Exudative Changes Research Articles

Histological Changes in the Lung Tissue in Association with COVID-19: Review Article

Background: It has been shown that SARS-CoV-2 is a multi-systemic virus and can affect number of body systems including the respiratory tract, the gastro-intestinal tract, the liver, the kidney and the nervous system. Despite the high mortality rate, there is little literature on postmortem findings of this unique virus, perhaps due to its highly contagious nature, inadequate information on prevention, and a lack of robust infrastructure for appropriate management of infected cases at various centers throughout the world. Aim of the study: The aim of the current study was to review and list the main histological changes seen in patients died because of COVID-19. Methods: A systemic search was carried out including Google Scholar, PubMed, and MEDLINE and the Google search Engine in order to scan all available published articles dealing with histological changes affection the lung in patients with documented COVID-19. The following key words were used to accomplish the search mission: COVID-19, SARS-CoV-2, Lung Histology, Pulmonary Histology, Histopathology. The search was limited to articles written in English language. Any article published between the end of 2019 and the time of initiating the current work was reviewed. The information in the current review is totally based on reviewed articles that are mentioned in the section of references. Results: The main sources of lung tissues were Whole lung biopsy, Postmortem study, Core needle biopsy and Ultrasound based samples from autopsy. The exudative changes include injury to pneumocytes, congestion of capillaries, giant cell formations, dilation of alveolar ducts, thickening of capillaries, edema of interstitium and formation of hyaline membrane. The proliferative changes include hyperplasia of Type-2 pneumocytes with some reactive atypia with proliferation of myofibroblastic cells leading to granulation tissue formation, thickening of alveolar wall accumulation of alveolar macrophages, interstitial thickening which harbors collections of proliferating fibroblasts together with foci of hemorrhage and lymphocytic infiltration. Conclusion: The main histopathological changes in lung of patients with COVID-19 can be grouped into three main phases, exudative, proliferative and fibrotic phases in addition to changes involving vascular tissues, bronchi and bronchioles and the main changes are the diffuse alveolar damage seen in exudative and proliferative phases.

Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants.

PurposeTo identify optical coherence tomography (OCT) biomarkers that may predict functional and anatomical outcomes in diabetic macular edema (DME) patients treated with intravitreal dexamethasone (DEX) implant.Materials and MethodsSixty-four eyes from 50 patients with DME were enrolled. Best-corrected visual acuity (BCVA) and OCT biomarkers including central retinal thickness (CRT), subretinal fluid (SRF), intraretinal cysts (IRC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudate (HE), hyperreflective foci (HRF), epiretinal membrane (ERM), and vitreomacular interface (VMI) changes were evaluated at baseline and at 3, 6, and 12 months after treatment. Multiple logistic analysis was performed to evaluate each OCT biomarker as a predictive factor for functional and anatomical improvement at the end of treatment.ResultsThe presence of SRF at baseline was associated with a favorable outcome, with CRT improving by more than 100 μm after treatment from multivariate logistic regression analysis [odds ratio 6.16 (1.75–21.6)]. In addition, baseline SRF predicted a greater CRT improvement from multiple regression analysis (model R-square 0.11, p = 0.006). The reduction of DRIL, SRF, LONLC, IRC, and EZD were correlated with better CRT improvement (more than 100 μm) (P < 0.05). SRF and EZD recovery can also predict better visual prognosis (P < 0.05).ConclusionOCT biomarkers can be used to predict who may benefit the most after DEX treatment. We suggest that the DEX implant should be considered as a first line treatment in DME patients with SRF.

Оценка микроциркуляции сетчатки методом окт-ангиографии в сравнительном анализе течения хориоидальной неоваскуляризации при патологической миопии и влажной возрастной макулярной дегенерации на фоне осевой миопии

Background. Optical coherence tomography angiography (OCTA) is a relevant modern method for visualizing choroidal neovascularization and may be promising in assessing retinal microcirculation in various fundus diseases. Aim. To conduct a comparative analysis of retinal microcirculation using OCTA in assessing the course of choroidal neovascularization (CNV) in pathological myopia (PM) and in wet age-related macular degeneration in combination with axial myopia (AMD + M) against the background of antiangiogenic therapy. Methods. The prospective study included 70 people (107 eyes, 70 of them with new-onset CNV). The patients were divided into 2 groups: the first group with pathological myopia (PM) – 47 people (47 eyes), the second group – with wet age-related macular degeneration in combination with medium and high axial myopia (AMD + M) with axial eyes length over 25.00 mm – 23 people (23 eyes). Results. In the PM group, in eyes with CNV, the values of the axial length of the eyes are significantly greater than in AMD + M (29.00 (27.98–29.66) and 25.42 (24.25–27.55) mm, respectively). Initial values of retinal microcirculation in the fovea did not differ between the groups. By the end of the observation period, the area and perimeter of the foveal avascular zone (FAZ) in PM increased significantly due to the progression of degenerative changes in the retina (FAZ area from 0.231 (0.214; 0.260) to 0.302 (0.247; 0.396) mm²; FAZ perimeter from 1.970 (1.897; 2.095) to 2.315 (1.997; 2.645) mm). In AMD + M these indicators significantly decreased due to a decrease in exudative changes in the retina (FAZ area from 0.268 (0.216; 0.398) to 0.191 (0.1345; 0.231) mm² , FAZ perimeter from 2.169 (1.879; 2.574) to 1.478 (1.437; 1.773) mm). Degenerative changes in the fovea and the periphery of the retina with a history of laser coagulation showed a strong direct correlation. Conclusion. OCTA reflects the distinctive features of retinal microcirculation in eyes with CNV in patients with PM and AMD + M at baseline and over time during antiangiogenic therapy. Key words: optical coherence tomography-angiography; OCTA; pathological myopia; age-related macular degeneration; choroidal neovascularization; anti-VEGF therapy; anti-angiogenic therapy.

Plant root exudates and rhizosphere bacterial communities shift with neighbor context

A plant's neighborhood context can alter its interactions with other organisms, but little is known about how these dynamics occur belowground, especially with soil microbes. Microbial communities in rhizosphere soil are influenced by many factors, including abiotic conditions and root-derived signals. In particular, root exudates have strong effects on rhizosphere assembly, respond to changes in abiotic conditions, and help plants interact with neighbors. Therefore, we predicted that root exudates likely play a central role in neighbor-induced shifts in rhizosphere communities. We conducted a greenhouse experiment to test this and determine how the rhizosphere bacterial community of a focal plant, Panicum virgatum, changed when beside different neighbors, and whether these shifts were mediated by neighbor-induced changes in root exudation. We found that neighbor altered both focal plant exudates and rhizosphere community, and that changes were largest when the focal plant was beside the most competitive neighbor, Rudbeckia hirta, which reduced both focal plant growth and nitrogen uptake. Several factors contributed to neighbor impacts on rhizosphere assembly, including neighbor-induced changes in root exudates during nitrogen-limitation and microbial spillover from roots of larger neighbors. Using an additional soil incubation, we also found that these changes in exudates can have even greater effects on soil nutrients than on microbial assembly. Overall, we show that neighbors influence one another's microbiomes, and highlight neighbor-induced changes in root exudates as one mechanism through which this may occur. This work suggests that rhizosphere assembly may differ in mixed-species communities and thus emphasizes a need for microbiome studies that consider neighborhood context.

One-year results of treat-and-extend regimen with intravitreal brolucizumab for treatment-naïve neovascular age-related macular degeneration with type 1 macular neovascularization

We evaluated 1-year outcomes of loading phase treatment followed by maintenance treatment using a treat-and-extend (TAE) regimen with intravitreal brolucizumab for neovascular age-related macular degeneration (nAMD) associated with type 1 macular neovascularization (MNV). We analyzed 68 eyes of 65 consecutive patients with treatment-naïve nAMD associated with type 1 MNV. Forty-five eyes (66.2%) completed the 1-year treatment with intravitreal brolucizumab. In those cases, best-corrected visual acuity (BCVA) showed significant improvement, while there were significant reductions in foveal thickness and central choroidal thickness, after the initial brolucizumab injection, which were maintained until the last visit. The average total number of injections over 1 year was 6.4 ± 0.6. The average intended injection interval at the last visit was 14.0 ± 2.9 weeks. Moreover, 17of 23 eyes (73.9%) with polypoidal lesions showed complete regression of these lesions after the loading phase treatment. Although intraocular inflammation (IOI) was observed in 15 of 68 eyes (22.1%) within 1 year, amelioration in response to combination therapy with topical and subtenon injection of steroids, without visual decline, was obtained. These results indicate that loading phase treatment followed by the TAE regimen with intravitreal brolucizumab might improve BCVA and ameliorate exudative changes in eyes with treatment-naïve nAMD associated with type 1 MNV. Moreover, intravitreal brolucizumab can potentially reduce the treatment burden of nAMD. Prompt steroid therapy might be efficacious for ameliorating brolucizumab-related IOI without visual decline.

Switching from aflibercept to brolucizumab for the treatment of refractory neovascular age-related macular degeneration.

To examine the 16-week outcomes of switching to brolucizumab in eyes with neovascular age-related macular degeneration (nAMD) refractory to aflibercept. Retrospective observational study. Data of eyes with nAMD who switched to brolucizumab because of resistance to aflibercept were collected. The best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution), central retinal thickness (CRT), central choroidal thickness (CCT), and exudative status on optical coherence tomography were analyzed. A total of 48 eyes of 48 patients were reviewed. At 4 to 7weeks after switching, BCVA changed from 0.26 ± 0.19 to 0.25 ± 0.21 (not significant; P = 0.95), but CRT significantly decreased from 298.9 ± 108.4µm to 241.9 ± 92.5µm (P < 0.001) and CCT from 182.6 ± 89.3µm to 169.7 ± 82.6µm (P < 0.001). Of the 23 eyes refractory to monthly aflibercept injections, 12 (52.2%) achieved a dry macula, and 8 (34.8%) reduced exudative changes at 1month. At 16weeks, 31 eyes (64.6%) achieved the treatment interval ≥ 8weeks. Two patients (4.2%) dropped out, 7 eyes (14.6%) developed intraocular inflammation (IOI), and 8 eyes (16.7%) switched back to aflibercept because of the failure to extend the treatment interval ≥ 8weeks. Switching to brolucizumab in eyes refractory to aflibercept conferred favorable outcomes in controlling exudative changes. However, IOI and the regulation of the treatment interval to at least 8weeks during the maintenance phase disrupted the continuation of brolucizumab treatment.

Modulation of the Tomato Rhizosphere Microbiome via Changes in Root Exudation Mediated by the Ethylene Receptor NR.

Plant hormones have been recently shown to exert an indirect influence on the recruitment of plant-associated microbiomes. However, it remains unclear the extent to which the disruption of the ethylene (ET) signaling pathway affects the assembly and functioning of plant-root microbiomes. In this study, the Never-ripe tomato mutant (Nr) was profiled for differences compared to the wild type (control). Tomato plants were subjected to root exudate profiling and the characterization of bacterial and fungal communities. Compared to the control, Nr revealed differences in the composition of root exudates, including lower amounts of esculetin, gallic acid, L-fucose, eicosapentaenoic acid, and higher amounts of β-aldehyde. Interestingly, Nr significantly differed in the composition and functioning of the rhizosphere bacterial community. We also identified the taxa that occurred at relatively higher abundances in Nr, including the genus Lysobacter, which displayed a significant negative correlation with changes in eicosapentaenoic acid and esculetin, and a significant positive correlation with changes in β-aldehyde. Taken together, our study provides evidence that a mutation in the ET receptor exerts predictable changes in the root-associated microbial taxa of tomato plants. These indirect effects can potentially be explored towards new strategies to engineer beneficial plant microbiomes via targeted changes in plant genetics and physiology.

Long-Term Outcome of Eyes with Vitrectomy for Submacular and/or Vitreous Hemorrhage in Neovascular Age-Related Macular Degeneration.

Purpose To study long-term clinical outcomes in patients with submacular hemorrhage (SMH) and/or vitreous hemorrhage (VH) associated with neovascular age-related macular degeneration (nAMD) and the real-world clinical situation of adding anti-VEGF therapy after pars plana vitrectomy (PPV). Methods In this retrospective case series, 25 eyes with SMH and/or VH associated with nAMD were treated by PPV and followed up for at least 24 months. When exudative changes were unresolved or recurred after PPV, additional intravitreal anti-VEGF therapy was given. Results The reasons for performing PPV were SMH (8 eyes) and VH (17 eyes) associated with nAMD. Mean best-corrected visual acuity (BCVA) of eyes with SMH improved significantly at 6 months (P < 0.01) and 12 months (P < 0.05) after PPV. Mean BCVA of eyes with VH improved at 1, 3, 6, 12, 18, and 24 months (P < 0.01) and at the final visit (P < 0.05). Post-PPV anti-VEGF therapy was initiated in 6 of 8 (75.0%) eyes with SMH and 7 of 17 (47.1%) eyes with VH. Of the 13 eyes given anti-VEGF therapy after PPV, 11 eyes had anti-VEGF therapy initiated within 10 months after surgery. Dry macula rate after PPV was 50.0% in SMH and 70.6% in VH. Conclusions BCVA improved in eyes with SMH at 6 and 12 months after PPV, and the BCVA was maintained until the end of the study. BCVA improved significantly in eyes with VH at all time points after PPV. In eyes undergoing PPV for nAMD, recurrence of exudative changes after 11 months from the initial PPV was rare.

Warming Affects Soil Nitrogen Mineralization via Changes in Root Exudation and Associated Soil Microbial Communities in a Subalpine Tree Species Abies fabri

Warming Affects Soil Nitrogen Mineralization via Changes in Root Exudation and Associated Soil Microbial Communities in a Subalpine Tree Species Abies fabri

Organic Acid Excretion in Root Exudates as a Mechanism of Cadmium Uptake in a Sonchus Asper-Zea Mays Intercropping System.

This study assessed how the Sonchus asper L.-Zea mays intercropping influenced the plant Cd level, as well as the organic acid (low molecular mass) types and concentrations in root secretions, which was accomplished by conducting pot experiments with soil that was collected from a farmland surrounding a mining area. The results showed that the oxalic and citric acids were the prevailing organic acids in the plant root secretions, and that the intercropping led to prominently elevated root exudate concentrations of the two acids for S. asper by 43.8 and 75.4%, respectively, while decreased such concentrations by 18.5 and 18.7% for Z. mays, compared to monoculture. According to observations, the root exudate concentrations of citric and oxalic acids were significantly positively related to the available rhizosphere soil Cd and plant Cd. The results indicate that changes in root exudation of oxalic acid and citric acid result in different available Cd contents of the rhizosphere soil, thereby affecting the bioavailability of soil Cd, which increases Cd uptake and accumulation in S. asper but inhibits Cd accumulation in Z. mays.

Linking plant-root exudate changes to micropollutant exposure in aquatic plants (Lemna minor and Salvinia natans). A prospective metabolomic study

Recent findings indicate that plant-root exudates can stimulate plant-associated microorganisms to enhance the biodegradation of contaminants in constructed wetlands. To understand this process, we studied the root-exudation changes of two aquatic plants (Lemna minor and Salvinia natans) upon micropollutants exposure (10, 100 and 1000 μg/L mixes containing naproxen, diclofenac, carbamazepine, and benzotriazole). After a 2-day exposure, plant exudates were collected, extracted and non-target analysis was performed with a gas chromatography–high resolution Orbitrap mass-spectrometer. Plants didn't show morphological or growth differences between the control and spiked reactors, but exudation changes were observed in both plants at all concentration levels. Partial least squares discriminant analysis showed that, for Lemna minor, the increase of micropollutants exposure was linked to the reduction of sugar and fatty acid exudation. This may trigger changes in the microbial community living on complex carbon forms. Instead, in Salvinia natans, micropollutants exposure was linked to the release of long-chain compounds such as cuticular waxes and sesquiterpenoids, which might be related to stress signaling. These results demonstrate that plant micropollutant-exposure at environmentally relevant concentration levels triggers changes in root exudates. This may help to design new strategies to enhance micropollutants degradation in nature based solutions such as in constructed wetlands.

Evaluation of the direct effects on retinal and choroidal microvascularity of systemic scleroderma

ObjectiveOcular involvement in systemic sclerosis (SSc) has been documented; however it cannot be distinguished from secondary changes due to concomitant hypertension.Therefore, the aim of this prospective cross-sectional study was to demonstrate the direct effects of Ssc on retinal and choroidal microvasculature in patients without hypertension. Methods47 SSc patients and 44 age- and sex-matched healthy control subjects were enrolled in this study. In fundus examination: Increased vascular tortitis, focal or general arteriolar narrowing, arteriovenous notch, severe exudation, microhemorrhage, and pigment epithelial changes in the retina of SSc patients without hypertension were investigated. Patients with at least two of the above findings were considered to have retinopathy After that, patients were divided into two groups according to the presence of retinopathy in this study. Retinal and choroidal microvasculature were evaluated using optical coherence tomography angiography. ResultsThere was a significant decrease in SSc patients with retinopathy in both superficial capillary plexus vessel density (SCP VD) and deep capillary plexus vessel density (DCP VD) compared to the control group. Full avascular zone (FAZ) evaluation tool variables (FAZ area, FAZ perimeter, foveal density) were significantly lower in all Ssc patients than in the healthy control group. It was found that the flow in the 1 mm and 3 mm circular area (Outer Retina 1–3 mm Flow Area) increased significantly in Ssc patients with retinopathy. Choroidal flow (Choriocapillaries 1 mm Flow Area) was statistically lower in Ssc patients with retinopathy. ConclusionsWe have showed an increase in the outer retina 1–3 mm flow area (circular area of the outer retina fold covering the fovea) despite the decrease in vascular density and choroidal thickness in scleroderma patients with retinopathy. Hence, we first demonstrated that Ssc itself may have an effect on retinal and choroidal microvasculature, independent of hypertension.

Short-term outcomes of intravitreal brolucizumab for treatment-na\xefve neovascular age-related macular degeneration with type 1 choroidal neovascularization including polypoidal choroidal vasculopathy

We evaluated the efficacy and safety of loading phase treatment with intravitreal brolucizumab for neovascular age-related macular degeneration (nAMD) with type 1 choroidal neovascularization (CNV). We analyzed consecutive 42 eyes of 40 patients with treatment-naïve nAMD associated with type 1 CNV. Three monthly injections of brolucizumab were completed in 36 eyes (85.7%). In those cases, best-corrected visual acuity (BCVA) was 0.24 ± 0.27 at baseline and improved significantly to 0.12 ± 0.23 after 3 months (P < 0.001). Central macular thickness was 301 ± 110 µm at baseline and decreased significantly to 160 ± 49 µm after 3 months (P < 0.001). Dry macula was achieved in 34 eyes (94.4%) after the loading phase. Central choroidal thickness was 264 ± 89 µm at baseline and decreased significantly to 223 ± 81 µm after 3 months (P < 0.001). Indocyanine green angiography after the loading phase revealed complete regression of polypoidal lesions in 15 of the 19 eyes (78.9%) with polypoidal lesions. Non-infectious intraocular inflammation (IOI) was observed in 8 of 42 eyes (19.0%) during the loading phase, while showing amelioration in response to combination therapy with topical and subtenon injection of steroids. In these eyes, BCVA after 3 months had not deteriorated as compared to that at baseline. These results indicate that loading phase treatment with intravitreal brolucizumab might be effective for improving visual acuity and reducing exudative changes in eyes with nAMD associated with type 1 CNV. Moreover, polypoidal lesions appear to frequently regress after this treatment. However, we must monitor patients carefully for brolucizumab-related IOI, and administer steroid therapy promptly.

Photodynamic therapy combined with anti-vascular endothelial growth factor therapy for pachychoroid neovasculopathy.

This multicenter retrospective study was conducted to evaluate the 1-year treatment outcome of photodynamic therapy (PDT) combined with anti-vascular endothelial growth factor (VEGF) therapy for pachychoroid neovasculopathy (PNV). A total of 42 eyes of 42 patients with treatment-naïve PNV who were treated with PDT combined with intravitreal injections of an anti-VEGF agent (ranibizumab or aflibercept) for 1 year. All eyes showed exudative and/or hemorrhagic changes that affected the fovea at baseline. After the initial combination therapy, subfoveal choroidal thickness (SCT) and central retinal thickness (CRT) were significantly reduced and were maintained as such for 12 months (P < 0.01 in SCT and CRT). The best-corrected visual acuity (BCVA) (0.19 ± 0.30 at baseline) significantly improved at 3 months (0.15 ± 0.29, P < 0.05) and further improved at 12 months (0.10 ± 0.30, P < 0.01) when compared to that at baseline. After the initial combination therapy, 32 eyes (76.2%) required no additional treatments for 12 months. The mean number of additional PDT and intravitreal injections of anti-VEGF agents was 0.1 ± 0.3 and 0.9 ± 1.9, respectively. Of the 42 eyes included in this study, 22 eyes (52.4%) had polypoidal lesions at baseline. No significant differences in SCT, CRT, or BCVA were observed at any time points between eyes with and without polypoidal lesions. Of 20 eyes without polypoidal lesions, only 1 eye (5.0%) needed additional treatments. PNV, especially without polypoidal lesions, can be treated effectively with PDT combined with anti-VEGF therapy with few sessions.

Ultra-Conformable Ionic Skin with Multi-Modal Sensing, Broad-Spectrum Antimicrobial and Regenerative Capabilities for Smart and Expedited Wound Care.

While rapid wound healing is essential yet challenging, there is also an unmet need for functional restoration of sensation. Inspired by natural skin, an ultra‐conformable, adhesive multi‐functional ionic skin (MiS) with multi‐modal sensing capability is devised for smart and expedited wound care. The base of MiS is a unique skin‐like, conductive and self‐adaptive adhesive polyacrylamide/starch double‐network hydrogel (PSH) and self‐powered, flexible, triboelectric sensor(s) is integrated on top of PSH for multi‐tactile sensing. MiS could enhance wound contraction, collagen deposition, angiogenesis, and epidermis formation in a full‐thickness skin defect wound model in vivo, while significantly inhibiting the biofilm formation of a wide range of microorganisms. MiS also exhibits multi‐modal sensing capability for smart and instant therapeutics and diagnostics, including skin displacement or joint motion, temperature, pressure and tissue exudate changes of wound bed, and locally releasing drugs in a pH‐responsive manner. More importantly, MiS could restore the skin‐mimicking tactile sensing function of both touch location and intensity, and thus could be used as a human‐machine interface for accurate external robotic control. MiS demonstrates a new comprehensive paradigm of combining wound diagnosis and healing, broad‐spectrum anti‐microbial capability and restoration of multi‐tactile sensing for the reparation of severe wound.

Plant Root Exudates and Rhizosphere Bacterial Communities Shift with Competitive Neighbor

Plants simultaneously interact with each other and soil microbial communities, yet most studies on plant-microbial interactions are performed on isolated, individual plants. A plant’s neighborhood context can alter its belowground signaling. In particular, signals in the form of root exudates help plants interact with neighbors, abiotic conditions and soil microbes. Therefore, we predicted that root exudates would also play a central role in neighbor-induced shifts in rhizosphere communities. We conducted a greenhouse experiment to test this and determine how the rhizosphere bacterial community of a focal plant, Panicum virgatum, changed when beside different neighbor plants, and whether these shifts were mediated by neighbor-induced changes in root exudation. We found that neighbor did affect both focal plant exudates and rhizosphere community, and that changes were largest when the focal plant was beside the most competitive neighbor, Rudbeckia hirta, which reduced both focal plant growth and nitrogen uptake. Multiple mechanisms mediated neighbor’s impacts on rhizosphere assembly, including neighbor-induced changes in root exudates during nitrogen-limitation and microbial spillover from roots of larger neighbors. Using an additional soil incubation, we also found that neighbor-induced changes in exudates can have even greater effects on soil nutrient cycling than on microbial assembly. Overall, we show that plant neighbors alter rhizosphere processes through changes in root exudates, particularly during strong competition. This work demonstrates that mechanisms driving rhizosphere assembly may differ in mixed-species communities, thus emphasizing a need for microbiome studies that extend beyond isolated plants.

Primary and prospective imaging of the chest using magnetic resonance imaging in patients with viral lung damage in COVID-19

Puropose of the study. Basing on the previously obtained results on the proven high efficiency of magnetic resonance imaging (MRI) of the chest organs in the visualization of major lung diseases, in the current period of mass incidence of viral pneumonia (VP) caused by COVID-19, we tried to study the possibility of using MRI OGK to image lung damage in this pathology both in primary detection and for follow-up reconvalescence control.Material and methods. MRI of the chest in T1 -, T2-weighted modes (T1-w, T2-w), also with fat suppression, diffusion-weighted, STIR-modes, in the axial and frontal planes, with breath holding, or with automatic synchronization of acquisition with breathing was carried-out in 47 patients with VP of various severity, 32 of them were confirmed by PCR as COVID-19, all did have a clinic of pneumonia. The control group comprised 15 volunteers, of them 8 non-smokers, and 7 smokers. In 18 patients, an CT study of the chest was also performed, with a step of 0.5–1.25 mm, with full coverage of the chest and reconstruction of axial and frontal slices, with a comparison of MRI and CT of the chest. In 8 patients, MRI of the chest was then performed again, for follow-up control of clinical recovery. There were no deaths among our patientsResults. The duration of a complete MRI examination of the chest was less than 25 minutes in all cases (21 ± 4 minutes on average), and less than 10 minutes in the chest CT. In all cases, MRI imaging of the affected area was achieved using a group of MRI protocols, which included axial T1-w and axial and frontal T2-w, and lasted &lt; 12 minutes, counting the time for laying the patient.In normal patients without pathology of the lungs, not smoking, the lung was visualized as a diffuse homogeneous air region with a minimum share interstitial and vascular space. In patients - smokers, lung MRI was slightly enhanced in the dorsal parts of both lungs, disorders of airiness and interstitial exudative changes weren't present. In the acute phase of the disease, pulmonary ventilation disorders and interstitial exudative changes that form the morphological basis of lung damage in COVID-19 were visualized as local, corresponding to the location and nature (sub-segmental, segmental, polysegmental) of the pathological focus, both T1-w and T2-w modes. MRI of the chest provided diagnosis of lung pathology in all cases, while the extent of the pathological focus on the MRI image in T2-w was 14–19% greater than on the CT. The correlation of the calculated volume of affected lung tissue between CT and MRI of the chest wasas high as r = 0.95 (p &lt; 0.001). The values of the volume of the affected tissue in T1-w and T2-w did not differ from each other in the intergroup comparison and correlated strongly and reliably, r = 0.985 (p &lt; 0.001). MRI in DWI mode showed a sensitivity of 81% (38/47) in detecting COVID-lung lesions. The duration of DWI in all cases was more than 6 minutes, more than twice as long as all other MRI protocols together. The volume of pleural effusion, clearly visible with T2-VI, in all our cases did not exceed 100 ml. In a prospective follow-up of 8 patients with COVID-19, chest MRI ptovided evidence-based visualization of the recovery process in all cases, with a decrease or complete regression of the exudation component.Conclusion. MRI of the chest with respiratory synchronization or with breath-holding can be used for early diagnosis of inflammatory lung lesions in COVID-viral pneumonia and for subsequent follow-up control, is not accompanied by radiation exposure and closely correlates with the results of chest CT recruited as a modern standard for the diagnosis of pneumonia.

Ten-Year Progression From Intermediate to Exudative Age-Related Macular Degeneration and Risk Factors: Bundang AMD Cohort Study Report 1

This study investigated the 10-year incidence of progression from intermediate to exudative age-related macular degeneration (AMD) and identified genetic and environmental factors influencing that progression in the Korean population. Retrospective, observational cohort study. In total, 632 eyes of 418 patients (age: ≥50 years) with intermediate AMD were enrolled. The incidence of exudative AMD was assessed from color fundus photographs and optical coherence tomography images obtained at baseline and during annual visits. Data regarding lifestyle variables and dietary habits were acquired through comprehensive questionnaires. Genotyping data concerning 3 single nucleotide polymorphisms (SNPs), rs800292 and rs1061170 in the CFH gene and rs10490924 in ARMS2 were also analyzed. The cumulative incidence of exudative changes was estimated using Kaplan-Meier analysis. Associated influential factors were evaluated using univariate and multivariate Cox regression models. The mean follow-up period was 3.99 ± 2.85 years. The cumulative incidence of progression to exudative AMD was 5.6%, 14.8%, and 28.4% at 2, 5, and 10 years, respectively. Multivariate Cox analysis showed that age (hazard ratio [HR]: 1.041; P= .0393), family history of AMD (HR: 3.175; P= .0184), and pre-existing exudative AMD in the fellow eye (HR: 3.186; P= 5.31× 10-5) were positively associated with exudative changes. Regular intake of green tea (HR: 0.632; P= .0475) was associated with a decrease in exudative changes. The ARMS2 SNP rs10490924 (HR: 1.482; P= .0185) showed a significant association with AMD progression. The annual progression rate from intermediate to exudative AMD in the Korean population is approximately 2.8%, which is comparable with that for whites. Intake of green tea may be a modifiable protective factor against exudative changes.

Clinical Course of Treated Choroidal Neovascularization in Eyes with Pre-existing Geographic Atrophy: Case Series and Reappraisal of the Literature

ABSTRACT Purpose: To report the clinical course of choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) treatment in eyes with pre-existing geographic atrophy (GA). Material and Methods: Multicenter retrospective series. Electronic medical records, clinical notes, and multimodal retinal imaging of patients attending four tertiary referring centers with a diagnosis of unilateral CNV in the context of a pre-existing diagnosis of GA were included. GA was assessed on multimodal retinal imaging including spectral-domain optical coherence tomography (SD-OCT) scan with simultaneous near-infrared (NIR) reflectance imaging (OCT Spectralis, Heidelberg Engineering, Heidelberg, Germany) which was acquired at baseline and every follow-up visit. GA area was measured in treated eyes and fellow eyes using NIR. Results: Fifty-four eyes from 27 patients (23 females, mean age 80.89 ± 7.5) were included. The mean number of injections in the treated eyes was 5.52 ± 1.9 by month 12. From baseline to month 12, stabilization of best-corrected visual acuity (BCVA) and a significant decrease (P = .002) of central macular thickness (CMT) in the treated eyes were observed; there was a slight worsening of BCVA (−2 ETDRS letters) and a non-significant change (P = .4) of CMT in the fellow eyes. GA significantly increased in both treated and untreated eyes (P < .001 and P < .001, respectively) with a similar absolute increase (+2.68 mm2 and +2.59 mm2, respectively) and growth rate (0.4 and 0.34, respectively). Conclusions: In our study anti-VEGF treatment for CNV in eyes with pre-existing GA was effective in terms of decrease of exudative changes and stabilization of VA by month 12. A similar growth rate of GA between treated and untreated eyes does not support a causal relationship between anti-VEGF treatment and GA progression in this subset of patients. Further studies with a longer follow-up are mandatory to confirm these results.

Four-year outcome of aflibercept administration using a treat-and-extend regimen in eyes with recurrent neovascular age-related macular degeneration.

To investigate the 4-year outcome of aflibercept treatment using a treat-and-extend (TAE) regimen for recurrent neovascular age-related macular degeneration (AMD). Retrospective observational study. Data of eyes with recurrent AMD previously treated with anti-vascular endothelial growth factor agents or photodynamic therapy and had started aflibercept treatment using a TAE regimen for the first time were collected. Best-corrected visual acuity (BCVA), intervals of treatments, the presence of exudation, central foveal thickness (CFT), and central choroidal thickness (CCT) were analyzed. Of 47 consecutive eyes, 30 of the 47 eyes completed a 4-year follow-up. The mean BCVA (logMAR) was sustained over the 4years (0.37 at baseline, 0.36 at 1year, 0.36 at 2years, 0.41 at 3years, and 0.43 at 4years, P = 0.21). Of the 30 eyes that completed the follow-up, BCVA of two eyes deteriorated by 0.3 logMAR or more at 4years. At 4years, 67% of eyes had extended treatment intervals to > 8weeks, and 47% of eyes had extended intervals to > 12weeks. Exudative changes in the macula, seen in all eyes at baseline, were only seen in 50% of the eyes at 4years. The mean CFT and CCT decreased significantly at 4years from 332μm to 248μm and from 218μm to 183μm, respectively. In clinical settings, aflibercept treatment using a TAE regimen may successfully maintain visual acuity for up to 4years even in recurrent cases of AMD.