Background Vitrectomy is a primary approach to the treatment of proliferative diabetic retinopathy (PDR).However,postoperative rehaemorrhagia often occur.Ranibizumab is an effective drug of antivascular endothelial growth factor,but whether the combination of intravitreal injection of ranibizumab with vitrectomy can reduce the incidence of postoperative rehaemorrhagia in PDR patients is still unclear.Objective This study was to investigate the preventive effect of the combination of intravitreal injection of ranibizumab with 25-gauge vitrectomy on postoperative rehaemorrhagia.Methods A retrospective cohort study was perfomed.The clinical data of Ⅴ-Ⅵ stage of PDR patients who received 25-gauge vitrectomy in Peking University Interuational Hospital from January 2014 to July 2015 were collected and analyzed.The PDR patients were divided into only surgery group and drug with surgery group.The patients in the only surgery group (34 eyes of 49 patients) received 25-gauge vitrectomy,and the patients in the drug with surgery group (32 eyes of 25 patients) received the intravitreal injection of ranibizumab 0.05 ml (0.5 mg) 7 days before 25-gauge vitrectomy.The distribution of eye number in different grades of visual acuities was observed and compared between the two groups in 1 day,1 week,1 month and 3 months after surgery,and the incidence of rehaemorrhagia was intergrouply compared in 1 day,3-7 days and 1 month after surgery.Results The eye number and percentage of the different visual acuities in the drug with surgery group was not significantly different from the only surgery group in 1 day,1 week,1 month and 3 months after surgery (1 day:Z=0.673,P=0.412;1 week:Z=0.113,P=0.737;1 month:Z=1.755,P=0.185;3 months:Z=2.474.P=0.116).Rehaemorrhagia occurred in postoperative day 1 and day 3-7 was 1 eye and 1 eye respectively in the drug with surgery group,and that in the only surgery group was 9 eyes and 9 eyes respectively,showing significant difference between the two groups (all at P＜0.05).The eye number of rehaemorrhagia in postoperative 1 month was 4 in the only surgery group,and no rehaemorrhagia appeared in the drug with surgery group.Conclusions The combination of intravitreal injection of ranibizumab with 25-gauge vitrectomy can efficiently reduce the incidence of postoperative rehaemorrhagia.

Objective To study the diagnosis and treatment of restless legs syndrome(RLS)in the elderly.Methods The diagnosis of RLS was based on criteria proposed by the International Restless Legs Syndrome Study Group.Ten elderly patients with RLS were enrolled in the research. The clinical presentation and treatment results were analyzed retrospectively.Results All 10 patients were complained of compelling urge to move their limbs.The sensory symptoms were involved in the 4 patients' legs,involved both arms and legs in another 5 patients.It occurred unilaterally in the left of I patient.All patients complained of syndromes aggravated in the night, other three patients also had distinct syndromes in the daytime.Three patients had family history of RLS.The unpleasant sensations were partially or totally relieved by movement.Neurophysiological tests in 5 patients were normal.The iron deficiency occurred only in 1 patient with low serum ferritin and iron levels,Rebound and augmentation were observed in 1 patient in the course of three years treatment with Sinemet.All patients administered a dopamine receptor agonist(pergolide)and showed positive results.Oral administration of iron improved RLS symptoms in a patient with iron deficiency. Conclusions The diagnosis of RLS is usually based on the patient's clinical presentation,which has characteristic feature in the elderly.Rebound and augmentation are serious side-effects in the course of long-term treating with L-DOPA.Therapy of RLS with dopamine receptor agonists is firstly chosen.

OBJECTIVE： To establish a HPLC assay for the determination of hydroxycamptothecinum and camptothecinum.METHODS： The concentrations of hydroxycamptothecinum and camptothecinum were assayed on a C18 column with a mobile phase consisting of methanol－ water(45∶ 55) at a flow rate of 1.0 ml/min,and detected at 266nm.RESULTS： The mean recovery of hydroxycamptothecinum was 100.2％ ,the 2,4,8 hours precision RSD were less than 1.8％ ;The mean recovery of camptothecinum was 99.7％ ,the 2,4,8 hours precision RSD were less than 2.0％ .CONCLUSION： The HPLC method for determination of hydroxycamptothecinum and camptothecinum was rapid,sensitive and accurate.

The treatment of total avulsion of the hand is somewhat difficult and the result usually not satisfactory. Four cases of such patients were treated from 1983 to 1987. After routine debridement, digital nerves and its surrounding adipose tissue were preserved. An "S" shape skin flap was designed an raised in the contralateral upper abdominal quadrant to cover the injured hand like a bag, so that both sides of the hand were covered. The donor area (12cm2) was directly sutured. Nerve endings might grow into the flaps because of the preservation of digital nerves. Three patients were followed-up for 2 to 6 years, the injured hands regained good pain sensation as well as stereognostic and temperatuer sensations. The function of the hand is satisfactory, but the flap looked bulky and multiple plastic operations were necessary to seperate the fingers.

AlM:To determine the changes of regional macular retinal thickness ( RT ) with spectral domain optical coherence tomography ( SD-OCT ) after successful pars plana vitrectomy ( PPV ) surgery with inner limiting membrane ( lLM ) peeling in patients with idiopathic macular hole.
METHODS:A non-randomized retrospective case study on 17 patients ( 17 eyes ) who were hospitalized between March 1, 2011 and June 30, 2013. All 17 eyes had been diagnosed with idiopathic macular hole and thereafter underwent 25G-PPV surgeries performed by the same surgeon with lLM peeling and short - term gas tamponade. ln the 6mo-plus follow-up after surgery, these eyes were found to have successful closure in the macular hole. The macular RT of the nine areas in the Early Treatment Diabetic Retinopathy Study was measured by SD-OCT. All patients were applied by SD-OCT with linear scan of the macular. At least four examinations on the operated eye were conducted in contrast to the other normal eye: before the surgery, 3~5wk after the surgery (stage A), 2~3mo after the surgery (stage B), and >6mo after the surgery (stage C).
RESULTS:ln stage A, the macular RT of operated eyes in the areas of C, lS, ll, lN, OS, Ol, ON (263. 00±39. 48, 313. 92±18. 35, 311. 00±18. 02, 335. 67±19. 91, 280. 83±33. 74, 269. 92 ± 23. 32, 307. 00 ± 28. 40 ) were significantly thicker than the corresponding areas of the normal fellow eyes (220. 51 ± 23. 94, 292. 08 ± 21. 93, 282. 50 ± 20. 30, 288. 33 ± 20. 76, 251. 25±17. 60, 247. 75±21. 48, 265. 17±24. 76ü m) (P<0. 01) with the exception of the lT (291. 58±18. 97, 280. 33± 20.82üm) and OT (250.83±21.21, 242.08±24.02üm) (P>0. 01). ln Stage B, the macular RT in the areas of ll, lN, OS (335.67±19.20,319.75±19.20, 273.50±16.89üm) were significantly thicker than the corresponding areas of the normal fellow eyes (286. 33±20. 46, 293. 42±17. 64, 252. 50± 16.32üm) (P<0. 01). However, the macular RT of the operated eyes in the areas of C, lS, lT, Ol and OT had no statistically significant difference compared with the corresponding areas of the normal fellow eyes (P> 0. 01). ln Stage C, the macular RT of operated eyes with the areas of lN (321. 17 ± 19. 71ü m) were significantly thicker than the corresponding areas of the normal fellow eyes (296.25±19.57üm) (P<0.01). Meanwhile the other areas of the operated eyes were not significantly different from the normal fellow eyes (P>0. 01). Moreover, the macular RT of operated eyes in the areas of ON, lT (307. 00±28. 40, 291. 58 ± 18. 97ü m ) in stage A significantly decreased compared to that of the corresponding areas in stage C (276. 08±32. 39, 278. 75±10. 19ü m) (P<0. 01).
CONCLUSlON: SD-OCT is a convenient tool for the observation of macular regional changes after macular hole surgery. Macular RT had persistent changes after vitrectomy on eyes with macular hole by SD-OCT. lLM peeling may have caused microstructural changes in wide areas of the macular region after PPV surgery. More support and evidence were provided to the further study of the long - term observation for the structural and function of macular after macular hole surgery.

AIM: To investigate the effects of rosiglitazone on fibroblast-like synoviocyte ( FLS )-induced osteoclastogenesis in rheumatoid arthritis ( RA) and the related mechanism.METHODS: RA-FLS were cocultured with peripheral blood monocytes from healthy volunteers in the presence of macrophage colony-stimulating factor ( M-CSF) and rosiglitazone.Osteoclasts were assayed by tartrate-resistant acid phosphatase ( TRAP) staining.Resorption lacunae area was identified by toluidine blue staining and quantified by image analysis software.The mRNA expression of RANKL and OPG was evaluated by real-time PCR, and the protein levels of RANKL, OPG, p-ERK, p-p38 and p-JNK were measured by Western blot.RESULTS:Compared with control group ( without rosiglitazone treatment) , rosiglitazone at concentration of 15 μmol/L significantly decreased the number of osteoclasts (P<0.01) and resorption lacunae area (P<0.05).The expression of RANKL at mRNA and protein levels was significantly down-regulated by rosiglitazone at concentration of 15μmol/L, while the mRNA and protein expression of OPG was up-regulated (P<0.01).Rosiglitazone (15 μmol/L) sig-nificantly decreased the protein level of p-ERK ( P<0.05 ) , but not the protein level of p-p38 or p-JNK ( P>0.05 ) . CONCLUSION:Rosiglitazone inhibits RA-FLS-induced osteoclast formation and its resorption activity by down-regulating RANKL expression and ERK phosphorylation, suggesting that rosiglitazone may inhibit RA osteoclastogenesis and bone re-sorption.

Objective To explore the relationship between the expression of Hypoxia-induciable factor-1α (HIF-1α) and changes of hepatitis microcimulation in patients with chronic hepatitis B (CHB).Methods 120 patients with CHB were studied. The expression of HIF-1 α was observed by immunohistochemistry and the morphotogic changes were observed with transmission eletron microscope. Results Stenosis, blockage, dilataltion, capillarization of hepatic sinusoids were the main morphotogic changes of liver. The expression of HIF-1α was positive or stronger positive. There is a positive correlation between the expression of HIF-1α and microcirculation disturbance of liver.Conclusion The disturbance of liver with CHB could exacerbate the dysbolism of nutrient substance and oxygen between hepatic cells and blood circulation. Hypoxia of hepatic cells was an important reason of the liver's pathological changes.

Objective To investigate the change of serum CD62p of coronary heart disease (CHD) patients after different doses of clopidogrel administration.Methods One hundred and ninety-one patients with CHD were selected as our subjects.Of which,95 cases were with SAP and 66 cases were with non ST segment elevation acute coronary syndrome (NST-ACS).SAP patients were randomly given clopidogrel at dose of 75 mg/d or 150 mg/d and served as A and B groups.NST-ACS patients were randomly given 300 mg clopidogrel,then randomly divided into C and D groups with sequentially taking clopidogrel at dose of 75 mg/d or 150 mg/d respectively.Thirty healthy peoples were served as E group without drug intervention.Concentrations of serum CD62p were detected by Elisa before taking clopidogrel,24 h and the fifty day of after taking clopidogrel.Results (1) Before taking clopidogrel,the serum concentrations of CD62p in CHD patients were higher (A group:(7.62 ± 2.99) ng/L,B group:(8.48 ± 3.13) ng/L,C group:(9.50 ± 3.32) ng/L,D group:(10.22 ± 5.14) ng/L than that of healthy control group ((5.49 ± 1.99) ng/L,P ＜ 0.05).The Serum CD62p levels in SAP patients were lower than that of NST-ACS patients (P ＜ 0.05).(2)The serum concentrations of CD62p in A and B groups at before taking clopidogrel were (7.62 ±2.99) ng/L and (8.48 ±3.13) ng/L respectively,higher than that four days after taking clopidogrel ((6.79 ± 2.51) ng/L,(6.37 ± 1.80) ng/L;t =2.390,4.520;P ＜0.05 or P ＜0.01).There was no statistical significant difference between A and B groups(P ＞0.05).(3) In C and D groups,the serum CD62p at before taking clopidogrel were (9.50 ±3.32) ng/L and (10.22 ±5.14) ng/L,higher than that after taking clopidogrel for four days ((8.21 ± 2.62) ng/L,(8.17 ± 2.37) ng/L; t =2.084,2.157 ; P ＜ 0.05).No significant difference was seen between C and D groups (P ＞ 0.05).Conclusion The serum CD62p in patients with CHD was higher than that in the healthy control.Clopidogrel administration can decrease serum CD62p in CHD patients.

Objective To investigate doctor's screening practice for hepatitis B virus (HBV) infection before immunosuppressive therapy for rheumatoid arthritis (RA) patients and clinical management of RA patients with positive surface antigen of HBV (HBsAg).Methods One hundred fifty doctors who treated RA patients in daily clinic were survied with a modified American College of Rheumatology (ACR) questionnaire which was composed of demographic data and 10 multiple-choice questions.Step-forward logistic regression analysis was performed to find out the influencing factors,then receiver operator characteristic curve analysis and area under the curve were performed to confirm the influencing factors.Results One hundred and thirtytwo effective questionnaires were collected.Before immunosuppressive therapy,HBV screening rate in outpatients with RA was significandy lower than that in hospitalized patients (68.7％ vs 94.6％,x2=31.5,P＜0.01).Only 23.7％(31/131) of doctors considered antiviral treatment for all RA patients with positive HBsAg.One hundred and thirteen doctors had clinical experience of antiviral treatment,but only 30.1％(34/113) and 23.9％ (27/113) of these doctors chose entecavir or adefovir as the antiviral drug respectively,59.3％ (67/113) prescribed antiviral drug before or together with immunosuppressive therapy compared with 40.7％(46/113) after HBV reactivation.Only 20.4％(23/113) of doctors would sustain antiviral treatment until the termination of steroid or disease modifying antirheumatic drugs (DMARDs).During immunosuppressive therapy for HBsAg(+) RA patients,11.4％(15/132) and 30.3％(40/132) of doctors reported no regular monitoring of aminotransferase or HBV DNA respectively.Conclusion Our survey shows that HBV screening rate in outpatients with RA is low and low awareness of antiviral treatment for all RA patients with positive HBsAg,and lack of awareness of indication,choosing of antiviral drugs,initiation,monitoring and duration of antiviral treatment during immunosuppressive therapy.Further medical education on the associated information and importance to collaborate with hepatologists should be emphasized.

Objective To observe the efficacy and safety of tocilizumab on patients with refractory rheumatoid arthritis (RA).Methods Eighteen RA patients who were refractory to disease-modifying antirheumatic drugs (DMARDs) or tumor necrosis factor-α (TNF-α) antagonist were treated with tocilizumab were included into this study.Their clinical disease activity indices,Hospital Anxiety and Depression Scale (HADS)and safety were evaluated regularly.Statistical analysis was conducted with Mann-Whitney U test and x2 test.Results According to clinical disease activity index,44％(8/18) of patients reached treatment target 2 weeks after the first infusion of tocilizumab,and 78％ (14/18) reached treatment target after three infusions of tocilizumab.Fifty-six percent (10/18) of patients had anxiety and 22％ (4/18) had depressive symptoms at baseline.After three infusions of tocilizumab,6％(1/18) had anxiety symptoms and 11％(2/18) had depressive symptoms.The adverse effects included upper respiratory tract infection,aminotransferase elevation and neutropenia (3 patients,respectively).Conclusion Tocilizumab can rapidly and significantly improve the disease activity and psychological state with good tolerance and safety,which can be applied to Chinese refractory RA patients who failed with DMARDs or TNF-α antagonist.