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Fundus imaging plays a pivotal role in diagnosing retinal and choroidal diseases. Optical coherence tomography angiography (OCTA), by capturing signals to reconstruct vascular structures, offers a clear depiction of retinal vasculature with notable advantages such as rapid scanning and non-invasiveness. Although OCTA, due to its underlying principles, cannot dynamically assess vascular function, exploring its future applications and potential to eventually replace traditional fundus angiography remains a key focus in the medical community. OCTA provides multiple parameters that conventional fundus angiography cannot obtain. With the expanding coverage area of OCTA scans and improvements in artifact elimination, the detection rate of various retinal and choroidal diseases has significantly increased, making the widespread clinical application of OCTA an inevitable trend. Although ultra-widefield OCTA cannot yet fully replace angiography in clinical practice, with continued clinical practice, expanded clinical research, and ongoing technological innovation, OCTA is expected to gradually replace fundus angiography in the future.

Objective: To study the macular choroidal volume (MCV) of patients with highly myopic foveoschisis and its clinical value. Methods: In this cross-sectional study, 39 outpatients (39 eyes) with highly myopic foveoschisis were included from January 2016 to December 2020 in Peking University People's Hospital, including 18 males and 21 females. Their age was (59.3±6.7) years old. Thirty-nine highly myopic patients (39 eyes) with no macular complications were enrolled as control group. The age, gender, and refractive error were matched between two groups. Medical history information and eye examination information including refractive error, axial length and best corrected visual acuity were recorded. All patients had undergone high-resolution enhanced depth imaging optical coherence tomography to measure the retinal and choroidal thickness of multiple parts of the macular zone. According to the image characteristics, myopic foveoschisis patients were divided into the inner and outer myopic foveoschisis subgroups, and the MCV characteristics were analyzed. The independent sample t test, Pearson correlation analysis and linear regression analysis were used. Results: The subfoveal choroidal thickness was (74.9±59.3) and (155.6±47.1) μm, and MCV was (2.3±0.8) and (5.3±1.0) mm 3 in the foveoschisis group and the control group, respectively. The differences were statistically significant ( t =-6.649, -15.229; P <0.01). Although no correlation was found between subfoveal choroidal thickness and central foveal thickness in both groups ( r =0.103, 0.214; P >0.05), MCV was negatively correlated with macular retinal volume (MRV) in the foveoschisis group ( y =-2.90 x +18.48; r 2 =0.47, P = 0.01). In the control group, there was a positive correlation between MCV and MRV ( y =0.74 x +2.02; r 2 =0.64, P =0.01). The best corrected visual acuity was positively associated with MCV in patients with foveoschisis ( r =0.677, P <0.05). The MCV of inner (19 eyes) and outer (15 eyes) foveoschisis subgroups was (2.80±0.81) and (1.92±0.27) mm 3 , and the difference was statistically significant ( t =4.610, P <0.05). Conclusions: The MCV significantly decreased in patients with highly myopic foveoschisis. The smaller the MCV, the scarcer the blood supply of the outer retina, the more serious the foveoschisis, and the larger the MRV. (Chin J Ophthalmol, 2021, 57:419-425) .

Objective: To evaluate the potential association between optic nerve invasion and optic nerve obscuration during treatment of advanced retinoblastoma. Methods: Retrospective case series study. Medical records of 77 patients (77 eyes) with advanced retinoblastoma (Group D/E) who were treated with primary or secondary enucleation in the Ophthalmology Department of Peking University People's Hospital from January 1 st 2012 to December 31 th 2015 were retrospectively reviewed. RetCam photographs under general anesthesia at diagnosis and each subsequent follow-up were evaluated for complete obscuration of the optic nerve. The primary endpoints included prelaminar invasion, postlaminar invasion and optic nerve transection invasion. Group difference was calculated with chi-square. Results: There were 46 boys and 31 girls in the study. The mean age at the first diagnosis was (27.1±22.1) months. The optic nerve was obscured in 62 eyes (80.5%) at the first diagnosis and 61 eyes (79.2%) at the last ocular examination prior to enucleation. Twenty-nine eyes (37.7%) underwent primary enucleation. Forty-eight eyes (62.3%) were treated with eye-preserving therapy, followed by enucleation. Fourteen eyes (18.2%) were in Group D and 63 eyes (81.8%) were in Group E. Histopathologic analysis of enucleated eyes without optic nerve obscuration (16 eyes) showed prelaminar invasion in 7 eyes, postlaminar invasion in 2 eyes and optic nerve transection invasion in 0 eyes. Histopathologic analysis of enucleated eyes with optic nerve obscuration (61 eyes) showed prelaminar invasion in 26 eyes, postlaminar invasion in 9 eyes and optic nerve transection invasion in 4 eyes. The difference between two groups did not achieve statistical significance ( P =0.935, 1.000, 0.296). Histopathologic analysis of enucleated eyes with persistent complete obscuration of the optic nerve showed a high risk factor in 10 eyes (10/40), while in 1 eye (1/8) the optic nerve was visible at the initial presentation and obscured before secondary enucleation ( P =0.529). Conclusion: Optic nerve obscuration at the last examination prior to enucleation may not be associated with postlaminar optic nerve invasion in advanced retinoblastoma. (Chin J Ophthalmol, 2020, 56: 681-687) .

Retinal vein occlusion (RVO) is the consequence of obstruction of retinal vein system caused by a variety of etiologies. Its ocular complications include macular edema, retinal ischemia and neovascular glaucoma. Although many drugs for management of RVO are available, some doctors do not fully understand the exact purpose of each treatment. This article starts from the etiology evaluation of RVO, emphasizing that, besides systemic etiology and risk factor management, the treatment of RVO should focus on the three major complications at the same time, rather than just dealing with macular edema. Meanwhile, a regular follow-up for observing the changes of the degree of retinal ischemia is important for whole course management. Anti-vascular endothelial growth factor therapy, the first-line treatment option of RVO, can not only reduce macular edema, but also prevent the complications caused by retinal ischemia and create opportunities for further laser photocoagulation. Laser photocoagulation has an irreplaceable value in the comprehensive treatment of ischemic RVO. Glucocorticoid intraocular implants should not be used alone in the treatment of macular edema secondary to RVO. (Chin J Ophthalmol, 2020, 56:246-249) .

Objective: To study the effects of human umbilical mesenchymal stem cells (HUMSCs) exosomes on the proliferation and apoptotic as well as migration of human retinal pigment epithelial cells (HRPE) in hypoxia, and explore its mechanism. Method: Direct adherent culture was adopted to cultivate umbilical cord mesenchymal stem cells and amplified to the fourth generation. Markers on the cell surface were identified by flow cytometry. Culture medium was collect without serum from the 4th generation umbilical cord mesenchymal stem cells. Exosomes were separated and extracted, then the ultrastructure was observed under electron microscope and examined expression of CD63 and CD9 protein by Western blot method with isolated and extracted exosomes. HRPE was cultivated in vitro culture, proliferation was detected at the time point of 0, 1, 2, 3, 4, 5 d with MTT assay under hypoxic condition. Meanwhile, the cell migration was quantified by Wound-Healing Assay under hypoxic condition at 0, 24, 48 and 72 h respectively combined with apoptosis test. The HRPE cells in the growth period were divided into 5 groups: the control group, the hypoxia group and the pretreated exosomes group (100, 200, 300 μg/ml). In all groups, apoptosis was observed by Annexin V/PI dual-dye flow cytometry after 48 h's incubation. Proliferation was observed by MTT assay and the migration was observed with Wound-Healing Assay. Results: Flow cytometry detection of the surface marker of HUMSCs in the 4th generation showed strong positive expression of CD105, CD73, CD90. It was suggested that HUMSCs with isolated culture had MSC specific phenotype with duction of lipids and osteoblasts in vitro. The separated exosomes were observed with spherical membranous structures in different sizes by scanning electron microscopy, and Western blot detected positive expression of CD63 and CD9. In vitro culture of HRPE detected by MTT assay for cell proliferation at the time of hypoxic 0, 1, 2, 3, 4, 5 d, the results showed that, comparing with time point 0 d, other groups had statistically significant OD values. In the first 2 days, the proliferation ability of RPE cells gradually increased as the time of hypoxia prolonged(1.862±0.135, 2.278±0.244). After 3 d, the proliferation ability of RPE cells gradually decreased(1.419±0.124, 1.599±0.156). Wound-Healing Assay results showed that the migration distance gradually increased as[(29.883±4.504), (36.200±1.928) μm] the time of hypoxia increased from 0 to 72 h. The cells were fully covering at the point of 72 h [(1.223±0.194), (0.430±0.299) μm]. Apoptosis test results showed that the number of apoptotic cells was different(3.628%±1.348%, 20.123%±1.183%) with the extension of hypoxia Oxygen before 2 d from 0 to 72 h. At the time of d3, there were more apoptotic cells(42.290%±3.217%). There is a significant difference from pre-2d.RPE cells were divided into 5 groups: the control group, the hypoxia group and the pretreated exosomes group (100, 200, 300 μg/ml).After 48 h hypoxia incubation, MTT assay results showed that, compared with the control group (1.870±0.499), the number of cell proliferation was significantly increased ( t= -3.116, P< 0.05), while compared with the hypoxia group(2.616±0.307), the proliferation number of exosomes was significantly reduced [(2.041±0.115), (1.931±0.205), (1.929±0.025); t =-4.920, -4.540, -5.286, P< 0.01], and there was no significant difference between groups with different doses of the exosomes ( F= 1.181, P> 0.05). Annexin V/PI dual-dye flow cytometry was used to observe the apoptosis results. Compared with the control group 1.180%±0.689%, the number of apoptosis in hypoxia group was significantly increased (19.273%±1.194%, t= -32.141, P< 0.01), while compared with the hypoxia group, the number of apoptosis in the exosomes was significantly decreased (12.318%±1.087%, 11.878%±1.348%, 11.090%±1.716%; t =-10.547, -10.057, 9.589, P< 0.01). There was no significant difference between the groups with different doses of exosomes ( F= 1.173, P> 0.05). Wound-Healing Assay results showed that, compared with the control group(68.047±2.851) μm, the migration distance of the hypoxia group was significantly increased [(13.470±2.255)μm, t= 36.778, P< 0.01] while compared with the hypoxia group, the migration distance of the exosomes was reduced (33.110±1.774, 24.650±1.175, 26.440±1.674; t =11.766, 10.770, 11.311, P< 0.01), and there was no significant difference between the groups of the exosomes ( F= 1.179, P> 0.05). Conclusion: Human umbilical cord mesenchymal stem cells can effectively inhibit the apoptosis and migration of HRPE cells in hypoxia. It provides a theoretical basis for the research and treatment of RPE related diseases. (Chin J Ophthalmol, 2019, 55: 933-941) .

Diabetic retinopathy (DR) is one of the most important etiologies of diabetic blindness. The vascular endothelial growth factor (VEGF) is thought to mediate pathophysiological changes of DR. Anti-VEGF therapy for DRdevelops rapidly. However, there are some misunderstandings about its clinical application, and the strategy is not clear. Sometimes its therapeutic effects are even exaggerated. In this article, by discussing whether anti-VEGF therapy can reverse the course of DR disease, promote the absorption of vitreous hemorrhage, and replace fundus laser therapy, the application strategy of anti-VEGF therapy for DR is proposed. At present, anti-VEGF therapy cannot completely replace retinal photocoagulation therapy, and its clinical application value should not be exaggerated. More innovative drugs and therapies are expected to provide new ways forthe treatment of DR while preserving visual function. (Chin J Ophthalmol, 2019, 55: 565-568) .

Macular telangiectasia type 2 (MacTel 2) is an idiopathic entity which is characterized by dilated capillary network near, or around, the fovea of the macula. The spectrums secondary to macular retinal vascular inflammation or obstruction are excluded. It is a binocular disease in general. MacTel 2 is now widely recognized as a macular neurodegenerative disease rather than a simple vascular disease. This article reviews the epidemiological features, clinical features, staging, special examinations, pathogenesis and treatment of MacTel 2. (Chin J Ophthalmol, 2019, 55:68 - 73) .

In the past 5 years, the diagnosis and management of ocular fundus diseases in China has been improved remarkably. Up-to-date international concepts of diagnosis and management, methods, and equipment have been introduced into China, which have promoted the therapeutic technology of ocular fundus diseases. In the field of diagnosis, the application of frequency-domain optical coherence tomography and fundus autofluorescence detection technology not only provided more detailed image information for clinical diagnosis, but also helped clinical ophthalmologists to understand the features and pathogenesis of ocular fundus diseases comprehensively, leading the doctors into a new era of examination of ocular fundus diseases. In the field of treatment, Chinese researchers actively performed innovative clinical studies, such as organizing domestic multi-center studies of various therapies of macular hole retinal detachment, developing full-length humanized antibody fusion protein KH902 with intellectual property rights, using implants of autologous retinal pigment epithelium patch with Bruch membrane to treat age-related macular degeneration, using photodynamic therapy to treat central serous chorioretinopathy, 20 gauge small incision vitrectomy and surgical therapy of central retinal artery occlusion, etc. Moreover, certain amounts of high quality clinical papers have been published in SCI journals, which showed that clinical research of ocular fundus diseases in China has entered the field of international ophthalmology and has geared to international standards.

Objective: To investigate the changing patterns and associated factors of microbial pathogens which caused ventilator-associated pneumonia (VAP) in our respiratory intensive care unit (RICU) from 1995 to 2004., Methods: Cases of VAP in our RICU from 1995 to 2004 (n = 137) were retrospectively analyzed, 47 cases from 1995 to 1999 and 90 cases from 2000 to 2004. VAP was diagnosed according to the following criteria: pneumonia occurred 48 hours after tracheal intubations; new or progressive infiltrative opacities on chest X ray film; and at least two of the following clinical features: (1) Temperature > 38.0 degrees C or < 35.5 degrees C, (2) WBC > 10 x 10(9)/L or < 4 x 10(9)/L, (3) purulent airway secretions; and positive bacterial cultures (the samples obtained through endotracheal intubations). The data were analyzed using statistical software SPSS version 11.5. Continuous data were expressed as (-x) +/- s. t-test and chi(2)-test were used for continuous and categorical data, respectively. Logistic regression analysis was used to determine the risk factors for special pathogens., Results: The mean incidence of VAP was 17.9% from 1995 to 2004 (137/765), 16.2% from 1995 to 1999 (n = 47, 3.1% - 29.8%) and 19.6% from 2000 to 2004 (n = 90, 12.4% - 27.7%). From 1995 to 1999, common pathogens were Stenotrophomonas maltophilia (n = 15, 23.4%), Pseudomonas aeruginosa (n = 12, 18.8%), Aerobacter cloacae (n = 8, 12.5%) and Acinetobacter baumanii (n = 7, 10.9%). From 2000 to 2004, common pathogens were Acinetobacter baumanii (n = 40, 34.2%), Pseudomonas aeruginosa (n = 32, 27.4%), Staphylococcus aureus (n = 24, 20.5%) and Stenotrophomonas maltophilia (n = 8, 6.8%). There were 2 cases (2/64, 3.1%) caused by Staphylococcus aureus from 1995 to 1999, and both were caused by Methicillin-resistant Staphylococcus aureus (MRSA); there were 24 cases caused by Staphylococcus aureus from 2000 to 2004, and 21 cases (21/117, 17.9%) were caused by MRSA.There were 11 (11/47, 23.4%) and 45 (45/90, 50.0%) cases with central intravenous catheters in the period of 1995 to 1999 and 2000 to 2004, respectively. In the period of 1995 to 1999 and 2000 to 2004, durations of aerosolized therapy were (46 +/- 55) and (28 +/- 30) days. There were 12 patients (12/47, 25.5%) using second-generation cephalosporin before VAP occurred in the period of 1995 to 1999 and 7 patients (7/90, 7.8%) in the period of 2000 to 2004. There were 13 patients (13/47, 27.7%) using penicillin before VAP in the period of 1995 to 1999 and 10 patients (10/90, 11.1%) in the period of 2000 to 2004. There were 10 patients (10/47, 21.3%) using quinolones before VAP in the period of 1995 to 1999 and 46 patients (46/90, 51.1%)in the period of 2000 to 2004. The occurrence of Staphylococcus aureus VAP may be related to the cross-infection between inpatients (Wald = 16.690, P < 0.01, OR = 9.212). VAP caused by Stenotrophomonas maltophilia was positively related to duration of aerosolized therapy (Wald = 7.852, P < 0.01, OR = 1.021). VAP caused by Acinetobacter baumanii was positively related to third-generation cephalosporin usage (Wald = 5.553, P < 0.05, OR = 3.461)., Conclusions: The incidence of VAP was not increased in the recent 10 years in our RICU, but the incidence of VAP caused by Acinetobacter baumanii. Staphylococcus aureus and MRSA increased significantly, may be related to the decrease of duration of aerosolized therapy, the usage of different kinds of antibiotics and cross-infection between inpatients.

Choroidal neovascularization (CNV) caused by multi-etiological factors is one of the most common reasons of visual loss. In recent studies, photodynamic therapy is the major treatment to sub-foveal CNV, and other anti-neovascular and anti-inflammatory agents were applied in clinical practice. In order to maximize the therapeutic effects and minimize the complications, combination management will be possibly applied by influencing multiple mechanisms.

Objective: To study the correlative factors of damage to the retinal pigment epithelium (RPE) after photodynamic therapy (PDT) in patients with idiopathic choroidal neovascularization (CNV)., Methods: A retrospective analysis was performed in 45 eyes of 43 patients with idiopathic CNV and 27 eyes of 25 patients with pathological myopia CNV as a contrast group who were treated with standard PDT. Visual acuity, fluorescein angiography and optical coherence tomography (OCT) were taken to evaluated the RPE alterations in the treating area after PDT., Results: Alterations of RPE with window defects in fluorescein angiography occurred in 21 of 45 eyes of idiopathic CNV after first PDT treatment and the same changes of RPE was seen in 1 eye after the second application of PDT, the incidence was 48.9%. In contrast, it occurred in only 2 eyes of pathological myopia CNV. Within the follow up period, 4 eyes of idiopathic CNV had the enlarged neovascular membrane after the therapy. Two groups had almost the same sexual ratio. Alterations of RPE occurred in 51.4% female and 40% male patients of idiopathic CNV. In contrast with pathological myopia CNV patients, idiopathic CNV patients were younger. Two cases that had the alterations of RPE in pathological myopia CNV were 37 years old and 15 years old., Conclusions: RPE alterations were observed in patients with idiopathic CNV following PDT. This might be related to a possible over reaction of RPE to the therapy in young patients.

Abundant progress has been made in the study of molecular biology in the last decade, which included the practical application of RNA interference, proteomic, molecular image and nano technology. The communication between bioscience with other branches (including ophthalmology) enhanced the further development of bioscience. This review briefly summarizes these new cutting age information in the field of molecular biology related with eye research to help us to acquire a deeper understanding of the pathogenesis and mechanism of treatment for systemic and eye diseases.

Objective: To compare the results for diagnosis of macular edema between Heidelberg retina tomography (HRT-II macular edema module) and optical coherence tomography (OCT)., Methods: Two hundred and twelve eyes of 106 macular edema patients were diagnosed with fundus fluorescein angiography (FFA). HRT-II was used to obtain Edema Index and OCT was used to measure the retina thickness in the fovea. The results were compared with FFA., Results: As FFA for gold standard, we compared with other diagnosis method. With regard to the diagnosis of macular edema by OCT, the Kappa value was 0.553, the odds ratio (OR) was 8.519. The Kappa value of HRT-II was 0.403 and OR was 3.210. In two groups of patients with and without macular edema, which were diagnosed by FFA, the difference of Macular edema Index P assayed by HRT-II between these two groups was significant (P = 0.00); while the difference of fovea retina thickness P assayed by OCT between these two groups was significant, too (P = 0.00). The best critical value of E was 2.00 and the ROC curve's area was 0.673 in the detection of macular edema by HRT-II. The best critical value of retina thickness for the diagnosis of macular edema was 170 microm and the ROC curve's area was 0.774 in the detection of macular edema by OCT., Conclusions: In regard to the diagnosis of macular edema, the sensitivity of HRT-II is better than that from OCT, with a lower false-negative result. However, HRT-II has a relatively low specialty with a higher false- positive result. As for the localization of macular edema, HRT-II has its advantage. Compared with FFA, the consistence of OCT for the diagnosis of macular edema is better than that of HRT-II. We can conclude from the OR value that OCT has greater influence than HRT-II in the diagnosis of macular edema. In addition, as for the diagnosis and different diagnosis, the clinical value of OCT is higher than that of HRT-II. Combination of these two different diagnostic methods might provide an accurate quantitative analysis of macular edema.

Objective: To analyze the clinical features and differential diagnosis of pleural disease caused by sarcoidosis., Methods: The clinical data of cases of sarcoidosis diagnosed with pathological evidence in this hospital were retrospectively analyzed. The clinical features and the diagnostic procedures of the cases with pleural disease as the main manifestations were reported. A review of case reports and series published in Chinese literature were carried out to study the incidence and the features of pleural effusion and pneumothorax in sarcoidosis., Results: Thirty-two cases of pulmonary sarcoidosis were diagnosed with pathological evidence, of which 2 cases (2/32, 6.3%) presented as pleural effusion with one confirmed by medical thoracoscopy; one case (1/32, 3.1%) presented as recurrent pneumothorax and interstitial lung disease, and the diagnosis was confirmed by open lung biopsy. Pleural fluid analysis showed exudates with lymphocyte predominance. The fluid level of adenosine deaminase (ADA) was all less than 30 U/L and increased angiotensin converting enzyme level was demonstrated in one case. All 3 cases had been misdiagnosed as tuberculosis and received anti-tuberculous therapy for a period of 1 - 12 months. A review of the case reports and series in Chinese literature showed that the incidence of pleural disease in sarcoidosis was 3.4% - 16.7% in different series, and that pleural effusion in sarcoidosis was misdiagnosed as tuberculous in most cases., Conclusions: Pleural sarcoidosis is not rare in Chinese patients, but often misdiagnosed as tuberculous pleural disease. Recognition of this fact is of clinical importance both in the diagnosis of sarcoidosis and in the differential diagnosis of pleural diseases.

Objective: To investigate the role of endogenous hydrogen sulfide (H(2)S) in patients with chronic obstructive pulmonary disease (COPD)., Methods: Levels of serum H(2)S and nitric oxide (NO), lung function and cell differential count in induced sputum were studied in 27 patients with acute exacerbation of COPD (AECOPD), 37 patients with stable COPD and 13 health subjects. Echo-Doppler assessment and arterial blood gas were measured in patients with AECOPD., Results: (1) The serum H(2)S level was significantly higher in patients with stable COPD [(50.8 +/- 2.5) micromol/L] as compared to those in the controls [(39.8 +/- 1.6) micromol/L] and in patients with AECOPD [(33.5 +/- 2.2) micromol/L, P < 0.01]. (2) The level of serum H(2)S was significantly lower in smokers with AECOPD [(28.1 +/- 1.3) micromol/L] as compared to nonsmokers with AECOPD [(39.4 +/- 3.9) micromol/L, P < 0.05] and healthy nonsmokers [(39.8 +/- 1.6) micromol/L, P < 0.01]. (3) There was significant difference in the serum H(2)S level among stable COPD patients with different severity of airway obstruction (P < 0.05); being lower in patients with stage III [(45.1 +/- 4.1) micromol/L] as compared to stage I obstruction [(70.2 +/- 6.2) micromol/L, P < 0.05]. (4) AECOPD with pulmonary hypertension pulmonary artery systolic pressure (PASP) > or = 35 mm Hg (1 mm Hg = 0.133 kPa) showed a lower serum H(2)S level [(26.3 +/- 2.2), (36.2 +/- 2.5) micromol/L, P < 0.05] than that with a normal resting PASP. (5) H(2)S in serum was positively correlated with NO levels (r = 0.278, P = 0.029), FEV(1)% predicted values (r = 0.533, P = 0.000), percentage of sputum lymphocytes (r = 0.286, P = 0.028) and macrophages (r = 0.334, P = 0.01); and negatively correlated with PASP (r = -0.561, P = 0.011) and the percentage of sputum neutrophils (r = -0.422, P = 0.001) in patients with COPD., Conclusion: Endogenous H(2)S may be involved in the pathogenesis of airway obstruction in COPD and may be a noninvasive marker of disease activity and severity.

In the last 5 years, a great progress in the clinical treatment and basic research of ocular fundus diseases in China has been obtained. An abundance of clinical experience and a great deal of research data have been accumulated. In the field of clinical work, the photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) of choroidal neovascular membrane have been established gradually in China. A rapid progress has been achieved in the vitreous surgery, intraocular injection of triamcinolone acetonide for treating macular edema, radial optic neurotomy (RON) for treating central retinal vein occlusion, the multi-access prevention and management of retinopathy of prematurity and intraocular tumor, and the update of the techniques and equipments for vitreous and retinal surgeries, etc. In the field of laboratory work, Chinese scientists achieved lasting and great progress in many fields: diabetic retinopathy, retinoblastoma, proliferative vitreoretinopathy, retinal pigment epithelial cells, retinal transplantation, gene therapy of ocular fundus diseases, etc. All of these achievements implied that both the clinical work and basic research of ocular fundus diseases in China have approached international advanced technology, while some fields have achieved the international advanced level.

Objective: To evaluate the epidemiological characteristics of non-symptomatic chronic obstructive pulmonary disease (COPD) patients in a rural area in Beijing., Methods: The data of 1,624 people aged more than 40 in 5 villages in Yanqing county in Beijing were collected. Information of medical history and symptom were obtained, and physical examination and lung function test were performed., Results: The prevalence of COPD was 9.1% (148/1 624) in this area. In these 148 patients, 62 (42%) were non-symptomatic and 86 (58%) were symptomatic, the prevalence of non-symptomatic COPD being 3.8% (62/1 624). There was no statistical difference in the sex, age, occupation, marriage status, education level and smoking index between the symptomatic and the non-symptomatic groups (all P > 0.05). The forced expired volume in one second (FEV(1)) and FEV(1)% predicted were lower in the symptomatic group [(1.3 +/- 0.7) L, (61 +/- 23)%] than those in the non-symptomatic group [(1.5 +/- 0.6) L, (70 +/- 22)%; all P < 0.05]., Conclusions: The prevalence of COPD was high in this area with a high percentage of non-symptomatic patients. The COPD prevalence might be underestimated due to the symptom free patients.

Objective: To describe the clinical,radiological and pathological features of non-specific interstitial pneumonia (NSIP), and to evaluate the multidisciplinary approach to the diagnosis of NSIP., Methods: The clinical data, lung CT scans and pathologic slides of patients with a diagnosis or a probable diagnosis of NSIP on discharge were re-evaluated by a panel of respiratory physicians, radiologists and pathologists. A pathological diagnosis and a clinical diagnosis were made by the panel according to the 2002 classification by American Thoracic Society/European Respiratory Society., Results: In the 7 cases diagnosed by surgical lung biopsy, diffuse bronchiectasis was found to be the predominant feature in 1 case, and organizing pneumonia in another case. The remaining 5 cases met the criteria of NSIP. CT guided percutaneous lung biopsy was performed in 2 probable cases, for which the specimens were inadequate for a definite diagnosis, but because of a lack of specific findings, and with the consistent clinical and radiological features, the diagnosis of probable NSIP was maintained. In the patients with NSIP or probable NSIP, ground glass opacities were the predominant CT features, without the typical appearance of idiopathic pulmonary fibrosis. Of the 2 probable cases, 1 died from disease deterioration 20 days after lung biopsy, and 1 was found to have multiple myositis/dermatomyositis 2 years after the initial diagnosis. Among the 5 definite cases, one was confirmed to have multiple myositis/dermatomyositis, but no underlying causes were found for the other 4 cases. One patient died from progressive fibrosis and respiratory failure 3 years after the initial diagnosis., Conclusions: The radiological manifestations of NSIP were not diagnostic, and therefore surgical lung biopsy was the procedure of choice in making a definite diagnosis. The clinical and pathological diagnosis of NSIP needs a multidisciplinary approach by respiratory physicians, radiologists and pathologists. The search for a possible underlying cause is an important part of the dynamic diagnostic process.

Objective: To investigate the changes of interleukin-17 (IL-17) both in rat models of chronic obstructive pulmonary disease (COPD) and in asthma., Methods: Male SD rats were randomly divided into COPD group, asthma group, smoking group and control group. The concentrations of IL-17 in lung tissues and in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immunosorbent assay (ELISA). The expression of IL-17 in lung tissue was determined by immunohistochemical staining and photographic analysis., Results: The concentrations of IL-17 both in the lung tissue and in the BALF were significantly higher in the COPD group and the asthma group than in the controls and the smoking group (all P <0. 01). IL-17 was mainly expressed in airway epithelial cells of COPD rats and in T lymphocytes around the airway in rats with asthma. The levels of IL-17 were also higher both in the COPD group and in the asthma group than in the smoking group and the controls (all P < 0. 01) evaluated by immunohistochemical staining and photographic analysis. In the COPD group,IL-17 concentration of lung tissue was positively correlated with percentage of neutrophils in BALF; it also tended to be positively correlated with the level of intercellular adhesion molecule-1 (ICAM-1) in airway epithelial cells, and the concentration of IL-17 in BALF was positively correlated with the degree of smooth muscle proliferation as well. The concentration of IL-17 in the lung tissue of the asthma group was positively correlated with the number of eosinophils in BALF and with the number of CD3 T lymphocytes in lung tissues respectively., Conclusions: The production of IL-17 in COPD and in asthma might be distinct. IL-17 probably recruits neutrophils into airways by enhancing the expression of ICAM-1 in airway epithelial cells, and it might play a role in pathological changes of small airways in COPD. The role of IL-17 in asthma maybe associated with the recruitment of eosinophils into airways.

Objective: To study the frequencies of interleukin-13 (IL-13) gene promoter 1055 (IL-13-1055) polymorphism in patients with chronic obstructive pulmonary disease (COPD) and to investigate the effect of this genetic polymorphism on COPD in Chinese., Methods: The polymorphism in 111 COPD patients and 97 controls who had non-obstructive pulmonary disease were studied. Genomic DNA was extracted from peripheral blood mononuclear cells by using standard high-concentration salt method. Genomic DNA was used as a template for amplification by polymerase chain reaction (PCR)-amplification of specific allele (PASA) to determine the polymorphism at -1055 in the IL-13 gene promoter region. The production was investigated by sequence analysis. SPSS was used for statistical analysis. chi(2) test was used to examine the genotype in COPD patients and controls. Logistic regression analysis was used to exclude confounding factors and evaluate the effect of smoking or family history on COPD combining with gene polymorphism., Results: The frequency of TT genotype in COPD was 11.7% (13/111), and 13.4% (13/97) in control group, P = 0.713. P value was increased to 0.244 using logistic regression analysis excluded confounding factors, including age, gender, smoking and combined diseases. TT genotype can increase the risk of smoking to COPD, OR = 6.40 (95% CI: 1.62 - 25.39) when the data was stratified by smoking status. TT genotype was positively related with family history of COPD, OR = 7.67 (95% CI: 1.37 - 43.80) using multiple factors regression analysis to clinic phenotype and TT genotype., Conclusion: TT genotype of IL-13-1055 is not an independent factor for COPD in Chinese Han people in Beijing, but increases the risk for smokers to develop COPD and the one who has COPD family history as well.

Objective: Compare membrane dissections and en bloc membranectomy in vitrectomy of proliferative diabetic retinopathy., Methods: Retrospective comparative (non-randomized) interventional study. 296 eyes of 276 patients with fibrovascular proliferation in diabetic retinopathy performed by vitrectomy from 1996 approximately 2000 were analyzed. 201 eyes complicated with vitreous hemorrhages in different severity, 110 eye with traction retinal detachment. We used membrane dissection in 110 eyes and en bloc excision in 186 eyes. Follow up time required more than 4 months, for the silicone oil temponade eyes required 3 months after silicone oil removal. The iatrogenic holes, postoperative hemorrhages, rubeosis iridis and visual improvement were compared in the same intraocular temponade for membrane dissections and en bloc excision, as well as visual acuity > 0.1., Results: There is no statistic significant difference in age, sex and type of fibrovascular proliferations for both groups. Membrane dissection techniques showed a lower incidence of iatrogenic breaks (35.5%) than that in en bloc membranectomy techniques, no significant difference in postoperative vitreous hemorrhages and visual improvement for both techniques., Conclusion: Both techniques showed no difference to visual results and postoperative complications, but membrane dissection techniques can decrease the formation of iatrogenic breaks.

Objective: To study the correlation between the inflammatory mediators released by alveolar macrophages and the pulmonary ventilatory capacity in patients with chronic obstructive pulmonary disease (COPD)., Methods: Alveolar macrophages were collected by fiberoptic bronchoscopy from 8 patients with chronic bronchitis, 8 with COPD with a forced expiratory volume in one second (FEV(1)) < or = 70%, and 8 healthy nonsmokers. All patients were in the stable stage. The macrophages were cultured and stimulated with lipopolysaccharide (LPS, 10 microg/ml). IL-8, IL-1 beta, TNF-alpha and IL-6 in the supernatants were measured by ELISA. Pulmonary functions were tested in all three groups. The correlation between different cytokines was tested with Pearson's relevant analysis, and the correlation between lung functions and cytokines was tested with multiple reverse regression analysis., Results: (1) The concentrations of IL-8 released from macrophages in the COPD group were (43 +/- 27) microg/L and (57 +/- 41) microg/L (with LPS), higher than those from healthy controls [(13 +/- 10) microg/L and (20 +/- 13) microg/L] (P < 0.05), but not different from those in patients with chronic bronchitis [(29 +/- 21) microg/L and (32 +/- 23) microg/L] (P > 0.05). (2) The concentrations of IL-1 beta released from macrophages in the COPD group, the chronic bronchitis group and the control group were [(50 +/- 41) ng/L, (94 +/- 59) ng/L, (37 +/- 32) ng/L] before LPS, and [(225 +/- 108) ng/L, (153 +/- 175) ng/L, (70 +/- 37) ng/L] after LPS stimulation, which were positively correlated with the concentrations of IL-8 (P < 0.05). The concentrations of TNF-alpha released from macrophages in three groups were [(1,238 +/- 679) ng/L, (3,088 +/- 2,879) ng/L and (1,332 +/- 1,846)ng/L], which were positively correlated with the concentrations of IL-1 beta (P < 0.05). The concentrations of IL-6 released from macrophages in the three groups were [(7,959 +/- 8,458) ng/L, (5,317 +/- 10,112) ng/L and (6,480 +/- 4,982) ng/L, which were positively correlated with the concentrations of IL-8 (P < 0.05). (3) The values of FEV(1)/FVC, V(max50) and V(max25) measured in the COPD group were [(65.1 +/- 5.3)%, (43 +/- 8)% and (37 +/- 11)%, respectively, which were negatively correlated with the concentrations of IL-8 (P < 0.05), but negatively correlated with the concentrations of IL-1 beta only in the presence of LPS (P < 0.05)., Conclusion: IL-8 released by alveolar macrophages plays an important role in the process from chronic cough to chronic airflow obstruction. TNF-alpha, IL-1 beta and IL-6 released by alveolar macrophages are also involved in the airway inflammation in COPD.

Qualitative and quantitative analysis was performed on 5 components of phospholipids (PL) isolated from bronchoalveolar lavage fluid (BALF) during the development of bleomycin induced pulmonary fibrosis in rats with high-performance liquid chromatography (HPLC). The measurement of cells and protein in BALF, the pathologic and morphometric observation with light and electronic microscope were also done. Results indicated that the changes both in BALF cells and in lung histopathology were similar, the amount of protein in BALF increased, the total amount of PL in BALF increased more than 1.8-fold over control animals at days 28 after administration of Bleomycin, phosphatidylglycerol (PG) decreased with time, phosphatidylinositol (PI) and phosphatidylethanolamine (PE) increased, PG/PI ratio decreased, the PG/PI ratio could be used as a marker for pulmonary fibrosis.

We studied 20 cases of legionella pneumonia and 23 cases of non-legionella pneumonia. Hyponatremia, elevated GOT and GPT were higher (P < 0.05) in legionella pneumonia group. In spite of the number of cases with diarrhoea, dyspnea, nervous symptoms, myalgia and complication were higher, especially with diarrhoea in legionella pneumonia group when compared to non-legionella pneumonia group, but the number of cases in both types of pneumonia did not show a statistically significant difference.