RATIONALE:Breast carcinoma is the most common primary source of choroidal metastasis (CM). In the present case, esophageal cancer was the primary tumour, brain metastasis occurred, and CM occurred later in the left eye with 2 retinal detachments, which is very rare.PATIENT CONCERNS:A 62-year-old man complained of a sudden decrease in visual acuity consisting of a small shadow in front of his left eye with a sensation of covered vision after 1 cycle of systemic chemotherapy and radiotherapy for resected esophageal cancer with brain metastasis. Fundus examination revealed exudative retinal detachment without retinal tears. CM with exudative retinal detachment was also considered. The patient refused further treatment. After the second cycle of chemotherapy, there were no significant changes in the retina and visual acuity improved. However, after craniocerebral surgery for brain metastasis, the visual acuity decreased again and showed 3 choroidal masses with macular involvement and retinal detachment but without retinal tears.DIAGNOSIS:The final diagnosis was CM with retinal detachment.INTERVENTIONS:The patient was advised to undergo enucleation of the left eye during the second retinal detachment, but he refused.OUTCOMES:Two months after the second retinal detachment, the patient died of systemic metastases.LESSONS:It is important to consider CM when the first retinal detachment and known cancer are diagnosed. At present, it is necessary to develop a standardised treatment plan as well as a multidisciplinary approach to early diagnosis, combined treatment, and timely intervention for such cases.

Background: To investigate the characteristics and distribution of anterior surface wavefront aberrations in patients suitable for corneal refractive surgery. Methods: A total of 121 myopic patients (121 eyes, 18-45 years old) who underwent corneal refractive surgery were randomly selected by the Pentacam anterior segment analysis system with a spherical equivalent (SE) of -0.25 to -10.00 D. The corneal anterior aberrations (total higher-order aberration; spherical aberration; Coma; Trefoil) and Q and K values were detected, and a correlation analysis of the relevant parameters was carried out. Results: The root-mean-square (RMS) of the third to sixth order aberrations of the corneal anterior wavefront aberrations at a 6mm analysis diameter showed a decreasing trend in patients suitable for the corneal refractive surgery, and the RMS of the third order aberrations accounted for 62.92% of the total HOAs. The coma ratio (coma/total cornea higher-order aberrations) was increased with the increasing diopters, while the spherical aberration ratio (spherical aberration/ total cornea higher-order aberrations) was not changed. In addition, the spherical aberration was 0.203±0.082 μm (range: 0.061 to 0.503 μm), and the Q30 was -0.19±0.03 (range: -0.58 to 0.31). There were significant differences in the coma aberrations of preoperative corneal anterior surface (3, 1) between the low, middle and high myopia groups (P=0.013). The spherical equivalent was positively correlated with the corneal coma of the anterior corneal surfaces (R=-0.241, P=0.009), and the Q value was positively correlated with the total higher-order aberrations (R=0.326, P<0.001). Conclusions: Individual wavefront aberrations on the anterior surfaces of the cornea are comparatively different, and the Zernike coefficients are related to the degree of myopia. Spherical aberrations are the most overriding aberrations of the cornea.

Background To investigate the characteristics and distribution of anterior and posterior surface wavefront aberrations in patients suitable for corneal refractive surgery. Methods Sixty myopic patients (120 eyes, 14-46 years old) who underwent corneal refractive surgery were randomly selected by the Pentacam anterior segment analysis system with a spherical equivalent (SE) of -1.50 to -12.00 D. The corneal anterior and posterior aberrations (higher-order aberration, HOA; spherical aberration, SA; Coma; Trefoil) and Q and K values were detected, and a correlation analysis of the relevant parameters was carried out. Results The root mean square (RMS) values from 3 to 6 (RMS 3 to 6) of the whole eye higher-order wave surface aberrations at a 6.0 mm pupil diameter showed a decreasing trend in patients with corneal refractive surgery, and an RMS value of 3 accounted for 62.92% of the total HOAs. The coma ratio increased with increasing diopter, while the spherical aberration ratio was not changed. In addition, the spherical aberration was 0.203 ± 0.082 μm (range: 0.061 to 0.503 μm), and the Q30 was -0.19 ± 0.03 (range: -0.58 to 0.31), which showed a normal distribution. There were significant differences in coma aberrations (3, 1) in the low, middle and high myopia groups (P=0.013). The spherical equivalent was positively correlated with corneal coma (R = -0.241, P = 0.009), and the Q value was positively correlated with total higher-order as well as spherical aberrations (R = 0.326, P <0.001; R = 0.675, P <0.001). Conclusions Individual wavefront aberrations on the anterior and posterior surfaces of the cornea are comparatively different, and the Zernike coefficients are related to the degree of myopia. Spherical aberrations are the most overriding aberrations of the cornea.

PURPOSE:To compare the visual and refractive outcomes after laser-assisted in situ keratomileusis (LASIK) surgery for correction of myopia or myopic astigmatism using a six-dimensional Amaris excimer laser.METHODS:In this retrospective cohort study, we enrolled 47 eyes of 28 patients (age: 19-36 years) with myopia or myopic astigmatism. We used the Custom Ablation Manager protocol and performed ablations with the SCHWIND AMARIS system. LASIK flaps were cut with an iFS Advanced Femtosecond Laser. Mean static (SCC) and dynamic cyclotorsion (DCC) were evaluated. Visual and refractive outcomes were evaluated during 6 months' follow-up. Corneal asphericity (Q-value) was analyzed at 4 months postoperatively.RESULTS:The spherical equivalent (SE) reduction was statistically significant reduce 1 day after refractive surgery (P < 0.001), with no additional significant changes during follow-up (P = 0.854). SCC registration rates were 81% in the Aberration-Free mode (AF) and 90% in the Corneal Wavefront mode (CW). SCC measurements were within ± 5 degrees in 57% (AF) and 68% (CW) of eyes. Mean DCC was within ± 1 degree in 96% (AF) or 95% (CW) of cases. At 6 months, the uncorrected distance visual acuity was 20/25 or better in all eyes. At last follow-up, both steep and flat keratometry values had significantly flattened in both groups (P < 0.001). Corneal asphericity also increased significantly during the postoperative period for an 8-mm corneal diameter (P < 0.001).CONCLUSIONS:LASIK for myopia or myopic compound astigmatism correction using the six-dimensional AMARIS 750S excimer laser is safe, effective, and predictable. Postoperative corneal asphericity can be analyzed by linear regression to predict the changes in postoperative corneal asphericity with this approach.

Objective:To explore the expressions of Survivin in endometrial carcinoma tissues and peritoneal fluid cells and the relationship with development and metastasis of endometrial carcinoma.Methods:The expression of Survivin was detected by immunohistochemistry and immunocytochemical SP method,the differences of Survivin expression in endometrial carcinoma tissues and peritoneal fluid cells and the relationship with clinical pathological characteristics were analyzed.Results:The positive expression rate of Survivin in peritoneal fluid cells was 25.0%,the positive expression rates of Survivin in peritoneal fluid cells of grade 1,grade 2 and grade 3 were 77.3%,37.5% and 23.1%,respectively,there was significant difference (P0.05).The positive expression rates of Survivin in cases with depth of myometrial invasion1/2 and cases with depth of myometrial invasion1/2 were 23.9% and 67.6%,respectively,there was significant difference (P0.05).The positive expression rate of Survivin in endometrial carcinoma tissues was 71.2%,the positive expression rates of Survivin in endometrial carcinoma tissues of grade 1,grade 2 and grade 3 were 86.4%,78.1% and 42.3%,respectively,there was significant difference (P0.05).The positive expression rates of Survivin in cases with depth of myometrial invasion1/2 and cases with depth of myometrial invasion1/2 were 58.7% and 88.2%,respectively,there was significant difference (P0.05).The positive expression rates of Survivin in cases without lymph node metastasis and with lymph node metastasis were 57.4% and 88.5%,respectively,there was significant difference (P0.05).Conclusion:Survivin plays an important role in carcinogenesis,development,infiltration and metastasis of endometrial carcinoma.

Objective To observe the expression of pinopode during endometrial implantation window of patients with polycystic ovary syndrome (PCOS). Methods In 15 patients with PCOS (PCOS group) and 15 normal women(control group),the endometrial morphology was detected,the appearance and development of endometrial pinopodes were observed on the 7th day of post ovulation.Endometrial thickness and pattern were assessed on the ovulating day,and serum estradiol(E2) and progestone(P) were measured on day of endometrial biopsies. Results Compared with the control group,there were significant differences on endometrial morphology,the development and abundance of pinopodes(P0.01),and serum E2/P significantly higher(P0.05) in PCOS group. Conclusion The expression of pinopodes in PCOS patients decreases during the implantation window,the disorder of serum E2/P may play an important role.

Objective To evaluate the effect of mifepristone on the expression of osteopontin (OPN) and p53 in the chorion and decidua of women in early pregnancy. Methods From Mar. 2006 to Jun. 2006, a total of 40 healthy women in 5 to 7 weeks of pregnancy, who demanded for voluntary termination of pregnancy, were admitted to the Department of Obstetrics Gynecology of Navy General Hospital. They were randomly divided into two groups (20 each): mifepristone group and control group. Patients in mifepristone group underwent medical abortion, and patients in control group received operative abortion. Semiquantitative immunohistochemistry method was used to detect the expression of OPN and p53 in the chorion and decidua specimens collected from the two groups of patients. Results The OPN expressions in chorion and decidua of mifepristone group (0.144±0.006, 0.080±0.007, respectively) were significantly lower than that of control group (0.245±0.005, 0.130±0.008, respectively, P0.05). The p53 expressions in chorion and decidua of mifepristone group (8.720±0.160, 2.900±0.810, respectively) were significantly higher than that of control group (3.600±0.110, 1.360±0.510, respectively, P0.05). Conclusion The mechanism of mifepristone for termination of early pregnancy might be related to the down-regulated expression of OPN and up-regulated expression of p53 protein in the chorion and deciduas.

目的 探讨整合素αvβ3和骨桥蛋白(OPN)在多囊卵巢综合征(PCOS)患者植入窗期子宫内膜的表达. 方法 选取15名典型PCOS患者(其中7例为自主排卵,8例为促排卵)为PCOS组,同期选择15例月经周期规律妇女为对照组.阴道超声监测排卵,排卵日测定子宫内膜分型及厚度;免疫组织化学技术测定植入窗期的子宫内膜整合素αvβ3和骨桥蛋白的表达;放射免疫法测定内膜活检当天的血清雌二醇(E2)和孕酮(P)的浓度. 结果 与对照组比较,PCOS组植入窗期子宫内膜整合素αvβ3和OPN表达均显著下调(P＜0.01),两者之间不伴有比例的失调;排卵日子宫内膜厚度两组无显著差异(P>0.05);子宫内膜分型有显著性差异(P＜0.05);血清E2水平显著高于对照组(P<0.01),E2/P比值亦显著高于对照组(P<0.05),而P显著低于对照组(P<0.01). 结论 PCOS患者植入窗期子宫内膜整合素αvβ3和OPN表达均下调,子宫内膜容受性降低,影响了胚泡着床.

Objective:To explore the influence of mifepristone on the expression of OPN and a-hCG in the chorion and decidua of early pregnancy. Methods: The patients with the 40 days’ pregnancy, who suppressedmenstruation 35-49 days and did not want to pregnancy come forward demended termination of pregnancy, they were divided into mifepristone grop and artificial abortion by surgical aspiration grop.every grop has 20 days’ pregnancy, we used the immunohistochemistry semiquantitative method to detect the expression of OPN and a- hCG in the chorion and decidua of early pregnancy. Results: (1) The effect of mifepristone on the immunohis- tochemical reaction intensity of OPN in the chorion and decidua from the early pregnancy mifepristone grop was significant lower than artificial abortion by surgical aspiration grop. difference has statistical significance (P<0.01) (2) The effect of mifepristone on the immunohistochemical reaction intensity of a-hCG in the chorion and decidua from the early pregnancy mifepristone grop was significant lower than artificial abortion by surgical aspiration grop. difference has statistical significance (P<0.01). Conclusion: OPN and a-hCG were related to embryo nidation,as well as to keep normal early pregnancy. The mifepristone was able to inhibit the synthesis of the OPN and a-hCG during the early pregnant stage as well as the capability of the adhesion,the proliferation and the migration of the trophocyte and the decidual cells.So both the imbedding of the blastocyst and the placental formation are affected, the corepus luteum was decreased, it’s hard for the patients to have a fetation,then the abortion occursed.

Objective To study the relationship of serum adiponectin(APN) and insulin resistance of young polycystic ovary syndrome(PCOS) patients.Methods Thirty eight young PCOS patients and 27 healthy young females were assigned as experiment group and control group.Each group was divided into obesity group[body mass index(BMI) ≥25 kg/m2 ]and non-obesity group(BMI25 kg/m2).Serum APN levels of the four groups were detected by Enzyme Linked Immuno Sorbent Assay(ELISA).Blood glucose concentration was detected by glucose oxidase method,and insulin concentration was detected by chemiluminescence method,and the Insulin Sensitivity Indexes(ISI) were calculated.Results ①The concentration of fasting blood glucose of experiment group was equal to the control group(P0.05).②The concentration of fasting insulin of experiment group was statistically higher than the control group(P0.01).③The serum APN concentration and ISI of experiment group were statistically lower than that of control group(P0.01).④The serum APN concentrations and ISI were statistically increased progressively,and the insulin concentrations were statistically decreased progressively(P0.01) in obesity group of experiment group,non-obesity group of experiment group,obesity group of control group and non-obesity group of control group successively.Conclusion Serum APN level of experiment group is lower than control group,and the tendency is more obvious in obesity group,which may be related to insulin sensitivity and insulin resistance.

The role of atrial natriuretic peptide (ANP) in the central regulation of the circulation is known to be a neurotransmitter or a neuromodulator, but its actions on baroreceptor reflex function are not fully resolved. The present study examined the role of ANP (6, 60 ng/0.2 microl) by direct microinjection into the hypothalamic paraventricular nucleus (PVN) in conscious rats. OPC-21268 (0.45 microg/3 microl), an antagonist of the V(1) receptor, was microinjected into the lateral ventricle to examine whether the effect of ANP on baroreflex sensitivity is mediated by vasopressin (VP). ANP significantly increased the baroreflex sensitivity, and OPC-21268 attenuated the increase of baroreflex sensitivity induced by ANP. Intravenous injections of ANP (60 ng/0.04 ml) did not affect baroreflex sensitivity. These results suggest that ANP in the PVN may produce a facilitative effect on baroreflex, and the effect may be via, at least in part, the central vasopressin.