2014年 · 第127卷第08期

With a volume of about 6 ml and weight of approximately 6 g,the eye makes out only 1/10 000 part of the body.Despite this minuscule proportion of the eye on the whole body,quality of life is profoundly influenced by the quality of vision.It shows the high importance of ophthalmology in the field of public health in general and in clinical medicine in particular。

Age-related macular degeneration (AMD) is the leading cause of legal blindness in the developed world.Evidence suggests that 10％ of individuals in western countries aged 65-74 years and 30％ of those aged 75-85 years show signs of AMD.1,2 The reported prevalence of AMD in Chinese cities is similar:15.5％ in Shanghai and 11.1％ in Taiwan among the people over 50 years of age.3,4 With cataract and glaucoma now being under control,China's AMD challenge is looming over the horizon。

Neovascular glaucoma (NVG) is a blinding,intractable disease,which is difficult to manage.It is referred to as an "end-stage" ocular disease.Conventional treatments for extremely uncontrolled NVG cases include retinal cryotherapy or enucleation.Major advancements in the diagnosis and the treatment of NVG,such as glaucoma drainage implant surgery and anti-vascular endothelial growth factor (anti-VEGF) treatment,have led to a new era in the management of this condition.However,many challenges still remain to be overcome。

Abstract：Background MicroRNAs (miRNAs) contribute to tumorigenesis by acting as either oncogenes or tumor suppressor genes.In this study,we investigated the role of miR-145 in the pathogenesis of uveal melanoma.Methods Expression profiles of miRNAs in uveal melanoma were performed using Agilent miRNA array.Quantitative real-time polymerase chain reaction was used to screen the expression levels of miR-145 in normal uveal tissue,uveal melanoma tissue,and uveal melanoma cell lines.Lenti-virus expression system was used to construct MUM-2B and OCM-1 cell lines with stable overexpression of miR-145.Cell proliferation,cell cycle,and cell apoptosis of these miR-145 overexpression cell lines were examined by MTT assay and flow cytometry respectively.The target genes of miR-145 were predicted by bioinformatics and confirmed using a luciferase reporter assay.The expression of insulin-like growth factor-1 receptor (IGF-1R),insulin receptor substrate-1 (IRS-1) proteins was determined by Western blotting analysis.IRS-1 was knocked down in OCM-1 cells.TUNEL,BrdU,and flow cytometry assay were performed in IRS-1 knocked down OCM-1 cell lines to analyze its function.Results Forty-seven miRNAs were up regulated in uveal melanoma and 61 were down regulated.miR-145 expression was significantly lower in uveal melanoma sample and the cell lines were compared with normal uveal sample.Overexpression of miR-145 suppressed cell proliferation by blocking the G1 phase entering S phase in uveal melanoma cells,and promoted uveal melanoma cell apoptosis.IRS-1 was identified as a potential target of miR-145 by dual luciferase reporter assay.Knocking down of IRS-1 had similar effect as overexpression of miR-145.Conclusion miR-145 might act as a tumor suppressor in uveal melanoma,and downregulation of the target IRS-1 might be a potential mechanism。

Abstract：Background Neovascular glaucoma is a refractory disease,and difficult to manage.The aim of this study was to evaluate the clinical outcomes of Ahmed glaucoma valve implantation (AGVI) in neovascular glaucoma (NVG) and nonNVG patients.Methods This prospective,non-randomized study included 55 eyes of 55 patients with refractory glaucoma; 27 had NVG (NVG group) and 28 had non-NVG (non-NVG group).All of the patients underwent AGVI.The NVG group was adjunctively injected with intravitreal ranibizumab/bevacizumab (IVR/IVB) before AGVI.Intraocular pressure (IOP) was the primary outcome measure in this study.Surgical success rate,number of antiglaucoma medications used,best corrected visual acuity (BCVA),and postoperative complications were analyzed between the groups.Results All of the patients completed the study (follow-up of 12 months).Kaplan-Meier survival curve analysis indicated that the qualified success rates in the NVG and non-NVG groups at 12 months were 70.5％ and 92.9％,respectively; this difference was significant (P=0.036).The complete success rates in the NVG and non-NVG groups at 12 months were 66.7％ and 89.3％,respectively (P=0.049).Compared with preoperative examinations,the postoperative mean IOP and use of medications were significantly lower at all follow-up time points in both groups (all P ＜0.05).There were significant differences in BCVA between the two groups at the 12-month follow-up (x2=9.86,P=0.020).Cox proportional hazards regression showed NVG as a risk factor for surgical failure (RR=15.08,P=0.033).Postoperative complications were similar between the two groups.Conclusions AGVI is a safe and effective procedure in refractory glaucoma,but the success rate of surgery was related to the type of refractory glaucoma.The complete and qualified success rates of NVG patient adjunctive anti-vascular endothelial growth factor treatment are still lower than those of non-NVG patients。

Abstract：Background Diabetic macular edema (DME) is one of the major causes of visual impairment in patients with diabetes mellitus.DME shows a variety of clinical characteristics with unpredictable results to treatment.The purpose of this study was to investigate the characteristics of fundus autofluorescence (FAF) in DME,which is a rapid,noninvasive technique for fundus diseases.Methods A total of 18 patients (30 eyes) with clinically significant macular edema (CSME) were enrolled.FAF imaging was performed with a confocal scanning laser ophthalmoscope.Other ophthalmic examinations included best corrected visual acuity (BCVA),MP-1 microperimetry,and spectral-domain optical coherence tomography (SD-OCT).Main outcome measurements included BCVA,macular sensitivity (MS),central retinal thickness (CRT),central retinal volume (CRV),the integrity of the inner segment-outer segment junction (IS/OS),and the integrity of the external limiting membrane (ELM).Results Among the 30 eyes,four eyes (13.3％) had normal foveal FAF and 26 eyes (86.7％) had abnormal FAF.Abnormal FAF was mainly divided into three types:cystoid increased FAF (iFAF) 16 eyes (53.3％),spot iFAF six eyes (20％),irregular decreased FAF (dFAF) four eyes (13.3％).According to the FAF morphology,patients were categorized into four groups:normal,cystoid iFAF,spot iFAF,and irregular dFAF.There was a significant difference in BCVA (P ＜0.001) and MS (P ＜0.05) among the four groups.The visual function of patients with spot iFAF and irregular dFAF was relatively poor.However,there was no difference in CRT (P=-0.186) and CRV (P=0.191) among the four groups.In the normal FAF group,the photoreceptor layers were mostly intact.Regarding the cystoid iFAF group,the photoreceptor layers were relatively intact,while in the other two groups,IS/OS and ELM were disrupted in most patients.No one had intact IS/OS or ELM layer.Conclusions FAF might reflect the damage of the retina and had a relationship with visual function as well as photoreceptor integrity,which gives new insight into the evaluation of DME.Dynamic FAF monitoring helps to better evaluate the disease progression of DME as well as visual function。

Abstract：Background The extent of our knowledge of the epidemiology of pediatric glaucoma in China is limited.To better characterize the epidemiology of pediatric glaucoma in eastern China,we report the clinical profile,etiologies,and treatment modalities in patients ＜18 years of age in Shanghai Eye,Ear,Nose and Throat Hospital.Methods The medical records of patients presenting glaucoma between January 2003 and December 2010 were retrospectively reviewed.The demographic characteristics,the proportion of different glaucoma subtypes and surgical precedures were collected and analyzed.Results A total of 1 142 eyes of 734 pediatric patients (500 males)were included.Congenital glaucoma was the leading subtype,accounting for 47.55％ of all patients.The ratio of boys to girls was 2.5:1.Patients with congenital glaucoma affecting both eyes accounted for 72.5％ of all patients examined.Patients with primary juvenile glaucoma were the second most common group (n=125,17.03％).Traumatic glaucoma was the third most common subtype (n=81,11.03％).The type of surgery was related to the subtype of glaucoma.Conclusions Congenital glaucoma,primary juvenile glaucoma,and traumatic glaucoma are the most prevalent subtypes in pediatric glaucoma patients in Shanghai Eye,Ear,Nose and Throat Hospital.The characteristics of congenital glaucoma in China are similar to those in Western countries。

Abstract：Background With the increasing popularity of cosmetic facial filler injections in recent years,more and more associated complications have been reported.However,the causative surgical procedures and preventative measures have not been studied well up to now.The aim of this stady was to investigate the clinical characteristics and visual prognosis of fundus artery occlusion resulting from cosmetic facial filler injections.Methods Thirteen consecutive patients with fundus artery occlusion caused by facial filler injections were included.Main outcome measures were filler materials,injection sites,best-corrected visual acuity (BCVA),fundus fluorescein angiography,and associated ocular and systemic manifestations.Results Eleven patients had ophthalmic artery occlusion (OAO) and one patient each had central retinal artery occlusion (CRAO) and anterior ischemic optic neuropathy (AION).Injected materials included autologous fat (seven cases),hyaluronic acid (five cases),and bone collagen (one case).Injection sites were the frontal area (five cases),periocular area (two cases),temple area (two cases),and nose area and nasal area (4 cases).Injected autologous fat was associated with worse final BCVA than hyaluronic acid.The BCVA of seven patients with autologous fat injection in frontal area and temple area was no light perception.Most of the patients with OAO had ocular pain,headache,ptosis,ophthalmoplegia,and no improvement in final BCVA.Conclusions Cosmetic facial injections can cause fundus artery occlusion.Autologous fat injection tends to be associated with painful blindness,ptosis,ophthalmoplegia,and poor visual outcomes.The prognosis is much worse with autologous fat injection than hyaluronic acid injection。

Abstract：Background The common pathological characteristics of corneal injury include inflammatory factors activation,vascular endothelial cells or inflammatory cells infiltration into lesions,corneal edema,corneal neovascularization (CNV),and scar formation.PEDF-34 is the functional fragment of pigment epithelium-derived factor (PEDF) that has anti-angiogenic and anti-inflammatory properties and contains an N-terminal 34-amino acid peptide.This study was to investigate the antiinflammatory effects of PEDF-34 on H2O2-induced corneal injury in vitro.Methods After cultured in H2O2 (0.1 mmol/L) for 2 hours,human corneal fibroblasts (HCFs) and human umbilical vein endothelial cells (HUVECs) were treated with PEDF-34-nanoparticles (NPs) at different concentrations (0.1,0.5,1.0,2.0 μg/ml) or 2.0 μg/ml control-NPs for 24 hours.The viable cells were quantified using the MTT assay.Western blotting or ELISA analysis was performed for measuring the human vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) expression of both HCFs and HUVECs.VEGF and nuclear factor κB (NF-κB) mRNA levels of HCFs were semi-quantified by RT-PCR.Results The survival rates of HCFs or HUVECs stimulated by H2O2 did not decrease significantly (P ＞0.05) compared to those in the normal conditions.As compared to control-NP group,PEDF-34-NPs had dose-dependent inhibitive effect on HUVECs with the MTT assay,but not HCFs.Western blotting analysis showed that the VEGF and ICAM-1 levels in the HCFs and HUVECs stimulated by H2O2 were significantly higher than those in the normal conditions,which were decreased dramatically in those treated with PEDF-34-NPs.RT-PCR analysis revealed that the VEGF mRNA and NF-κB mRNA levels increased in H2O2-stimulated HCFs,while both of them decreased in PEDF-34-NP groups dose dependently.Conclusions PEDF-34-NPs may play an important role in regulating the NF-κB pathway,inhibiting inflammatory activity.PEDF-34-NPs may be a potential new drug for treating corneal injury in the future。

Abstract：Background The performance of computed tomography X-ray absorptiometry (CTXA) against the dual energy X-ray absorptiometry (DXA) as standard has not been studied in Chinese population.The aim of this study was to evaluate the precision of this measurement and validate the value of quantitative computed tomography (QCT) by comparing CTXA results with DXA results in an elderly Chinese population.Methods One hundred and three females of 46 to 76 years old and 49 males of 52 to 76 years old were recruited from the Prospective Urban Rural Epidemiology study.All subjects underwent hip scans by both QCT and DXA on the same day.For precision determination,30 subjects had duplicate DXA hip scans.The hip QCT data of a subset of 27 subjects were separately analyzed by two observers and reanalyzed by one observer at a different time.The inter-and intra-observer variations of CTXA measurement were assessed,and the difference and correlation between CTXA and DXA results were analyzed.Results The inter-and intra-observer variations of CTXA were 0.070 and 0.024 g/cm2 in the femoral neck (FN),and 0.030 and 0.012 g/cm2 in the total hip (TH),which were comparable to the DXA inter-scan variations (0.013 g/cm2 for FN and 0.014 g/cm2 for TH).The results of CTXA bone mineral density (BMD) were highly correlated with those of DXA (R2 =0.810 for FN and R2=0.878 for TH).The BMD values of CTXA in FN and TH were lower than those of DXA by 21.0％ and 17.8％ (P＜0.05),respectively.However,after appropriate transformation,the difference was eliminated and a comparable T score could be obtained.Conclusions CTXA shows good agreement with DXA for the measurement of BMD in the proximal femur,which makes QCT suitable for the quantification of bone mineral content in the hip and helpful for the diagnosis of osteoporosis。

Abstract：Background The advent of targeted therapy has proved a milestone in the history of metastatic renal cell carcinoma treatment,and several guidelines now recommend sunitinib as first-or second-line treatment.But little is known about its efficacy in Asian patients.The aim of this article was to evaluate the efficacy of sunitinib monotherapy in patients with metastatic renal cell carcinoma treated at two Chinese centers.Methods One hundred and forty-one patients with metastatic renal cell carcinoma were included in the study.Of them,119 patients received single-agent sunitinib as first-line therapy and the remaining 22 patients received it as second-line therapy.One hundred and twenty patients received sunitinib in a dosage of 50 mg orally once daily on a 4-2 schedule (4 weeks on treatment,2 weeks off),while 21 patients received 37.5 mg/day continuously until either disease progression or unacceptable toxicity occurred.The overall response rate,survival outcomes,and safety were evaluated.Results Over a median follow-up time of 23 months (16 cycles; range 2-45 months),complete responses,partial responses,and stable disease lasting two cycles or longer were achieved in 2.8％,24.1％,and 60.3％ of patients respectively (objective response rate 26.9％; overall benefit 87.2％).The median progression-free survival was 14.2 months (range 3-39 months).During the study,53 patients died and the median survival time was 13.5 months (range 7-25 months).Dose modification or treatment interruption due to adverse events was required in 36.9％ of the patients.The most common adverse events were hand-foot syndrome (71.4％),thrombocytopenia (68.8％),hypertension (47.1％),and fatigue (46.3％).Conclusion Sunitinib had a favorable efficacy/tolerability profile in Chinese patients with metastatic renal cell carcinoma。

Abstract：Background Endometrial carcinoma is one of the most common gynecological cancers and the incidence has been increasing.This study was to identify the relationship of estrogen receptor (ER),progestrone receptor (PR),P53 protein,Ki-67 and phosphatase and tensin homolog deleted on chromosome ten (PTEN) with endometrial carcinoma,the assessment of these biomarkers and their association with clinicopathological parameters was performed.Methods A total of 198 cases of primary endometrial carcinoma were investigated for ER,PR,Ki-67,P53,and PTEN antigens by immunohistochemical methods.The association of these markers with age,menopause status,histological type,FIGO stage,grading,depth of invasion,lymph node involvement and serum tumor marker was examined.Results The percentages of Ki-67-and P53-negative endometrial tumors were significantly higher in ER-positive compared with ER-negative tumors (both P=0.O00).The same trend was evident with PR status.The percentage of PTEN-positive tumors was significantly higher in PR-positive compared with PR-negative tumors (P=0.021),but was no difference in tumors with different ER status.There was no clear association between PTEN positivity and clinicopathological parameters except more relevance with endometrioid histotype (P=0.013).There was a statistically significant difference in the distribution of the different combined biological factors examined in disease-free survival.Conclusions ER and PR status were significant predictors with staging,grading and recurrence.P53 and Ki-67 expression were inversely correlated with both ER and PR expression and have more aggressive clinicopathological features.PTEN expression was inversely correlated with PR expression but not with ER expression.The combined type of ER+PR+P53-PTEN+ was in the majority in endometrial cancer and seemed to be related to better clinical outcome.The combination of ER-PR-P53+PTEN-represented the worst disease-free survival and was strongly associated with poorest survival rate。

Abstract：Background Personalized medicine becomes essential in lung cancer treatment,however lung-cancer-related gene expression profiles in Chinese patients remain unknown.In this study,the correlation of gene expression profiles and clinical characteristics in non-small-cell lung cancer (NSCLC) was investigated.Methods Seventy-six Chinese patients with NSCLC were enrolled in the study to investigate mRNA expression profiles of excision repair cross complement group 1 (ERCC1),thymidylate synthetase (TYMS),ribonucleotide reductase (RRM1),class Ⅲ β-tubulin (TUBB3),and epidermal growth factor receptor (EGFR) genes and their correlation with patient clinical characteristics.A novel liquidchip technology was used to detect mRNA expression levels in formalin fixed paraffin embedded tumor pathology samples.The relationships between gene expression and clinical characteristics were assessed using the Mann-Whitney test.Results ERCC1 mRNA levels were higher in tumors from patients with metastatic disease than patients with nonmetastatic disease (P=0.021),and higher in adenocarcinomas than squamous cell carcinomas (P=0.006).Increased TUBB3 mRNA expression levels were found in patients with performance status (PS) 1 in comparison with PS 0 (P=0.049),with poorly differentiated tumors in comparison with tumors that were moderately and well differentiated (P ≤0.000 1),and with advanced stage in comparison with early stage disease (P≤0.000 1).Conclusions ERCC1 mRNA levels were higher in metastatic adenocarcinoma NSCLC; TUBB3 mRNA levels were significantly higher in poody differentiated tumors and in advanced stage NSCLC,which indicates the poor prognosis。

Abstract：Background Helicobacter pylori (Hp) is a common and potentially curable cause of gastric mucosa lesion.This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years.Methods From an initial group of 1 006 adults,552 Hp-positive subjects were randomly assigned to a treatment group (T;n=276) or a placebo group (P; n=276).In the randomized,double-blind,placebo-controlled,parallel trial,T group subjects received oral doses of omeprazole,amoxicillin and clarithromycin for 1 week; those in the P group received a placebo.One month after treatment ended,a 13C urea breath test was performed,and Hp was undetectable in 88.89％ of the T group.All subjects were followed at 1,5,8,and 10 years after treatment,with endoscopy and biopsies for histological examination.Results Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years.Glandular atrophy and intestinal metaplasia (IM) had deteriorated in both groups during ten years.However,the increased score of glandular atrophy at both the gastric antrum and corpus,and IM only at the gastric antrum,in the P group was more obvious than that in the T group.During the 10 years,9 patients were diagnosed with gastric cancer (2 in the T group; 7 in the P group; P=0.176).When mucosal atrophy was absent at the gastric antrum and corpus when entering the study,the incidence of gastric cancer in the P group (n=6) was much higher than that in the T group (n=0,P=0.013).Conclusions Hp eradication may significantly diminish and help halt progression of gastric mucosal inflammation and delay the development of IM and atrophy gastritis.Hp eradication is helpful for reducing the risk for gastric cancer,especially in the early stage of Hp infection。

Abstract：Background Advances in transplantation immunology show that the balance between dendritic cells (DCs) and their subsets can maintain stable immune status in the induction of tolerance after transplantation.The aim of this study was to investigate if DCs and DC subpopulations in recipient peripheral blood are effective diagnostic indicators of acute rejection following kidney transplantation.Methods Immunofluorescent flow cytometry was used to classify white blood cells (WBCs),the levels of mononuclear cells and DCs (including the dominant subpopulations,plasmacytoid DC (pDC) and myeloid DC (mDC)) in peripheral blood at 0,1,7,and 28 days and 1 year after kidney transplantation in 33 patients.In addition,the blood levels of interleukin-10 (IL-10) and IL-12 were monitored before and after surgery.Fifteen healthy volunteers served as normal controls.Patients were undertaking hemodialysis owing to uremia before surgery.Results The total number of DCs,pDC,and mDC in peripheral blood and the pDC/mDC ratio were significantly lower in patients than controls (P ＜0.05).Peripheral DCs suddenly decreased at the end of day 1,then gradually increased through day 28 but remained below normal levels.After 1 year,levels were higher than before surgery but lower than normal.The mDC levels were higher in patients with acute rejection before and 1 day after surgery (P ＜0.005).There was no significant difference in IL-10 and IL-12 levels between patients with and without acute rejection.Conclusion The changes in DCs and DC subpopulations during the acute rejection period may serve as effective markers and referral indices for monitoring the immune state,and predicting rejection and reasonably adjusting immunosuppressants。

Abstract：Background Sepsis-induced myocardial injury (SIMI) is caused by a variety of mechanisms.The aim of the study is to investigate the effects of metalloproteinase-8 (MMP-8) on SIMI and its mechanisms in rats.Methods Forty male Sprague Dawley rats were randomly divided into four groups:MMP-8 inhibitor (M8I),dexamethasone (DEX),sepsis,and sham groups.The sepsis model was established by cecal ligation and puncture (CLP).Rats in the M8I group immediately received an intraperitoneal injection of M8I (0.1 mg/kg) after CLP.Rats in the DEX group immediately received an intraperitoneal (IP) injection of DEX (2 mg/kg).Rats in the sepsis and sham groups received intraperitoneal injections of normal saline.Rats were sacrificed 12 hours after CLP.Paraffin sections were stained with hematoxylin and eosin to observe the myocardium.The myocardial ultrastructure was observed with transmission electron microscopy.MMP-8,tumor necrosis factor-α (TNF-α),and interleukin-1β (IL-1β) were detected by immunohistochemistry.The expression of MMP-8 was measured by Western blotting.TNF-α and IL-1β levels in serum and myocardial tissue were determined by enzyme-linked immunosorbent assay.Results Compared with the sham group,the myocardium in the sepsis group was seriously injured.MMP-8,TNF-α and IL-1β expression was higher in the sepsis group than in the sham group.Treatment with M8I or DEX,however,attenuated sepsis induced histopathological changes in the heart,and was associated with significant reductions in serum and myocardial levels of TNF-α and IL-1β (P ＜0.05).M8I significantly inhibited MMP-8 expression in myocardial tissue (P ＜0.05).In addition,treatment with DEX was not associated with a change in myocardial levels of MMP-8 (P ＞0.05).Conclusion MMP-8 inhibitor attenuated myocardial injury in septic rats,which might be related to reduced expression of TNF-α and IL-1β。

Abstract：Objective This review aims to summarize the progress of current clinical studies in ocular angiogenesis treated with antivascular endothelial growth factor (VEGF) therapy and to discuss the benefits and challenges of the treatment.Data sources Pubmed,Embase and the Cochrane Library were searched with no limitations of language and year of publication.Study selection Clinical trials and case studies presented at medical conferences and published in peer-reviewed literature in the past decade were reviewed.Results Anti-VEGF agents have manifested great potential and promising outcomes in treating ocular neovascularization,though some of them are still used as off-label drugs.Intravitreal injection of anti-VEGF agents could be accompanied by devastating ocular or systemic complications,and intimate monitoring in both adult and pediatric population are warranted.Future directions should be focused on carrying out more well-designed large-scale controlled trials,promoting sustained duration of action,developing safer and more efficient generation of anti-VEGF agents.Conclusions Anti-VEGF treatment has proved to be beneficial in treating both anterior and posterior neovascular ocular diseases.However,more safer and affordable antiangiogenic agencies and regimens are warranted to be explored。

Abstract：Objective The aim of this review is to comprehensively and unbiasedly summarize the improvements in the techniques for classical corneal collagen cross-linking (CXL) by covering the reasons for this improvement,measure,and effect to approach the future direction of the CXL.Data sources All articles used in this review were mainly retrieved from the PubMed database.Study selection Original articles and reviews were selected if they were related to the improvement in the technique of classical CXL.Data were mainly extracted from 94 articles,which are listed in the reference section of this review.Results This innovative research involves every step such as instrument preparation,epithelial management,riboflavin instillation,and UVA irradiation.These clinical and experimental results seem promising.Conclusions CXL treatment is the only recent promising method for preventing the progress of keratoconus.The limitations and potential complications that accompany classical CXL such as corneal thickness limitations,ultraviolet-A (UVA) light injury,and the impact of de-epithelialization encourage people to research new improvements in techniques.While this research needs to be further investigated,we hope our review can help related researchers and patients。

Abstract：Objective This study aimed to review the available literature on vitreomacular traction (VMT) syndrome and propose the future study prospect in this field.Data sources The data used in this review were mainly obtained from articles listed in Medline and Pubmed (1970-2013).The search terms were "vitreomacular traction," "optical coherence tomography," "vitrectomy," and "ocriplasmin."Study selection Articles regarding the pathophysiology,diagnosis,and treatments of VMT were selected and reviewed.Results VMT syndrome is a persistent attachment of vitreous to the macula in eyes with an incomplete posterior vitreous detachment and considered to be an uncommon status which correlated with some other macular disorders.Optical coherence tomography (OCT) can support a new way to examine and classify VMT.Nonoperative and operative intervenes on this disease have been developed recently,especially the intravitreal medical therapy.Conclusions VMT syndrome may be associated with various disorders in the macular region,depending in part on the size and strength of the residual vitreomacular adhesion.Regular OCT monitoring is recommended to detect it.Patients with asymptomatic VMT should be observed for at least 2-3 months; nonoperative treatment with ocriplasmin should be considered when disorders persist; surgery is recommended if VMT-related disease is significant。

Matrix metalloproteinases (MMPs) are members of the family of zinc-dependent endopeptidases.MMPs are active during normal wound healing,but also in serious illnesses,such as cancers.1 Metalloproteinases participate in the inflammatory stage of wound healing by inducing inflammatory factors and assisting in cellular migration.2 However,when MMPs build up during inflammation,3 the wounds can become chronic and fail to reach the remodeling stage.4 Cell apoptosis,cancer,and other life-threatening illnesses can evolve as the condition worsens,causing the wound to remain permanently open.5 Fortunately,the technology of medical biomarkers has shed light on this endless cycle.6 By determining the baseline for metalloproteinase concentrations near wound sites,physicians may understand the severity or presence of certain disease states and the stage of wound healing。

Nephrolithiasis is a common source of morbidity with a lifetime prevalence of 5 ％-10％.Despite technical advances in the treatment of nephrolithiasis,the prevalence of stone disease appears to be increasing.Raised serum and/or urinary uric acid are a well-established risk factor for calculogenesis.Hyperuricemia is a level of uric acid in the blood that is abnormally high.Urinary stones are often found in patients with hyperuricemia.This excess uric acid may lead to the formation of uric acid-related nephrolithiasis.Uric acid-related nephrolithiasis may involve calcium stones,uric acid stones,or a combination of both.In some cases,uric acid crystals act as nucleus and calcium oxalate crystals get deposited around the uric acid nucleus due to epitaxy and lead to uric acid-induced calcium oxalate stones。

Primary undifferentiated embryonal sarcoma (UES)of the liver,also called malignant mesenchymoma of the liver,is a rare hepatic malignancy.It arises from the mesoderm and comprises more than two types of sarcomas.UES can occur at any site of the body;common sites include the retroperitoneum and the lower extremities.Only a few cases of UES have been reported worldwide.1 In this study,we retrospectively examined the clinical data of 11 patients with UES between January 2000 and November 2011 at the People's Liberation Army General Hospital。

For the patients with a relatively slow heart rate,the frequency of opening and closing of biological valves and the number of impact of mechanical stress upon biological valves were relatively less,so the mechanical wear was reduced.The question is whether this can slow the failure and calcification of the biological valve.A retrospective analysis of 92 biological mitral valve replacement (MVR) cases during the period of 1996-2003 was carried out。

Patent foramen ovale (PFO),a congenital cardiac lesion that persists into adulthood,has become the subject of much clinical interest.PFO has been implicated in several serious clinical syndromes,including paradoxical systemic emboli (which contribute to ischemic stroke),myocardial infarction,and complications of pulmonary embolism.Currently,two-dimensional transesophageal echocardiography (TEE) is the standard procedure for diagnosing PFO.The diameter and contrast score have been used to size the PFO.1 None of these techniques is optimal as they are all indirect ways of measuring PFOs.Few data exist on the relation between stroke risk,anatomical characteristics,and physiological behavior.The purpose of our study therefore was to explore the clinical feasibility of sizing or displaying the morphology and physiological behavior of PFOs using three-dimensional TEE。

Thymic carcinoma is a very rare and aggressive malignant tumor.It is indolent and invasive cancer that easily metastasis.Invasive thymoma occurs most commonly into the pleura,pericardium,lungs,and recurrent laryngeal nerve,but invasion into the intracardiac and great vessel is rare.1 We reported a rare case of invasive thymic carcinoma which extended into aorta,pericardium,and right ventricular outflow tract (RVOT),causing right ventricular outflow tract flow acceleration。

Endogenous endophthalmitis (EE) accounts for 2％-15％ of endophthalmitis cases;1 EE may occur when microorganisms from remote infection site enter into the eye by crossing the blood-ocular barrier and reproduce in the eye.It is well known that EE often occurs secondary to systemic underlying condition,such as diabetes mellitus,extraocular infective foci,malignancy,and intravenous drug use (IVDU).Common pathogens of EE are bacteria and fungi.Gram-negative bacterial infections are gradually increasing in the Asian countries,in particular,Klebsiella pneumoniae.This is the first report referring to the case of endogenous Klebsiella pneumoniae panophthalmitis associated with IVDU in China。

To the editor:Merkel cell carcinoma (MCC) is an extremely rare primary neuroendocrine neoplasm of the skin.It occurs more frequently in elderly and immunosuppresed individuals with a male predominance.1 Merkel cell polyomavirus (MCPyV) has been recently associated with MCC,which was described as one of 7 known human oncogenic viruses.2 MCC is characterized by early and rapid metastases,although there are some reported cases with spontaneous regression.3 Mohs micrographic surgery should be considered for treatment of MCC.However,successful treatment still lies in diagnosis and therapy at the early stage of disease,consisting of regular dermatological checkups in older immunocompromised individuals,and early initiation of combination therapy including radical surgical treatment,radiotherapy,and chemotherapy。

To the editor:A 44-year-old Chinese man presented with an 8-year history of central diabetes insipidus and 3-month history of edema in both lower extremities was referred to our department.He developed fever and coughed with sputum after admission.His laboratory tests showed persistent low level of serum calcium (1.78-1.91 mmol/L) and parathyroid hormone (PTH) (10.55 ng/L),indicating hypoparathyroidism.Triiodothyronine (T3) and tetraiodothyronine (T4) were below normal (2.62 and 11.43 pmol/L,respectively),but thyroid-stimulating hormone (TSH) was within normal range (2.69 mIU/L),thus we considered the possibility of secondary hypothyroidism。

To the editor:Primary squamous cell carcinoma of the fallopian tube (PSCCFT) is one of the rarest gynecological malignancies with only ten reported cases in the English language literature.We present the eleventh case and briefly review it. A 64-year-old postmenopausal woman presented with pain and a 6 cm×5 cm mass in the left pelvic.The cancer antigen (CA) 125 was 46.1 1U/L.An enlarged left fallopian tube with 5 cm of diameter was found during the operation.Frozen section diagnosis was squamous cell caicinoma of the left fallopian tube.Surgical staging procedures were performed。

To the editor:We present a male patient,75 years old,admitted to our emergency room with right arm pain for about an hour.The patient had only a history of arterial hypertension.On his physical examination,she had an irregular pulse.The right arm showed hypothermic with cyanotic hand.The right upper limb pulses were not palpable.Her initial electrocardiogram revealed atrial fibrillation with a fast ventricular response.Vascular ultrasound revealed complete occlusion of humeral right artery 2 cm distal to their origin.The patient was subjected to emergency upper limb angiography,and brachial embolus without flow on the right radial and cubital artery was found (Figure 1A)。

To the editor:Severe acute interstitial lung disease is not uncommon during and after irradiation of the lung,but is very rare during crizotinib treatment.We reported here one case of severe acute interstitial lung disease after one month crizotinib treatment. A 53-year-old Chinese male patient with one month dyspnea was admitted to our hospital.He had a smoking history with one pack cigarette a day for 28 years,but denied any other specific family history.Physical examination revealed facial edema,venous distention in the neck,distended veins in the upper chest and arms,enlarged supraclavicular lymph nodes on both sides.Chest CT scan revealed right lung 3.5 cm × 4.5 cm mass with right plural invasion,diffused mediastinal lymph nodes enlargement compressing the superior vena cava。