Objective To observe and evaluate the short-term therapeutic effect of intravitreal injection with topotecan for refractory vitreous seeding from retinoblastoma (RB).Methods Eleven patients (11 eyes) of RB with refractory vitreous seeding (received intravenous chemotherapy,intra-arterial chemotherapy,intravitreal melphalan,laser,cryotherapy and subsequently developed refractory viable vitreous seeds) were enrolled in this study.There were 6 males (6 eyes) and 5 females (5 eyes).The aged from 9 to 44 months,with the mean age of 26 months.According to International Intraocular Retinoblastoma Classification,11 eyes were initially classified as group E (3 eyes),D (6 eyes),B (1 eye) or A (1 eye).All patients were received intravitreal injection with topotecan.A total of 32 intravitreal topotecan injections were performed with a mean of 2.9 injections (median 3 injections;range 2-4 injections).The mean follow-up was 10 months.The safety and effectiveness of intravitreal injection with topotecan for refractory vitreous seeding from RB were observed.Results Complete regression of vitreous seeds was achieved in 11 of 11 eyes (100％),including complete disappearance in 9 eyes and fibrosis in 2 eyes.None of the patients needed enucleation and occured ocular or systemic complications in the follow-up period.Conclusion Intravitreal injection with topotecan for refractory vitreous seeds from RB is effective and safe.

Objective To analyze the angiographic characteristics of Kasabach-Merritt syndrome (KMS) and study the value of transcatheter arterial embolization (TAE) in KMS therapy. Methods The clinical data of 36 infants with KMS treated between June 2010 and June 2016 in our hospital were reviewed retrospectively. All infants performed angiography and TAE therapy. These angiographic characteristics were analyzed by comparing with infantile hemangioma(IH).The times of TAE and the level of platelet after TAE therapy were observed. Results The angiographic characteristics of KMS were as follows: The capillary blush of KMS were ill defined with no-uniform distribution. There were a lot of very fine feeding arteries. The diameter of feeding artery was disproportionate to the volume of tumor blush because the feeding arteries were too small or fine. Normal artery was usually embedded in tumor blush. However, the angiographic characteristics of IH were different as follows:the capillary blush of IH were well defined with uniform distribution.There were about 1-4 feeding arteries.The diameter of feeding artery was proportional to the volume of tumor blush. Normal artery was not embedded in tumor blush. Tumor blush was usually located beside the normal artery. In 36 patients, 107 embolization treatments were performed. The platelet declined for 11 times and increased for 96 times after TAE therapy. The platelet count for these 96 cases increased to ≥100×109/L at(7.1 ± 2.4)days following therapy. However, the platelet level fluctuated thereafter and the average relapse time was(45.9 ± 21.8)days. All cases were followed-up ranging from 6 months to 2 years and finally received other therapies.Eight cases were cured and the other 28 cases were improved. Conclusions The angiographic characteristics of KMS are different from common infantile hemangioma. It is difficult to embolize the feeding arteries of KMS because there are a lot of very fine feeding arteries.TAE may rapidly improve the level of platelets while the long term effect was poor.It might be better to combine TAE with other medical therapies to treat KMS.

Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.

Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.

Ten compounds were isolated and purified from the ethyl acetate fraction of Houttuynia cordata by silica gel and ODS column chromatographies. The chemical structures of the compounds were identified on the basis of physicochemical properties as well as spectral data. These isolated compounds were elucidated as sequinoside L(1), a new phenolic glycoside, together with nine known compounds, including sequinoside K(2), methyl chlorogenate(3), chlorogenic acid(4), hydroquinone(5), vanillic acid(6), hyperin(7), isoquercitrin(8), quercetin(9), and quercitrin(10). In addition, the anti-inflammatory activities of compounds 1-10 were evaluated in LPS-induced RAW264. 7 macrophages. Among them, compounds 1, 2, 6 and 9 showed potent anti-inflammatory activity which was similar to that of positive control dexamethasone.