Abdul Basit, a former Pakistani high commissioner to India. “No matter what happens between India and Bangladesh, Pakistan and Bangladesh will forge ahead,” he told Al Jazeera. “We have issues from the past, but they can be handled skilfully and should not become barriers.”
Both could benefit from closer economic relations, too, suggested Pakistan’s former China ambassador Khalid and Dhaka University’s Hossain.
Bangladesh, with a growth rate of 6 percent since 2021, is among South Asia’s fastest-growing economies. Pakistan lags behind, recording 2.5 percent growth last year. At the moment, bilateral trade is modest, tilted towards Pakistan, whose exports to Bangladesh totalled $661m in 2024, compared with $57m in imports.
But if both countries try and revitalise trade relations, Hossain said they could each benefit from the other – both as a source of raw materials and as a potential market.
The academic said Bangladesh may benefit from importing cotton and textile products, rice, cement, fruits and processed food from Pakistan. On the other hand, Pakistan can import jute and jute products, hydrogen peroxide, chemicals and tobacco products from Bangladesh.
“Bangladesh and Pakistan have a combined population of 430 million”, he pointed out, “which is more than twice the size of West Europe”.
Historical grievances remain
The deepest fault line in Pakistan-Bangladesh relations is the legacy of the 1971 war.
Dhaka continues to demand a formal apology for the atrocities.
Then there is the dispute over the status of more than 200,000 Urdu-speaking Muslims in Bangladesh. After the partition in 1947, the community had mostly moved to East Pakistan from Bihar in present-day India. East Pakistan — today Bangladesh — was closer to Bihar geographically than West Pakistan. But Bangladesh, whose formation in 1971 was built on Bengali nationalism, has only given Urdu-speaking Muslims limited rights, and wants Pakistan to take them, something Islamabad is reluctant to do.
Bangladesh also seeks a division of the pre-1971 assets of the state of Pakistan, and the transfer of aid that was promised by West Pakistan to East Pakistan in 1970 after a devastating cyclone, in which an estimated 300,000 people died. The slow and largely inadequate response of the West Pakistan-based government is cited by many historians as a major catalyst for the liberation war that led to the formation of Bangladesh.
Still, Chaudhry, the former Pakistani foreign secretary, argued that public sentiment in both countries supports reconciliation.
“People of Pakistan are also as sad about the events of 1971 as the people of Bangladesh. I think this pain is common, and people in both countries now want to move on,” Chaudhry said.
However, Dhaka University’s Hossain said that, despite strong support from the current political forces for strengthening Bangladesh-Pakistan relations, issues related to the 1971 war continue to remain a barrier for improved ties.
“It is important to remember that the ouster of Hasina from power has not fundamentally changed the mindsets of the people of Bangladesh about the liberation war and an expectation from Pakistan for healing the past,” Hossain said.
Still, he added, Dhaka did not want to stay stuck in the past either.
“Diplomacy is a dynamic process. Both the countries can move forward for cooperation in economic, diplomatic and cultural sectors, while they will continue to maintain the healing process,” he said.
2025 smartphone shipments are forecast to grow 1.0% YoY to 1.24 billion units, says IDC, followed by a CAGR of 1.5% from 2024-29.
“Strong growth in U.S. and Middle East and Africa of 3.6% and 6.5%, as well as 0.8% growth in Asia Pacific excluding China in 2025 will help offset the 1% decline in China expected this year,” says IDC’s Nabila Popal.
Although unit growth is only 1% for 2025, the market is expected to see 5% YoY growth in ASP and 6.0% growth in value this year as vendors focus on value growth rather than chasing volume share.
“IDC forecasts the foldable market to accelerate to 6% YoY growth in 2025 (from 4% in 2024), followed by another 6% in 2026 and 11% in 2027,” says IDC vp Francisco Jeronimo, “nevertheless, we expect foldables to remain somewhat niche and continue representing less than 3% of total smartphone shipments by 2029.”
The service was recommended to Una after the death of her husband
A user of a support service for people who are lonely has described those on the other end of the phone as a “second family”.
The Good Morning programme, which operates throughout Northern Ireland, offers social phone calls to elderly people who feel isolated or lonely.
Almost 18% of people in Northern Ireland reported feeling lonely “at least some of the time”, according to the latest available figures from the Northern Ireland Executive.
Una McCrory was recommended the Mid Ulster service after she felt “very nervous” about living alone following her husband’s death eight years ago.
“I didn’t know what to do, and I have good family and good friends, but you can’t expect them to be dancing to attendance on you all the time,” she told BBC News NI.
The telephone friend and alert service runs between 09:00 and 13:00 local time, Monday to Friday, and provides social interaction for older people as well as highlighting different services.
Una told BBC News NI it was “one of the best” decisions she ever made to get involved and she looks forward to every call.
“You make friends there too, and even in town if you meet them they give you a wave and whatnot. It’s very, very good.”
Libby Hingham says there is “no big referral” needed to use the service
Libby Higham, who helps run the Antrim programme, said: “Sometimes with loneliness, a wee chat can help get someone through from one day to the next, and that’s the difference that we make.”
Sometimes the calls start with laughter, Libby said, “but in the next minute they’re crying and opening up about how lonely they are”.
“At times we have had to get people to go around to someone’s house because we haven’t been able to get in touch with them, and we’ll find that they have fallen down the stairs, or slipped in the shower and our calls have saved their lives,” Libby said.
“And that’s what we’re here for.”
What started as one or two calls a week has grown to thousands across each of the regional Good Morning services.
“All they have to do is pick up the phone and ask, there’s no big referral service,” Libby explained.
“I think that’s why it works so well.”
Eddie told BBC News NI the calls help ease symptoms of anxiety and depression
Eddie Smiles looks forward to his daily calls, saying it makes him realise that he isn’t alone.
As well as checking in for a chat, the volunteers remind Eddie to take his medication and have recommended other services, such as a support group he attends at the centre every week.
He said he had been “going into a really dark place”, but that the continuity of the calls “helps to build your confidence and lessen your anxiety”.
“It has really helped me an awful lot,” he continued.
“The staff are absolutely brilliant for caring, it’s not just a job, it’s a vocation.
“It’s something they look forward to and they get as much out of helping us as we do from receiving help and it all sort of balances out in the end.”
Volunteer Sandra said the people she speaks to have become friends
Although the service was established primarily to tackle loneliness in older people, many of the volunteers say it has been mutually beneficial.
Sandra McKenna was inspired to begin volunteering about five years ago following her mum’s death.
“My mum had gone out into the community and visited old people in nursing homes and people that were living on their own,” she said.
“When she died, nobody found her until the following night, and it’s stuck with me.
“There’s so many people living out on their on their own and if they had a call, at least we would know that and we could go and do something about it.”
No two calls are the same for volunteers – some may take a few minutes while others can last an hour.
“They’ll tell you things that they might not tell anybody else,” Sandra said.
“It’s just lovely that you become friends.
“That’s like an extended family to me. I really, really love some of them, they’re like replacement mothers nearly for me.”
Yvonne said volunteering has helped grown her own confidence
Volunteer Yvonne Gilmore agrees with this sentiment.
“I really love this work,” she said.
“We’ve actually come to know each other over the years and they’re more like family.
“It has gone from just being ‘Hello how are you doing? Hope you’re keeping alright?’, to lengthy conversations.
“It’s an honour and a privilege whenever they do share things with you.”
Marie Devlin said demand is so high they are constantly trying to recruit volunteers
When the first calls were made from Good Morning Mid Ulster in 2006, four people were registered. That number has now grown to 1,126.
Manager Marie Devlin said she is “very lucky” to have a dedicated pool of callers making up to 800 calls a day with service users ranging from their 50s to 100.
“We have some very loyal volunteers, but you’re all the time trying to recruit,” she said.
“It’s a very difficult job too – the calls can be mentally challenging and we all have to mind our own mental health in order for us to deliver those calls every day.
“I think there is maybe a stigma attached to saying ‘Look, I’m lonely or I feel isolated’.
“We’re trying to dissolve that plight; trying to get people out and about in the community, mixing more in the community, but obviously if they’re not able to do that, then we bring the services to them and to the home.”
Chronic dacryocystitis (CD), primarily resulting from primary acquired nasolacrimal duct obstruction (PANDO), is a prevalent ocular inflammatory condition and a common ophthalmological and nasal-related disorder. Symptoms of CD typically include excessive tearing, purulent discharge, skin swelling in the dacryocyst area, and pain, predominantly affecting women aged 40–60 years.1,2 These symptoms frequently impact patients’ daily lives and diminish their quality of life.
Clinically, it has been observed that patients often exhibit severe symptoms and experience disease courses that may persist for several months or even years when they seek medical treatment. Currently, the pathogenesis of PANDO remains unclear, and there is no effective pharmacological treatment available; thus, surgical intervention is the primary therapeutic approach.3,4 Presently, endoscopic dacryocystorhinostomy (En-DCR) has emerged as the preferred surgical technique for managing PANDO.5–7
Quality of life is defined as individuals’ subjective assessment of their goals, expectations, standards, and concerns within different cultural and value systems. Over the past few decades, vision-related quality of life has garnered increasing attention.8,9 Considering the essential role of vision in everyday activities,10 the symptoms of chronic dacryocystitis (especially excessive tearing) can greatly impair visual clarity and negatively impact overall quality of life. Our previous study has demonstrated that when lacrimal duct obstruction occurs, patients exhibit an excessive production of tears, known as epiphora, which disrupts the stability of the tear film on the ocular surface and may consequently impair visual acuity.11 The National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) is a widely utilized instrument for evaluating vision-related health status and quality of life in individuals with chronic ocular conditions, including cataracts, glaucoma, corneal transplantation, and various surgical interventions.12 Research has also been conducted on its applicability to macular disease, diabetic retinopathy, Graves’ ophthalmopathy, immune-mediated eye disorders, cytomegalovirus retinitis, and other chronic ocular diseases.13–15 The NEI-VFQ-25 effectively captures patients’ psychological states, social functioning, and levels of dependency, demonstrating its broad applicability. Consequently, it has been extensively translated into numerous languages and has been the subject of studies in China.16
Given that CD significantly impacts patients’ quality of life, analyzing the improvement in vision-related quality of life and associated factors before and after En-DCR surgery is of considerable importance.
Method
Participants
This study prospectively enrolled 57 patients diagnosed with CD who were scheduled to undergo En-DCR between August 2023 and December 2023. All surgeries were performed according to the standard En-DCR procedure and were performed by the same senior oculoplastic surgeon. Patients with concurrent ocular diseases affecting visual quality, significant systemic illnesses, inability to cooperate with examinations and surgical procedures, or psychiatric disorders were excluded from the study. Upon enrollment, detailed demographic and clinical information, including gender, age, and disease duration, were meticulously recorded. Comprehensive preoperative assessments were conducted at our institution. Ultimately, 54 patients completed the entire follow-up period, after accounting for those lost to follow-up. With the assistance of local community workers, individuals of the same age and gender who did not have other diseases affecting their quality of life were selected. Concurrently, a control group representative of the general population, matched for age and gender distribution, was established via a home-based questionnaire survey after obtaining informed consent.17
The main project to which this study belongs followed the tenets of the Declaration of Helsinki and was approved by the Medical Ethics Committee of Zhongshan Eye Center, Sun Yat-sen University, Guangzhou, China (2021KYPJ100), which has obtained written informed consent from the participants. The content of this study has been covered by the main project, and the collection of data through questionnaires with the patients’ consent does not impose any additional risk on the treatment of the individuals involved.
Diagnosis of Disease
CD typically arises secondary to nasolacrimal duct obstruction, leading to tear retention within the lacrimal sac and subsequent bacterial infection. The diagnosis of chronic dacryocystitis was confirmed through lacrimal duct irrigation18 and computed tomography dacryocystography (CT-DCG),19 in conjunction with clinical manifestations.
Method of Assessment of Vision-Related Quality of Life
The NEI-VFQ-25 is a widely employed, comprehensive instrument designed to assess vision-related health status and quality of life in individuals with chronic eye conditions. It consists of 25 single-choice items that address 12 dimensions of vision-related quality of life, including general health, general vision, ocular pain, near activities, distance activities, peripheral vision, social functioning, color vision, driving, role difficulties, dependency, and mental health. Each item provides 5–6 response options, corresponding to a score ranging from 0 to 100. All dimensions are equally weighted in the calculation of the overall score, with higher scores indicating an enhanced visual quality of life.20,21 The scale’s universality has facilitated its translation into multiple languages including Chinese for widespread application.
The scale’s broad applicability has enabled its translation into several languages, including Chinese, for extensive use. This study employed the NEI-VFQ-25 to evaluate vision-related quality of life in patients with CD. Assessments were conducted using questionnaires at four time points: prior to surgery, and 1, 3, and 6 months post-surgery. All questionnaires were recorded by the researchers after they asked the participants in detail. The general methodology of this study is illustrated in Figure 1.
Figure 1 This figure shows the general process of this research.
Evaluation of Operative Effect
The impact of the surgical intervention will be assessed six months post-operation. Currently, the efficacy of En-DCR in China is evaluated using the criteria established by Zhou Bing and Tang Xin, which categorize outcomes into three levels: cured, improved, and ineffective. The criteria for determining curative effect are as follows: 1) Cured: the patient exhibits no symptoms of excessive tearing or pus secretion; 2) Improved: the patient continues to experience epiphora but without symptoms of pus secretion; 3) Ineffective: the patient persists with symptoms of both epiphora and pus secretion.22
Statistical Analysis
Continuous variables following a normal distribution are presented as the mean ± standard deviation, while categorical variables are expressed as rates and constituent ratios. The t-test was employed to assess differences in the Visual Quality of Life (VQF) scores before and after surgery, which was normal distribution. Pearson’s correlation coefficient was utilized to examine the relationship between the duration of the disease and changes in VQF scores. A P-value of less than 0.05 was considered indicative of statistical significance. For missing data resulting from loss to follow-up, this sample will be excluded from the final statistical analysis.
Result
Basic Information
In this study, 57 patients with unilateral chronic dacryocystitis were initially enrolled. However, 3 patients were lost to follow-up, resulting in 54 patients completing all follow-up assessments. Baseline characteristics of these patients are presented in Table 1. The mean age of the patients was 51.39±9.35 years, with an average disease duration of 41.09±62.62 months. The cohort included 7 males and 47 females. Surgical outcomes were assessed at a six-month postoperative review, revealing that 34 patients were cured, 16 showed improvement, and 4 exhibited no effect. Of these, 40 patients underwent intraoperative intubation, while 14 did not. Additionally, a control group, matched for age and sex ratio, was included, consisting of 69 participants (10 males and 59 females) with a mean age of 49.26±6.01 years. Statistical analysis indicated no significant differences in age and sex ratio between the control and patient groups (p > 0.05).
Table 1 Baseline Data of Enrolled Patients
Differences in Vision-Related Quality of Life Between Preoperative Patients and the Normal Population
The comparative analysis of vision-related quality of life between the preoperative patient group and the control group revealed significant differences in individual scores (p < 0.0001) (Table 2). Specifically, the patient group exhibited markedly lower scores than the control group across four domains: ocular pain (p = 0.0053), distance activities (p = 0.0251), role difficulties (p = 0.0280), and mental health (p = 0.0044).
Table 2 Comparison of VQF Scores Between Preoperative Patient Group and Control Group
Differences in Vision-Related Quality of Life Before and After Surgery in Patient Group
Following a 6-month follow-up period, it was observed that the VQF scores of patients at 1, 3, and 6 months post-surgery demonstrated varying degrees of improvement compared to preoperative scores (p < 0.05), as illustrated in Figure 2. Notably, at 1 month post-surgery, patients showed significant enhancements in three areas: general health, general vision, and ocular pain. By 3 and 6 months post-surgery, improvements were also noted in general health, general vision, ocular pain, role difficulties, and mental health compared to preoperative assessments. All observed differences were statistically significant (p < 0.05) (Table 3).
Table 3 Comparison of VQF Scores in Patients Before and After Surgery
Figure 2 The variation curve of the VQF score is depicted, with the horizontal axis representing four distinct time points for patient scale evaluation and the vertical axis indicating the average VQF score of the patient cohort at these time points.
Abbreviation: M AF, month after surgery.
Analysis of the Correlation Between the Course of Disease and the Changes in in Vision-Related Quality of Life
Correlation analysis results revealed a negative correlation between the disease course and changes in the VQF score (p < 0.0001, r = −0.6634) (Figure 3).
Figure 3 The correlation analysis between the disease course and VQF score changes is illustrated in the figure, where the abscissa represents the disease course and the ordinate represents changes in the VQF score. #The changes in score were calculated as the VQF score at six months post-surgery minus the pre-surgery VQF score.
Effect of Prosthetic Tube Implantation on in Vision-Related Quality of Life
The findings indicated no significant differences in preoperative VQF scores, VQF scores at six months post-surgery, or changes in scores between the catheterized (all silicone tubing in place) and non-catheterized groups. None of these differences were statistically significant (p > 0.05) (Table 4).
Table 4 Effect of Prosthetic Tube Implantation on VQF Score
Discussion
Chronic dacryocystitis (CD), as an eye condition that does not typically lead to blindness, has historically been under-researched. The etiology of CD primarily involves the obstruction or narrowing of the nasolacrimal duct, often accompanied by secondary infections. Clinical manifestations include persistent epiphora, increased ocular discharge, and purulent exudate. The prevalence of CD is notably higher among middle-aged and elderly females. In its early stages, the disease is frequently asymptomatic, lacking overt signs such as redness, swelling, or pain, which contributes to its frequent underdiagnosis.23 Nonetheless, extant research indicates that impaired lacrimal drainage in individuals with CD compromises the physiological cleaning function of the ocular surface, leading to the accumulation of deleterious substances and disruption of tear film homeostasis.24 Consequently, this may precipitate a cascade of complications, including secondary dry eye syndrome,25 infections, and potentially even blindness.3 With societal advancements and an increased emphasis on quality of life, there has been a growing recognition of CD, leading to heightened awareness and research interest.19
In clinical practice, it has been observed that the majority of patients with CD experience a prolonged disease course, with some cases persisting for months or even years. These patients frequently resort to surgical intervention once the disease significantly impairs their daily life and occupational functioning.6 Such delays in treatment not only exacerbate patient suffering but may also contribute to further disease progression. Our findings indicate that patients who adopt a proactive approach early in the disease trajectory and undergo surgical treatment tend to achieve more favorable outcomes, both in terms of prognosis and subjective quality of life. Previous research has predominantly concentrated on surgical techniques and short-term outcomes, with limited exploration of the relationship between surgical timing and improvements in patients’ quality of life. While research has suggested that surgery can improve quality of life in patients with CD,26 but the scope of assessment is not comprehensive, follow-up period is not long enough.
Furthermore, our prior study demonstrated that epiphora resulting from chronic dacryocystitis can adversely affect patients’ visual quality.11 In this study, we conducted a further examination of the results and discovered that the VQF scores for patients with CD were significantly lower than those of the control group. This finding suggests that the frequent lacrimal tearing associated with the disease adversely impacts patients’ vision-related quality of life, particularly in areas such as ocular pain, distance activities, role difficulties, and mental health.
En-DCR has emerged as a well-established surgical intervention for the treatment of CD.27 Compared to the traditional external approach, En-DCR offers advantages such as reduced surgical trauma, minimal bleeding, and the absence of facial scarring, making it a preferred option among patients. It is associated with high patient satisfaction and demonstrates a success rate exceeding 90%.28 In our study, the procedure’s efficacy rate was 92.59% (including both cured and improved cases). By establishing a channel between the lacrimal sac and the nasal cavity, the procedure facilitates the passage of tears through the lacrimal sac, bypassing the obstructed nasolacrimal duct, and allowing direct flow into the nasal cavity. This effectively alleviates symptoms such as epiphora and increased secretions.29 In the longitudinal assessment of patients following En-DCR, it was observed that postoperative VQF scores exhibited substantial enhancement. At one month post-surgery, there was a notable improvement in patients’ overall health, general vision, and ocular pain. By three and six months postoperatively, significant advancements were also observed in patients’ role-related difficulties and mental health. These findings suggest that En-DCR markedly ameliorates symptoms and enhances vision-related quality of life in individuals with CD.
Correlation analysis revealed a negative association between the duration of the disease and changes in VQF scores (p<0.0001, r=−0.6634). Patients with a prolonged disease course are at an elevated risk of infection due to prolonged obstruction of the lacrimal drainage system, which exacerbates the impact of chronic epiphora and increased secretions on their quality of life. Post-surgical intervention results in significant alleviation or even resolution of symptoms such as tearing and purulent discharge, thereby substantially improving patients’ vision-related quality of life. In certain patients with a prolonged disease course, significant ocular surface damage and severe disruption of tear film homeostasis are often observed. While En-DCR surgery effectively addresses issues related to tear overflow, it may not sufficiently mitigate other daily ocular surface function abnormalities, necessitating more comprehensive examination and treatment. Our research indicates that as the disease advances, patients experience exacerbated symptoms and a more substantial decline in vision-related quality of life. Conversely, patients who underwent surgical intervention earlier in the disease course exhibited greater postoperative improvements in vision-related quality of life, likely due to less pre-existing ocular surface damage.
For patients with anastomotic stenosis and severe lacrimal duct inflammatory reactions, lacrimal duct catheterization is adopted to support the lacrimal duct, maintain the anatomical structure of the anastomosis, and promote tear drainage. Although previous studies have demonstrated that lacrimal duct catheterization can enhance the prognosis of En-DCR,30,31 the impact of intraoperative catheterization on postoperative quality of life remains unexplored. The findings of this study indicate that for patients undergoing intraoperative catheterization (with all silicone tubing in place), the enhancement in their postoperative VQF scores was not significantly different from that of patients who did not undergo catheterization. This suggests that catheterization does not impact the improvement of vision-related quality of life. Therefore, we can decide whether to place a catheter based on the intraoperative situation without worrying about affecting the patient’s quality of life.
Furthermore, it was observed that some patients with a prolonged disease course exhibited postoperative VQF scores exceeding the average values of the normal population. This phenomenon may be attributed to the heightened subjective experiences of these patients, whose quality of life had been substantially impaired by the disease, leading to a pronounced sense of relief and well-being once symptoms were alleviated. Consequently, these patients may experience a level of satisfaction that surpasses that of the general population.
This study has some limitations that need addressing: First, patients with bilateral obstruction typically undergo En-DCR in both eyes through two separate procedures within a month, impacting the evaluation of postoperative vision-related quality of life. Consequently, patients with bilateral disease were excluded from the cohort, leading to a lack of analysis for these cases. Second, the large number of postoperative follow-up visits and questionnaire questions resulted in a slightly insufficient sample size, with some patients not complying and being lost to follow-up. This not only reduces the number of included patients, but also weakens the reliability of statistical analysis and brings about a certain degree of response bias. Larger-sample prospective studies are needed for further validation in the future. Attempting additional studies in different populations and clinical settings would enhance the generalizability of the findings.
Conclusion
CD is a condition that adversely affects patients’ vision-related quality of life, primarily manifesting in ocular pain, difficulties with distance activities, role limitations, and mental health challenges. En-DCR is an effective procedure that can significantly enhance the postoperative vision-related quality of life for these patients. In clinical diagnosis and treatment, early diagnosis and treatment should be prioritized, and medical staff should educate patients to seek timely medical attention after symptoms appear to enhance their quality of life and achieve better surgical outcomes.
Data Sharing Statement
The data used for the analysis are available from the corresponding author upon reasonable request.
Ethics Approval
This study was approved by the Institutional Review Board of the Zhongshan Ophthalmic Center, Sun Yat-sen University, China (No. 2021KYPJ100) and adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from all subjects involved in the study.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
This study was partly supported by the Zhongshan Ophthalmic Center 2024 Innovations in Graduate Education Project (NO.91017-12240013).
Disclosure
The authors declare that they have no conflicts of interest in this work.
References
1. Paulsen FP, Thale AB, Maune S, Tillmann BN. New insights into the pathophysiology of primary acquired dacryostenosis. Ophthalmology. 2001;108(12):2329–2336. doi:10.1016/s0161-6420(01)00946-0
2. Yuksel D, Kosker M, Akoz I, Simsek S. Long-term results of simultaneous bilateral external dacryocystorhinostomy in cases with bilateral dacryostenosis. Seminars Ophthalmol. 2015;30(1):20–24. doi:10.3109/08820538.2013.810282
3. Chakrabarti S, Dasgupta S, Banerjee M, Pal D. Role of histomorphology and chronic inflammation score in chronic dacryocystitis. J Clin Diagn Res. 2016;10(7):EC01–EC03. doi:10.7860/JCDR/2016/19515.8089
4. Ma Y, Wang Z, Zhou G, et al. Comparison of the surgical outcomes of endoscopic dacryocystorhinostomy in chronic dacryocystitis with or without previous bicanalicular silicone tube intubation. Am J Otolaryngol. 2024;45(2):104200. doi:10.1016/j.amjoto.2023.104200
5. Watkins LM, Janfaza P, Rubin PA. The evolution of endonasal dacryocystorhinostomy. Surv Ophthalmol. 2003;48(1):73–84. doi:10.1016/s0039-6257(02)00397-1
6. Hammoudi DS, Tucker NA. Factors associated with outcome of endonasal dacryocystorhinostomy. Ophthalmic Plastic Reconstructive Surg. 2011;27(4):266–269. doi:10.1097/IOP.0b013e31820c72b7
7. Tooley AA, Klingler KN, Bartley GB, et al. Dacryocystorhinostomy for acquired nasolacrimal duct stenosis in the elderly (≥80 Years of Age). Ophthalmology. 2017;124(2):263–267. doi:10.1016/j.ophtha.2016.10.018
8. Assi L, Chamseddine F, Ibrahim P, et al. A global assessment of eye health and quality of life: a systematic review of systematic reviews. JAMA Ophthalmol. 2021;139(5):526–541. doi:10.1001/jamaophthalmol.2021.0146
9. Lin L, Yang L, Jin X, Zhao Y, Fan F. Management lacrimal sac abscesses using lacrimal probe and crawford silicon tube. BMC Ophthalmol. 2016;16(1):211. doi:10.1186/s12886-016-0378-y
10. Enander JMD, Spanne A, Mazzoni A, Bengtsson F, Oddo CM, Jörntell H. Ubiquitous neocortical decoding of tactile input patterns. Front Cell Neurosci. 2019;13:140. doi:10.3389/fncel.2019.00140
11. Meng Z, Chen R, Cao S, et al. Quality of vision in eyes with chronic dacryocystitis after endoscopic dacryocystorhinostomy. Clin Ophthalmol. 2023;17:3729–3737. doi:10.2147/OPTH.S441094
12. Wan Y, Zhao L, Huang C, et al. Validation and comparison of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and the Visual Function Index-14 (VF-14) in patients with cataracts: a multicentre study. Acta Ophthalmol. 2021;99(4):e480–e488. doi:10.1111/aos.14606
13. Trento M, Durando O, Lavecchia S, et al; EUROCONDOR trial investigators. Vision related quality of life in patients with type 2 diabetes in the EUROCONDOR trial. Endocrine. 2017;57(1):83–88. doi:10.1007/s12020-016-1097-0
14. Garweg JG, Stefanickova J, Hoyng C, et al; AQUA Investigators. Vision-related quality of life in patients with diabetic macular edema treated with intravitreal aflibercept: the AQUA Study. Ophthalmol Retina. 2019;3(7):567–575. doi:10.1016/j.oret.2019.03.012
15. Ng H, Vermeer KA, van Meurs JC, La Heij EC. Visual acuity inadequately reflects vision-related quality of life in patients after macula-off retinal detachment surgery. Invest Ophthalmol Visual Sci. 2020;61(10):34. doi:10.1167/iovs.61.10.34
16. Wang CW, Chan CL, Jin HY. Psychometric properties of the Chinese version of the 25-item national eye institute visual function questionnaire. Optometry Vision Sci. 2008;85(11):1091–1099. doi:10.1097/OPX.0b013e31818b9f23
17. Ezhumalai S. Outcome of camp approach in treatment of alcohol use disorder: a non-randomized controlled study. J Psychiatry Spectr. 2024;3(2):101–109. doi:10.4103/jopsys.jopsys_48_23
18. Shen X, Huang C, Wang S, Wen J. Optimisation of reduction for prolapsed silicone tube after lacrimal intubation. J Laryngology Otol. 2024;138(5):535–539. doi:10.1017/S0022215123001706
19. Eshraghi B, Abdi P, Akbari M, Fard MA. Microbiologic spectrum of acute and chronic dacryocystitis. Int J Ophthalmol. 2014;7(5):864–867. doi:10.3980/j.issn.2222-3959.2014.05.23
20. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD; National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001;119(7):1050–1058. doi:10.1001/archopht.119.7.1050
21. Nickels S, Schuster AK, Singer S, et al. The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) – reference data from the German population-based Gutenberg Health Study (GHS). Health Qual Life Outcomes. 2017;15(1):156. doi:10.1186/s12955-017-0732-7
22. Li M, Li W, Sha Q, Yu L, Wang X. Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. Medicine. 2024;103(3):e36934. doi:10.1097/MD.0000000000036934
23. Ali MJ, Kamal S, Gupta A, Ali MH, Naik MN. Simple vs complex congenital nasolacrimal duct obstructions: etiology, management and outcomes. Int Forum Allergy Rhinol. 2015;5(2):174–177. doi:10.1002/alr.21435
24. Marcet MM, Shtein RM, Bradley EA, et al. Safety and efficacy of lacrimal drainage system plugs for dry eye syndrome: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(8):1681–1687. doi:10.1016/j.ophtha.2015.04.034
25. Yu X, Wang K, Hu Y, et al. Dry eye and decreased tear film stability in primary acquired nasolacrimal duct obstruction patients. Int Ophthalmol. 2024;44(1):277. doi:10.1007/s10792-024-03204-8
26. Ali MJ, Iram S, Ali MH, Naik MN. Assessing the outcomes of powered endoscopic dacryocystorhinostomy in adults using the Lacrimal Symptom (Lac-Q) questionnaire. Ophthalmic Plast Reconstr Surg. 2017;33(1):65–68. doi:10.1097/IOP.0000000000000660
28. Nowak R, Ali MJ. Experience of the first three years of independent practice following surgical training: time taken and long-term outcomes of powered endoscopic dacryocystorhinostomy. Seminars Ophthalmol. 2023;38(7):665–669. doi:10.1080/08820538.2023.2195025
29. Torabi P, Stenstrom B, Larsson AM, Bjornberg P, Svensson C, Engelsberg K. Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q). Med Hypothesis Discov Innov Ophthalmol J. 2023;12(2):55–61. doi:10.51329/mehdiophthal1470
30. Evereklioglu C. Primary probing with and without Monoka Silastic stent intubation for epiphora in older children and adults. Curr Eye Res. 2020;45(1):87–90. doi:10.1080/02713683.2019.1643026
31. Orsolini MJ, Schellini SA, Souza Meneguim RLF, Catâneo AJM. Success of endoscopic dacryocystorhinostomy with or without stents: systematic review and meta-analysis. Orbit. 2020;39(4):258–265. doi:10.1080/01676830.2019.1677726
(Reuters) -Dormakaba reported a higher than expected full-year profit on Tuesday, as cost-cutting measures helped the Swiss security and access group cushion the impact of softer demand in the residential and automotive markets and uncertainty over U.S. import tariffs.
The company, whose entrance systems can be found in venues such as offices, airports and sports stadiums, reported adjusted net profit of 188 million Swiss francs ($234 million) for the year that ended on June 30, beating analysts’ average estimate of 176 million francs provided by the company.
Dormakaba forecast organic sales growth of between 3% and 5% for the 2025/26 financial year, compared with the 4.1% growth it saw in the past year. It expects its adjusted core profit (EBITDA) margin to exceed 16%, up from the 15.5% it reported for the prior year.
It also said that lower interest rates in Europe and higher investments in Germany and the U.S. presented growth opportunities for the current fiscal year.
The company’s board proposes an annual dividend of 9.20 Swiss francs, up 15% from a year earlier, and intends to at least maintain the dividend per share each year, Dormakaba said in the press release.
($1 = 0.8019 Swiss francs)
(Reporting by Maria Rugamer and Bernadette Hogg in Gdansk, editing by Milla Nissi-Prussak)
Heavy torrential rains have unleashed flash floods in local streams and water channels across Buner, causing a dangerous surge in water flow and creating panic among residents.
According to the district administration, the worsening situation has prompted the issuance of a high alert to manage potential emergencies and ensure public safety. Rainwater has already entered local market areas, forcing shopkeepers and residents to evacuate to safer locations.
Deputy Commissioner Buner confirmed that the ongoing downpour has significantly increased the risk of further flooding in the area. He said emergency measures are being implemented to safeguard lives and property, while authorities remain on high alert and continue to closely monitor the situation.
The administration has urged citizens to remain cautious and cooperate with rescue and relief teams as the heavy rainfall persists.
