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Objective: To explore the molecular mechanism of circDDX17 regulating the proliferation and apoptosis of non-small cell lung cancer cells by targeting the miR-223-3p/RIP3 molecular axis. Methods: The expression levels of circDDX17, miR-223-3p, and RIP3 in human normal lung epithelial cell lines BEAS-2B and non-small cell lung cancer cells H1299, A549, and H446 were detected by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The plasmids of pcDNA, pcDNA-circDDX17, anti-miR-con, anti-miR-223-3p, pcDNA-circDDX17 and miR-con, pcDNA-circDDX17 and miR-223-3p mimics were transfected into H1299 cells. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay was used to detect the cell proliferation. Flow cytometry was used to detect the cell cycle and cell apoptosis. Plate cloning experiment was used to detect cell proliferation ability. The dual luciferase report experiment was applied to verify the targeting relationship between miR-223-3p with circDDX17 and RIP3. Western blot was used to detect the protein expression of cyclinD1, CDK2, cleaved caspase-3 and Bax. Results: The expression levels of circDDX17 and RIP3 mRNA in H1299, A549, and H446 cells were significantly reduced ( P <0.05), the expression level of miR-223-3p mRNA was significantly increased ( P <0.05) compared with BEAS-2B. The cell viability [(69.46±4.68)%], the number of cell clones (83.49±7.86), the proportion of cells in S phase [(22.52±1.41) %], the protein expression levels of cyclinD1 and CDK2 in PCDNa-CircDDX17 group were lower than those in pcDNA group [(97.54±7.72)%, 205.03±13.37, (28.69±1.49)%, respectively, P <0.05], while the percentage of G 0 /G 1 phase cells [(64.45±3.56)%], apoptosis rate [(18.36±1.63)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17 group were higher than those of pcDNA group [(51.33±2.76) % and (5.21±0.54) %, respectively, P <0.05]. The viability [(72.64±5.44)%], the number of cell clones (78.16±8.23), the proportion of S-stage cells [(21.34±1.59) %], the protein expression levels of CyclinD1 and CDK2 in anti-miR-223-3p group were lower than those in anti-miR-con group [(103.47±6.25)%, 169.32±14.53, (28.43±1.26)%, respectively, P <0.05]. Percentage of G 0 /G 1 phase cells [(62.86±3.28)%], apoptosis rate [(14.64±1.67)%], the protein expression levels of cleaved caspase-3 and Bax in the anti-miR-223-3p group were higher than those of anti-miR-con group [(51.33±2.71)% and (4.83±0.39)%, respectively, P <0.05]. MiR-223-3p has complementary sites with circDDX17 or RIP3. The viability [(135.45±9.28)%], the number of cell clones (174.64±10.68), the proportion of S-phase cells [(26.39±2.25)%], the protein expression levels of cyclinD1 and CDK2 in pcDNA-circDDX17+miR-223-3p group were higher than those in pcDNA-circDDX17+miR-con group [(101.56±6.68)%, 107.65±7.62, (21.64±1.72)%, P <0.05]. Percentage of G 0 /G 1 phase cells [(56.64±2.76)%], apoptosis rate [(8.34±0.76)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17+miR-223-3p group were lower than those of pcDNA-circDDX17+miR-con group [(64.03±3.48)% and (15.21±1.18)%, respectively, P <0.05]. Conclusion: circDDX17 could inhibit the proliferation and induce apoptosis of non-small cell lung cancer cells via targeting the miR-223-3p / RIP3 molecular axis.

Objective: To investigate the clinical features of pediatric ulcerative colitis (UC) and analyze the risk factors of disease relapse. Methods: The clinical data of 79 children with UC diagnosed in Beijing Children's Hospital, Capital Medical University from January 2016 to February 2021 were retrospectively analyzed. They were divided into early relapse group and non-early relapse group according to the clinical relapse within 12 months after diagnosis. T -test, rank sum test, χ 2 test or Fisher's exact test were used to compare the variables between the 2 groups, including the clinical features, laboratory examination results and treatments. The Logistic regression was used to analyze the risk factors of early relapse. The cumulative relapse rate during follow-up was calculated by Kaplan-Meier method. Results: Among the 79 UC children, 46 were males and 33 were females, and the age of onset was 10.6 (6.4, 12.7) years. The children were mainly characterized by extensive disease (E3) and pancolitis (E4) (51/79, 65%), moderate to severe activity (48/79, 61%) and moderate to severe inflammation of colonic mucosa (71/79, 90%). Thirty-eight (48%) patients had atypical phenotype and 17 (22%) had extraintestinal manifestations. The follow-up period was 43.9 (22.8, 61.3) months, and of the 41 patients rechecked with colonoscopy, 7 (17%) had disease progression. According to Kaplan-Meier analysis, the cumulative relapse rate of the 79 cases at 3 months, 6 months, 1 year and 2 years after diagnosis were 27% (21/79), 47% (37/79), 57% (45/79) and 73% (53/73), respectively. There were 45 children (57%) in early relapse group and 34 (43%) in non-early relapse group. In early relapse group, hemoglobin and mucosal healing rate were both significantly lower (105 (87, 122) vs. 120 (104, 131) g/L, 28% (7/25) vs. 7/9, Z= -2.38, χ²=4.87, both P< 0.05). The rate of steroid-dependent, E3 and step-up therapy during the induction period were all significantly higher than those in non-early relapse group (11/19 vs. 1/12, 24% (11/45) vs. 6% (2/34), 29% (13/45) vs. 6% (2/34), χ²=5.67, 4.85, 6.66, all P <0.05). Multivariate Logistic regression analysis showed that extraintestinal manifestations ( OR= 4.33, 95% CI 1.05-17.83), E3 ( OR= 8.27, 95% CI 1.47-46.46) and step-up therapy during the induction period ( OR= 5.58, 95% CI 1.01-30.77) were independent risk factors for early relapse. Conclusions: Pediatric UC is usually extensive and severe, with atypical phenotype, a high rate of relapse and a risk of disease progression. Extraintestinal manifestations, E3 and step-up therapy during the induction period are independent risk factors for early relapse.

Objective: To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods: The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children's hospitals from 2014 to 2018 were analyzed retrospectively. Results: Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced β-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively. Conclusions: Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.

Objective: To investigate the clinical features, treatment strategies and long term outcomes of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods: The data of clinical features, auxiliary examinations, treatments and prognosis in children with anti-NMDAR encephalitis in Xiangya Hospital of Central South University from March 2014 to October 2017 were collected and retrospectively analyzed. A total of 71 patients were enrolled, including 33 males and 38 females. The youngest age of onset was 4 months old, and the age of onset was (9±4) years. The first-line immunotherapy treatment for anti-NMDAR encephalitis was short course corticosteroid (high-dose impulse therapy and oral maintenance therapy for 1 month in acute period) and (or) immunoglobulin. The clinical evaluation was performed 2 weeks after first-line immunotherapy treatment. The second-line immunotherapy treatment, including rituximab and (or) cyclophosphamide, would be started if the symptoms did not improve significantly and the modified Rankin scale (mRS) score ≥3. All patients were followed up and evaluated for prognosis. T- test, Mann-Whitney U , Chi square test and Fisher's exact probability method were used for comparison between good outcome group and poor outcome group, first-line immunotherapy group and first-line immunotherapy combined with second-line immunotherapy group. Results: The more common clinical manifestations were psychiatric symptoms ( n= 61, 86%), dyskinesia ( n= 55, 77%) and convulsions ( n= 51, 72%). Two cases (3%) had tumors. Electroencephalogram (EEG), cerebro-spinal fluid (CSF) and brain magnetic resonance imaging (MRI) studies were abnormal in 83% (59/71), 39% (27/69) and 38% (27/71) patients, respectively. For the treatment regimens, all the 71 patients underwent first-line immunotherapy, resulting in improvement within 14 days in 40 cases (56%), and 1 case (1%) died. The rest 30 cases (42%) received second-line immunotherapy. The patients were followed up for 5.0-41.8 months, with a median of 19.3 months. At the last follow-up, 49 cases (69%) recovered completely, 15 cases (21%) had mild disability, 6 cases (8%) had severe disability, 1 case (1%) died and 3 cases (4%) had relapse. There were significant differences between the groups with good prognosis and poor prognosis on admission to pediatric intensive care unit (PICU) and consciousness disorder (10/64 vs. 5/7, 39/64 vs. 7/7, P= 0.047, 0.004). There were significant differences between first-line immunotherapy group and the first-line combined second-line immunotherapy group on admission to PICU, consciousness disorder, sleep disorder and first mRS score (12% (5/41) vs. 33% (10/30), 44% (18/41) vs. 93% (28/30), 56% (23/41) vs. 90% (27/30), 3 (1-5) vs. 4 (3-5), respectively; χ(2)=4.645, 18.555, 9.560, Z= 5.184, P= 0.031, <0.01, 0.002, <0.01, respectively). Conclusions: Anti-NMDAR encephalitis can occur in all ages of children. The most common clinical manifestations are psychotic symptoms, dyskinesia and convulsions. Paraneoplastic cases are less common in children. Immunotherapy is effective. The second-line immunotherapy should be given after the failure of first-line therapy (mRS score≥3).

Objective: To summarize the clinical data including manifestations, diagnosis, treatment and prognosis of eosinophilic gastroenteritis (EGE) in children. Methods: A retrospective analysis was performed in 71 patients with pathologically proven EGE at Beijing Children's Hospital Affiliated to Capital Medical University from January 2008 to January 2017. Their clinical manifestations, laboratory and imaging examinations, endoscopic findings, histopathological examinations, and treatment were collected and analyzed. Results: Among 71 EGE cases, 47 (66%) cases were male and 24 (34%) cases were female, and the median age was 9.2 (0.2-16.5) years old. The main clinical manifestations included abdominal pain (76%, 54/71), vomiting (68%, 48/71), anorexia (54%, 38/71), weight loss (38%, 27/71), and diarrhea (37%, 26/71). There were 27 cases (38%) with a history of allergic diseases or family history. The median absolute value of eosinophil in peripheral blood of the 71 patients was 0.4 (0-36.8)×10(9)/L, and 27 cases (38%) showed an increase in eosinophil counts. Serum IgE was measured in 52 patients (104.3 (3.4- 3 000.0)×10(3) U/L), and 30 patients (58%) showed an increase in serum IgE. A large number of eosinophils ((41.0±8.5)/HP) were found in 3 patients' ascites. The endoscopic examination of upper gastrointestinal tract revealed hyperemic edema in 62 cases (87%), plaque in 44 cases (62%), erosion in 17 cases (24%) and ulceration in 16 cases (23%). Histopathologically, in 8 cases (11%) the disease involved both stomach and duodeneum, in 21 cases (30%) involved stomach only, and in 37 cases (52%) involved duodeneum only. In addition, in 6 cases (8%) the disease involved esophagus and in 10 cases (14%) involved colorectum. Microscopically, eosinophil counts averaged 67/HP, 33/HP, 40/HP and 38/HP in esophageal, gastric, duodenal and colorectal mucosa respectively. A total of 34 cases were treated with glucocorticoid, and all these patients had alleviation of symptoms, which occurred within 14.9 days on average, but EGE recurred in 11 cases (32%). Conclusions: The clinical symptoms and endoscopic findings of EGE are diverse and nonspecific. Histopathological examination of gastrointestinal mucosa is particularly important for the diagnosis. Glucocorticoid treatment is effective, but the patients with EGE are prone to relapse.

Objective: To analyze the clinical manifestations, diagnosis, treatment and prognosis of intestinal lymphangiectasia (IL) in children in order to improve the skills of diagnosis and treatment of IL. Method: Clinical manifestations, laboratory findings, gastroscopic findings, histopathological examinations and lymphatic radionuclide imaging assessments were analyzed retrospectively among 47 IL patients who were hospitalized in the Gastroenterology Department of Beijing Children's Hospital Affiliated to Capital Medical University from June 2007 to December 2015. All patients were followed up by telephone. According to the various causes, the patients were divided into the primary intestinal lymphangiectasia (PIL) group and secondary IL group, and their clinical manifestations were compared by t test, Rank sum test or Chi-square test. Result: In 47 IL patients, there were 38 children (81%) younger than 3 years old. There were 43 PIL patients (91%) and 4 secondary IL patients (9%). Between PIL and secondary IL, there were statistical differences in serum albumin ( t=- 3.950, P< 0.005) , globulin( t=- 2.850, P= 0.007), age of onset( U =27.000, P= 0.024), age at diagnosis( U =29.000, P= 0.030) and course of disease( U =26.500, P= 0.023), whereas there were no statistical differences in lymphocyte count, IgG, lymphatic radionuclide imaging, histopathology and gender(all P> 0.05). Edema (44 cases, 94%), diarrhea (42 cases, 89%), accompanied with infection (35 cases, 74%) and ascites (30 cases, 64%) were the main clinical manifestations. In 47 IL patients, 45 patients were done gastroscopy and histopathological examinations, and there were 31 patients' histopathological examinations(69%) were positive. Forty patients were done lymphatic radionuclide imaging, and there was evidence of protein losing from gut via lymphatic radionuclide imaging in 39 patients(98%). Among 47 patients, 35 patients (74%) were followed up, 32 patients had good prognosis, 2 patient failed to show evidence of improvement, 1 patient died and no patient experienced a relapse till the end of the follow-up. In 35 patients, 28 patients were treated with medium chain triglycerides (MCT) dietary therapy, 26 patients showed improvement in symptoms, and 2 patients had no improvement. Among 35 patients with follow-up, there were 6 patients received surgical treatment, and their symptoms were improved. Conclusion: PIL are the majority of IL in children younger than 3 years old. The main clinical manifestations are edema, diarrhea, accompanied with infection and ascites. For the patients without the evidence of lymphangiectasia from duodenum histopathological examination, further consideration of lymphatic radionuclide imaging, clinical manifestations, and laboratory studies are needed to make a final diagnosis. MCT dietary therapy is the cornerstone of IL medical management.

Objective: To investigate the clinical data of children with inflammatory bowel disease (IBD) retrospectively, including Crohn's disease (CD) and ulcerative colitis (UC) and identify the clinical characteristics and trends of change. Method: Clinical data of hospitalized patients diagnosed as IBD in Beijing Children's Hospital from January 2000 to December 2014 were collected and retrospectively analyzed. Patients were divided into six groups based on type of disease and year of admission: Group A1(CD, 2000-2004) included 12 patients, Group B1(CD, 2005-2009) included 11, Group C1(CD, 2010-2014) included 51; Group A2(UC, 2000-2004) included 17, Group B2(UC, 2005-2009) included 25, Group C2(UC, 2010-2014) included 68. Result: A total of 184 IBD patients were included in the study, 74 had CD and 110 had UC. The hospitalization constituent ratio of CD increased from 0.6/10 000 in Year 2000 to 2.9/10 000 in Year 2014. The hospitalization constituent ratio of UC increased from 0.5/10 000 in Year 2001 to 3.9/10 000 in Year 2014. The hospitalization constituent ratios of CD and UC both increased gradually( P <0.05). Up to 61.4%(113/184) of IBD patients belong to early onset IBD, furthermore the very early onset IBD and infantile IBD accounted for 41.8%(77/184) and 26.6%(49/184) respectively. For CD, ileocolonic type(47.3%, 35/74) and non-structuring, non-penetrating type (67.6%, 50/74) were more common. Perianal disease occured in 31.1%(23/74) of CD patients; 81.1%(60/74) of CD patients had moderate/severe activity. For UC, pancolitis type(59.1%, 65/110) was more common. There were no significant changes for location of pathological change, disease behavior, activity degree of CD, extent of UC lesion and incidence of surgery, intestinal perforation and hemorrhage of gastrointestinal tract for IBD in the past 15 years( P >0.05). Severe UC(S3) was more common in Group A2(64.7%, 11/17), but moderate UC(S2) was more common in Group C2(48.5%, 33/68), the difference was statistically significant ( P =0.001 7). Conclusion: During the past 15 years, the hospitalization constituent ratio for IBD in our hospital showed a growing trend. The ratio of infantile IBD and very early onset IBD was high. For CD, perianal disease was commonly seen and most patients had moderate/severe activity. The surgery rate and incidence of intestinal obstruction and perforation were higher in the CD patients than UC patients. For UC, the lesions were more extensively combined with higher disease activity.

Objective: To increase the recognition of pancreatic cystic fibrosis (PCF) in children and facilitate diagnosing and treatment of this rare entity. Method: This is a retrospective analysis of children who presented to Beijing Children's Hospital affiliated to Capital Medical University from January 2010 to December 2015. We describe their clinical features, laboratory testing and management. Result: Eleven children were diagnosed with PCF by genetic testing or sweat chloride test during these 5 years, including 4 boys and 7 girls. Their age ranged from 0.5-14.3 (mean 9.0±3.9) years. Family history was positive in 3 children. Significant clinical findings on presentation were: malnutrition 6, including 2 cases of mild, moderate and severe malnutrition each; diarrhea 4 (yellow mushy or watery stool with frequency ranging from 2-5 times a day), including 1 case of acute diarrhea and 3 of chronic diarrhea, 3 of them had steatorrhea; abdominal pain 3. All of them had pancreatic lesions shown by abdominal ultrasound. Blood tests showed 6 cases had elevated serum amylase and lipase. The main treatment was pancreatic replacement therapy and nutritional support. Conclusion: PCF is rare in children. Malnutrition, diarrhea and abdominal pain are the main clinical manifestations. Treatment is mostly pancreatic enzymes replacement and supportive care.

Objective: To study the effects of transpupillary thermotherapy (TTT) on circumscribed choroidal hemangiomas (CCH)., Methods: It was a retrospective cases series study. One hundred and fourteen cases (114 eyes) in out-patient department were enrolled in the study with 80 male cases and 34 female cases. The age ranged from 16 to 71 yrs with an average at 44 years. Single eye was affected in all cases. Indirect ophthalmoscope, fundus fluorescein angiography (FFA), ultrasound (B) were used for the examination. Treatment was delivered via slit lamp by using an 810 nm diode laser (Irises) with spots or composed spots (larger tumor) covering the whole tumor. If the tumor was located or partly located in the fovea, laser spot should be avoided in the fovea and papillo-macular bundle. The laser power should be lesser (light gray color) in parafovea area. Routine laser spot (gray-white color) was used in perifovea area. A width of 200 µm out of disk border should not be placed by laser spot in paradisk tumor cases., Results: The visual acuity (VA) ≥ 0.5 of pre-and post-treatment was 17 eyes (14.9%) and 27 eyes (23.7%), respectively. Pre-treatment, the retinal detachment extended in the inferior part in 27 cases (23.7%) except on the tumor surface. The tumor was located at macular area in 67 cases (58.8%), around the disc in 35 cases (30.7%), at the temporal arcuate in 12 cases (10.5%). In our cases, VA maintenance with fluid absorption was noted in 76 cases (66.7%) after the treatment. VA improvement with fluid absorption in 28 case (24.6%). Both VA maintenance and improvement (rate of efficiency) with fluid absorption were 91.2%. Fluid non-absorption or VA decline was regarded as unsuccessful in 10 cases (8.8%). The average thickness of 32 cases tumor pre- and post-treatment was (3.90 ± 1.15) mm and (2.41 ± 1.30) mm. Twenty seven cases were followed up for ≥ 1 year (mean 22.8 months) with rate of efficiency at 81.5%. The complications (9 eyes, 7.9%) contained minor macular hemorrhage in 2 eyes, macular pucker in 3 eyes, macular edema and cystoid macular edema in 2 eyes, retinal branch occlusion in 1 eye, and arcuate scotoma in 1 eye., Conclusions: The treatment of TTT on CCH, whether the tumor located around-disc or in foveal area with exudative fluid could get successful in the majority of cases. TTT is one of the treatments worth doing owing to fewer complications, less expenses and easy-doing with definite and persistent effect.

Objective: To report the clinical features of occult macular dystrophy (OMD)., Methods: It was a retrospective case series study. 9 cases (14 eyes) with 3 males, 6 females, mean age 36 (7 to 53) years, were examined with vision acuity, fundus ophthalmoscope, fundus fluorescein angiography (FFA), electroretinogram (ERG), visual evoked potential (VEP), multifocal electroretinogram (mfERG) and optical coherence tomography (OCT). In mf ERG, the amplitude density and implicit time of P1 ring1 and ring2 of the affected eyes were compared with the normal control eyes. The correlation between the implicit time & amplitude density of P1 ring1 & ring2 of the affected eyes and visual acuity were examined., Results: 9 eyes VA were 0.05 to 0.2, 4 eyes were 0.3 to 0.6 and 1 eye it was ≥0.7. All of the 9 cases possessed their unique clinical features, including progressive visual decline, normal fundus, FFA, and F-ERG. Macular function impairment was showed only by mfERG. In mfERG, the results of comparison between the affected eyes and normal control eyes were as follows:On implicit time of P1 ring1, average figure of the affected eye group was (27.67±1.07) ms, the control group was (26.28±1.88) ms. The parameters were significant difference between 2 groups (t=-2.308, P<0.05). On ring1 amplitude density, average figure of the affected eye group was (42.71±15.48) nv/deg2, average figure of the control group was (66.79±14.87) nv/deg2, there was also a significant difference between two groups (t=5.259, P<0.05). On implicit time of ring2, average figure of the affected eye group was (27.80±1.20) ms, average figure of the control group was (26.91±0.82) ms, the results from the 2 groups showed significant difference (t=-2.275, P<0.05). On ring2 amplitude density, average figure of the affected eye group was (24.99±8.49) nv/deg2, average figure of the control group was (39.20±6.47) nv/deg2, there was significant difference between two groups (t=4.943, P<0.05). No correlation was found between the implicit time (r=-0.329, -0.369) & amplitude density (r=0.053, 0.057) of P1 ring1 & ring2 of the affected eyes and visual acuity (P>0.05)., Conclusions: The major signs of OMD are visual acuity decline with normal fundus, FFA and F-ERG, macular function impairment manifested only by mfERG. It's probably a type of cone dystrophy.

Objective: To analyze the clinical characteristics of the patients with pituitary stalk interruption syndrome (PSIS), and to achieve better comprehension of this disease., Method: Data of 13 patients with PSIS were retrospectively analyzed for the clinical, laboratory and imaging features., Result: All the 13 patients (9 male, 4 female) had the chief complaint of growth retardation, 81.5 - 135.0 cm in body height, which were minus two standard deviations below the average of the normal children of same age and same sex. GH stimulated peak levels were all below 5 microg/L; Among them, one was accompanied by delayed sexual development, one by central diabetes insipidus, one was complicated with central hypothyroidism and one was accompanied by central adrenocortical hypofunction., Conclusion: The most remarkable clinical manifestations of patients with PSIS were growth retardation, partial or complete adenohypophyseal dysfunction. MRI revealed absence of pituitary stalk or anterior pituitary hypoplasia with ectopic posterior pituitary gland.

Objective: To assess the clinical features and management of choroidal metastasis., Methods: Fundus examination was performed in 49 patients (66 eyes) with choroidal metastasis. Fundus fluorescein angiography (FFA) was performed in 44 cases, combined with indocyanine green angiography (ICGA) examination in 12 cases. B-scan ultrasound examination was performed in 8 cases. Transpupillary thermotherapy (TTT) was performed in 24 eyes, combined with photo-dynamic therapy in one eye. Plaque radio-therapy was used in one eye. The parameters of treatment for TTT were 1.2 - 3 mm spot size, 450 - 1000 mV, 60 s; 2 sessions of TTT in 2 eyes and 3 sessions in 3 eyes., Results: Fourteen cases were male and 35 cases were female. Both eyes were affected in 17 cases (34.7%). Age ranged from 23 - 74 years old with an average of 47 years. The visual acuity was 0.05 or less in 13 eyes; 0.06 - 0.2 in 22 eyes and 0.3 or more in 31 eyes. Primary tumours were found in 40 cases (81.6%) (surgical excision in 25 cases), consisting of breast carcinoma in 16 cases (32.7%), lung carcinoma in 14 cases (28.6%), hepatoma and cholangiocarcinoma in 3 cases, colon and stomach carcinomas in 3 cases, gynecologic appendix carcinoma (including 1 case of ovarian mucous cyst adenocarcinoma) in 2 cases, nasopharyngeal adenocarcinoma in 1 case, vertebra tumor in 1 case, undetected in 5 cases (10.2%) and under detection in 4 cases (8.2%). The fundus had 1 lesion in 58 eyes (58/66 = 87.8%), 2 lesions in 4 eyes (4/66 = 6.0%), 3 or more lesions in 2 eyes (including 7 lesions in 1 eye). According to the location and development status of the lesions, they could be divided into solitary type, 39 eyes (39/66 = 59.1%); diffuse type, 19 eyes (19/66 = 28.8%); and early type, 8 eyes (8/66 = 12.1%). FFA examination: early stage lesions showed hypofluorescence and later stage lesions showed moderate to strong hyperfluorescence. In 8 cases of solitary lesions, the size of the lesion measured by B-scan averaged 11.5 mm x 10.5 mm x 3.6 mm with the maximal height at 4.9 mm. The tumor became flattened and vision remained stable at 3 months after plaque radiotherapy in 1 case. Three cases were followed-up for 2, 3, and 4 months after TTT treatment. The lesions remained stable with vision unchanged or slightly decreased., Conclusions: The choroidal metastasis has specific clinical features. The classification of metastatic lesions into solitary, diffuse and early types is helpful for the evaluation of the disease process. The primary tumor can be found in 80% of cases. The most common primary cancer is breast carcinoma, followed by lung carcinoma. These two cancers account for 75% of primary tumors. In solitary type and early type lesions, TTT combines with systemic treatment could result in regression of lesions, saving of vision and improvement of the life quality.

Objective: To investigate the clinical features of choroidal neovascularization (CNV) in different classifications., Methods: In this retrospective case series, 393 eyes of 312 patients with CNV between May 2005 and March 2007 in our department was classified based on their etiology, location, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) findings., Results: The relative frequency of various causes in CNV was as follows: there were 153 cases (49.04%) from age-related macular degeneration (AMD) , 94 cases (30.13%) from idiopathic CNV, 37 cases (11.86%) from pathologic myopia, 15 cases (4.81%) from inflammatory disorders, 7 cases (2.24%) from polypoidal choroidal vasculopathy (PCV), 3 cases (0.96%) from angioid streaks and 1 case (0.32%) from either hereditary disease or trauma or tumor, respectively. The majority cases from AMD was male (64.71%), whereas most from pathologic myopia, idiopathic CNV and inflammatory disorders were female (78.38%, 73.40%, 73.33%). The age range of the cases from AMD was 49-95 years (68.73 +/- 8.31), and 98.04% of them were at least 50 years old. Patients with idiopathic CNV aged 13-43 years old (29.86 +/- 6.45), and 84.04% of them were between 20 and 40 years old. The sex (chi2 = 57.17, P<0.05) and age (F=172.57, P< 0.05) had significant difference in each etiological group. FFA showed that CNV in 43.48% from AMD and 66.67% from PCV were occult and non-classic. CNV in 91.67% from pathologic myopia, 76.19% from inflammatory disorders and 95.00% from idiopathic CNV was classic. In each group, most of the CNV was subfoveal type (58.00%-100.00%), followed by juxtafoveal type (0%-35.00%). In the ICGA of 54 eyes with AMD, 11 eyes (20.37%) were occult CNV (plaque, spot and mixed CNV), 17 eyes (31.48%) were CNV fibrosis. CNV was active in most cases. The frequency of active and inactive CNV in AMD was approximately 61.11% and 37.04%, respectively, no lesions were noted in 1 eye (1.85%) in ICGA., Conclusions: The clinical characteristics and frequency of various types of CNV are different due to different causes. Classification of CNV based on its etiology, FFA and ICGA findings, location, and activity in detail is important for the diagnosis, treatment and prognosis judgment in CNV.

Unlabelled: OBJECTIVE; To make a comparative study of the clinical characteristics and risk factors of nonischemic central retinal vein occlusion (CRVO) between patients younger and older than the age of 40., Methods: It was a retrospective case series. Retrospective data analysis (including best corrected visual acuity, color fundus photograph and fundus fluorescein angiography, etc. ) was conducted in patients with nonischemic central retinal vein occlusion who were followed-up for 6 months or longer., Results: The data of 148 cases (151 eyes) were analyzed. The follow-up time was 6 months to 15 years, averaged 17 months. Among them, 39 patients (40 eyes) aged 40 years or younger, their age ranged from 15 to 40 years, averaged 27 years old. There were 20 cases of male patients (20 eyes) and accounted for 51% of total cases. The rest of the patients were above the age of 40 years old. Their age ranged from 41 to 76 years, averaged 57 years old. Male patients (53 cases, 54 eyes) accounted for 49% of total cases. In the younger patients, only 2 of them had a history of hypertension, no other systemic illness was found. In the older patients, more than 40% of them had a history of systemic illness, including hypertension and diabetes mellitus. Initial visual acuity showed no statistically significant difference between these two groups (Pearson, chi2 =0. 087, P = 0.769). There was a significant difference in final visual acuity between these two groups (Pearson, chi2 = 4.692, P = 0.047). Final visual acuity was 20/60 or better in 18 cases (45%) in the younger group, but only 25 cases (23%) in the older group. Final visual acuity was 20/200 or less in 67% of cases in the older group, while 35% in the younger group. Complications occurred more frequently in the older group. The difference of complication rate in these two groups was statistically significant (Pearson, chi = 8.763, P = 0.006). Final vision was statistically correlated with age, initial visual acuity and complications, but not with sex or systemic illness. CONCLUSIONS Systemic illness is a risk factor for the occurrence of CRVO in the older group, but not in the younger group. It does not affect the final visual acuity. Complications occurs less common in the younger group. Although final visual acuity was better in the younger group, but still 35% of them was 20/200 or less. Most of the patients in the older group have severe visual impairment. Active treatment should be given to both groups.

Objective: To study the consistency of the color fundus photography and fluorescein angiography for grading the diabetic retinopathy., Methods: It was a retrospective case series. The agreement study was conducted in a series of diabetic patients, who were excluded from the mild non-proliferative diabetic retinopathy (NPDR) and the severe proliferative diabetic retinopathy (PDR). Ninety-nine cases (188 eyes) met the selected criteria Five 50 degrees non-stereoscopic photography for each eye were taken in all cases before FFA was performed. The diabetic retinopathy was graded from the fundus photography and FFA images according to international diabetic retinopathy disease severity scale. The kappa value was calculated according to the grading outcomes from the fundus photography and FFA images to estimate the agreement of the grading outcomes., Results: The fundus photography showed 59 moderate NPDR (31.4%), 76 severe NPDR (40.4%) and 53 PDR eyes (28.2%) respectively, FFA showed 50 moderate NPDR (26.6%), 72 severe NPDR (38.3%) and 66 PDR (35.1%) respectively. The agreement for the grading of DR by the fundus photography and FFA was substantial (K = 0.601). In the evaluation whether it was necessary to implement PRP (more serious than NPDR and PDR), there was higher agreement between them (K = 0.652)., Conclusions: Five 50 degrees photography can provides the support of the application of PRP for diabetic patients, FFA may be earlier and relatively accuracy in the diagnose of diabetic retinopathy.

Objective: To investigate the feasibility of modified frontolateral partial laryngectomy without tracheostomy in the treatment for early laryngeal cancer or severe atypical hyperplasia of the true vocal cord., Methods: A retrospective analysis of 41 patients treated in the past 6 years with modified frontolateral partial laryngectomy without tracheostomy was carried out. There were 39 early laryngeal cancers of the lateral vocal cord with 34 in T1a stage and 5 in T2, and the remain 2 patients had severe atypical hyperplasia of the lateral vocal cord. An ipsilateral false vocal cord flap was used in 39 patients and cervical skin flap in 2 to reconstruct the defect after resection of the true vocal cord. In order to get a large laryngeal cavity, a reverted sternohyoid fascia was used to cover the front area, which made the new laryngeal lumen become ladder-shaped., Results: The incisions of all 41 patients healed up by first intention. The only postoperative complication was subcutaneous emphysema, which developed postoperatively in 9 patients, but subsided prior to discharge. The estimated 1-, 3- and 5-year survival rates were all 100%. No patients died during the postoperative period., Conclusion: Modified frontolateral partial laryngectomy without tracheostomy is effective with a high rate of success in eradicating early or selected invasive glottic squamous cell carcinoma or severe atypical hyperplasia of the true vocal cord.

Objective: To explore the clinical characteristic, visual prognosis and related factors of nonischemic central vein occlusion., Methods: Retrospective data analysis (including visual acuity, color fundus photography and fundus fluorescein angiography) was conducted in patients with nonischemic CRVO who were followed-up for 3 years or longer., Results: The data of 35 cases (37 eyes) were analyzed. The follow-up time was 3 - 15 years, averaged 4.5 years. Age of those patients ranged from 18 to 76 years, averaged 56 years. Thirty cases (32 eyes) were over 40 years old. Two cases had chronic angle closure glaucoma. At the final visit, visual acuity improved in only 2 eyes (5%), remained the same in 11 eyes (30%), and decreased in 24 eyes (65%). Twenty-eight eyes (75%) had a final visual acuity of 20/200 or less. Nine eyes (24%) transformed to the ischemic type, among which neovascular glaucoma occurred in 5 eyes. Macular complications were the major causes of serious visual impairment. The patients with chronic angle closure glaucoma and partial optic nerve atrophy had relatively good final visual acuity., Conclusions: Nonischemic CRVO can cause severe visual impairment. Macular complications are the major causes of vision loss. Partial optic nerve atrophy may have a protective effect on visual acuity in CRVO.

Objective: To observe clinical features of Retinitis pigmentosa with retinal vascular occlusion and its prognosis., Methods: To analyze the clinical Data in 18 cases retrospectively using fundus examination, fundus fluorescein angiography, indocyanine green angiography, electroretinogram, visually evoked potential etc. Gene screening was performed in 3 cases., Results: the major clinical manifestations of the disease were optic atrophy, vascular attenuation to obliteration, widespread retinal pigment epithelium atrophy with depigmentation and/or fine pigment spots, total or nearly total a and b wave were extinct in the examination of electroretinogram. All this manifestations were compatible with that of typical Retinitis Pigmentosa (tapeto-retinal dystrophy). It also had its unique features, such as total or nearly total vascular obliteration, marked optic atrophy in later stage, and choroidal vessels abnormal. Gene mutation was not found in gene encoding area of RHO gene of No: 3 chromosome and of RLBPI gene of No: 15 chromosome. vision loss in this kind retinitis pigmentosa is much faster than that of typical retinitis pigmentosa., Conclusion: Retinitis pigmentosa with retinal vascular occlusion may belonged to a kind of tapeto-retinal dystrophy, vascular progressive obliteration was probably its associated disease.

Objective: To evaluate the clinical value of stereotactic radiosurgery (SRS) for uveal melanoma., Methods: From Jan, 1996 to March, 2004, 16 patients with uveal melanoma were treated with SRS, two by one session (35 Gy, 25 Gy) and fourteen by fractionated SRS (30-55 Gy/2-4F/4-16D). The follow-up period ranged from 3 to 100 months (median: 66 months)., Results: All 16 patients were still alive though all were blind in the diseased eye during recent follow-up. Local control rate was 93.4%, 5-year survival rate of 13 patients who have been followed for more than 5 years, was 100% (13/13). However, 7 patients received eyeball enucleation due to corneal ulcer (n = 2), suspicion for uncontrolled tumor (n = 2) and secondary glaucoma (n = 3). One patient developed distant metastasis, though still alive., Conclusion: Fractionated radiosurgery is safe and effective for uveal melanoma. It is indicated for lesions of limited size (longest diameter < 20 mm, depth < 15 mm) located in the posterior pole or behind the equator at the back of the eyeball.

Objective: To study the characteristics of optical coherence tomography (OCT) pictures in pathologic myopia., Methods: 100 cases (195 eyes) of pathologic myopia were examined with OCT. The Age ranges of all the cases was 16-76 years and refraction error was -6.00 - -36.00 diopters., Results: OCT image was normal in 7 eyes (4.3%), the reflectivity band of RPE and chorio-capillaries were uneven and thinning in 147 eyes (90.2%). Full-thickness macular hole was found in 21 eyes (10.8%), of which 10 (5.1%) eyes were associated with retinal detachment; local shallow retinal detachment was found in 24 eyes (12.3%), of which 7 eyes (3.6%) were associated with retinal schisis, 19 eyes (9.7%) with macular choroidal neovascularization (CNV). retinal swelling was often associated with the following diseases: Fuchs spot 9 eyes (4.6%), thick macular hemorrhage 3 eyes, epiretinal macular membrane 18 eyes (9.2%); macular sensory retina thinning in 5 eyes (2.6%)., Conclusion: Compared with fundus examination including slit lamp with pan-retinoscope, OCT showed unique preference for observation of the changes of retinal pigment epithelium (RPE), chorio-capillary layer, diagnosis macular hole and epiretinal macular membrane, discovery of small sensory retinal detachment, schisis and thinning of sensory retina layer etc. OCT can not either discover a piece of thin macular hemorrhage or differentiation between thick macular hemorrhage and pigment spot.

Objective: To test the effectiveness and safety of laser-induced chorioretinal venous anastomosis in the treatment of nonischemic central retinal vein occlusion (CRVO), and also the effectiveness of the preventative measures for complications associated with the treatment., Methods: Laser-induced chorioretinal venous anastomosis was performed on 34 cases, 35 eyes with nonischemic CRVO. During the treatment, preventative measures for complications were taken as follows: (1) Patients with total retinal papillary nonperfusion area of less than 5 DA were selected to receive the treatment. (2) Treatment sites must be at least 3 PD away from the optic disc and 4 PD away from the macula. (3) At most 2 argon laser shots were attempted over each treatment site, to avoid severe laser damage. (4) Scattered argon laser photocoagulation was done over the drainage area of the vein distal to the treatment site, in order to prevent neovascular complications in case distal vein occlusion occur., Results: During the 3 approximately 12 months (average 6 months) follow-up, successful anastomosis formed in 28 eyes out of 35 eyes (80%) with a mean of 2.4 attempts to create an anastomosis in each eye. With successful anastomosis, retinal hemorrhage started to be absorbed gradually 2 weeks after the treatment, and almost entirely absorbed 1 approximately 2 months later. Retinal edema also alleviated. Visual acuity improved in 20 out of 28 eyes (71%), and remained unchanged in the rest of the patients with successful anastomosis. In comparison with the natural course of the disease, our treatment has improved both the visual prognosis and the retinal damage caused by the disease. No serious complications occurred in these patients with successful anastomosis. Anastomosis failed to form in 7 cases (7 eyes), among which, 2 eyes developed serious neovascular complications., Conclusions: CRVA treatment is effective in the treatment of non-ischaemic CRVO. With proper preventative measures for complications associated with the treatment, the safety of the treatment can be increased prominently, but serious neovascular complications was not entirely prevented.

10 cases were reported with a special type of retinal vasculitis which was characterized by progressive obliteration of retinal blood vessels from peripheral retinas to the posterior poles in both eyes. In the late stage of the disease, it was complicated by vitreous hemorrhage in 5 eyes, neovascular glaucoma in 5 eyes, etc. The visual acuities of 10 eyes (50%) were < or = 0.05. It seems that argon laser photocoagulation can delay its natural course. Its fundus changes, fluorescein angiographic findings, differential diagnosis and treatment were discussed.

During 1986-1989, the authors treated 23 cases of complicated retinal detachment with vitrectomy in combination with reattachment surgery and intraocular injection of C3F8 gas. The PVR gradings were C1, 3 cases; C2, 7 cases; C3, 8 cases; D1, 4 cases; and D2, 1 case. Retinal breaks occurred in 16 cases, in whom the rate of surgical success was 65.2%. The visual acuity improved in 66.6% of the cases after operation. The advantages, the actual procedures and the causes of failure of the combined surgery were discussed.

Eight (8) cases of choroidal hemangioma, comprising 6 of the solitary type and 2 of the diffuse type, were treated with Argon laser, including 2 cases in combination with cryotherapy. The success rate was 76.5%, with visual acuity improved in 75% of them during an average follow-up of 11.7 months. Tumors with much subretinal fluid were first given cryosurgery before Argon laser treatment for good synergic therapeutic effects.

45 cases (52 eyes) of non-diabetic vitreous hemorrhage, including 21 cases of Eales' disease, 20 cases of retinal venous obstruction, 4 cases of SMD etc. had visual acuities of 0.05 or less, except 1 eye of 0.4. After pars plana vitrectomy, some in combination with scleral encircling, vision in 62.7% of the eyes reached 0.1 or over, while 80.7% showed improvement. The points of note during operation, the proper timing of the surgery and complications were discussed.