Exudative Changes Research Articles

Endophyte infection enhances accumulation of organic acids and minerals in rice under Pb2+ stress conditions

This study aimed to assess the effects of endophyte infection on Pb accumulation, organic acids (OAs) and mineral element contents by comparing endophyte-uninfected (E-) and endophyte-infected (E+) rice exposed to 0, 10.36, 20.72, 31.08 and 41.44 mg/L Pb2+ for 10 days. Pb2+ stress decreased growth, dry weight, and chlorophyll (Chl) content in E- and E+ in a concentration-dependent manner. Pb2+ accumulation was similar in E- and E+. Under Pb2+ stress, E+ accumulated more malate and fumarate in the leaves compared to E-, as well as more tartrate, malate, succinate and fumarate in the roots. Furthermore, E+ secreted more malate and lactate under 41.44 mg/L Pb2+ stress. Malate accumulation was induced by endophyte infection under Pb2+ exposure suggesting that malate is the most obvious candidate ligand for Pb2+. Endophyte infection increased Ca, Mg, P, Fe and Ni contents in the leaves and Ni contents in the roots under Pb2+ stress, but reduced Fe content in the roots under high Pb2+ stress. Under same Pb2+ concentration, endophyte infection significantly increased plant height, the dry weight of the shoots, and Chl content. The effects of endophyte infection might be due to changes in OAs accumulation and exudation and improvements in mineral uptake under Pb2+ stress.

Plant Root Exudates Are Involved in Bacillus cereus AR156 Mediated Biocontrol Against Ralstonia solanacearum.

The biological control process mediated by microbes relies on multiple interactions among plants, pathogens and biocontrol agents (BCAs). One such efficient BCA is Bacillus cereus AR156, a bacterial strain that controls a broad spectrum of plant diseases and potentially works as a microbe elicitor of plant immune reactions. It remains unclear, however, whether the interaction between plants and B. cereus AR156 may facilitate composition changes of plant root exudates and whether these changes directly affect the growth of both plant pathogens and B. cereus AR156 itself. Here, we addressed these questions by analyzing the influences of root exudate changes mediated by B. cereus AR156 during biocontrol against tomato bacterial wilt caused by Ralstonia solanacearum. Indeed, some upregulated metabolites in tomato root exudates induced by B. cereus AR156 (REB), such as lactic acid and hexanoic acid, induced the growth and motile ability of in vitro B. cereus AR156 cells. Exogenously applying hexanoic acid and lactic acid to tomato plants showed positive biocontrol efficacy (46.6 and 39.36%) against tomato bacterial wilt, compared with 51.02% by B. cereus AR156 itself. Furthermore, fructose, lactic acid, sucrose and threonine at specific concentrations stimulated the biofilm formation of B. cereus AR156 in Luria-Bertan- Glycerol- Magnesium medium (LBGM), and we also detected more colonized cells of B. cereus AR156 on the tomato root surface after adding these four compounds to the system. These observations suggest that the ability of B. cereus AR156 to induce some specific components in plant root exudates was probably involved in further biocontrol processes.

MINIMAL OPTICAL COHERENCE TOMOGRAPHY B-SCAN DENSITY FOR RELIABLE DETECTION OF INTRARETINAL AND SUBRETINAL FLUID IN MACULAR DISEASES.

To determine the minimal optical coherence tomography B-scan density for reliable detection of intraretinal and subretinal fluid. Spectral domain optical coherence tomography raster scanning (Spectralis; Heidelberg Engineering, Heidelberg, Germany) using a scan field of 20° × 20° of 97 B-scans with an interscan distance (ISD) of 60 μm was performed in 150 eyes of 150 consecutive patients at monitoring visits for intravitreal anti-vascular endothelial growth factor therapy. Using custom software, every other B-scan was repeatedly deleted to generate additional data sets with an ISD of 120 μm (49 B-scans), 240 μm (25 B-scans), and 480 μm (13 B-scans). Two independent reviewers evaluated the data sets for the presence of cystoid spaces of intraretinal fluid and subretinal fluid. Treatment diagnoses were neovascular age-related macular degeneration (68.0%), macular edema secondary to retinal vein occlusion (20.7%), diabetic macular edema (10.7%), and other retinal diseases (4.0%). Using the source data sets with an ISD of 60 μm, intraretinal fluid was detected in 56.0%, subretinal fluid in 19.3%, and either/both in 68.7%. Compared with these results, the sensitivity of detection of intraretinal fluid and/or subretinal fluid using an ISD of 120 μm, 240 μm, and 480 μm was 99.0% (95% confidence interval, 94.7-100.0; P = 0.5), 97.1% (91.7-99.4; P = 0.1), and 87.4% (79.4-93.1; P = 0.0001), respectively. An increase of ISD up to 240 μm does not significantly impair the detection of treatment-relevant exudative retinal changes in monitoring during intravitreal therapy of macular diseases. These findings are relevant for the choice of optical coherence tomography B-scan density in both routine clinical care and interventional clinical studies.

Protective effect of forsythoside B against lipopolysaccharide-induced acute lung injury by attenuating the TLR4/NF-κB pathway

Acute lung injury (ALI), which is mainly triggered by infection, pneumonia, vasculitis, and sepsis, has no specific and effective therapy except for primary supportive treatment or bedside care. Excessive inflammation caused by innate immune cells is the major characteristic of ALI. Forsythoside B, a phenylethanoside compound, possesses good antioxidant and anti-bacterial properties in vivo and in vitro. In this study, the therapeutic potential of forsythoside B and its mechanism of action were investigated in a lipopolysaccharide (LPS)-induced ALI mouse model. The results showed that LPS-induced edema exudation and lung pathological changes in mice were significantly suppressed by forsythoside B pre-treatment. Furthermore, it also attenuated lung inflammation caused by LPS stimulation, evidenced by decreased inflammatory cell infiltration and down-regulated expression of cytokines, chemokines, and inducible enzymes. The anti-inflammation property of forsythoside B was confirmed in vitro using LPS-stimulated RAW 264.7 macrophages. Moreover, it alleviated LPS-induced inflammation by inhibiting the activation of TLR4/NF-κB signaling pathway in vivo and in vitro. In conclusion, the results demonstrated that forsythoside B protects against LPS-induced ALI by attenuating inflammatory cell infiltration and suppressing TLR4/NF-κB-mediated lung inflammation. Therefore, it might be a potential therapeutic agent for ALI caused by sepsis.

Successful resolution of coats disease by photodynamic therapy: a case report

BackgroundCoats disease is a retinal disease characterized by exudative retinal detachment due to abnormal retinal blood vessels. Coats disease is generally treated using laser photocoagulation and cryotherapy to ablate the abnormal retinal blood vessels. However, if abnormal blood vessels are present near the posterior pole of the eye and there is a severe exudative change there, it is difficult to perform these standard treatments. We describe a case of Coats disease with severe exudative retinal change and retinal vascular abnormality near the posterior pole for which we performed photodynamic therapy and successfully suppressed the disease and improved vision.Case presentationA 15-year-old Japanese boy presented to hospital with a chief complaint of decreased vision in his right eye. At the initial examination, corrected visual acuity of the right eye was 20/100. On the right fundus, exudative retinal detachment with subretinal haemorrhage was observed from the upper intermediate periphery to the posterior pole. Abnormal telangiectatic vessels and microaneurysms were found at the nasal peripheral retina. From these findings, we diagnosed the case as Coats disease. We conducted photodynamic therapy for the right eye. At 10 months after treatment, both the subretinal haemorrhage and the exudative retinal detachment had disappeared completely. Further, the retinal structure of the macula had recovered, and right vision had improved to 20/20.ConclusionPhotodynamic therapy may be an effective and safe treatment for Coats disease in cases that present with abnormal retinal vessels close to the posterior pole of the eye.

Repeat Colonoscopy Revealing CMV Ileitis in an ALL Patient With GVHD

Introduction Graft-versus-host disease (GVHD) and Cytomegalovirus (CMV) infection of the GI tract can occur concomitantly as a complication of allogenic stem cell transplantation (SCT). Repeat endoscopy is sometimes necessary to diagnose GI CMV in the setting of GVHD. Case Patient is a 42 year old female with relapsed acute lymphoblastic leukemia (ALL), s/p chemotherapy and allogenic SCT who presents with intractable diarrhea. Her post SCT course was complicated by recurrent C. difficile diarrhea, CMV viremia and cutaneous GVHD. The Gastroenterology (GI) service was consulted and colonoscopy revealed diffuse colitis with crypt loss and focal apotosis consistent with Grade 2 GVHD. No evidence of infection was seen. She was started on IV steroids and tacrolimus, however, had persistent diarrhea. CT showed non-specific colitis and repeat infectious work-up was unrevealing. GI was re-consulted, and the utility of repeating a colonoscopy in the setting of known GI GVHD was considered. Repeat endoscopy revealed terminal ileum mucosa with extensive ulceration, neutrophilic exudate, apoptosis and regenerative changes suggestive of Grade 4 GVHD (Figure 1 and 2). CMV immunostain was positive, as was CMV PCR (Figure 3). Given findings, she was treated with IV foscarnet with eventual resolution of GI symptoms. Discussion Diagnosis of CMV infection in the setting of GVHD is challenging. After SCT, both are common complications and can occur together. The histologic hallmark of GI GVHD is epithelial cell apotosis. This is however nonspecific as other etiologies such drugs and infections including CMV are known to elicit epithelial apoptosis. During initial colonoscopy in our case, inclusion bodies were not seen, and CMV PCR was negative. Although CMV PCR has a high sensitivity at 89%, it is not perfect, as evidenced by an initially negative result. An important learning point is that repeat endoscopy might be necessary if there is no improvement despite treatment. A similar case is reported by Sun, et. al. Further, GI CMV disease was diagnosed at follow-up endoscopies in 39% of patients with GI GVDH in a study by Cho, et. al. As GI CMV can lead to dire complications such as obstruction and perforation, accurate diagnosis is vital and justifies repeat endoscopy.1914_A Figure 1. Terminal ileum showing ulceration and edema.1914_B Figure 2. Microphotograph of colonic biopsy showing changes of GVHD including apoptosis (arrow), crypt loss (arrowheads) and regenerative changes.1914_C Figure 3. Microphotograph of terminal ileal biopsy showing background of severe GVHD without surviving crypts. Few viral inclusions are seen (arrows) that are positive for CMV with CMV immunostain (dark brown nuclear staining in the inset).

Fundus examination of 199 851 newborns by digital imaging in China: a multicentre cross-sectional study

BackgroundThe prevalence of ocular abnormalities of newborn in China has seldom been reported. To report the implementation of digital imaging in ocular screening of all newborns in multiple centres in...

Gingival Exudatome Dynamics Implicate Inhibition of the Alternative Complement Pathway in the Protective Action of the C3 Inhibitor Cp40 in Nonhuman Primate Periodontitis.

Periodontitis is a prevalent chronic inflammatory disease associated with dysbiosis. Although complement inhibition has been successfully used to treat periodontitis in animal models, studies globally analyzing inflamed tissue proteins to glean insight into possible mechanisms of action are missing. Using quantitative shotgun proteomics, we aimed to investigate differences in composition of inflammatory gingival tissue exudate ("gingival crevicular fluid"; GCF), before and after local administration of an inhibitor of the central complement component, C3, in nonhuman primates. The C3 inhibitor, Cp40 (also known as AMY-101) was administered locally in the maxillary gingival tissue of cynomolgus monkeys with established periodontitis, either once a week (1×-treatment; n = 5 animals) or three times per week (3×-treatment; n = 10 animals), for 6 weeks followed by another 6 weeks of observation in the absence of treatment. 45 GCF samples were processed for FASP digestion and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Data were processed using the ProgenesisQI software. The statistical significance of differences between the groups was determined by RM-ANOVA, and a protein expression change was considered as a true regulation at >2-fold and p < 0.05. The human orthologues were subjected to Gene Ontology analyses using PANTHER. Data are available via ProteomeXchange with identifier PXD009502. 573 proteins with >2 peptides were longitudinally quantified. Both 3× and 1× administration of Cp40 resulted in significant down-regulation of dozens of proteins during the 6-week course of treatment as compared to baseline. Following drug withdrawal at 6 weeks, more than 50% of the down-regulated proteins showed increased levels at week 12. The top scored pathway was "complement activation, alternative pathway", and several proteins involved in this pathway were down-regulated at 6 weeks. We mapped the proteomic fingerprint changes in local tissue exudate of cynomolgus monkey periodontitis in response to C3 inhibition and identified the alternative pathway of complement activation and leukocyte degranulation as main targets, which are thus likely to play significant roles in periodontal disease pathogenesis. Label-free quantitative proteomics strategies utilizing GCF are powerful tools for the identification of treatment targets and providing insights into disease mechanisms.

Clinical outcomes in Caucasian patients with polypoidal choroidal vasculopathy.

To describe treatment outcomes in a cohort of Caucasian patients with polypoidal choroidal vasculopathy (PCV). Clinical charts from 48 eyes of 45 Caucasian patients with PCV were retrospectively reviewed. All cases were diagnosed with indocyanine green angiography. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) imaging were analyzed at baseline and final follow-up. Eyes were treated with a combination of verteporfin photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) (n = 24), or PDT monotherapy (n = 9), or anti-VEGF monotherapy (n = 8), or no treatment (n = 7). Aflibercept was the anti-VEGF agent in 30 out of 32 eyes. Sixteen out of 24 eyes in the combination treatment group received initial PDT at diagnosis. All treatments led to stabilization of BCVA at final visit with a trend for better visual acuity in the anti-VEGF monotherapy group. There was a substantial reduction in central retinal thickness associated with resolution of subfoveal fluid and improvement in retinal pigment epithelial detachment in all treatment groups. BCVA and OCT findings remained stable in eyes which received no treatment. The use of PDT was associated with 0.5 fewer intravitreal injections per annum, which was not statistically significant. In the largest series of Caucasian patients with PCV presented to date, anti-VEGF monotherapy, PDT, or their combination preserved visual acuity and improved subfoveal exudative changes. Combination treatment was not superior to anti-VEGF monotherapy.

Incidence of Fellow Eye Involvement in Patients With Unilateral Exudative Age-Related Macular Degeneration

Since the advent of optical coherence tomography angiography (OCT-A), nonexudative neovascularization has been described in the fellow eyes of unilateral exudative age-related macular degeneration (AMD). However, there is limited literature describing the natural course and optimal management of these lesions. To determine the incidence of fellow eye involvement in patients presenting with unilateral typical AMD or polypoidal choroidal vasculopathy and to evaluate the patterns of OCT-A changes within 6 months before the onset of exudative changes, especially focusing on nonexudative neovascularization. Data for this study were taken from a prospective, observational cohort study involving Asian patients with exudative AMD in the Asian AMD Phenotyping Study between October 2015 and March 2016. Analyses began in June 2017. Only patients who had gradable OCT-A and indocyanine green angiography (ICGA) scans of the fellow eye at baseline and follow-up at least 6 months apart were included for the analysis. The contralateral eye was evaluated for presence of nonexudative neovascularization based on multimodal imaging, which included ICGA, spectral domain optical coherence tomography, and OCT-A. The difference between the incidence of those with nonexudative choroidal neovascularization and those without as analyzed using log-rank test and qualitative analysis of OCT-A images. We included 95 fellow eyes of 95 patients who presented with unilateral exudative AMD with a mean (SD) age of 68.6 (8.6) years. Nonexudative neovascularization was present in 18 eyes (19%) (8 [22.9%] and 10 [19.0%] fellow eyes with typical AMD and polypoidal choroidal vasculopathy, respectively; 8 [44.4%] on OCT-A; 5 [27.8%] on ICGA; and 5 [27.8%] on both OCT-A and ICGA). Development of exudative changes was noted in 6 fellow eyes (6.3%). Four eyes developed exudation from previously noted nonexudative neovascularization, and 2 eyes arose exudative changes from de novo. The probability of developing exudation within 6 months was significantly higher in eyes with baseline nonexudative neovascularization (0.087; 95% CI, 0.0033-0.210) compared with eyes without (0.010; 95% CI, 0.0026-0.041) (P = .008). In all eyes whose OCT-A images were available immediately before the onset of exudative changes, there was an increase in the size of network vessels compared with baseline. The presence of nonexudative neovascularization may predispose to the development of exudative changes.

CHARACTERISTICS OF ADMINISTRATION OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN ANKYLOSING SPONDYLITIS: CLINICAL OBSERVATION

The study objective is to demonstrate characteristics of prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) for ankylosing spondylitis (AS) through a clinical case. Materials and methods . Male patient N., 34 years old, sought medical help complaining of pain in the cervical, thoracic, and lumbar spine, predominantly at night, at rest; limited range of motion in cervical and lumbar spine, pain in the area of external thigh surface, morning tightness longer than 2 hours. Stomachache after eating was also a complaint. The first episode of inflammatory pain was 10 years ago. Diagnosis of AS was determined 2 years ago, NSAIDs were prescribed which the patient didn’t take regularly. Based on clinical and laboratory examination, the following diagnosis was made. Main disorder: ankylosing spondylitis, late stage, stage III bilateral sacroiliitis, frontal spondylitis, high activity (BASDAI 5, 7, ASDAS-CRP 2, 7), HLA-В27-associated, with extra-articular manifestations (stage II bilateral coxitis, tendinitis of the shoulder rotator cuff muscle – superspinatus, supraspinatus, teres minor muscle, trochanteritis on both sides). Secondary diagnosis: NSAID-gastropathy, gastroesophageal reflux disease with esophagitis, gastroduodenitis associated with H. pylori. Meloxicam 15 mg/day in constant continuous regimen, methotrexate 12.5 mg SC once a week, folic acid 1 mg 5 days a week, sirdalud 4 mg 2 times a day, H. Pylori eradication therapy, glucocorticoid administration in the area of inflamed entheses were prescribed. Results . During the patient’s visit a month later, significant positive dynamics were observed: decreased pain in the lumbar, cervical, and thoracic spine, decreased pain in the shoulder joints, pain relief in the area of the greater trochanters, full active and passive range of motion in the shoulder joints. Duration of morning tightness was 1.5 hours. No complaints of pain in the epigastric region. In blood test: clinical and biochemical characteristics without abnormalities, С-reactive protein decreased from 62.5 to 20 mg/l. BASDAI 4, 3, ASDAS-CRP 2.0. Treatment with NSAIDs, methotrexate, proton pump inhibitor, folic acid was continued. Conclusion. NSAIDs are leading drugs for treatment of AS. Their prescription allows to relieve spinal pain and tightness, decreases enthesitis manifestations, exudative changes in the joints, allows to prevent or slow down structural changes in the spine. A very important treatment aspect is providing patients with information on the necessity of long-term continuous administration of NSAIDs and basic drugs, as well as on possible adverse events, regular laboratory control, necessity of gastroprotective drugs. Effectiveness of meloxicam in AS therapy was proved in a number of multicenter studies with a large number of patients. Meloxicam’s effectiveness is comparable to traditional NSAIDs – the “golden standard” (diclofenac, piroxicam, naproxem), but it’s more safe.

Efficacy of treat-and-extend regimen with aflibercept for pachychoroid neovasculopathy and Type 1 neovascular age-related macular degeneration.

To evaluate the efficacy of intravitreal aflibercept therapy using a treat-and-extend regimen on treatment-naïve pachychoroid neovasculopathy (PNV) and Type 1 neovascular age-related macular degeneration (AMD). We retrospectively studied 42 eyes with PNV and 60 eyes with Type 1 neovascular AMD. We assessed best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and total number of injections over 2 years. The BCVA and CMT improvements during the 2-year treatment period did not differ significantly between PNV and AMD; however, CCT decreased significantly in PNV than in AMD (P<0.05). Management of PNV required significantly fewer injections than AMD during the 2-year period (P<0.05). There were no significant differences in BCVA, CMT and CCT changes between PNV with and without polypoidal lesions (28 vs. 14 eyes) during the 2 year period. Significantly fewer injections were needed for PNV with polypoidal lesions than for PNV without (P<0.01). There were no significant differences in BCVA, CMT and CCT changes, or in the number of injections during the 2-year treatment period, between AMD with and without polypoidal lesions (30 vs. 30 eyes). Treat-and-extend regimen of intravitreal aflibercept injection may be equally effective in terms of improvement of BCVA and exudative changes both in eyes with PNV and those with Type 1 neovascular AMD requiring fewer injections for the former. Among eyes with PNV, those with polypoidal lesions needed fewer injections than those without polypoidal lesions.

Impact on the Fe redox cycling of organic ligands released by Synechococcus PCC 7002, under different iron fertilization scenarios. Modeling approach

Abstract The kinetics of Fe redox transformations are of crucial importance in determining the bioavailability of iron, due to inorganic Fe(II) and Fe weakly organic complexes being the most easily assimilated species by phytoplankton. The role played by the natural organic ligands excreted by the cyanobacteria Synecococcus PCC 7002 on the iron redox chemistry was studied at different stages of growth, considering changes in the organic exudation of the cyanobacteria, associated with growth under two different scenarios of iron availability. The oxidation/reduction processes of iron were studied at nanomolar levels and under different physicochemical conditions of pH (7.2– 8.2), temperature (5– 35 °C) and salinity (10– 37). The presence of natural organic exudates of Synechococcus affected the redox behavior of iron. A pH-dependent and photo-induced Fe(III) reduction process was detected in the presence of exudates produced under Fe-Low conditions. Photolytic reactions also modified the reactivity of those exudates with respect to Fe(II), increasing its lifetime in seawater. Without light mediated processes, organic ligands excreted under iron deficient conditions intensified the Fe(II) oxidation at pH A kinetic modeling approach to describe the speciation and the contribution of individual Fe(II) species to the overall oxidation rate was applied, considering the experimental data and delimiting the equilibrium and redox constants between iron and the major ligands present in solution. Two organic type ligands for the exudates of Synechococcus PCC 7002, with different iron-chelation properties were included in the model. The Fe(II) speciation was radically affected when organic ligands were considered. The individual contributions to the overall Fe(II) oxidation rate demonstrated that these organic ligands played a key role in the oxidation process, although their contributions were dependent on the prescribed iron conditions. The study, therefore, suggests that the variability in the composition and nature of organic exudates released, due to iron availability conditions, might determine the redox behaviour of iron in seawater.

Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy

Hypertensive retinopathy is seen frequently in patients with systemic hypertension and is usually asymptomatic. An acute rise in blood pressure may lead to exudative changes in the form of macular edema, hemorrhages, and serous macular detachment that can lead to visual decline. The authors report prompt resolution of exudative changes in a case of hypertensive retinopathy following intravitreal bevacizumab.

Cellular mechanisms of slime gland refilling in Pacific hagfish (Eptatretus stoutii).

Hagfishes use their defensive slime to ward off gill-breathing predators. Slime gland refilling is a surprisingly slow process, and previous research has shown that the composition of the slime exudate changes significantly during refilling, which likely has consequences for the functionality of the slime. This study set out to expand our understanding of slime gland refilling by examining the cellular processes involved in refilling of the glands, as well as determining where in the gland the main slime cells - the gland thread cells and gland mucous cells - arise. Slime glands were electro-stimulated to exhaust their slime stores, left to refill for set periods of time, and harvested for histological and immunohistochemical examination. Whole slime glands, gland thread cell morphometrics and slime cell proportions were examined over the refilling cycle. Slime glands decreased significantly in size after exhaustion, but steadily increased in size over refilling. Gland thread cells were the limiting factor in slime gland refilling, taking longer to replenish and mature than gland mucous cells. Newly produced gland thread cells underwent most of their growth near the edge of the gland, and larger cells were found farthest from the edge of the gland. Immunohistochemical analysis also revealed proliferating cells only within the epithelial lining of the slime gland, suggesting that new slime cells originate from undifferentiated cells lining the gland. Our results provide an in-depth look at the cellular dynamics of slime gland refilling in Pacific hagfish, and provide a model for how slime glands refill at the cellular level.

Development of Age-Related Macular Degeneration (AMD) in the Fellow Eye of Patients with AMD Treated by Treat-and-Extend Intravitreal Therapy with Aflibercept

Purpose: To evaluate the development of neovascular age-related macular degeneration (nAMD) in the fellow eye in patients with unilateral nAMD treated by a treat-and-extend (TAE) regimen with intravitreal aflibercept injections. Methods: We retrospectively studied 104 patients with treatment-naïve unilateral nAMD. We assessed best-corrected visual acuity (BCVA) and exudative changes in the treated eyes and development of nAMD in the fellow eye for 2 years. Results: The subjects included 46 patients with typical AMD (tAMD), 44 with polypoidal choroidal vasculopathy (PCV), and 14 with retinal angiomatous proliferation (RAP). BCVA was significantly improved after the loading phase in all subtypes. Forty-six patients (44.2%) had no recurrence within 2 years after the loading phase, including 12 (26.1%) with tAMD, 23 (52.2%) with PCV, and 11 (78.6%) with RAP (p < 0.01). Eleven patients (10.6%) developed nAMD in the fellow eye within 2 years, including 4 (8.7%) with tAMD, 0 (0%) with PCV, and 7 (50.0%) with RAP (p < 0.001). Conclusions: Patients with RAP had significantly more frequent development of nAMD in the fellow eye compared to other subtypes, while they showed significantly less recurrence during the TAE regimen with intravitreal aflibercept injections. Development of nAMD in the fellow eye should be monitored in RAP when the injection interval is extended.

Colonizing tropical seagrasses increase root exudation under fluctuating and continuous low light

AbstractWhile light availability plays a critical role in seagrass growth and distribution, there is limited understanding of how changes in light exposure impact belowground processes. We investigated the effect of prolonged and fluctuating reductions in light on root growth and exudation by three colonizing seagrasses: Cymodocea serrulata, Halophila ovalis, and Halodule uninervis. Seagrasses were grown in mesocosms under continuous full light (control), under continuous light reduction (medium or low), or under fluctuating light (10 d of low and 4 d of high light, repeated three times). Plants were harvested (1) 6 weeks after light treatments (impact), and (2) after an additional 4 weeks of continuous full light (recovery). Root exudates were collected from trap solutions and measured for dissolved organic carbon (DOC), total dissolved nitrogen (TDN), and dissolved organic matter (DOM) excitation/emission fluorescence spectroscopy. Root biomass decreased in all shading treatments. The most notable impact of light treatment was an increase in root exudation of DOC, protein‐like DOM and humic‐like DOM under fluctuating light for all species. After 4 weeks of recovery, exudation of DOC, and protein‐like DOM observed under fluctuating light returned to the control light levels. However exudation of DOC and protein‐like DOM by H. ovalis grown in continuous low light remained greater than the control, likely due to root death. This study suggests the belowground environment of seagrasses is sensitive to light reduction. Monitoring changes in root exudation of seagrasses can provide an effective and rapid method to assess light stress and short‐term recovery of seagrasses.

Treat-and-Extend Regimen with Aflibercept for Neovascular Age-Related Macular Degeneration: Efficacy and Macular Atrophy Development

To evaluate the effects of intravitreal injection of aflibercept using a treat-and-extend dosing regimen on treatment-naïve neovascular age-related macular degeneration (AMD) and the development of macular atrophy. Retrospective, interventional case series. Eyes (n = 137) with treatment-naïve neovascular AMD, including 18 eyes with typical AMD with classic choroidal neovascularization (CNV), 44 eyes with typical AMD with occult CNV, 58 eyes with polypoidal choroidal vasculopathy, and 17 eyes with retinal angiomatous proliferation (RAP). Clinical records of eyes with neovascular AMD that underwent 3 consecutive monthly intravitreal injections of aflibercept followed by a treat-and-extend dosing regimen were reviewed, and the corresponding imaging studies were analyzed. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and the extent of macular atrophy in the macular area during a 2-year follow-up period. In all subtypes after 1 and 2 years, CMT and CCT were reduced significantly, whereas macular atrophy showed significant enlargement. At baseline, the extent of macular atrophy was greater in RAP than other subtypes; after 2 years, the macular atrophy enlargement was also greatest in RAP and correlated negatively with CCT (rs=-0.72; P < 0.01). Best-corrected visual acuity showed significant improvement after 1 and 2 years in all subtypes other than RAP. In RAP, BCVA was improved significantly after 1 year, but the magnitude of this improvement lost statistical significance after 2 years. Treat-and-extend with intravitreal aflibercept may be effective for improving BCVA and ameliorating exudative changes in neovascular AMD. However in RAP, choroidal thinning during the treatment regimen may accelerate enlargement of macular atrophy, thereby diminishing the improvement in BCVA after 2 years.

Clinical value of type III procollagen peptide in sequential treatment with Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning

Objective To investigate the clinical value of type Ⅲ procollagen peptide (PⅢP) in sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning (APP). Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups: A group (n=30, routine therapeutic agents coupled with a single hemoperfusion), B group (n=34, treated by Rheum officinale Ball. as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion), C group (n=40, treated by Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion). Before and 3 days and 7 days after treatment, tumor necrosis factor α (TNF-α), interleukin-18 (IL-18), maleic dialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) of patients were detected, and the change of sequential organ failure assessment (SOFA) scores were observed. Before and 3 days, 7 days, 10 days and 14 days after treatment, PⅢP were detected, and the changes of lung CT in three groups were observed before and 7 days, 14 days after treatment. Pearson correlation test was used to analyze the correlation between PⅢP in patients with APP and the concentration of paraquat, and the outcomes in 28 days were compared with chi square test. Results At admission, there were no differences in the levels of plasma TNF-α, IL-18, MDA, PⅢP, SOD, GSH-PX and SOFA scores among three groups (P>0.05). At 3 days after treatment, the levels of plasma TNF-α, IL-18, MDA and SOFA scores were elevated in three groups compared with those at admission, especially in group A were increased significantly, whereas the activity of plasma SOD and GSH-PX were decreased in thress groups, especially in group A decreased most significantly (P 0.05). At 7 days after treatment, lung CT mainly manifested ground glass lesions in C group. At 14 days after treatment, lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A, B group, while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group, and those A group was higher than those in B group(P<0.05). The level of serum PⅢP in patients with APP was positively correlated with the concentration of paraquat (r=0.310, P=0.001). The mortality rate of three groups were 53.33%, 44.12% and 25.00%, respectively, with significant difference among three groups (P<0.05). Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine in patients with APP was distinct. It could decrease the levels of PⅢP, TNF-α, IL-18 and MDA, enhance the expression of SOD and GSH-PX, reduce pulmonary fibrosis in patients and the mortality rate of patients.The PⅢP is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP. Key words: Acute paraquat poisoning; Type Ⅲ procollagen peptide; Traditional Chinese medicine; Hemoperfusion; Pulmonary fibrosis; Oxidative stress

Two-Year Outcomes of a Treat-and-Extend Regimen Using Intravitreal Aflibercept Injections for Typical Age-Related Macular Degeneration

Purpose: The aim of this study was to evaluate the efficacy of a treat-and-extend (TAE) regimen using intravitreal injection of aflibercept (IVA) for typical age-related macular degeneration (tAMD). Methods: We retrospectively studied 61 treatment-naïve eyes with tAMD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), number of injections, and complications during 2 years were evaluated. Results: BCVA significantly improved by on average 0.13 logMAR units, and CMT and CCT significantly decreased after 2 years. The number of injections was on average 13.6. In the second year, eyes with classic choroidal neovascularization (CNV) needed significantly fewer treatments than eyes with occult CNV. Fourteen eyes, which developed subfoveal fibrosis, showed significantly poorer BCVA after 2 years. Subfoveal fibrosis was significantly common in classic CNV. Conclusion: A TAE regimen using IVA for tAMD might be effective for improving BCVA and exudative changes. The exudation may be suppressed with fewer treatments in classic CNV compared to occult CNV.