Exudative Changes Research Articles

Significance of new membrane formation in peritoneal biopsies of peritoneal dialysis patients: a case\u2013control study

BackgroundNewly formed membrane (NFM) on the peritoneal membrane proper is a unique pathological hallmark of encapsulating peritoneal sclerosis (EPS), but its definition and diagnostic significance have not been well described. This study investigated the pathological features of NFM in EPS and prevalence of NFM in peritoneal biopsy at catheter removal.MethodsThis multicenter retrospective, observational study was conducted by the Japanese Society of Peritoneal Dialysis and enrolled ten patients with and 52 without EPS at peritoneal biopsy during enterolysis surgery or catheter removal. All patients were treated using conventional, acidic peritoneal dialysis (PD) solutions. Thirty of the 52 non-EPS patients perform peritoneal lavage once daily after completing PD to prevent the development of EPS and 22 discontinued PD without lavage. NFM was defined as additional membrane structure on the peritoneum that is properly characterized by exudative or fibrous matrices and fibroblast-like cells. Immunostaining of fibrin and podoplanin was performed for the evaluation of NFM.ResultsNFM was confirmed histologically in eight of the ten patients with EPS. It was also detected in 13 of the 30 patients (43.3%) in the post-PD lavage group and in one of the 22 patients (4.5%) in the non-lavage group. The NFM histology showed various stages of EPS pathology, from early exudative changes with fibrin deposition (stage I; n = 5), progressing to proliferative and fibrosing changes with podoplanin-positive fibroblast-like cells (stage II; n = 9), and finally resulting in adhesive and fibrous scar formation (stage III; n = 8). Immunostaining of fibrin and podoplanin was helpful for evaluating the stage of the NFM.ConclusionsNFM contributes the encapsulation of intestines and is a pathological hallmark of EPS, but can be detected microscopically in patients without EPS, especially those with peritoneal lavage after PD. New membrane formation starts insidiously in peritoneal membrane damaged by PD treatment, but does not necessarily lead to the development of EPS.

Two-year results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy.

To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve polypoidal choroidal vasculopathy (PCV). In a retrospective interventional case series of 58 eyes of 58 patients with PCV, we assessed best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and number of injections for 2years. Polypoidal lesions were also evaluated before treatment and after the loading phase by indocyanine green angiography. BCVA significantly improved after the loading phase and was maintained in the maintenance phase. CMT and CCT significantly reduced after the loading phase and were maintained throughout the follow-up period. The number of injections averaged 7.72 in the first year and 4.67 in the second year. The average number of polypoidal lesions per patient was 2.43 before treatment. In 32 patients (55.2%), polypoidal lesions regressed completely after the loading phase; these patients also needed significantly fewer injections compared to other patients. CCT at baseline was positively correlated with the decreased amount of CCT after 2years and negatively correlated with the number of injections for 2years. Treat-and-extend intravitreal therapy with aflibercept may be effective for improving BCVA and exudative change in eyes with PCV. The regression of polypoidal lesions after the loading phase and thicker choroid at baseline might lead to fewer total number of intravitreal injections of aflibercept.

Deciphering the Mechanisms of Endophyte-Mediated Biofortification of Fe and Zn in Wheat

An investigation was carried out to understand the mechanism(s) underlying enhanced Fe or Zn uptake in low Fe–Zn accumulator wheat genotype 4HPYT-414, due to inoculation of siderophore-producing and zinc-solubilizing endophytes—Arthrobacter sulfonivorans DS-68 and Arthrobacter sp. DS-179. Root anatomical features, using transmission electron microscopy (TEM), qualitative and quantitative aspects of production of organic acids and sugars in root exudates, and expression of TaZIP genes were analysed to relate to endophyte-mediated higher concentrations of Fe and Zn in the roots and shoots of wheat plants. TEM studies revealed that the endodermis, cortical region, root hair extension, xylem and xylem vessels, pericycle and vascular bundles were more pronounced and thicker in inoculated treatments, as compared to control. The organic acid profile of root exudates revealed five types of organic acids, with citric acid being predominant. Inoculation of A. sulfonivorans and Arthrobacter sp. brought about 5- and eightfold increases in the amounts of acids, respectively, as compared to control, particularly citric acid, succinic acid and acetic acid. Among the four TaZIP genes targeted, expression was achieved only for TaZIP3 and TaZIP7 genes, which showed 1–2 fold increases in the inoculated treatments. The results clearly indicated that the endophyte-mediated overexpression of TaZIP3 and TaZIP7 genes in roots and shoots, and the observed anatomical and exudate changes were acting synergistically in facilitating higher Fe and Zn translocation in roots and shoots.

CT-guided microwave ablation through the lungs for treating liver tumors near the diaphragm.

PurposeTo explore the short-term efficacy and safety of CT-guided microwave ablation (MWA) for treating liver tumors near the diaphragm.ResultsThe complete response (CR) rate for CT-guided MWA through the lung was 94.7% (124/131). The incomplete response (ICR) rate was 5.3% (7/131), of which 6 patients with ICRs achieved CRs after MWA. The CR rate for Group I was higher than Group II (99.0% vs. 80.0%, P=0.001). The mean follow-up time was 11.2 ±7.50 months. The total local recurrence (LR) rate was 15.3% (20/131). The complication rate was 26.5%, and no severe complications were recorded. All complications were controllable and treatable. The incidence of diaphragmatic thickening during the MWA was 18.8% (P>0.05); the incidence of exudative changes inside the lungs was 6.8% (P>0.05).ConclusionsCT-guided MWA can detect changes in liver tissue, in the diaphragm and nearby lung tissues during the ablation process. It’s safe and effective to treat tumors close to the diaphragm by CT-guided MWA through the lung.MethodsCT-guided MWA was used on 131 tumors that were close to the diaphragm (distance between tumor and diaphragm ≤ 5 mm) in 117 patients with liver cancer. The tumors were divided into a < 3.0 cm group (Group I, n= 101) and a ≥ 3.0 cm group (Group II, n= 30) based on tumor diameters. The complications within 2 weeks following treatment were counted, and the safety and short-term efficacy of MWA were analyzed.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVEALS BLOOD FLOW IN CHOROIDAL NEOVASCULAR MEMBRANE IN REMISSION PHASE OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

The aim of the study was to investigate blood flow in choroidal neovascular membrane in remission phase of neovascular age-related macular degeneration using optical coherence tomography (OCT) angiography. OCT angiography was obtained in eyes with remission phase of neovascular age-related macular degeneration after treatments, defined as no exudative change (such as macular edema, subretinal fluid, and subretinal hemorrhage) observed in eyes without any treatment for neovascular age-related macular degeneration within the previous 6 months. Irregular blood flows shown in the segmentation of outer retina detected by OCT angiography were considered as blood flows in choroidal neovascular membrane. The vascular area and vessel density were obtained from OCT angiography images. Twenty eyes of 20 patients were included in this analysis. The blood flows in choroidal neovascular membrane were observed in all eyes (100%) using OCT angiography. The mean vascular area was 3.81 ± 3.41 mm and the mean vessel density of lesion was 28.9 ± 8.2%. The vessel density was significantly correlated with best-corrected visual acuity and duration of remission (best-corrected visual acuity: P = 0.008, r = -0.576; duration of remission: P = 0.017, r = -0.525, respectively). Optical coherence tomography angiography revealed that blood flows in choroidal neovascular membrane remained in eyes with clinically inactive neovascular age-related macular degeneration.

RANIBIZUMAB FOR MACULAR EDEMA AFTER BRANCH RETINAL VEIN OCCLUSION: One Initial Injection Versus Three Monthly Injections.

To compare the 12-month-efficacy of 1 initial intravitreal ranibizumab injection (IVR) followed by pro re nata (PRN) dosing with that of three initial monthly IVR followed by PRN dosing in patients with macular edema (ME) after branch retinal vein occlusion. Prospective, interventional study. Of 81 eyes, 42 received 1 initial IVR injection (1+PRN group) and 39 eyes received 3 monthly IVRs (3+PRN). Pro re nata injections were performed when fovea exudative changes were evident. At Month 12, the visual acuity (VA) changes from baseline were -0.245 ± 0.227 and -0.287 ± 0.222, in the 1+PRN and 3+PRN groups, respectively; there were no significant difference between groups (P = 0.728). The stratified analysis showed that patients with better VA (baseline VA >20/40) had similar significant improvement in VA at Month 12 (P < 0.001) to that of those with poorer VA (≤20/40). Better VA at Month 12 was significantly associated with younger age, better baseline VA, and thinner baseline central foveal thickness (P = 0.003, < 0.001, and < 0.001, respectively). Mean total number of IVR injections in the 1+PRN and 3+PRN groups were 3.8 ± 1.8 and 4.6 ± 1.4, respectively (P = 0.060). In both groups, shorter durations to the first PRN injection were associated with greater total PRN injection number (1+PRN, P = 0.006; 3+PRN; group, P < 0.001). In IVR treatment for ME after branch retinal vein occlusion, 1+PRN and 3+PRN regimens achieved similar 12-month functional outcomes. Patients with shorter durations to initial PRN injection may require more PRN treatments.

Incidence and risk factors of retreatment after three-monthly aflibercept therapy for exudative age-related macular degeneration

Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. In the present study, we studied 140 treatment naïve eyes with typical neovascular AMD (n = 71) or polypoidal choroidal vasculopathy (PCV) (n = 69) and investigated the incidence and risk factors of retreatment after 3-monthly intravitreal aflibercept injection for exudative AMD during the 12-month period. At 12 months, best-corrected visual acuity (BCVA) improved significantly from 0.45 ± 0.39 to 0.26 ± 0.33 (P = 4.1 × 10−11). Multiple regression analysis revealed that better baseline BCVA (P = 3.6 × 10−14) and thicker subfoveal choroidal thickness (P = 0.039) were associated with better BCVA at 12-months. Retreatment was required in 94 out of 140 (67.1%) eyes. Multivariate logistic regression analysis revealed that older age (P = 7.2 × 10−3) and T-allele of ARMS2 A69S (rs10490924) variants (P = 1.9 × 10−3) were associated with retreatment. Cox-regression analysis revealed that older age (P = 1.0 × 10−2) and T-allele of the ARMS2 gene (P = 6.0 × 10−3) were associated with retreatment-free period. The number of retreatment episodes was significantly different among the ARMS2 genotypes (P = 8.1 × 10−4). These findings might be helpful for physicians when considering the optimal treatment regimen for exudative AMD.

Surgical Management of Coats Disease.

Coats disease is a sporadic, chronic retinal vascular disorder with telangiectatic and aneurysmal retinal vessels, with retinal exudation and retinal detachment in severe cases. Various treatment modalities have been used, including laser therapy, cryotherapy, anti‒vascular endothelial growth factor (VEGF) therapy, and surgery. Anti-VEGF therapy seems to be effective in reducing exudative changes and is often combined with other treatment modalities. For severe cases with exudative retinal detachment, external drainage of subretinal fluid with or without vitrectomy is commonly performed, combined with laser therapy and/or cryotherapy. Relatively good anatomical outcomes have been reported; however, postoperative functional results, particularly in young patients and/or severe cases, seem to be limited.

Patterns of Polypoidal Choroidal Vasculopathy among a Multiracial Population in a Malaysian Hospital

Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to preferentially affect pigmented individuals and is considerably high among Asians. Most reports on patterns of PCV around Asia are based on a homogenous race (e.g. Chinese, Japanese) and very few descriptions from a multiracial population like those seen in Malaysia. The present study aimed to describe the demographic features, clinical and investigative characteristics of PCV in a multiracial group at Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86 PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic examination and investigations. Mean patient age was 70.4 years with a male preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were located generally within the macula area (86.8%), manifesting mainly as submacular hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen. Optical coherence tomography largely demonstrated exudative changes (75.9%) and almost all patients (97.7%) had loss of external limiting membrane (ELM) and IS/OS interface. On indocyanine green angiography, majority of eyes had multiple polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In conclusion, although the patterns of PCV in UKMMC were mainly similar to other Asian patients, a number of our patients had associated drusen. This indicates that PCV in our population could be a variant of neovascular age related macular degeneration and not solely idiopathic in nature.

Exudative Inflammatory Lesions in the Nasal Cavities of the 26-Week Tg.rasH2 Mice Oral Gavage Carcinogenicity Studies

Three levels of nasal cavity sections (anterior, middle, and most posterior) are routinely examined as protocol required tissues in our 26-week carcinogenicity studies involving Tg.rasH2 mice. Exudative inflammation of the nasal cavity was noted in the most posterior section of both males and females that were administered vehicle and/or test article via oral gavage, particularly when the vehicle and/or test article had irritant properties, was in the form of a salt, had a low pH, and/or was viscous. The exudative inflammatory lesion was characterized by the presence of eosinophilic proteinaceous fluid, fibrin, mucin, sloughed cells, and degenerate neutrophils within the nasal cavities. In lesions of increased severity, there was often degeneration, necrosis, and erosion of the underlying mucosa. Often, there was hyperplasia as well as squamous metaplasia of the mucosa. Retrospective analysis of our data, involving thirty-two 26-week Tg.rasH2 carcinogenicity studies, revealed that despite the presence of these exudative inflammatory changes with degeneration, necrosis, and mucosal hyperplasia, progression to tumor formation in the nasal cavities was rare and the incidence of nasal tumors was comparable in animals with or without exudative inflammatory lesions.

TREAT-AND-EXTEND REGIMEN WITH AFLIBERCEPT FOR RETINAL ANGIOMATOUS PROLIFERATION.

To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve retinal angiomatous proliferation (RAP) and development of retinal pigment epithelium (RPE) atrophy. We retrospectively studied 17 treated eyes with RAP and 13 untreated fellow eyes. We assessed best-corrected visual acuity (BCVA) in logarithm of the minimal angle of resolution (logMAR) units and recorded the total number of injections for 12 months. Central macular thickness (CMT) and central choroidal thickness (CCT) were assessed by optical coherence tomography (OCT), and RPE atrophy extent in the macular area was assessed by fundus autofluorescence. Average BCVA in eyes with RAP was 0.57 logMAR units (Snellen 20/74 or approximately 56.5 ETDRS letters) before treatment and significantly improved to 0.38 (Snellen 20/48 or approximately 66 ETDRS letters, P < 0.01) after 3 months and 0.32 (Snellen 20/42 or approximately 69 ETDRS letters, P < 0.01) after 12 months. Average CMT was 340 μm before treatment and significantly reduced to 133 μm (P < 0.001) after 3 months and 130 μm (P < 0.001) after 12 months. Average CCT was 147 μm before treatment, 123 μm (P < 0.01) after 3 months, and 131 μm (P < 0.01) after 12 months. Average total number of injections was 7.2. Average area of RPE atrophy enlarged by 1.00 mm in treated eyes compared with 0.34 mm in fellow eyes (P < 0.01). The enlarged area of RPE atrophy was inversely correlated with central choroidal thickness after 12 months (rs = -0.49, P < 0.01) and positively correlated with the number of injections (rs = 0.58, P < 0.01). Treat-and-extend intravitreal therapy with aflibercept may be effective for improvement and stabilization of visual acuity and exudative change in eyes with RAP. However, choroidal thinning during the treatment regimen may accelerate enlargement of RPE atrophy.

Retreatment of polypoidal choroidal vasculopathy after photodynamic therapy combined with intravitreal ranibizumab.

To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV). We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present. During the follow-up period (mean 44±13months, median 48months), 46 eyes (75.4%) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59% at the 12-month visit, 41% at the 24month, 31% at the 36month, and 20% at the 60-month visit. The median retreatment-free period was 15.0 [95% confidence interval (CI) 7.4-22.7] months, and the mean period was 24.9 (95% CI 19.3-30.6) months. Cox regression analysis revealed that older age (P=0.010, hazard ratio 1.06, CI 1.02-1.11) and male gender (P=0.043, hazard ratio 2.41, CI 1.03-5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits. About 80% of eyes with PCV require retreatment within 5years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.

Changes in Choroidal Structures in Eyes with Chronic Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy.

PurposeTo determine the structural changes in the choroid after half-dose photodynamic therapy (hPDT) in eyes with chronic central serous chorioretinopathy (CSC).MethodsThis was a retrospective interventional study of 29 eyes of 29 patients who underwent hPDT for chronic CSC with serous retinal detachment (SRD) and were followed for ≥3 months. Enhanced depth imaging optical coherence tomographic (EDI-OCT) images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), the cross sectional subfoveal choroidal area, the hyporeflective and hyperreflective areas of the inner, outer, and whole choroid were determined at the baseline, and at 1, 3, and 12 months after the hPDT.ResultsThe SRDs were resolved in 26 (89.7%) eyes at 3 months after the hPDT. The mean CCT (P = 0.001), the total choroidal area (P = 0.001), and the hypo-reflective area (P = 0.003) of the whole choroid were significantly decreased from the baseline at 3 months. The hyperreflective area of whole choroid was not significantly changed during the study period (P = 0.083). The hyperreflective but not the hyporeflective area of the inner choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively). The hyporeflective but not the hyperreflective area of the outer choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively).ConclusionsThe hyperreflective area of the inner choroid and hyporeflective area of the outer choroid were significantly decreased after hPDT for chronic CSC. Because the hyperreflective and hyporeflective area correspond to the choroidal stroma and vessels, respectively, the decreased CCT and subfoveal choroidal area after hPDT may be attributed to a decrease in the exudative changes in the inner choroidal stroma and the reduction of the dilation of the outer choroidal vessels.

Efficacy of vitrectomy and inner limiting membrane peeling in age-related macular degeneration resistant to anti-vascular endothelial growth factor therapy, with vitreomacular traction or epiretinal membrane.

We assessed the efficacy of vitrectomy and inner limiting membrane (ILM) peeling, followed by anti-vascular endothelial growth factor (VEGF) therapy, anti-VEGF-resistant age-related macular degeneration (AMD) due to vitreomacular traction (VMT) or epiretinal membrane (ERM). We identified six patients with anti-VEGF-resistant AMD due to VMT or ERM amongst a total of 588 patients with AMD (821 eyes) referred to Okayama University Hospital between February 2012 and May 2014. These patients underwent vitrectomy to release the VMT (4 cases) or remove the ERM (2 cases), along with ILM peeling. The regimen used for intravitreal injections of anti-VEGF reagents after surgery was based on the severity of exudative changes in each patient. Preoperative and postoperative best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements were compared. After vitrectomy and ILM peeling, all six patients responded to anti-VEGF therapy, which was then able to maintain dry retinas. Mean BCVA did not improve significantly (0.49 ± 0.28 before vs. 0.43 ± 0.38 after surgery, P = 0.538). However, mean CR was significantly decreased after surgery, from 423 ± 83.5μm to 257 ± 75.8μm (P = 0.0078). Vitrectomy and ILM peeling followed by anti-VEGF therapy may be a useful therapeutic option for anti-VEGF-resistant AMD with VMT or ERM.

Stellate nonhereditary idiopathic foveomacular retinoschisis concomitant to exudative maculopathies

PurposeTo report the clinical course of patients presenting with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) concomitant with exudative maculopathies.MethodsRetrospective case series. Multimodal imaging findings, including spectral-domain optical coherence tomography (SD-OCT) were reviewed. Genetic testing for the RS1 gene was performed in one patient.ResultsWe identified two female patients who fit the definition of SNIFR and presented with concomitant neovascular age-related macular degeneration (n-AMD). In both the patients, SD-OCT showed exudative macular features and splitting (bilateral in patient 1, unilateral in patient 2) of the outer plexiform layer (OPL) in the macula with no other evidence of hereditary or an acquired predisposing condition. Genetic testing excluded mutation of RS1 gene in patient 1. The fundi of both the patients showed characteristic signs of active choroidal neovascularization (CNV) and following anti-VEGF treatment, visual acuity improved and CNV-related exudative changes resolved. However, the split along the OPL remained unaltered.ConclusionsSNIFR may be associated with n-AMD. It is important to recognise the presence of retinoschisis when there is other exudative pathology as the former may be misinterpreted as intraretinal fluid, prompting unnecessary treatment.

Self‐recognition of recurrences among patients with exudative age‐related macular degeneration

PurposeThe aim was to investigate factors influencing a patient's self‐recognition of the recurrence of exudative changes secondary to age‐related macular degeneration (AMD).MethodsIn this retrospective study, we reviewed medical records for patients with exudative AMD who were diagnosed with a recurrence of exudation. Various parameters were compared, including age, sex, diagnosis, spectacle use, visual acuity before and after the recurrence and the extent of the decrease in visual acuity. In addition, visual acuity and unaided vision before the recurrence were compared in patients who did not use eyeglasses.ResultsForty‐eight eyes from 48 patients were included in the analysis. Twenty‐seven patients (56.3 per cent) identified a decrease in visual acuity. These patients had better visual acuity before the recurrence (p = 0.023) and reported a greater decrease in visual acuity (p = 0.005) than patients who did not identify a visual change. Patients who wore spectacles were also more likely to notice the change in their visual acuity (p = 0.027). Visual acuity was significantly better than uncorrected vision (p < 0.001).ConclusionsPatients who do not use eyeglasses or who have relatively poor vision tend not to promptly recognise visual deterioration caused by the recurrence of exudation. Prescribing eyeglasses may facilitate accurate self‐recognition of the recurrence of exudation in cases where vision can be improved with correction.

Pathology of Mycoplasma gallisepticum infection in naturally infected layer birds

Sixty five commercial layer farms with lesions suggestive of respiratory problem were investigated during the study period from May 2014 to April 2015 to evaluate the pathology of Mycoplasma gallisepticum infection in laying chicken. Mycoplasma gallisepticum was confirmed through PCR in 36 out of 65 farms. The positive farms were examined for gross and histopathological changes in tissues like trachea, lungs, air sacs and liver. The highest incidence of MG infection occurred during the winter season. Grossly, MG affected birds showed catarrhal inflammation of trachea and bronchi, slight pneumonic changes in lungs, cloudiness, air sacculitis and caseous exudate in thoracic air sacs, congestion and haemorrhages in lungs, caseous mass in both thoracic and abdominal air sacs. Histopathologically, focal destruction of superficial cells, goblet cell formation, hyperplasia of mucosal epithelium, submucosal infiltration of lymphocytes, macrophages along with haemorrhagic areas were observed in the trachea. Lungs revealed interstitial haemorrhages, parabronchiolar oedema, mucosal hyperplasia of secondary bronchiole and interstitial pneumonia characterized by thickening of interstitium. Air sacs showed epithelial destruction and increased thickening due to proliferation of submucosal connective tissue with congested blood vessels and neovascularization. This study proved that MG infection occurs severely among laying chicken causing more economic loss to the farmers.

Bilateral exudative retinal detachment in a case of paraganglioma

Bilateral exudative retinal detachment due to extra-adrenal pheochromocytomas in a pediatric age group has been rarely reported. We report a case of a 12-year-old female child with exudative retinal detachment and hypertensive retinopathy changes secondary to hypertensive emergency due to extra-adrenal pheochromocytoma. The patient presented with sudden painless diminution of vision in both eyes since 15 days. Fundus examination showed exudative retinal detachment with Grade 4 hypertensive retinochoroidopathy changes. Supine blood pressure of 190/140 mm of Hg was recorded. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a heterogeneously enhancing right para-aortic mass likely representing extra-adrenal pheochromocytoma. Hypertensive ocular damage represents target organ damage in humans with systemic arterial hypertension. Fundus examination is a rapid and low cost modality for detecting previously existing and new onset vascular damage. Prompt recognition and timely referral of such cases have prodigious implications for both ocular and general health of a person.

ONE-YEAR RESULTS OF INTRAVITREAL AFLIBERCEPT FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

To evaluate the 1-year results of intravitreal aflibercept injections for polypoidal choroidal vasculopathy based on indocyanine green angiography findings. Twenty-nine eyes with treatment-naive polypoidal choroidal vasculopathy treated with intravitreal aflibercept injections and followed longer than 1 year were retrospectively reviewed. The best-corrected visual acuity, optical coherence tomography findings, and polypoidal lesions in indocyanine green angiography were evaluated. The mean number of injections through 1 year was 3.9 ± 1.9 (range: 1-8). Fourteen eyes (48%) were received no additional injections because of no recurrence of exudative change after the first loading dose. The mean best-corrected visual acuity levels at 6 months and 1 year significantly improved, and the mean central retinal thickness significantly decreased at all observation points from the baseline. At 3 months, the polypoidal lesions completely resolved in 19 (66%) eyes. At 1 year, the complete resolution of polypoidal lesions was seen in 4 of 10 eyes with persistent polypoidal lesions at 3 months. However, polypoidal lesions recurred at 1 year in 5 of 19 eyes (26%) with complete resolution of polypoidal lesions at 3 months. Aflibercept is effective for the eyes with treatment-naive polypoidal choroidal vasculopathy to achieve the resolution of polypoidal lesions. The authors need to carefully observe the eyes after confirming complete resolution of polypoidal lesion because of recurrent polyps seen in one-quarter of the study eyes.

Specific influence of white clover on the rhizosphere microbial community in response to polycyclic aromatic hydrocarbon (PAH) contamination

Legumes respond to PAH-contamination in a systemic manner and influence the overall rhizosphere microbial community structure, but the effect on the functional microbial community is unknown. In this study, plant-mediated PAH effects on specific bacterial taxa and the PAH-degraders in the rhizosphere were examined. White clover was cultivated using a split-root system, with one side exposed to phenanthrene or pyrene, and the other side uncontaminated. Rhizosphere microbial diversity and activity were assessed with DGGE and qPCR, and changes in the root exudation were analyzed with GC-MS and HPLC. PAH contamination of one side of the rhizosphere significantly influenced the community structure of Alphaproteobacteria, Betaproteobacteria, Gammaproteobacteria, Acidobacteria, Actinobacteria, Bacteroidetes, Firmicutes and Verrucomicrobia in the uncontaminated side of the rhizosphere. This indirect PAH-effect also influenced the diversity of bacterial PAH dioxygenase genes present, though the expression levels of these genes was not affected. No significant difference in the root exudation of general metabolites (amino acids, organic acids, sugars and sugar alcohols) and a flavonoid was observed. In response to PAH-stress, white clover specifically influenced the diversity of the PAH-degrading community in its rhizosphere, but the abundance and activity of these PAH-degraders was not enhanced by the indirect PAH-effect. The plant-mediated response therefore does not appear to be directed towards enhanced removal of PAH for plant protection.