The clinical manifestations of infectious retinal diseases are complicated,especially these result from serious infectious diseases such as acquired immune deficiency syndrome (AIDS),tuberculosis and syphilis infections.It is an important issue to differentiate infectious retinal disease from non-infectious intraocular inflammation in the clinic.It is,therefore,highly desirable to follow a proper steps to reach the correct diagnosis.Complete history review and comprehensive ocular examination remains the first step in diagnosing infectious retinal diseases.Although an array of laboratory and serological tests are available to assist in the diagnosis,some situations may require a diagnostic therapy or a tissue biopsy.Identification of the pathogen and histopathologic examination of the ocular specimen remain to be the gold standard of diagnosis.Initiation a specific and appropriate antimicrobial therapy needs multidisciplinary collaborations including ophthalmologists and infectious specialists.Updated knowledge of general medicine and management of infectious diseases,interdisciplinary collaborations and optimization of treatment processes will improve the diagnosis and treatment of retinal infectious diseases in the future.

Objective To search for the application of trehalose as cryoprotectant for keeping aortic valve homograft in liquid nitrogen.Methods The aortic valve homografts of Wistar rat were kept in 10%DMSO and divided into 2 groups(control and test group).The test group was added a supplement of trehalose 0.1mol?L~(-1) and all the hemografts were gradually hypothermied and then cryopreserved in-196℃ liquid nitrogen.After 6 months all the cryopreserved valves were thawed.The aortic valve homografts were observed by light and electron microscope.At the same time,the viability of endotheliocyte was measured.Results The viability of endotheliocyte in test group was higher than that in the control group and the structural damage was also much lighter.Conclusion The cryoprotective effect of combined use of 10%DMSO+0.1mol?L~(-1) trehalose was much better than that of 10%DMSO alone.

Objective To evaluate the clinical features and treatment outcomes of ocular posteriorsegment syphilis.Methods The clinical data of 24 patients with active ocular syphilis wereretrospectively reviewed.The diagnosis was made first in eye clinic,and verified by treponema pallidumparticle agglutination(TPPA)and rapid plasma reagin(RPR).The patients,17 males and 7 females,aged from 30 to 63 years with an average of 47.6 years.The duration of symptoms ranged from 3 days to2 years with an average of 5.8 months(≤1 month,7 cases;1-3 month,5 cases;3-6 months,5 cases;>6 months,7 cases).There were 18 bilateral cases and 6 unilateral cases.The result of humanimmunodeficiency virus(HIV)test was negative for all cases.Twenty-three patients received systemicpenicillin therapy and 1 patient was treated with oral erythromycin due to penicillin allergy.Beforetreatment,the mean visual acuity was 0.17±0.1 9,the mean titer of RPR was 1:84.The follow-up periodwas half a year.Results The major ocular manifestations included bilateral(16 cases)or unilateral(1case)chorioretinitis,unilateral retinal vasculitis(2 cases),unilateral neuroretinitis(2 cases),andbilateral(2 cases)or unilateral(1 case)optic neuritis.The mean follow-up visual acuity was 0.60±0.29,the mean follow-up titer of RPR was 1:18.8.Some patients had got the diagnosis and prompt treatment atthe early stage of the disease and their visual acuity recoveried very well.Conclusions The majormanifestion of ocular posterior segment syphilis is chorioretinitis.It is important tO consider the possibilityof syphilis when patients have inflammation of posterior segment.Prompt serology examination andpenicillin treatment are the keys to cure ocular syphilis.

Epigenetic modifications such as DNA methylation,histone post-translational modifications,non-coding RNA are reversible,heritable alterations which are induced by environmental stimuli.Major risk factors of diabetes and diabetic complications including hyperglycemia,oxidative stress and advanced glycation end products,can lead to abnormal epigenetic modifications in retinal vascular endothelial cells and retinal pigment epithelium cells.Epigenetic mechanisms are involved in the pathogenesis of macular edema and neovascularization of diabetic retinopathy (DR),as well as diabetic metabolic memory.The heritable nature of epigenetic marks also plays a key role in familial diabetes mellitus.Further elucidation of epigenetic mechanisms in DR can open the way for the discovery of novel therapeutic targets to prevent DR progression.

Objective The aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy (PPV)and secondary internal limiting membrane (ILM)peeling.Methods This was a retrospective study.The clinical data of 1 5 patients (1 5 eyes)with macular hole retinal detachment and high myopia,who underwent primary PPV and secondary ILM peeling,were analyzed,including disease history,refraction diopter,ocular axis length,posterior scleral staphyloma,BCVA,macular reattachment and macular hole heeling.There were 3 males (3 eyes)and 12 female (12 eyes),the average age was (60.80 ± 5.85 )years.All patients were examined by best corrected visual acuity (BCVA ), slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy,A scan and optical coherence tomography (OCT).After the first PPV and silicone oil tamponade,a shallow retinal detachment around the macular hole,especially around the scleral staphyloma was detected by OCT.During the 2nd surgery to remove the silicone oil,ILM peeling and C3 F8 tamponade were performed.Results The average refraction diopter was (- 12.6 ± 1.86)D,the average ocular axial length (29.82±0.993)mm and the average disease duration was (5.20±1.24)months.All eyes had total retinal detachment of all four quadrants,choroid detachment and macular choroidal atrophy,and type ⅡCurtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination.OCT examination indicated that macular hole closure in 7 eye,macular hole attached and retinal attached in 8 eyes.Their BCVA improved after both the first and second surgery (P =0.000),the BCVA after second surgery was better than that after first surgery (P =0.038).Conclusions The clinical characteristic of our series of patients were as follows:long history,with choroidal detachment and type ⅡCurtin posterior scleral staphyloma.All 1 5 eyes showed retinal attached after secondary ILM peeling.The secondary ILM peeling and C3 F8 tamponade may improve the visual outcome and retinal reattachment rate.

Objective To observe the clinical features and treatment outcomes of presumed tubercular retinal vasculitis.Methods This is a retrospective non-comparative interventional clinical research.A total of nine patients (11 eyes) with major presentation of retinal vasculitis were included in this study.Patients first consulted the eye clinic and were diagnosed presumed tubercular retinal vasculitis.The patients,seven males and two females,aged from 19 to 66 years,with an average of 43.89 years.The time interval from symptoms to diagnosis ranged from two weeks to six months with an average of 76.27 days.Visual acuity,slit lamp ophthalmoscopy,fundus fluorescein angiography (FFA),optical coherence tomography (OCT),hematological and tuberculosis related investigations were examined and analyzed.All patients had standard anti-tuberculosis treatment.Treatment outcomes were followed for six to 37 months with an average of 14.11 months.Results Baseline visual acuity ranged from hand movement to 0.8 with an average of 0.28.Among 11 eyes,six presented mild to moderate vitritis,five presented as retinal vein occlusion with no obvious vitirits.Fundus examination showed six cases with retinal hemorrhage,four cases with macular edema,two with macular epiretinal membrane,and two with vitreous hemorrhage.FFA revealed 11 cases with leakage of vessels,11 with nonperfusion area,four with macular edema,three with retinal neovascularization,and two with choroidal lesions.OCT of nine eyes suggested six eyes with retinal edema,three with macular edema,three with macular epiretinal membrane.TST of seven patients were all strong positive.T-SPOT.TB of four patients were all positive.Three of eight patients who had chest X-ray or chest CT were suggested tuberculosis infection.Four to six weeks after the start of anti-tuberculosis treatment,vitritis,exudates,retinal and macular edema subsided.During follow up,inflammation was stable with no recurrence observed.The visual acuity of last follow-up ranged from 0.15 to 0.8 with an average of 0.51.Conclusions The main presentations of presumed tubercular retinal vasculitis are vitritis,retinal vein occlusion,and retinal hemorrhage.Standard anti-tuberculosis treatment can improve inflammation and retinal hemorrhage.

BACKGROUND:Aortic root homograft has been widely used, but it stil has a high incidence of calcification and degeneration after operation.
OBJECTIVE:To investigate the alteration of biological and immunological properties of rabbit aortic root homograft treated with de-endothelialization and decellularization methods, and to find a better decellularization method.
METHODS:Aortic root homografts obtained from rabbits were randomly divided into fresh group, de-endothelialization group, and decellularization group. The morphology of homografts was evaluated by hematoxylin-eosin, Masson and VG stainings. The biological properties such as thickness, tensile strength, broken extension rate, and heat shrinkage temperature were detected. The immunological features (inflammatory cellinfiltration, calcium content and CD152 expression) were determined with immunohistochemistry and flame atomic absorption spectrometry.
RESULTS AND CONCLUSION:As demonstrated in morphological observation, protocols of de-endothelialization and decellularization methods we used attained our desired aim of decellularization perfectly. Tensile strength and broken extension rate of decellularization group were decreased significantly compared with fresh group (P<0.01), while the difference between de-endothelialization group and fresh group was not significant (P>0.05). Hematoxylin-eosin staining showed that, inflammatory reaction was the most apparent in fresh group, showing a large amount of inflammatory cells infiltration;compared with fresh group, inflammatory reaction was significantly attenuated in de-endothelialization group, the number of inflammatory cells was significantly decreased. The inflammatory reaction was the lowest in the decellularization group, only inflammatory cells infiltrated the tissue edge. Immunohistochemistry showed that, CD152 expression was significantly increased in de-endothelialization and decellularization groups compared with fresh group (P<0.05). Calcium content in de-endothelialization and decellularization groups was significantly decreased compared with fresh group (P<0.05). It could be concluded that the immunogenicity of de-endothelialized and decellularized aortic homografts is decreased significantly, and the de-endothelialization method could better maintain the tensile property.

Asymmetric dimethylarginine(ADMA)is an endogenous inhibitor of nitric oxide synthase(NOS).it reduces nitric oxide production. ADMA is correlated with the risk factors of atherosclerosis, such as hypercholesterolemia, hypertension and hyperglycaemia. Accumulating evidence suggests that a derangement of the NOS pathway plays a critical role in atherogenesis and ADMA may participate in the process.

Objective To understand common X-ray signs of bone and joint of forearm and shank,in order to provide a basis for diagnosis of skeletal fluorosis.Methods A total of 15 villages which were built for more than 50 years in Nongan and Qianan counties of Jilin province were selected and surveyed by quantitative epidemiological methods.These villages had no industrial and coal-burning-borne fluorine pollution; no other high fluoride sources; had not yet changed to low-fluoride drinking water,and had complete and stable historic data of fluoride content in drinking water.Drinking water fluoride content was determined.Inhabitants lived in the local for more than 10 years,between the age of 16-60 were chosen from the villages based on the 11 levels of fluoride content of drinking water from 0.5-7.0 mg/L and these people were divided into 5 age groups:16-,21-,31-,41-,51 to 60.In each age group,10-15 individuals were taken by stratified random sampling to do the forearm and shank joint X-ray examination.Drinking water fluoride content between 0.5-1.0 mg/L acted as the low fluoride group(control group),1.5-7.0 mg/L as the high fluoride group and various X-ray findings and the detection rate were observed.Results Three X-ray signs of skeletal fluorosis,joint degenerative change and osteoporosis were observed.Thereinto,joint degenerative change was the most common.In the high fluoride group(31.55％,153/485),the detection rate of joint degenerative change was higher than that of the low fluoride group (21.58％,41/190) and the difference was statistically significant (x2 =6.62,P ＜ 0.05).Seventy two of 675 peoples used by X-ray were detected with skeletal fluorosis,which occurred mainly in the higher intake of high fluoride group (x2 =25.65,P ＜ 0.01).When water fluoride was up to 6.0-7.0 mg/L,the detection rate of endemic skeletal fluorosis was increased to 44.92％(53/118).Regardless of higher or lower of water fluoride and mild or more serious of the state of fluorosis,changes of X-ray signs of bone surroundings happened first; on average with a detection rate of 95.83％ (69/72),the joint change followed by 79.17％ (57/72) and bone substance change the least at 56.94％(41/72),and the difference was statistically significant (x2=9.64,P ＜ 0.01).Regardless of water fluoride high and low,joint of elbow knee and wrist underwent degenerative change.Degenerative change of elbow joint happened first with a detection rate of 17.78％ (120/675),knee joint followed by 15.41％ (104/675),and wrist joint was the least at 7.85％ (53/675).The difference was statistically significant (x2 =30.74,P ＜ 0.01).Elbow degeneration detection rate(21.03％,102/485) in high fluoride group was significantly higher than that of the low fluoride group(9.47％,18/190; x2=12.47,P ＜ 0.01).X-ray examination showed 35 kinds of signs; most signs could be seen in the high fluoride and the low fluoride groups.But the changes of bone around were seen more often in higher fluoride content group than in lower fluoride content group.Conclusions X-ray signs of endemic skeletal fluorosis are complex and diverse.Only after comprehensive analysis,the diagnostic results are accurate and reliable.

AIM: To observe the effect of thichosanthes injection on the expression of proliferating cell nuclear antigen (PCNA) of vascular smooth muscle cell (SMC). METHODS: The expression of PCNA of cultured rabbit aortic SMC was examined with LSAB immunohistochemical technique, and [ 3H]-thymidine([ 3H]-TdR) incorporation data of SMC and the contents of superoxide dismutase (SOD), lipid peroxide (LPO), prostacyclin (PGI 2) and cyclic AMP (cAMP) in medium were simultaneously determined. RESULTS: Thichosanthes injection has an effects of increasing SOD activity, decreasing LPO, elevating PGI 2 and cAMP, reducing [ 3H]-TdR incorporation and expression of PCNA (all P