Background Bevacizumab and triamcinolone acetonide (TA) has been widely used in the treatment of diabetic macular edema (DME) clinically,but the effectiveness of both treatment has disadvantage.Therefore,some researchers try to combine bevacizumab with TA for the management of DME,but its efficacy is controversial.Objective This study was to evaluate the efficacy and safety of intraovitreal injection of bevacizumab combined with TA versus bevacizumab for DME.Methods The randomized controlled trials (RCTs) of bevacizumab combined with TA versus bevacizumab via intraovitreal injection for DME were searched from Pubmed,EMbase,Cochrane Library,CNKI.The methodological quality of the literature was evaluated according to evidencebased medicine (EBM),and the quality of the RCTs was appraised based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.The outcome indicators including the change values of central macular thickness (CMT) and best-corrected visual acuity (BCVA) as well as the safety indicators including topical and system adverse response of RCTs were analyzed with Cochrane Collaboration' s software RevMan 5.0.Results Nine RCTs were included with 665 eyes.The decrease value of CMT was more remarkable in the bevacizumab combined with TA group than that of the only bevacizumab group 12 weeks and 18 weeks after intravitreal injection (WMD =-44.69,95％ CI:25.27-64.11,P ＜ 0.000 001 ; WMD =-66.86,95％ CI:40.67-93.05,P ＜ 0.000 001).However,no significant differences were found in the change value of CMT in 6 weeks and 6 months after injection between the two groups (WMD =-15.40,95％ CI:-4.04-34.85,P =0.12 ; WMD =-2.57,95％ CI:-19.62-24.75,P =0.82).The improvement value of BCVA (LogMAR) in the bevacizumab combined with TA group was superior to that of the only bevacizumab group 6 weeks after injection (WMD =-0.04,95 ％ CI:-0.08--0.00,P =0.05),but there were no significant differences between the two groups at 12weeks,18 weeks and 6 months after treatment (WMD =-0.04,95％ CI:-0.12-0.05,P=0.36;WMD =-0.04,95％ CI:-0.11-0.03,P=0.28; WMD =0.03,95％ CI:-0.05-0.12,P=0.45).The incidence rate of transient anterior response after injection was not significantly different between the two groups (RR =0.89,95％ CI:0.49-1.60,P =0.70).Secondary ocular hypertension after injection occurred in 30 eyes in the bevacizumab combined with TA group,but no hypertension was seen in the only bevacizumab group.Conclusions Compared with only bevacizumab,intravitreal injection of bevacizumab combined with TA has a better efficacy in improving CMT but no obvious dominant in increasing BCVA for early DME.Intravitreal injection of bevacizumab combined with TA seemingly has a higher risk of inducing controllable ocular hypertension than administration of only bevacizumab.

AIM: The multi-residues method was used to determine organophosphorus pesticides in traditional Chinese herbal medicines (TCHMs).METHODS: Fifty three pesticides were extracted by high-speed homogenization,and then cleaned sequentially by C_(18) and Carb/NH2 solid phase extraction (SPE) cartridges.The residues were simultaneously identified and quantified by GC-FPD equipped with dual tower,dual column and two FPD detectors.RESULTS: The analytical performance was demonstrated by the analysis of 6 TCHMs samples extracts,spiked at three concentration levels for each pesticide.In general,the recoveries ranging from 70% to 120%,with relative standard deviations (RSDs) less than 15%,were obtained.The limit of detection (LOD) for most of the targeted pesticides tested was below 0.01 mg/kg.CONCLUSION: The method has good extraction efficiency,purification effect and good reproducibility,which can be applied to the determination of organophosphorus pesticide residues in the routine analysis of TCHMs.

AIM:To study a method for the determination of 13 N-methylcarbamate peticides in traditional Chinese herbal medicines(TCHMs).METHODS:Thirteen pesticides were extracted by acetonitrile,and purified through solid phase extraction(SPE)cartridges,then detected by HPLC with post-column derivatization and Fluorescense Detector excited wavelength was 330 nm,emissive wavelength was 465 nm.RESULTS:The analytical performance was demonstrated by the analysis of 6 TCHMs samples' extracts,spiked at three concentration levels for each pesticide.In general,the recoveries ranging from 74.1 to 108.8%,with relative standard deviations(RSDs)better than 15%,were obtained.The limit of quantification(LOD)of 13 pesticides from 0.000 3 to 0.06 mg/kg.CONCLUSION:The method has good extraction efficiency and purification effect,which could be standard of N-methylcarbamate peticides residues in the routine analysis of TCMs.

The paper is to report the establishment of a method for the determination of multi-residue organochlorine and pyrethroid pesticides in traditional Chinese medicines (TCMs). Fifty-six pesticides were extracted by high-speed homogenization, and then purified through gel permeation chromatography (GPC) and solid phase extraction (SPE) cartridges. The residues were simultaneously identified and quantified by GC-ECD equipped with dual tower, dual column and two micro-ECD detectors. The analytical performance was demonstrated by the analysis of 3 TCMs samples' extracts, spiked at three concentration levels for each pesticide. In general, the recoveries ranging from 70% to 110%, with relative standard deviations (RSDs) better than 15%, were obtained. The limit of detection (LOD) for most of the targeted pesticides tested was below 0.01 mg kg(-1). The method had good extraction efficiency, purification effect and good reproducibility, which could be applied to the determination of organochlorine and pyrethroid pesticide residues in the routine analysis of TCMs.

Objective To observe the foveal contour characteristic of idiopathic epiretinal membrane (iERM).Methods A total of 53 eyes in 52 patients with iERM who underwent pars plana vitrectomy with epiretinal membrane and inner limiting membrane peeling were enrolled in this retrospective study.All eyes received the examination of optical coherence tomography (OCT) and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA).Foveal contour grading was according to the ratio of central macular thickness (CMT) to the thickness of the retina 1 mm away on OCT line scan:Grade 0,depressed;Grade 1,flat;Grade 2,elevated.Baseline foveal contour grade was as follows:28 eyes with Grade 1 (Group 1),and 25 eyes with Grade 2 (Group 2).The mean logMAR BCVA was 0.40±0.26 in Group 1,and 0.60±0.27 in Group 2 respectively.The mean CMT was (433.52± 133.05) μm and (571.70± 85.40) μm respectively.The logMAR BCVA and CMT both demonstrated significant difference between the two groups (t=-2.825,-4.512;P＜0.05).OCT images and BCVA at 1,3 months after surgery were collected and analyzed.The change in foveal contour,BCVA and CMT were evaluated.The relationship between surgical outcome and different preoperative grading was analyzed.Results Foveal contour grade at 3 months after surgery was as follows:15 eyes with Grade 0,21 eyes with Grade 1,and 17 eyes with Grade 2,demonstrating significant difference compared with baseline (Z=-3.588,P＜0.05).In Group 1,there were 12 eyes with Grade 0,10 eyes with Grade 1,and 6 eyes with Grade 2 postoperatively.In Group 2,there were 3 eyes with Grade 0,11 eyes with Grade 1,and 11 eyes with Grade 2 postoperatively.The postoperative foveal contour grade was significantly different between the two groups (Z=-2.466,P＜0.05).The logMAR BCVA at 1,3 months after surgery both improved significantly compared with baseline (P＜0.05) in Group 1 (t=3.226,5.439) and Group 2 (t=-4.137,5.919).The logMAR BCVA at 1,3 months after surgery demonstrated significant difference between the two groups (t=-2.231,-2.291;P＜0.05).The CMT decreased significantly at 1,3 months after surgery in Group 1 (t=-2.674,4.090) and Group 2 (t=-9.663,-9.865) compared with baseline (P＜0.05).TheCMT at 1,3 months after surgery demonstrated significant difference between the two groups (t=-2.825,-3.003;P＜0.05).The improvement of logMAR BCVA 3 months after surgery was negatively correlated (P＜0.05) with preoperative logMAR BCVA (r=— 0.758) and preoperative CMT (r 0.359).Conclusion In iERM eyes,flat foveal contour had better surgical prognosis than elevated ones.

Objective:To evaluate the efficacy and safety of conbercept in patients with choroidal neovascularization secondary to chronic central serous chorioretinopathy (CSC-CNV).Methods:A retrospective case study was performed.The medical records of 13 patients (14 eyes) diagnosed as chronic CSC-CNV in Hangzhou Branch of Eye Hospital of Wenzhou Medical University from September 2015 to January 2018 were collected.All the study eyes received intravitreal injection of conbercept (0.05 ml/0.5 mg) under one intravitreal injection and pro re nata (PRN) treatment.The best corrected visual acuity (BCVA) and central macular thickness (CMT) before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were measured and analyzed.This study followed the Declaration of Helsinki and written informed consent was obtained from each patient before initial injection.The study protocol was approved by the Ethics Committee of Hangzhou Branch of Eye Hospital of Wenzhou Medical University (No.2019-029-K-28).Results:During the 6-month follow-up, the mean administration times was 1.93±0.83, and all the CNV secondary to CSC did not grow outside the retinal pigment epithelium layer.The BCVA values before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were 0.51±0.32, 0.43±0.34, 0.36±0.35, 0.31±0.28, 0.27±0.29 and 0.26±0.30, respectively, with a significant difference among different time points ( F=21.225, P<0.05). The BCVA values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). The CMT values before initial injection and 1 week and 1 month, 2, 3, 6 months after initial injection were (299.07±132.90), (216.50±70.94), (203.00±61.87), (234.29±95.70), (194.21±46.46) and (207.43±55.46) μm, respectively, and the difference was statistically significant among different time points ( F=3.768, P<0.05). The CMT values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). No severe treatment complications were observed during the follow-up period. Conclusions:Intravitreal injection of conbercept is safe and can effectively reduce the CMT and improve BCVA of chronic CSC-CNV patients in the short term.

Background The introvitreal injection of triamcinolone acetonide (TA) before vitrectomy for retinal with choroidal detachment (RD/CD) can alleviate inflammatory response,but it easily lead to complications under the low intraocular pressure.The study on the efficiency and safety of subtenon injection of TA for treatment of RD/CD is lack.Objective This study was to evaluate the efficiency and safety of subtenant injection of TA with vitrectomy for treatment of RD/CD.Methods A retrospective study was adopted.The data of 22 eyes of 22patients who received subtenon injection of TA with vitrectomy for RD/CD were collected and analyzed in Affiliated Eye Hospital of Wenzhou Medical University from May 2010 to June 2014.TA of 40 mg in 0.4 ml was administered subtenantly 5 days before RD repair surgery.After initiating the treatment,the therapeutic effects on uvitis were analyzed.Intraocular pressure was monitored and CD height and range were determined by B type ultrasonography before injection and 5 days after injection respectively.In addition,blood glucose and blood pressure of the patients were evaluated.Results Ocular inflammation alleviated to some degree after TA injection in all 22 eyes.The mean intraocular pressure was (5.4±2.9) mmHg (1 mmHg =0.133 kPa) in pre-injection and (8.2±4.3) mmHg in postinjection,showing a significant difference between them (t =3.430,P ＜ 0.01).The mean maximum CD height was 5.2 (3.1,6.6)mm in pre-injection and 0.9 (0,3.8)mm in post-injection,with a significant difference between the before and after injection (Z=-4.198,P＜0.01).The mean CD range was 12 (10,12) clock before injection and 3(0,6) clock after injection,and no significant difference was found between before and after injection (all at P＞0.05) (Z=-4.124,P＜0.01).There were no statistically significant difference in the changes of blood glucose and blood pressure between before and after injection.The LogMAR visual acuities were 2.14±0.46,1.29±0.57 and 1.17±0.55 before injection and 1 month,3 months after injection,respectively,with a siginificant difference among them (F =22.060,P＜0.001).The retinal reattachment rate was 95.5 ％.Conclusions Subtenon injection of TA seems to be a good option for perisurgical management of RD/CD patients,which can alleviate uvitis,increase intraocular pressure,reduce CD height and CD range.

Objective: To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole. Methods: A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed. Results: In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ²=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631). Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.

Objective:To investigate the efficacy and safety of anlotinib combined with whole brain radiation therapy in the treatment of driver gene mutation-negative non-small cell lung cancer (NSCLC) patients with multiple brain metastases.Methods:Forty-two driver gene mutation-negative NSCLC patients with multiple brain metastases who were admitted to Shaoxing People's Hospital from March 2018 to March 2022 were included. Among them, 21 patients in the anlotinib combined with whole brain radiation therapy group were enrolled from a prospective single-arm study (clinical trial registration number: ChiCTR1900027769), and the patients in the whole brain radiation therapy-alone group were enrolled from a concurrent retrospective study, and after 1∶1 propensity score matching, a total of 21 patients were finally included. The intracranial objective response rate (iORR), intracranial disease control rate (iDCR), intracranial progression-free survival (iPFS), overall survival (OS), and adverse events were compared between the two groups.Results:Among 21 patients in the arotinib combined with whole brain radiation therapy group, there were 1 case (4.8%) of complete remission (CR), 13 cases (61.9%) of partial remission (PR), 6 cases (28.6%) of stable disease (SD), and 1 case (4.8%) of progressive disease (PD). Among 21 patients in the whole brain radiation therapy-alone group, there were 0 case of CR, 10 cases (47.6%) of PR, 7 cases (33.3%) of SD, and 4 cases (19.0%) of PD. The iORR was 66.7% (14/21) and 47.6% (10/21) in the anlotinib combined with whole brain radiation therapy group and whole brain radiation therapy-alone group, respectively ( P = 0.212), and the iDCR was 95.2% (20/21) and 81.0% (17/21), respectively ( P = 0.343). The median iPFS time was 10.4 and 5.3 months in the anrotinib combined with whole brain radiation therapy group and the whole brain radiation therapy-alone group, respectively, and the difference in iPFS between the two groups was statistically significant ( P = 0.049); the 1-year OS rate was 50.5% and 39.5%, and the 2-year OS rate was 29.9% and 26.3%, respectively, with the median OS time of 13.4 and 6.6 months, respectively. The difference in OS between the two groups was not statistically significant ( P = 0.452). The most common treatment-related adverse effects in the anlotinib combined with whole brain radiation therapy group were loss of appetite (13/21, 61.9%), hypertension (11/21, 52.4%), fatigue (10/21, 47.6%), diarrhea (6/21, 28.6%), vomiting (6/21, 28.6%), dizziness (9/21, 42.9%), and headache (8/21, 38.1%). No ≥grade 4 adverse effects were observed, and there were no significant differences in adverse effects between the two groups (all P > 0.05). Conclusions:Anlotinib combined with whole brain radiation therapy can prolong the iPFS time of driver gene mutation-negative NSCLC patients with multiple brain metastases, and it is well-tolerated in terms of safety.

Objective To investigate the correlation between the vitreomacular adhesion (VMA) and exudative age-related macular degeneration (AMD).Methods A literature research was performed in PubMed,EMbase,Cochrane Library,CNKI and Wanfang database from January 2000 to December 2016.Case-control studies on the relationship between VMA or posterior vitreous detachment and exudative AMD were included in this analysis.Literature screening and data extraction were performed according to inclusion and exclusion criteria.The qualities of the literatures were evaluated according to the Newcastle-Ottawa Scale (NOS).Seven literatures were selected into meta-analysis.The NOS score was 9 points in 1 article,8 scores in 4 articles,7 points in 2 articles.A total of 947 eyes with exudative AMD,638 eyes with dry AMD,and 618 eyes with controls were included.The correlation between exudative AMD and VMA were analyzed using the software Review manager 5.3.Results The prevalence of VMA in exudative AMD eyes was higher than that in controls [odds ratio (OR)=2.14,95％ confidence interval (CI)=1.19-3.84,P=0.010] and dry AMD eyes (OR=2.24,95％CI=1.24-4.03,P=0.007).There was no difference in PVD prevalence among exudative AMD eyes,dry AMD eyes (OR=0.44,95％CI=0.16-1.20,P=0.110) and controls (OR=0.70,95％CI=0.41-1.18,P=0.180).Conclusion There is correlation between VMA and exudative AMD.