AIM: To observe the efficacy of intravitreal injection with ranibizumab combined with laser photocoagulation for macular edema ( ME ) secondary to macular branch retinal vein occlusion( MBRVO) .
METHODS:A retrospective analysis included 33 patients (33 eyes) with ME secondary to MBRVO were taken. All patients received intravitreal injection of 0. 5mg ranibizumab ( 0. 05ml ) at first visit. The continue PRN treatment and laser photocoagulation were based on the visual acuity changes and optical coherence tomography findings. The changes of best corrected visual acuity ( BCVA) , central macular thickness( CMT) , and amplitude density and latency of P1 wave in mfERG were observed before treatment and 6mo after treatment.
RESULTS: Before the treatment, logMAR was 0. 68±0.35, 6mo after treatment was 0. 34±0. 23, BCVA was improved obviously ( P < 0. 01 ), BCVA in 21 patients ( 63.64%) were improved in two rows among all the patients. CMT before treatment was(487. 30±63. 58) μm, after treatment was(238. 84±52. 66) μm(P<0. 01). The amplitude densities of P1 wave in ring 1, ring 2 and ring 3 after treatment were significantly increased(all P<0. 01), and the latencies were decrease ( all P < 0. 05 ). The conjunctival hemorrhage was observed in 2 eyes after treatment.
CONCLUSION: Intravitreal injection with ranibizumab combined with laser photocoagulation for ME secondary to MBRVO can reduce the CMT and improve visual function.

Objective To investigate the value of predicting testicular viability following unilateral testicular torsion by color-Doppler ultrasound (CDU). Methods The clinical manifestations, intraoperative findings and scrotol CDU appearances before and after operation of 42 cases with testicular torsion were compared. According to a bleeding test intraoperatively, testicular viability was divided into A-D level. Testis of level A-C would be saved .while the level D removed. Testicular viability assessed by follow-up CDU was then classed into Ⅰ-Ⅲ level. In Ⅰ-Ⅱ level, the salvaged testis were recovery ultimatelybut atrophy in level Ⅲ. Results Seventeen cases of the 42 underwent orchidopexy and the remaining 25 cases underwent orchidectomy. As followed up, however, testis in only 7 cases were recovered, including 2 cases in level A,3 cases in level B and 2 cases in level C. respectively. The preoperative scrotal CDU appearances of the recovered testis were mainly as follows: ① Homogeneous parenchyma with decreased or disappeared blood perfusion. ②Sheet or radial hypoechoic in the local testis but with preserved blood perfusion in most area else. Testis in the remaining 10 patients, including 8 cases in level C and 2 cases in level D, respectively, were atrophy finally. And large radial hypoechoic or diffuse inhomogeneous echo with none or a small amount of blood supply on the edge parenchyma were found during their preoperative CDU (similar CDU performance was present in the orchidectomy group. The CDU appearances of contralateral testes both in orchidopexy and orchidectomy group were not obviously abnormal during follow-up. Conclusions The scrotal CDU examination is competent to predict testicular viability after detorsion. In addition, timely operation would be a key to CDU evaluation.

ObjectiveTo assess the protective effect of ischemic postconditioning in different ways after rabbit's testis completely torsion and detorsion and to assess the value of contrast-enhanced ultrasonography(CEUS) in it.MethodsForty male white rabbits were divided into 5 groups randomly:a control group,directly perfusion group (R),ischemic postconditioning groups (IP1,IP2 and IP3),with 8 in each.The acute testicular hemodynamic disorder models were established in R,IP1,IP2,IP3 groups by completely blocking the left testicular blood flow for 4 hours,then group R was directly subjected to perfusion,group IP1 was subjected to 15 s release and 15 s occlusion (15 s/15 s),IP2 was subjected to 30 s/ 30 s,IP3 was subjected to 45 s/45 s,each group was taken 3 cycles.All the groups underwent CEUS before operation and after 3 days,examined for the contents of malonaldehyde(MDA),superoxide dismutase(SOD) and histology,and observed for the pathobgieal changes of the testicular tissue.ResultsThe CEUS parameters of bilateral testes showed no significantly difference in all group before operation( P ＞0.05),3 days after reperfusion.The half of declining time of intensity was extended significantly in all operation groups comparing with control group (P ＜ 0.05),but the difference of peak and base intensity were increased in group IP1 and IP2,comparing with control group( P ＜0.05).The contents of MDA and SOD were remarkable differences in group IP1,IP2 comparing with group R and IP3 ( P ＜ 0.05).Johnsen' s score,apoptosis index showed significantly differences in group IP1,IP2 comparing with group R and IP3 (P ＜ 0.05).ConclusionsMicrocirculation of the complete torsion testicular was significantly improved by ischemic postconditioning after reperfusion,and the effects of ischemic postconditioning could be evaluated by CEUS.

Objective To identify the host-cell death pathways (apoptosis, autophagy or necrosis) in L929 cells at the time point of 48 hours post infection (h.p.i.) with Chlamydia muridarum.Methods L929 cells were infected with Chlamydia muridarum at a multiplicity of infection (MOI) of 0.85 for 48 hours.Nuclear fragmentation was observed under fluorescence microscopy following staining L929 cells with DAPI (4′,6-diamidino-2-phenylindole).L929 cells were stained with propidium iodide (PI) plus Annexin Ⅴ and then analyzed by fluorescence-activated cell sorting (FACS) to clarify whether apoptosis or necrosis occurred after Chlamydia muridarum infection.L929 cells were transiently transfected with GFP-LC3 and observed under fluorescent microscopy to analyze cell autophagy.Western blot assay was performed to detect LC3 protein for further analysis of autophagy.Results Apoptosis was not induced in L929 cells by Chlamydia muridarum infection at 48 h.p.i.as no significant nuclear fragmentation was observed.Results of FACS showed that most cells died due to necrosis.Moreover, fluorescent dots of GFP-LC3 formed after infecting transfected L929 cells with Chlamydia muridarum.An increased ratio of LC3Ⅰ to LC3Ⅱ in the L929 cells infected with Chlamydia muridarum was detected by Western blot assay, indicating that autophagy occurred during Chlamydia muridarum infection.Conclusion Necrosis and autophagy rather than apoptosis are induced in L929 cells 48 hours after infection with Chlamydia muridarum.

To discuss the influence of dexamethasion on lL-1β and TNF - α expression in suture - induced rabbit corneal neovascularization ( CNV ) and analyze the potential mechanism.
●METHODS: For 43 healthy rabbits, 40 were randomly selected for establishing CNV model in corneal stroma. The right eyes (group A) were received no medicine and the left eyes ( group B) were injected dexamethasone after successfully establishing the model. The no modeling 3 rabbits were normal control group. The morphologic change of corneal was observed with slit lamp microscope and the areas of CNV was calculated every day, then 8 rabbits were randomly chosen for sacrificing at 1, 4, 7, 14, 21d respectively. The pathological characteristics of CNV were observed after HE staining, and lL - 1β and TNF - α expression was detected by immunohistochemistry.
●RESULTS: CNV was grown at the 4d after suture, and the 7-14d was vigorous growth period. inflammatory cell infiltration appeared after HE staining, and CNV was located at the superficial stroma of cornea. lmmunohistochemistry results showed that lL - 1β and TNF - α expression was gradually increased with prolonged suture time. Compared with corneal stitch group, the rabbits cured by dexamethasone were found with less inflammatory cells infiltrating and neovescularization, moreover, the expression of lL - 1βand TNF-α decreased. There were statistical significance between the two groups (P<0. 05).
● CONCLUSlON: Dexamethasone can inhibit the CNV growth by controlling the inflammation of corneal and restraining lL-1β and TNF-α expression.

Objective To detect high-frequency ultrasound and clinical features of acute scrotum in children. Methods High-frequency ultrasound and clinical manifestations of 112 children with acute scrotum were analyzed and compared with the final diagnosis and therapeutic regimen.Results Torsion of appendage with uneven echo nodular near the upper pole of testis or head of epididymis, accompanying secondary reactive inflammation or not were detected in 65 children. Complete testicular torsion was found in 21 children who had the whirlpool sign and absent flow in the affected testicle. There was incomplete torsion in 4 patients with winding courser sign and some flow with low resistant index. Flow increased in 22 children with acute epididymo-orchitis, except 1 with suppurative orchitis. The ultrasonic diagnose accordance rate was about 98.21% (110/112). The clinical manifestations of acute scrotum had some characteristics though partial overlapping exited. Fifteen children with torsion of appendage, 25 with complete torsion and 1 with acute orchitis received operation, and the other received expectant treatment.Conclusion The objective and precise emergency ultrasonic diagnosis combined with the overall and profound analysis of related clinical data may provide important information for the diagnosis and treatment of acute scrotum in children.

Objective To explore the sonographic features of intrascrotal adenomatoid tumor.Methods The sonographic features of 21 cases with intrascrotal adenomatoid tumor confirmed by surgery and pathology were retrospectively analyzed.Results Twenty-one cases with intrascrotal adenomatoid tumor could be typed into 3 ultrasonic patterns:(1) The homogeneous echo type:15 cases,their ultrasonic features were homogeneous echo,including 5 cases with low echo,8 case with equal echo,and 2 case with high echo;5 cases with testicular albuginea adenomatous tumors were also homogeneous echo,2 cases of equal echo,2 cases of low echo and 1 case of high echo that was posterior echo attenuation slightly.(2) The edge halo type:4 cases,they showed the epididymis or testis sheath round or oval nodules,of which the middle was low echo and the edge is high echo halo ring.(3) The mixed echo type:2 cases,they showed cystic mixed echo of epididymis nodules,1 case with irregular cystic areas and poor sound transmission,while the other one with good sound transmission cystic areas and a small papillae on the wall.Conclusions Sonography is a valuable method for diagnosis of intrascrotal adenomatoid tumor.The edge halo type has sonographic features.

Objective To explore the way of contrast-enhanced ultrasound(CEUS)and quantitative analysis technology to assess testicular microvascular ischemia-reperfusion inj ury.Methods Twenty-four healthy adult rabbits were randomly divided into the control group and the microvascular mild,moderate, serve ischemic inj ury group (group Ⅰ,including group Ⅰ1 ,Ⅰ2 ,Ⅰ3 ).The spermatic cord of the control group were threaded but not ligated.The group Ⅰ1 ,Ⅰ2 ,Ⅰ3 were reperfused 2 h after 2 h,4 h,6 h complete testicular ischemia respectively.The ultrasound contrast angiographic parameters of each group were analyzed by the quantitative analysis techniques,including peak intensity(PI),time to peak(TP),slope,mean transmit time(MTT),DT/2 and area.The levels of plasma vWF,NO and ET-1 were tested after the CEUS. The pathological changes of the ipsilateral testicular were observed by the HE and immunohistochemical staining.Statistical analysis was performed by SPSS 13.0 software.Results Preoperativeiy,each parameter of the experimental group and the control group showed no statistical significance (P > 0.05 ). Postoperatively,the PI,slope,area of the group Ⅰ1 increased significantly,while the TP,MTT were prolonged(P <0.05).Contrast time-intensity curve was significantly higher peak and retrusion.The groupⅠ2's PI,slope,area increased further,DT/2 was significantly prolonged,but TP significantly reduced (P <0.05).The contrast curve significantly increased,forward and decreased slowly.The contrast curves of the group Ⅰ3 was approximate a straight line.The vWF,NO,ET-1 levels of each experimental group were significantly higher than those in control group (P <0.05),among them,the levels of group Ⅰ2 were the highest (P <0.05 ).With the aggravation of ischemia,the testicular capillaries expansion,erythrocyte sedimentation,leakage,infiltration of inflammatory cells,MMP-9 expression in vascular basement membrane gradually increased.Conclusions The CEUS and quantitative analysis techniques can effectively evaluate testicular microvascular inj ury.

Objective To study the clinical value of color Doppler ultrasonography in typing tuberculous epididymitis.Methods The appearances of color Doppler ultrasound and the findings on operation were analysed in 33 patients with tuberculous epididymitis.Results Of the 33 patients,epididymis appeared as diffusely and heterogeneously enlarged lesions with increased flow in 2 cases,appeared as nodular lesions in 13 cases including nodi with echofree space in 3 cases, nodi with high-level echo patches in 3 cases, and low echo-level nodi in 7 cases. Multiple lesions in scrotum were detected in 17 cases, of whom epididymis up to 11 cases appeared as diffusely enlarged heterogeneous lesions with flow increased.The sonographic appearancs of tuberculous epididymitis could be divided into 3 types:diffusion type, nodus type and complicated type. Nodus type included 3 subtypes: purulence type, calcification type, and cheese type.The accuracy rate of ultrsound diagnosis was 87.9%.Conclusions Testis is easy to be involved when epididymitis appears as diffusion type, so surgical treatments should be early.Purulence type and complicated type need surgical treatments while calcification type does not. Antituberculous drug treatments can be tried before surgical treatments in cheese type.Sonography of urinary system is helpful for the diagnosis of asymptomatic tuberculosis in urinary system when tuberculous epididymitis is first suspected on sonography.

AIM:To investigate the effect of photodynamic therapy(PDT)combined with intravitreal injection of ranibizumab on circumscribed choroidal hemangioma(CCH).

METHODS:A retrospective study was performed for 6 eyes(6 cases)diagnosed as CCH. Before treatment, OCT examination showed macular cystoid edema and retinal neurepithelium layer detachment in all patients. All patients underwent photodynamic therapy, then intravitreal injection of ranibizumab 0.5mg(0.05mL)were administered at 48h after PDT. The best corrected visual acuity(BCVA), examination of the ocular fundus, fundus photography, fluorescence fundus angiography(FFA), indocyanine green angiography(ICGA), eye B ultrasonic and optical coherence tomography(OCT)were performed respectively at 1, 3 and 6mo after treatment.

RESULTS:The patients were followed up for 4 to 10mo, the final vision of follow-up increased than before, it was raised 7 lines. The images of ICGA revealed hypofluorescence or no leakage in focal area. Eye B ultrasonic showed that hemangioma shrunk or faded. The images of ICGA revealed macular region retinal reattached well and edema disappeared completely. Mean flow-up was 6mo postoperative. There had no evidence of recurrence.

CONCLUSION:For CCH patients, hemangioma got smaller obviously by PDT. Intravitreal ranibizumab injection promote effusion absorption under the retina. Combining use of the two therapies could improve visual acuity in a short-term.