·Hemophilia is a rare disorder that occasionally has visual symptoms after diagnosis. The authors present a case in which visual symptoms led to the initial diagnosis, a 22-year-old man who represented with spontaneous fundal haemorrhage. There is no history of bleeding and trauma. The fundal haemorrhage was absorbed significantly without any treatment after 3 months follow-up. Hemophilia A was found to be the causative disorder in this previously healthy man. The authors present a rare case in which unilateral visual complaints led to the diagnosis of hemophilia A. Thus, though uncommon, hemophilia should be considered in the differential diagnosis of otherwise unexplained fundal haemorrhages.

Background Many kindof cells,cytokineand extracellulamatrix components,such aconnective tissue growth facto(CTGF) and fibronectin (FN),can regulate and controll the formation and developmenof epiretinal membrane.Iiimportanto investigate the morphology and pathology of epiretinal membrane fothe prevention of relevanretinopathies.Objective Thistudy wato investigate the expression of CTGF and FN in differentypeand stageof epiretinal membranes.MethodEpiretinal membranewere collected during vitrectomy and silicon oil removal surgery from 24 eyeof 24 casewith rhegmatogenouretinal detachment(RRD) (including 14 eyewith courses＜90 dayand 10 eyewith course≥ 90 days),20 eyeof 20 casewith diabetiretinopathy (DR)associated with vitreouhemorrhage and tractional RD (course≥ 90 days)and 7 eyeof 7 casewith silicon oil tamponade (course≥ 90 days).The grading of the proliferative vitroretinopathy (PVR) wa＞C2 in all the eyes.Histopathological examination waperformed to assesthe pathological elemenin the differentypeand stageof epiretinal membrane,and the differential expressionof CTGF and FN in the varioutypeof epiretinal membranewere detected by immunochemistry.The amounof cellpositive foCTGF and FN wacompared using the FisheExacProbability method.ResultHistopathological examination showed thaincrease in the numbeof RPE celland inflammatory cellwaprimary characteristiin the epithelial membrane of RRD with courses＜90 days,buthere were loof neurogliocyteand fibroblastin the RRD group with course≥ 90 days.In addition,the infiltration of inflammatory cellwapredominanin the RRD and Dgroups,bufibroplasiwaobviouin the silicon oil tamponade group.When the course wa≥ 90 days,7 eye(70.0％)in the RRD group wapositive foCTGF,and 18 eyes(90.0％)in the Dgroup and 2 eyes(28.6％)in the silicon oil tamponade group were positive foCTGF,with significandifference among them(P=0.037).In regardto FN,9 eyeshowed expression in the RRD group(90.0％),18 eyein the Dgroup(90.0％)and 7 eyein the silicon oil tamponade group(100.0％),withousignificandifference among them (P =0.379).In the RRD group,7 eyewith course≥ 90 dayand 13 eyewith courses＜90 days(92.9％)were positive foCTGF,showing significandifference between them(P =0.032).AfoFN,9 eye(90.0％)with course≥ 90 dayshowed positivity,which wasignificantly highethan the 7 eyewith courses＜90 day(50.0％) (P =0.019).ConclusionThe expression of CTGF in epiretinal membranevariewith the disease type and course duration,buthe expression of FN in epiretinal membrane varieonly with the course duration.

Objective To evaluate interventional therapy for biliary stricture (BS) after orthotopic liver transplantation (OLT). Methods The efficacy of interventional therapy for BS after OLT from Oct 2003 to Jan 2006 was analyzed retrospectively. Fifty-three patients received 107 times of interventional therapy through endoscopic retrograde cholangiography ( ERC) which included 68 nasobiliary catheter placements,26 biliary balloon dilatations and stent placements and 13 ERC. Nine patients received 11 times of interventional therapy through percutaneous transhepatic cholangiography ( PTC) including 2 PTC, 7 percutaneous drainages,3 biliary balloon dilatations and 1 biliary stent replacement. One patient received bile drainage through T tube. Results The success rate of ERC was 88. 8% (95/107) , that of nasobiliary catheter placement 94% (64/68) , biliary stent placement 88. 5% (23/26). The success rate of PTC was 81. 8% (9/11) , that of percutaneous drainage was 100% (7/7) , biliary stent replacement 100% (1/1). The curative rate of interventional therapy for 53 patients with BS was 28. 3% (15/53) ,the improvement rate was 41. 5% (22/53). The curative rate of interventional therapy for anastomotic, extrahepatic, intrahepatic hilar and diffuse BS was respectively 66. 7% (4/6)、66. 7% (10/15)、50% (1/2)、0 (0/7) and 0 (0/22). Conclusions The efficacy of interventional therapy for BS after OLT was not satisfactory. The result relates to the type of BS, for anastomotic, extrahepatic and solitary intrahepatic BS this therapy was effective, while that for hilar and diffuse BS the prognosis was poor.

OBJECTIVETo evaluate the cost-benefit for the Influenza Type A H1N1 Virus (Influenzae H1N1) vaccination in Shanghai primary and junior schools.

METHODSA semi-experiment study was selected to evaluate the cost-benefit for Influenza H1N1 vaccination in primary and junior schools in 6 districts of Shanghai, including 414 636 students in total. According to the voluntary principle, the students were divided into the vaccinated group (233 445 students) and control group (181 191 students). The information of vaccine cost was collected from CDC in 19 districts in Shanghai by questionnaire; and the information of medical treatment cost was collected from questionnaire and abstracts of retrospective medical records, which included 31 mild cases and 15 severe cases. The cost-benefit analysis was conducted by health economic evaluation.

RESULTSIn total, there were 414 636 students enrolled in this study; while 233 445 (56.3%) students were in the vaccinated group and 181 191 in the control group. The attack rate in vaccinated group and control group was 0.61% (1433/233 445) and 1.76% (3166/181 191) respectively. The protection ratio was 65.34% ((1.76 - 0.61)/1.76) in the vaccinated group. The average cost of Influenza H1N1 was 36.81 yuan/person; and the average cost of medical treatment was (358.3 ± 243.6) yuan/mild case and (49 188.4 ± 99 917.3) yuan/severe case. The total benefit of vaccination in schools was 19 155 566.3 yuan, and the net benefit was 10 560 673.7 yuan. Therefore, the benefit-cost ratio was 2.24:1.

CONCLUSIONInfluenza H1N1 vaccine could protect the students from Influenza H1N1 infection, and the cost-benefit analysis showed that the intervention strategy was worth trying.

Adolescent ; Child ; China ; Cost-Benefit Analysis ; Humans ; Influenza A Virus, H1N1 Subtype ; immunology ; Influenza Vaccines ; economics ; immunology ; Influenza, Human ; economics ; prevention & control ; Schools ; Students