[Analysis of prognostic factors of extranodal NK/T-cell lymphoma treated with pegaspargase/L-asparaginase: a multicenter retrospective study].

Objective: To explore the prognostic factors of extracellular NK/T cell lymphoma (ENKTL) treated with pegaspargase/L-asparaginase. Methods: The clinical data of 656 ENKTL patients diagnosed at 11 medical centers in the Huaihai Lymphoma Working Group from March 2014 to April 2021 were retrospectively analyzed. The patients were randomly divided into two groups: a training set (460 cases) and a validation set (196 cases) at 7∶3, and the prognostic factors of the patients were analyzed. A prognostic scoring system was established, and the predictive performance of different models was compared. Results: Patients' median age was 46 (34, 57) years, with 456 males (69.5% ) and 561 nasal involvement (85.5% ). 203 patients (30.9% ) received a chemotherapy regimen based on L-asparaginase combined with anthracyclines, and the 5-year overall survival rate of patients treated with P-GEMOX regimen (pegaspargase+gemcitabine+oxaliplatin) was better than those treated with SMILE regimen (methotrexate+dexamethasone+cyclophosphamide+L-asparaginase+etoposide) (85.9% vs 63.8% ; P=0.004). The results of multivariate analysis showed that gender, CA stage, the Eastern Cooperative Oncology Group performance status (ECOG PS) score, HGB, and EB virus DNA were independent influencing factors for the prognosis of ENKTL patients (P<0.05). In this study, the predictive performance of the prognostic factors is superior to the international prognostic index, Korean prognostic index, and prognostic index of natural killer lymphoma. Conclusion: Gender, CA stage, ECOG PS score, HGB, and EB virus DNA are prognostic factors for ENKTL patients treated with pegaspargase/L-asparaginase.

[Investigation and analysis on the detection of IgG antibodies against the rubella virus among rural childbearing-age women in preconception period in Yunnan Province from 2013 to 2019].

A study was conducted on rural women of childbearing age aged 20-49 who underwent the National Free Preconception Health Examination Project (NFPHEP)in Yunnan Province from 2013 to 2019. Descriptive analysis was conducted to determine the negative rate of IgG antibodies against the rubella virus and its differences among various socio-demographic characteristics. Among the 1 511 203 study subjects, the negative rate of IgG antibodies against the rubella virus was 24.36%. Only 2.64% of the population had received rubella virus vaccine. The negative rate of IgG antibodies among rural childbearing-age women in the preconception period in Yunnan Province decreased with age and educational level (Ptrend<0.001). The negative rate of IgG antibodies in ethnic minority women of childbearing age in the preconception period (25.19%) was higher than that of Han women (23.88%). Among the 22 ethnic groups with over 1 000 participants, the negative rates of IgG antibodies in women of childbearing age from the Blang (32.85%), Bouyei (31.03%), Zhuang (31.01%), and Miao (30.70%) ethnic groups were higher than those of women from other ethnic groups. Among the 16 states (cities) in Yunnan Province, the negative rate of IgG antibodies in pregnant women of childbearing age in Wenshan Zhuang and Miao Autonomous Prefecture (38.06%) and Lincang City (32.63%) was higher than that in other states (cities). The negative rate of serum IgG antibodies in women who reported having received rubella virus vaccine (18.60%) was lower than that in other non-vaccinated populations (24.52%). The proportion of rural women of childbearing age in Yunnan Province who were susceptible to the rubella virus before pregnancy was still high. It is necessary to promote rubella vaccination among people susceptible to rubella, especially pregnant women, to prevent rubella virus infection and reduce the incidence rate and disease burden of rubella people.

[Clinical prognostic analysis of 124 adult patients with hemophagocytic lymphohistiocytosis: a multicenter retrospective study of the Huaihai Lymphoma Working Group].

Objective: Factors influencing the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults were analyzed based on multicentric data. Methods: Clinical data of 124 adult patients with HLH diagnosed in eight medical centers in the Huaihai Lymphoma Working Group from March 2014 to July 2020 were collected. The optimal truncation value of continuous variables was obtained based on the Maxstat algorithm, X-Tile software, and restricted cubic spline. Cox proportional risk regression model was used to construct the adult HLH risk prediction model, and the visualization of the model was realized through the histogram. The bootstrap resampling method was used to verify the model, C-index and calibration curve was used to verify the histogram, and the prediction accuracy was checked. Kaplan-Meier analysis was used to calculate the survival rate and draw the survival curve. Furthermore, the differences between groups were tested by log-rank. Results: The median age of the 124 patients was 55 (18-84) years, including 61 (49.19%) males. The most common etiology was infection. Serum ferritin increased in 110 cases (88.71%) , hepatosplenomegaly in 57 cases (45.97%) . Of the 124 patients, 77 (62.10%) died, and the median survival time of the patients was 7.07 months. Univariate results showed that the prognosis of adult HLH was influenced by sex, age, fibrinogen, serum creatinine, alanine aminotransferase, and albumin (P<0.05) . The results of multivariate analysis showed that gender, platelet, albumin, alanine aminotransferase, and treatment regimens were independent influencing factors for prognosis. Based on the above five risk factors, the prediction model of the histogram was established, and the C-index of the model was 0.739. Finally, the calibration chart showed good consistency between the observed and predicted values of HLH. Conclusion: The prognosis of the adult hemophagocytic syndrome is influenced by many factors. Gender, platelet, albumin, alanine aminotransferase, and treatment regimens are independent risk factors. Therefore, the established histogram provides a visual tool for clinicians to evaluate the prognosis of adult HLH.

[Research progress of ocular manifestations and treatments of human immunodeficiency virus and syphilis co-infection].

Acquired immune deficiency syndrome caused by human immunodeficiency virus (HIV) infection is a fatal disease involving multiple systems. Syphilis is a systemic chronic infection disease caused by treponema pallidum infection. In recent years, the incidence of the two infectious diseases in China has been on the rise. Both of them have the same high-risk population and similar transmission routes, and co-infection is increasing day by day. They can influence each other. Syphilis significantly increases the risk of HIV infection, and HIV is able to change the natural course of syphilis. HIV and syphilis co-infection leads to diverse ocular manifestations which are not typical or specific. This condition results in not only a high rate of missed diagnosis and misdiagnosis, but also a high rate of treatment failure and recurrence. There is a high correlation between ocular syphilis and neurosyphilis in HIV-positive patients. Many patients with HIV/syphilis co-infection visit eye clinics for the initial symptom. In order to provide reference for clinical diagnosis, treatment and research, this article reviews the recent advances on the studies of the co-infection of HIV and syphilis, including epidemiological characteristics, ocular manifestations and treatments. (Chin J Ophthalmol, 2021, 57: 865-870).

Comparison of outcomes of direct-acting oral anticoagulants vs. vitamin K antagonists in patients with bioprosthetic heart valves or valve repair: a systematic review and meta-analysis.

OBJECTIVE: To compare the outcomes between direct-acting oral anticoagulants and vitamin K antagonists, particularly for risk of stroke and bleeding, among patients with atrial fibrillation (AF) and bioprosthetic heart valve replacement or repair. MATERIALS AND METHODS: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews and Google scholar databases. Studies that were done in patients with AF who underwent bioprosthetic heart valve replacement or repair and that compared the outcomes between the use of direct-acting oral anticoagulants (DOACs) and vitamin K antagonists were eligible for inclusion. Studies that were preferably randomized controlled trials or adopted a cohort approach or retrospective data-based studies were considered for inclusion. The strength of association was presented in the form of pooled hazards risk (HR). Statistical analysis was done using STATA version 16.0. RESULTS: A total of 8 articles were included in the meta-analysis. There were no significant differences in the risk of "all-cause stroke" [HR 0.72, 95% CI: 0.39, 1.34] and ischemic stroke [HR 0.79, 95% CI: 0.49, 1.29] between the two groups. The risk of "any bleeding" [HR 0.74, 95% CI: 0.64, 0.87], major bleeding [HR 0.60, 95% CI: 0.42, 0.86] and intra-cranial bleeding [HR 0.54, 95% CI: 0.36, 0.81] was much lower in those that received DOAC compared to warfarin. Compared to those receiving warfarin, those on DOACs had substantially reduced risk of any clinical thromboembolic events [HR 0.52, 95% CI: 0.39, 0.70]. No significant differences were noted for all-cause mortality [HR 0.88, 95% CI: 0.74, 1.05], cardiovascular events/myocardial infarction (MI) [HR 0.58, 95% CI: 0.33, 1.04] and and readmission rates [HR 0.85, 95% CI: 0.62, 1.18]. CONCLUSIONS: Findings suggest that the use DOACs in patients with AF with bioprosthetic valve replacement or repair is comparatively better than vitamin K antagonists in reducing the risk of bleeding and thrombo-embolic events. Future studies with a randomized design and larger sample sizes are needed to further substantiate these findings.

[Retinal toxicity study of intravitreal ganciclovir in albino rabbit].

Objective: To elevated the retinal toxicity of intravitreal ganciclovir in albino rabbit eyes. Methods: Experimental study. Twenty-four New Zealand albino rabbits (forty-eight eyes) were divided into four groups by random. Three groups were prepared for ganciclovir experiment, named A, B, C. Each group received intravitreal injection ganciclovir dose at 400 µg/0.05 ml, 2 mg/0.05 ml and 5 mg/0.05 ml respectively. The other group named D served as a control accepted intravitreal injection 0.9% normal saline 0.1 ml. Before and after 1, 2 and 4 weeks, flicker full field electroretina gram (ERG) was recorded. After 1, 2 and 4 weeks light and electron microscopic tests were recorded for further toxicity study. Results: There was significant difference in amplitude of maximal combined response a wave in one week(χ(2)=8.319, P=0.04), and pairwise comparison the 5 mg group (140.50 µV) was significantly lower than the control group (165.00 µV) (χ(2)=-2.830, P=0.028). Maximal combined response b wave in four weeks(χ(2)=-10.626, P=0.014), and pairwise comparison the 5 mg group (261.50 µV) was significantly lower than the control group (398.00 µV) (χ(2)=-2.973, P=0.018). 30 Hz flicker response in one, two and four weeks(χ(2)=17.589, 8.225, 8.997, P=0.001, 0.042, 0.02), and pairwise comparison the 5 mg group (71.3µV, 106.00µV, 63.60µV) was significantly lower than the control group (118.50µV, 129.00µV, 116.50µV) (χ(2)=-4.142, -2.826, -2.713, P=0.000, 0.028, 0.040). There was no histologic retinal toxicity evidence of group 400 µg and control group observed by light microscopy in any stage of the study. Histologic changes of group 2 mg four week later, group 5 mg two and four week later include inner nuclear layer loose arranged, nuclear of ganglia were widened and outer plexiform layer stained less in four week later. By electron microscopic observation, the ultrastructure of retina changed to different degrees and became worse in each experimental group with significant mitochondrial swelling and hydropic changes were seen in the inner segments of photoreceptors, loosely arranged and disordered in the outer segment of photoreceptors four weeks later. Conclusions: The retinal function and morphology were normal in group 400 µg. Group 2 mg and 5 mg had retinal toxicity, and 5 mg was more severe. Therefore, the clinical application of ganciclovir in the treatment of acute retinal necrosis (ARN) should select the minimum effective dose to avoid the occurrence of retinal toxicity. (Chin J Ophthalmol, 2020, 56:279-285).

[Advance study of rhinocerebralmucormycosis].

Mucormycosis is a rare, rapidly progressive life threatening opportunistic fungal infection, with rhinocerebral mucormycosis being the most common type. Rhinocerebral mucormycosis usually presents symptoms similar to sinusitis and orbital cellulitis during its early stage,which often leads to a misdiagnosis at the very beginning,and progresses rapidly to endophthalmitis,blindness,sclera perforation, eyeball atrophy, and even gets the central nervous system involved, thus leading to death. Mucormycosis is particularly common in patients with poor glycemic control, ketoacidosis and immunosuppression. The purpose of this review is to highlight the predisposing factors, infection pathway, pathogenesis, clinical presentations, diagnosis, and management of rhinocerebral mucormycosis, hence further promote the early diagnosis and immediate treatment of the disease. (Chin J Ophthalmol,2019,55:629-633).

[The ocular manifestations of human immunodeficiency virus and syphilis coinfection].

Objective: To investigate the ocular manifestations of human immunodeficiency virus (HIV) and syphilis coinfection. Methods: A retrospective analysis of the ocular manifestations was carried out in 27 patients (54 eyes) diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017. The research included 26 males and 1 female, aging from 24 to 76 years old, with a mean age of 40.40±12.94 years old. Ocular anterior segments were examined with slit-lamp microscope. Fundus examinations were conducted with papillary dilation, fundus photography. Results: At the first visit, there were 2 eyes without light perception, 4 eyes with light perception, 1 eye with hand movement, 1 eye with finger counting, 2 eyes with 0.01-0.09 eyesight, 8 eyes with 0.1-0.2 eyesight, 12 eyes with 0.25-0.4 eyesight, 15 eyes with 0.5-0.9 eyesight, 9 eyes with 1.0-1.5 eyesight. Among the 27 patients (54 eyes) coinfected with HIV and syphilis, keratic precipitates were identified in 20 eyes, aqueous flare positive in 20 eyes, float positive in 15 eyes, and iris posterior synechias in 7 eyes. Nineteen eyes were diagnosed as syphilis uveitis, including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis, among which, vitreous inflammatory opacity was observed in all 19 eyes, disk atrophy in 2 eyes, optic edema in 1 eye, vitreous hemorrhage in 1 eye, retinal detachment in 2 eyes, retinal hemorrhage and white vein in 1 eye. In addition, 8 eyes were diagnosed as HIV retinopathy, all manifested as cotton-wool spot. Among the 8 eyes, 4 were diagnosed as cytomegalovirus retinitis, 3 showed retinal yellow-white lesions, and 1 was in late phase which showed retinal pigmentation. The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased. The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis. Six patients first visited the Department of Ophthalmology, and were then diagnosed as HIV and syphilis coinfection. Conclusions: The ocular manifestations of HIV and syphilis coinfection are diversified, which can be manifested as fundus necrotic lesions as well as anterior and posterior inflammatory. For HIV positive patients, syphilis serologic test should be routinely performed. The same, syphilis positive patients should be tested for HIV serum antibodies, in order to improve the diagnosis level of HIV/syphilis coinfection and give timely etiological treatment, which is of vital importance for saving visual acuity. (Chin J Ophthalmol, 2019, 55:267-272).

[Pathophysiology and therapeutic progress of diabetic macular edema].

Diabetic macular edema (DME) is the leading cause of vision loss in diabetics. The destruction of blood retinal barrier is the primary pathological feature. At present, a large number of animal experiments and clinical studies show that DME not only has abnormal vascular structure, but also is an inflammatory disease. A variety of inflammatory media and chemokine are involved in the process of DME. With the extensive clinical application of anti-vascular endothelial growth factor (VEGF), the treatment of DME got a revolutionary breakthrough. However, unlike proliferative diabetic retinopathy (PDR), DME patients response intensively to anti-VEGF agents and couldn't resolve completely despite of multiple injections. Therefore, in addition to VEGF, other possible therapeutic targets and clinical trials of new drugs are also widely carried out. This article reviews the therapeutic process of DME. (Chin J Ophthalmol, 2018, 54: 625-630).

[The necessity of artificial kidney seeper in the ultrasonography-guided percutaneous nephrolithotomy: a randomized controlled study].

Objective: To investigate the necessity of artificial kidney seeper which made through inserting a ureteral tube in the ureter to the ultrasonography-guided percutaneous nephrolithotomy (PCNL). Methods: This was a randomized prospective study. Patients who conformed to the inclusion and exclusion criteria were enrolled at Department of Urology, Frist Affiliated Hospital of Wenzhou Medical University from January 2016 to May 2017. Totally 291 patients were included in the study. Patients were randomly assigned into two groups (artificial kidney seeper group and non-artificial kidney seeper group) in different kidney seeper level (5 to <10 mm, 10 to 20 mm) respectively. The artificial kidney seeper group was inserted by a ureteral cathedral, then were underwent the ultrasonography-guided PCNL in prone position. The non-artificial kidney seeper group were underwent the ultrasonography-guided PCNL in prone position directly. The t test, χ(2) test, repeated measure analysis was used to data measurement, respectively. Results: Four patients who diagnosed pyonephrosis were excluded. On the 5 to <10 mm level, fever rate (14.6% vs. 4.8%, χ(2)=5.07, P=0.03), operation time ((65.7±9.9)min vs. (50.3±7.4)min, t=11.47, P=0.00), cost ((18 327±903) yuan vs. (14 583±784) yuan, t=24.50, P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences. And on the 10 to 20 mm level, fever rate (14.5% vs. 3.39%, χ(2)=4.53, P=0.03), operation time ((66.0±9.9)min vs. (52.4±8.9)min, t=8.30, P=0.00), cost ((16 548±537) yuan vs. (13 102±629) yuan, t=32.10, P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences. And there were no statistical differences in the success rate of puncturing, the failures of the treatment to the stone pieces falling into the ureter and clearance rate of the stone and so on. In this study, 2 cases recovered after received transfusion and digital subtraction angiography artery embolization treatments; D-J tube was indwelled into 4 cases guiding by super smooth thread; 4 cases were finished the surgeries with the help of ureteroscopy, because the stone pieces fell into the ureter during the surgeries. And there was no patients developing septic shock, adjacent viscera injury or other serious complications. Conclusion: For seasoned doctors, there is no necessity of regularly artificial kidney seeper for PCNL when the pre-operation seeper ranging from 5 to 20 mm.

[Research on the surgery treatment and etiology of fungal endophthalmitis].

Objective: To evaluate the efficacy of vitrectomy and etiological diagnosis in the treatment of fungal endophthalmitis. Methods: A retrospective survey was done on the clinical manifestation, etiological diagnosis and treatment efficacy of 15 patients (15 eyes) who had been diagnosed with fungal endophthalmitis at the inpatient department of Peking Union Medical College Hospital during 2002-2015. A total of 15 eyes of 15 patients, 3 male and 12 female patients, were included in this study. The mean age of the patients was (45.8±15.3) years. Among the 15 eyes, 12 (12 patients) were diagnosed with endogenous fungal endophthalmitis and 3 (3 patients) were diagnosed with exogenous fungal endophthalmitis. Fourteen eyes have been misdiagnosed with uveitis, systematic or local application of glucocorticoid and/or immunosuppressor have been conducted on the patients which resulted in exacerbation. Baseline visual acuity: light perception in 2 eyes, hand movement for 12 eyes, and 1 eye of 0.1. Six eyes showed slight inflammatory reaction in anterior chamber, four eyes showed moderate inflammatory reaction in anterior chamber, while five eyes showed severe inflammatory reaction with hypopyon in anterior chamber. B-Scan ultrasound examination showed inflammatory vitreous opacity in all 15 eyes, combined proliferative vitreoretinopathy (PVR) were found in 11 eyes, retinal detachment were found in 10 eyes, which include 6 cases of tractional retinal detachment, 1 case of exudative retinal detachment, and 3 cases of retinal and choroid detachment. Forty eyes underwent vitrectomy, 1 eye underwent intravitreal injection. Nine eyes were processed with silicone oil tamponade, one eye was processed with C(3)F(8) tamponade. At the beginning of the operation, vitreous fluids were collected for preparing smears which were later used for fungus culture and drug susceptibility testing. Results: According to the smear results of vitreous fluid, fungal hyphae and spores were found in 10 eyes. The fungus culture indicated positive results in 12 eyes, including candida albicans in 6 eyes, fusarium, candida parapsilosis, paecilomyces lilacinus, asoergullus terreus, mulan candida and aspergillus in 1 eye respectively. Based on etiological diagnosis, 14 eyes received amphotericin B intraocular injection during operation, and 9 patients received fluconazole (venous transfusion or oral administration), 2 patients received voriconazole through venous transfusion or oral administration, one patient received itraconazole through oral administration. All 15 eyes received local application of amphotericin B eyedrop or fluconazole eyedrop. The intraocular inflammations in all 15 eyes were mitigated. The visual acuity improved in 6 eyes, remained unchanged in 4 eyes, and reduced in 5 eyes. Postoperative visual acuity achieved 0.1 to 0.15 in 2 eyes, 0.01 to 0.04 in 2 eyes, CF in 2 eyes, HM in 4 eyes, LP in 2 eyes, and NLP in 3 eyes. The retina of 5 eyes remained in position, the retina of 2 eyes reattached, the retina of 2 eyes failed to reattach. Recurrent retinal detachment happened in the other 6 eyes, 5 of which received reoperation. Eventually, the retina of 10 eyes reattached, and the retina of the 5 eyes failed to reattach. Conclusions: Vitrectomy is an effective method for treatment of fungal endophthalmitis. The positive rates of vitreous smear and fungus culture were really high. Application of sensitive anti-fungal drugs based on etiological diagnose can improve therapeutic level. (Chin J Ophthalmol, 2018, 54: 270-276).

[Research progress on the diagnosis and treatment of acute retinal necrosis].

Acute retinal necrosis is an uncommon but devastating and potentially blinding ophthalmopathy featured with unfavorable prognosis as the lesions tend to develop rapidly in a circumferential way in few days. Therefore timely diagnosis and early treatment are of great significance. The polymerase chain reaction test on intraocular fluid can improve specificity and sensitivity of the etiological detection for acute retinal necrosis. Etiology results included in the diagnostic criteria is favorable for etiological diagnosis. Current treatment for acute retinal necrosis is generally based on systemic antiviral therapy, and supported by hormone and antithrombotic drugs, while surgical treatment should be considered when the disease progresses. This article reviews the research progress on the diagnosis and treatment of acute retinal necrosis in an effort to improve the diagnosis and treatment performance of acute retinal necrosis. (Chin J Ophthalmol, 2018, 54: 306-311).

[The relationship between optical coherence tomography performance and visual acuity of acute retinal necrosis].

Objective: To analyze the relationship between optical coherence tomography(OCT) performance and visual acuity of patients with acute retinal necrosis (ARN). Methods: Retrospective analysis was performed on the patients diagnosed with ARN at the ophthalmology department of Peking union hospital during October 2011 and May 2016. Fourteen patients (15 eyes), 9 males and 5 females, whose anterior and posterior inflammation disappeared and the retinal necrosis lesion in the fundus of the eye subsided were included. The mean age was (41.6±12.2) years. All patients underwent careful examinations including best corrected visual acuity (BCVA), slit-lamp microscope, indirect ophthalmoscope, color fundus picture, fundus fluorescein angiography (FFA) and OCT (results of their last consultations). Results: BCVA: 8 eyes were increased, 2 eyes were unchanged and 5 eyes were decreased at the last visit; light perception (LP) 1 eye, finger count (FC) 1 eye, 3 eyes of 0.01 to 0.1, 6 eyes of 0.15 to 0.25. The inflammatory reaction in the anterior segment of 14 eyes disappeared, while the inflammatory reaction of the remaining 1 eye was relieved. The fundus lesions of all 15 eyes disappeared. According to OCT results: five eyes (5/15) exhibited normal macula area, among the 5 eyes, 4 eyes are of 0.15 to 0.25 visual acuity, and 1 eye is of 0.5 visual acuity;macular epiretinal membrane is present in three eyes (3/15), of which the visual acuity is 0.02, 0.25 and 0.3 respectively macula edema is present in three eyes (3/15), among the 3 eyes, 1 eye (visual acuity of 0.01)showed thickening of neurosensory retina, cystoid change of fovea and several fluid dark areas, the other 2 eyes (visual acuity of 0.02 and 0.5 respectively) showed small diffuse fluid dark area in the neurosensory retina;atrophy of neurosensory retina and absence of IS/OS was found in four eyes (4/15), among the 4 eyes, the visual acuity of 3 is below 0.01, and the other 1 eye is of 0.08 visual acuity. Conclusions: The OCT performance of stationary phase of ARN tends to be positively correlated with the visual acuity of patients. The prognosis of visual acuity of the patients whose OCT results showed atrophy of neurosensory retina and absence of IS/OS is poor. (Chin J Ophthalmol, 2018, 54: 369-374).

[Current research of sympathetic ophthalmia].

Sympathetic ophthalmia (SO) is a rare, bilateral, non-necrotizing, granulomatous uveitis that usually occurs after open ocular injury or intraocular surgery. The pathophysiology is not clearly understood, but generally SO is an immediate hypersensitivity mediated by T lymphocytes which are related to ocular tissue antigens. The main histopathological features are granulation tissues composed of lymphocytes, macrophages and multinucleated giant cells. The clinical manifestations are different from person to person, which might be mild or severe. Although it could be presented with anterior uveitis, intermediate uveitis and posterior uveitis, panuveitis is the most common sign. The ophthalmic examinations, such as fundus fluorescein angiography, optical coherence tomography and B-scan, could be used to observe the patients' conditions and monitor the therapeutic effect. The main treatment of SO is medical therapy with corticosteroids, immunomodulators and biomodulators. Topical drug administration, including intravitreal injection of triamcinolone acetonide and implantation of a fluocinolone acetonide implant, can be considered. There is controversy about whether enucleation or evisceration is more appropriate and when the procedure should be done. The prognosis of SO could be poor. SO is liable to deteriorate and may lead to blindness. This article reviews the etiology, mechanisms, histopathology, clinical characteristics, diagnosis and treatment of SO. (Chin J Ophthalmol, 2017, 53:778-782).

[The fundus manifestations and SD-OCT findings of patients with acute Vogt-Koyanagi-Harada disease].

Objective: To conclude the characteristics of fundus appearance and spectral domain optical coherence tomography(SD-OCT) findings of patients with acute Vogt-Koyanagi-Harada (VKH) disease. Methods: The clinical data of 17 patients (34 eyes) diagnosed of acute VKH in Peking Union Medical College Hospital from Jan. 2012 to Dec. 2014 were studied retrospectively.Examinations included visual acuity, slit lamp, fundus, color fundus pictures, FFA and SD-OCT. Results: Eight men and 9 women were enrolled with mean age of (40.5±11.6) years old ranging from 26.0 to 62.0 years old. Vision acuity of their first consultations were as follows: 14 eyes (41.2%) were below 0.01-0.09, 17 eyes(50%) were among 0.1-0.3, 3 eyes (8.8%) were among 0.4-0.7. All patients were divided into 3 groups according to their fundus appearance: 14 eyes (41.2%) were optic disc swelling-type, 10 eyes (29.4%) were retinal detachment type and 10 eyes(29.4%)were mixed type. Subretinal fluid and serous retinal detachment appears in SD-OCT of all 34 eyes, with highly reflective signals in detached area. Other common characters were also noticeable, suh as RPE folds(19 eyes, 55.9%), subretinal septa (16 eyes, 47.1%) and internal limiting membrane(ILM) fluctuation (8 eyes, 23.5%). In addition, SD-OCT features were in accordance with multilobular dye pooling at late period of FFA. Conclusion: SD-OCT of acute VKH presents some typical features: subretinal fluid and serous retinal detachment, RPE folds, ILM fluctuation, and subretinal septa.(Chin J Ophthalmol, 2017, 53: 436-439).

[Application of optical coherence tomography angiography in ophthalmology].

Optical coherence tomography angiography (OCTA) is a new technology of angiography in recent years. It has advantages of the optical coherence tomography (OCT), moreover, it can hierarchically observe the vascular morphology of the retina and choroid. By using the pseudo-color, abnormal vascular structure can be distinguished from normal vascular structure of the retina. With the fusion of the OCTA image and the regular OCT image, the structure and blood flow information can be obtained at the same time. This technology provides another method of examination for clinical ophthalmology, especially for the diagnosis of retinal diseases. This review will analyze and summarize the operating principle of OCTA, its application in ophthalmology, as well as its advantages and limitations. (Chin J Ophthalmol, 2017, 53: 65-72).

[Ocular immune reconstitution inflammatory syndrome].

Immune reconstitution inflammatory syndrome (IRIS) is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes or emerging diseases or even dead after the initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected individuals in a period of recovery of immune function. Ocular immune reconstitution inflammatory syndrome is mainly caused by cytomegalovirus which performing a series of ocular inflammation accompanied with the increase of CD4+ T lymphocytes, such as cytomegalovirus retinitis, after HAART. With HAART widely used, the patients of IRIS gradually increased. But the clinical presentations of IRIS were various because of different pathogens. This review summarized the clinical manifestations, risk factors, diagnosis and treatment of ocular IRIS.

Association of variable number of tandem repeat polymorphism in the IL-4 gene with ischemic stroke in the Chinese Uyghur population.

Ischemic stroke (IS) is a multifactorial disorder, and genetic factors act as important contributors to its onset and progression. Inflammation is a key event that is closely associated with the pathophysiology of IS. The association of genetic polymorphisms of inflammatory cytokines with IS remains poorly understood. We investigated the relationship between the variable number of tandem repeats (VNTR) for IL-4, which is an important biomarker of inflammation, and the risk of IS. To assess the nature of the VNTR polymorphism in IL-4 and identify any links with IS, we recruited 200 subjects from a unique population that has 60% European and 40% East Asian ancestry. The subjects comprised 100 IS patients diagnosed using magnetic resonance imaging within 24 h of symptom onset and 100 age-, gender- and ethnicity-matched normal healthy controls. VNTR was identified using high-performance capillary electrophoresis with specially designed tailed primers. The IL-4 VNTR polymorphism was significantly associated with IS after adjustment for cardiovascular risk factors (OR = 0.571, 95%CI = 0.330-0.949, P < 0.05). Our data indicate that IL-4 VNTR polymorphism may affect susceptibility to IS in the Chinese Uyghur population. Moreover, total cholesterol, fasting blood glucose, waist-to-hip ratio, hypertension, history of heart diseases, and negative events may increase the risk of IS, with a trend for HDL to be a protective factor for IS in the Uyghur population.

Adult prostate sarcoma: radiological-clinical correlation.

AIM: To describe the imaging features and the correlation with clinical findings of adult prostate sarcoma. MATERIALS AND METHODS: Radiological data of seven adult male patients with prostate sarcoma, documented by pathological examination of specimens, were analysed retrospectively. Radiological features were correlated with clinical and pathological findings. RESULTS: The mean age of the study population was 45.8 years (range 21-76 years). The mean value of the serum prostate specific antigen (PSA) in seven patients was 1.59 ng/ml (range 0.735-3.72 ng/ml). Five patients had leiomyosarcomas and two had rhabdomyosarcomas. The most common symptom was urinary obstruction (n=7) and the most common sign was the markedly enlarged prostate as revealed by digital rectal examination (n=7). The mean size of the tumours was 8.7 x 7.2 x 7 cm (range 6.5 x 5x 6.5 to 12.1 x 10.2 x 8.9 cm). Tumours were round (n=4), lobular (n=2), or irregular (n=1). Two tumours occupied the majority of the prostate and five occupied the entire prostate. One tumour appeared as a homogeneous mass, and six tumours contained cystic areas on computed tomography (CT) and magnetic resonance imaging (MRI). Tumours enhanced avidly on contrast-enhanced CT (n=5) and MRI (n=2). Magnetic resonance spectroscopy (MRS; n=2) showed the ratio of choline:citrate to be 1.6 and 10.75. Tumour invasion was present in the bladder (n=3) and rectum (n=1). CONCLUSIONS: Adult prostate sarcoma was characteristically shown to be a large and heterogeneous mass with rapid, hypervascular and heterogeneous enhancement on CT and MRI. The main MRS feature was a marked increase in the choline:citrate ratio. The clinical manifestations corresponded mainly to local mass effects and tumour invasion.

Correlation analysis on total lymphocyte count and CD4 count of HIV-infected patients.

OBJECTIVE: To determine the relationship between CD4 count and other blood indices and to explore the prediction of total lymphocyte count (TLC) for CD4 count in HIV-infected patients. METHODS: Cross-sectional study was performed for the prediction of TLC and other indices for CD4 count, and historical cohort study was performed for the TLC changes as a surrogate for CD4 changes of patients on antiretroviral therapy (ART) to further understanding the utility of TLC changes for AIDS patients' management. RESULTS: In our cross-sectional study, both TLC and white blood corpuscle count positively correlated to CD4 count, but differed in these patients. For patients on ART, the prediction of TLC for CD4 count is better than that of patient without ART. Further investigation of historical cohort study indicated that, among AIDS patients on highly active antiretroviral therapy, their TLC and haemoglobin changes also positively correlated to CD4 change, with a total correlation coefficient of 0.31 (p < 0.01) and 0.19 (p < 0.01) respectively. The prediction of TLC change for CD4 change differed each time point when patients underwent ART. CONCLUSIONS: Total lymphocyte count and its change can be used as alternative in conjunction with other indices to CD4 count and its change in the management of HIV-infected individuals in China.