Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most vision-threatening diseases associated with macular retinal schisis and macular holes.To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair.However,there are many controversial issues in the efficacy of the surgerical procedures including gas injection,scleral buckling and vitrectomy.How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.

Objective To observe the clinical effects of vitreoretinal surgery for myopic foveoschisis,evaluate the visual prognostic factors.Methods Twenty-seven eyes of 23 patients with myopic foveoschisis underwent vitreoretinal surgery were analyzed retrospectively. All the patients had undergone the examinations of best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,direct ophthalmoscope,binocular indirect ophthalmoscope, A or B ultrasonic scan and optical coherence tomography (OCT).Follow-up duration varied from 6 to 36 months,with the mean of (19.4± 10.03)months.The visual acuity,retinal reattachment and the complications were observed.Logistic regression analysis was performed to predict the prognosis of visual acuity.Results Twenty-one eyes (77.78％) were anatomically reattached, six eyes (22.22％) were not anatomically reattached. Postoperative BCVA improved in 24 eyes (88.89％),reduced or remained unchanged in three eyes (11.11％). No ocular complications such as fundus hemorrhage,low or high intraocular pressure,endophthalmitis were found.The preoperative BCVA (OR =9.11,P =0.007),axial length (OR =0.31, P =0.038) and the photoreceptor inner and outer segment (IS/OS) junction line continuity (OR=4.32,P=0.001) are closely related to visual prognosis.Conclusions Vitreoretinal surgery is an effective approach to treat myopic foveoschisis with both anatomical and visual improvement.The preoperative BCVA,axial length and IS/OS line continuity are closely related to visual prognosis.

Objective To observe the expression of proinflammatory factors messenger RNA (mRNA) in periretinal membrane of proliferative vitreoretinopathy. Methods Fourteen specimens of periretinal membrane were collected during vitrectomy, and they were made into paraffin sections.The presence of mRNA coding for IL-1,IL-6,IL-8 and TNF alpha was observed by in situ hybridization(ISH) with biotin labeled oligonuclotide probes respectively.The eyeball after corneal grafting was made as normal control. Results No expression of proinflammatory factors mRNA was found in normal human retina.Positive staining was present in 5 specimens.In these specimens, IL-1? mRNA was found in 3 specimens and TNF? mRNA was found in 3 specimens,there is 1 specimen expressed IL-8 mRNA and 3 specimens expressed IL-6 mRNA.In these positive specimens, one contained cells expressing mRNA for IL-1 ? beta and IL-6, and one exhibited cells expressing mRNA for IL-1??IL-8 and TNF ?,two membranes possessed positive cells for IL-6 and TNF? mRNA, one membrane contained IL-1? mRNA positive cells only. Conclusion These findings suggest that these cytokines may be locally produced by cells infiltrating epiretinal membranes. The expression of IL-1?, IL-6, IL-8 and TNF? mRNA within retinal membranes provides further evidence of a pathogenic role of these cytokines in proliferative vitreoretinopathy.

Objective To investigate production of interleukine 6 (IL 6) and interleukine 8 (IL 8) by retinal pigment epithelial (RPE) cells and its inhibition by interleukine 1 receptor antigonist(IL 1ra). Methods Cultured human RPE cells was treated with interleukine 1 ? (IL 1?, 10 ng/ml) and/or IL 1ra ( IL 1ra, 1、10、100 ng/ml). IL 6 and IL 8 mRNA and protein expression were detected by ELISA, immunohistochemistry and in situ hybridization (ISH) assay. Results IL 6 and IL 8 in conditioned media of RPE cells in controls was 2 000 pg/ml and 5 000 pg/ml respectively after stimulation of IL 1? for 8 h. IL 1ra (100 ng/ml) significantly inhibited IL 6 (300 pg/ml, t=8.011, P

Posterior vitreous detachment (PVD), retinal breaks, and lattice degeneration are common problems in ophthalmic clinical practice, which not only cause disturbance to patients' life-quality, but also increase the risk of retinal detachment and vitreoretinal traction.In September 2019, the American Academy of Ophthalmology published Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern (PPP). Based on clinical evidence, this PPP provides authoritative guidance for the definition, epidemiological background, diagnosis and treatment of these diseases.This PPP also gives definite solution for treatment and follow-up of different sub-types.This article provides introduction and interpretation of this PPP.

Objective:To analyze the early changes of gene expression levels and signaling pathways in 661W cell line under hypoxic conditions and to find potential functional target genes.Methods:The cultured mouse 661W cells were divided into hypoxia treatment group and normoxia control group. Cells in the hypoxia treatment group were cultured in a three-gas incubator with volume fraction of 1% and 5% CO 2 at 37 ℃. Cells in the normoxia control group were cultured in an incubator at 37 ℃ with volume fraction of 5% CO 2. High-throughput sequencing technology was used to sequence the transcriptome of 661W cell treated with hypoxia and normoxia for 4 hours to screen for differentially expressed genes (DEG). Clustering heat map analysis, gene ontology (GO) functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and protein-protein interaction network (PPI) analysis were performed. The reverse transcription-polymerase chain reaction (RT-PCR) was used to verify the accuracy of the sequencing results. Results:A total of 506 differentially expressed genes were screened, including 459 up-regulated genes and 47 down-regulated genes. GO functional enrichment analysis showed that the main biological processes of DEG were the cell's response to hypoxia, glycolysis, negative regulation of cell proliferation and apoptosis. hypoxia inducible factor (HIF)-1α pathway, glycolysis, Forkhead box O (FoxO) pathway, Insulin signaling pathway and Adenosine 5′-monophosphate-activated protein kinase (AMPK) pathway were involved in the above process. PPI analysis results showed that hub genes related to hypoxia were Aldoa, Aldoc, Gpi1, Hk2, Hk1, Pfkl, Pfkp, Vhl, Fbxo10 and Fbxo27. The RT-PCR results showed that the relative expression levels of 15 DEG mRNA in the hypoxic treatment group were higher than that of the normoxic control group, and the difference was statistically significant ( P<0.05). The mRNA expression levels of N-myc downstream-regulated gene-1 ( Ndrg1 ), Mt1, and vascular endothelial growth factor A ( VEGFA) were time-dependent on hypoxia. Conclusions:Under hypoxia, DEG is mainly related to glucose metabolism, cell response to hypoxia, regulation of proliferation and apoptosis. HIF-1α pathway, glycolysis, FoxO pathway and AMPK pathway are involved in the early changes of 661W cells under hypoxia. Aldoa, Aldoc, Gpi1, Hk2, Hk1, Pfkl, Pfkp, Vhl, Fbxo10, Fbxo27 may play key roles in the response of 661W cells to hypoxia. Ndrg1, Mt1 and VEGFA could be potential functional target genes for the study of ischemia and hypoxia-related fundus diseases.

Objective To investigate the occurrence trend and risk factors of recurrent respiratory tract infection during the ifrst year after Mycoplasma pneumoniae pneumonia (MPP) in children. Methods The clinical data of 133 children complete-ly recoved from MPP and one year follow-up after MPP were included in this study, MPP IgM IgG double antibody titer were measured in different time slots (3 month, 6 months, 9 months, 12 months) after discharge. Information on frequency of recurrent respiratory tract infections, respiratory tract infection site, and drug use within one year were collected. Possible factors affecting the occurrence of recurrent respiratory tract infection were analyzed by means of single factor and multi factor analyses. Results In 133 patients, the recurrent rate was 31.58%in the ifrst year;aged 3-6 years old (OR=2.29,95%CI:1.13~4.64), or continuous positive or negative to positive antibodies (OR=4.47,95%CI:1.47~13.65), or low CD4/CD8 (OR=10.26,95%CI:3.30~31.90), or low IgA (OR=1.90,95%CI:1.06~3.40) is independent risk factor of recurrent respiratory tract after MPP;immune enhancer therapy is an independent protective factor (OR=0.29,95%CI:0.11~0.78). Conclusions Immune function disorders in the ifrst year after MPP were independent risk factors of recurrent respiratory tract infection. MP antibody positive without clinical symptoms and sustained antibody positive can not prevent the recurrence of respiratory tract infection without use of antibiotics. Immune enhancer was advocate to adjust immune function and reduce the incidence of repeated respiratory tract infection.

Objective To observe the effects of tetramethyipyrazine(TMP) on retina to find out whether it can protect retina from glaucomatous damage. Methods Twenty-four rabbits were randomly divided into four groups. One eye of each rabbit was model eye induced by 2％ methylcellulous, and the other was control eye. Normal saline, TMP, timolol and a combination of timolol and TMP were administrated to group A, B, C and D respectively. At the end of 4th week, eyes were excavated for light and electron microscopic study. Results The numbers of ganglion cells (P ＜0. 01) and bipolar cells (P ＜0. 01) in model eye were different significantly between group A and B. In group A, the model eye ganglion cells were karyopyknosis, chromatin margination and nuclear membrane rupture; some in ner nuclear cells dcveloped marked lytic changes; outer segment appeared disorganized; but group B changed slight ly. Conclusion The results suggest that TMP may protect retina from glaucomatous damage.

Objective To investigate the effect of BIS-guided closed-loop target-controlled infusion on perioperative Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy under different anesthesia and sedation depths. Methods We applied random number table method to divide 73 elderly patients undergoing elective laparoscopic radical gastrectomy into BIS closed-loop target-controlled infusion group with BIS value of 55(group H, n=36) and BIS value of 45(group L, n=37).Intravenous blood samples were collected immediately before surgery (T1), 2h after surgery (T2), 24h after surgery (T3) and 72h after surgery (T4).IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were determined by flow cytometry microsphere array.We compared operation duration, postoperative PACU stay time and postoperative hospitalization time between two groups. Results Compared with T1, IL-6 and IL-10 concentration in group H at T2, T3 and T4 significantly increased (P < 0.05), IL-4 and TNF-α in group H at T4 were significantly increased (P < 0.05), IL-2 and IFN-γ in group H at T2 and T4 were significantly increased (P < 0.05), the concentration of IL-6 and IL-10 in group L at T2, T3 and T4 were increased (P < 0.05), IL-2 in group L at T4 was decreased (P < 0.05), and IFN-γ/IL-6 in two groups were decreased at T2, T3 and T4(P < 0.05).Compared with group L, IL-6 and IL-10 in group H were significantly increased at T2(P < 0.05), IFN-γ/IL-6 in group H was significantly decreased (P < 0.05), IL-2 and IL-10 in group H were significantly increased at T4(P < 0.05).Operation duration, postoperative PACU stay time and postoperative hospitalization time had no statistical significance between two groups (P > 0.05). Conclusion The anesthesia and sedation depth of BIS-guided closed-loop target-controlled infusion set at 45 is better than 55 in maintaining Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy, but it has no obvious effect on long-term prognosis.

Objective To observe the efficacy of lamellar hole-associated epiretinal proliferation (LHEP) flap insertion and autologous blood for degenerative type lamellar macular hole (LMH).Methods Retrospective case review.Twenty-eight eyes of 28 patients with LMH were enrolled in this study.There were 2 males (2 eyes) and 26 females (26 eyes).Best corrected visual acuity (BCVA),medical optometry,slit-lamp biomicroscop,indirect ophthalmoscope,spectral domain optical coherence tomography,b-scan ultrasonography and axial length detection were performed on all patients.Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity.There were 10 eyes (35.7％) with degenerative type LMH (flap insertion group) and LHEP.There were 18 eyes (64.3％) with tractional type LMH (general group).The differences of BCVA,AL,horizontal hole diameter from retina and lens state between two groups were not significant (P＞ 0.05).The differences of horizontal hole diameter of internal limiting membrane (ILM),central foveal thickness (CFT) and integrity of ellipsoidal zone between two groups were significant (P＜ 0.05).LHEP flap insertion and autologous blood without ILM peeling were used in eyes of flap insertion group.Vitrectomy combined ILM peeling were used in eyes of general group.The follow-up was ranged from 3 to 14 months.The changes of CFT,central foveal form and logMAR BCVA were observed.Results At latest follow-up,the BCVA of flap insertion group and general group were 0.34±0.27,0.31±0.29;which significantly better than the preoperative BCVA (Z=-3.519,-4.945;P＜ 0.001).The CFT of flap insertion group and general group were (200.10±58.78),(226.61±70.49) μm.There was no difference between pre-and post-operative CFT in eyes of general group (Z=-1.455,P=0.146).There was significant difference between pre-and post-operative CFT in eyes of flap insertion group (Z=-2.798,P=0.005).In flap insertion group,regular recovery of the foveal contour occurred in 9 eyes (90.0％),improvement in 1 eyes (10.0％).In general group,regular recovery of the foveal contour occurred in 10 eyes (55.6％),improvement in 8 eyes (44.4％).The closure rate of LMH were 100％ both in two groups.Conclusion LHEP flap insertion and autologous blood is an effective treatment of degenerative type LMH.