Exudative Changes Research Articles

Imaging drusens using Spectral Domain Optical Coherence Tomography

PurposeThe purpose was to evaluate pathological changes of photoreceptor layer and retinal pigment epithelium in eyes with drusens using Spectral Domain Optical Coherence Tomography (SD-OCT). MethodsTwenty-nine eyes of 29 patients with (drusens) dry age-related macular degeneration and 43 eyes of 43 controls were included in this study. All subjects underwent complete ophthalmic examination including SD-OCT. Central foveal thickness (CFT), photoreceptor layer (PRL) thickness and retinal pigment epithelial (RPE) thickness were measured and compared between the groups. P value<0.05 was considered statistically significant. ResultsBest corrected visual acuity (BCVA) ranged between 20/20 and 20/200. RPE (36.10±5.48μm Vs 39.27±4.30) and PRL thickness (53.93±7.36μm Vs 61.20±4.50μm) were significantly reduced in patients with drusens compared to controls. Increase in age was a significant risk factor for drusens (OR: 1.22, p<0.001) and increased PRL thickness was a protective factor (OR: 0.720, p=0.002). PRL thickness was significantly associated with BCVA (p=0.019). ConclusionWith an increased resolution of SD-OCT, the involvement of the outer retinal layers was more clearly defined. SD-OCT may allow for the early detection of exudative changes.

Combining the genetic algorithm and successive projection algorithm for the selection of feature wavelengths to evaluate exudative characteristics in frozen–thawed fish muscle

The potential use of feature wavelengths for predicting drip loss in grass carp fish, as affected by being frozen at −20°C for 24h and thawed at 4°C for 1, 2, 4, and 6days, was investigated. Hyperspectral images of frozen–thawed fish were obtained and their corresponding spectra were extracted. Least-squares support vector machine and multiple linear regression (MLR) models were established using five key wavelengths, selected by combining a genetic algorithm and successive projections algorithm, and this showed satisfactory performance in drip loss prediction. The MLR model with a determination coefficient of prediction (R2P) of 0.9258, and lower root mean square error estimated by a prediction (RMSEP) of 1.12%, was applied to transfer each pixel of the image and generate the distribution maps of exudation changes. The results confirmed that it is feasible to identify the feature wavelengths using variable selection methods and chemometric analysis for developing on-line multispectral imaging.

P08.05 Chlamydia trachomatisandtrichomonas vaginalisco-infection in the macaque model

Introduction We have used the pigtailed macaque model to individually study chlamydia (bacteria) and trichomonal (parasite) infections. To increase utility of the model, we explored infection potential for both chlamydia and trichomoniasis, when delivered simultaneously to macaques. This co-infection model will be useful for testing the efficacy of developing multi-purpose technologies. Methods Twelve female Macaca nemestrina were challenged by cervical inoculation with C. trachomatis E (CT: 5E6 IFU in 0.5 mL volume), immediately followed by vaginal exposure to T. vaginalis ATCC 50148 (TV: 5E5 trichomonads in 0.5 mL volume). For five weeks, infection status, chlamydia-specific serum antibody, and tissue responses were followed. Nucleic acid amplification tests were employed to detect each organism; cervical swabs were also cultured for chlamydia detection. Cervicovaginal tissues were monitored by colposcopy. Each animal completed a five day regimen of oral azithromycin plus metronidazole followed by test of clearance. Results Nine of twelve macaques tested positive for infection with both pathogens on at least three weekly visits. One animal was positive for chlamydial infection only (TV negative) for two weeks. These ten animals developed chlamydial IgG antibody titers of at least 1:16. The two remaining animals had limited, self-clearing infections; CT positive for one week, plus TV positive for one or two weeks. Neither of these macaques developed serum antibody to CT. During five weeks of secretion sampling, chlamydia positivity ranged from 1 to 5 weeks (median 5 weeks) and TV positivity ranged 0–5 weeks (median 5 weeks) as well. Colposcopy revealed blisters on the cervix of three co-infected animals. Neither infection could be correlated to changes in vaginal pH, exudate or polymorphonuclear cell presence. Conclusion We have demonstrated that co-infection with Chlamydia trachomatis and Trichomonas vaginalis is achievable in the pigtailed macaque model. Infections are individually detectable and concurrent treatments are effective in clearing both organisms. Disclosure of interest statement This research was supported by NIH Contract HHSN272201000006I, Task Number HHSN27200008 and by the Office of Research Infrastructure Programs (ORIP) of the National Institutes of Health through Grant Number P51 OD010425 Washington National Primate Research Centre. No pharmaceutical grants were received in the development of this study.

Factors Associated with Recurrence of Age-Related Macular Degeneration after Anti-Vascular Endothelial Growth Factor Treatment: A Retrospective Cohort Study

To investigate the predictive factors associated with recurrence after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD). Retrospective cohort study. A total of 343 eyes of 326 patients with subfoveal neovascular AMD who were treated with an as-needed regimen after 3 monthly loading doses of intravitreal ranibizumab. Patients were followed up by an as-needed regimen for more than 1 year after the first injection. Baseline data and CFH I62V and ARMS2 A69S polymorphisms were analyzed for their association with recurrence after anti-VEGF treatment. Regression analysis was used to identify independent predictors of visual acuity (VA) prognosis. The primary end point was the presence or absence of recurrence. The secondary end point was VA improvement. In total, 236 eyes (68.8%) showed complete resolution of retinal exudative change after the 3 loading injections, and 81 eyes (34.3%) experienced no recurrence during the first year. Of the 236 eyes, 139 (58.9%) were followed for more than 2 years and 35 (25.2%) showed no recurrent retinal exudation during 24 months. Visual acuity improvement was significantly better in eyes without recurrence than in eyes with recurrence during the 2-year period. Baseline characteristics and genotypes had no influence on response to ranibizumab loading treatment. Stepwise analysis revealed that age (P<0.001), subtype of AMD (P=0.041), and VA at baseline (P<0.001) were associated with VA at 24 months. Older patients (P=0.006) and male patients (P=0.018) tended to require re-treatment for recurrence during the first year, yet the statistical significance disappeared when evaluated in 2 years. The subtypes of neovascular AMD were solely associated with the interval to the recurrence, which was shorter in eyes with polypoidal choroidal vasculopathy (PCV) than in eyes with typical AMD (P=0.015). Older age and male sex may predict recurrence after 3 monthly ranibizumab injections, and PCV may be associated with shorter interval to recurrence. Predicting the risk of recurrence would help us to choose the most appropriate follow-up treatment strategy for patients with AMD.

RELATIONSHIP BETWEEN VISUAL PROGNOSIS AND DELAY OF INTRAVITREAL INJECTION OF RANIBIZUMAB WHEN TREATING AGE-RELATED MACULAR DEGENERATION.

In age-related macular degeneration, various factors in clinical practice cause delays to arise between the time exudative change is observed and the time anti-vascular endothelial growth factor drugs are actually injected. We investigated the influence of injection delay on prognosis. Subjects were 50 eyes (50 patients from 2 hospitals) that were administered ranibizumab monotherapy for age-related macular degeneration for 1 year since exudative change was first observed. We investigated the mean number of delay days for each injection. Mean injection delay was between 0 and 104 days. Significant prognostic factors for visual acuity were initial best-corrected visual acuity (P < 0.01) and mean injection delay (P = 0.03). We estimated that for an initial best-corrected visual acuity of 0.40 logMAR unit (20/50 Snellen equivalent), the respective best-corrected visual acuity values after 1 year for mean injection delays of 0, 7, 14, 28, and 56 days would be 0.22 (20/33), 0.24 (20/35), 0.26 (20/37), 0.31 (20/40), and 0.39 (20/49). For an initial best-corrected visual acuity of 0.097 (20/25), the respective values would be 0.054 (20/23), 0.075 (20/24), 0.10 (20/25), 0.14 (20/28), and 0.22 (20/33). Long-term visual acuity prognosis worsened when scheduling problems delayed intravitreal injection of anti-vascular endothelial growth factor drugs.

Influence of macular oedema on the measurement of macular pigment optical density.

The purpose of this study was to determine macular pigment optical density (MPOD) in patients with macular degeneration as well as in patients with non-proliferative diabetic retinopathy. Fifty-one phakic patients with either age-related macular degeneration (60 eyes of 30 patients; average age, 70.9 years) or non-proliferative diabetic retinopathy (42 eyes of 21 patients; average age, 61.7 years) were included in this cross-sectional study. Within the groups, patients were divided into those suffering from macular oedema and those with no oedema. An intra-subject comparison between eyes was carried out in both groups. Data were investigated on the basis of the coefficient of determination (R (2)). Macular pigment optical density was measured by fundus reflectometry using the one-wavelength reflection method (Visucam 500; Carl Zeiss Meditec AG, Jena, Germany), in conformity with the method described by Schweitzer et al. (2010). We evaluated the maximum optical density in the measurement area (max OD) and the average optical density across the reference area in the measurement area (mean OD). Specifically, the influence of macular oedema on macular pigment optical density was examined. The subsequent measurement of retinal thickness was carried out by spectral-domain optical coherence tomography (Spectralis SD-OCT, Heidelberg Engineering GmbH, Heidelberg, Germany). The current study included two groups. The first group consisted of patients with non-proliferative diabetic retinopathy, as follows: no macular oedema on either side (max OD: R (2) = 43.2 %, p = 0.16; mean OD: R (2) = 68.7 %, p = 0.04); one-sided macular oedema (max OD: R(2) = 16 %, p = 0.60; mean OD: R(2) = 100 %, p = 0.04); or macular oedema in both eyes (max OD: R(2) = 79.7 %, p < 0.01; mean OD: R(2) = 81.4 %, p < 0.01). The second group comprised patients with age-related macular degeneration (AMD), as follows: non-exudative changes on both sides (max OD: R(2) = 64.0 %, p = 0.20; mean OD: R (2) = 16 %, p = 0.60); one-sided exudative macular changes (max OD: R (2) = 50.6 %, p < 0.01; mean OD: R (2) = 20.8 %, p = 0.04); or exudative macular degeneration on both sides (max OD: 3 R (2) = 6.0 %, p = 0.29; mean OD: R (2)= 81.0 %, p = 0.04). The data available presented a correlation of MPOD values of both eyes of an individual within the groups investigated. In this respect, the data of the partner eyes within the group of patients with diabetic retinopathy were more highly correlated with each other than the values of both eyes of patients suffering from age-related macular degeneration. The present study showed that macular oedema did not seem to have an influence on a valid measurement of MPOD by one-wavelength fundus reflectometry. Thus, meaningful data could also be obtained on patients with exudative retinal changes.

Impact of plant domestication on rhizosphere microbiome assembly and functions.

The rhizosphere microbiome is pivotal for plant health and growth, providing defence against pests and diseases, facilitating nutrient acquisition and helping plants to withstand abiotic stresses. Plants can actively recruit members of the soil microbial community for positive feedbacks, but the underlying mechanisms and plant traits that drive microbiome assembly and functions are largely unknown. Domestication of plant species has substantially contributed to human civilization, but also caused a strong decrease in the genetic diversity of modern crop cultivars that may have affected the ability of plants to establish beneficial associations with rhizosphere microbes. Here, we review how plants shape the rhizosphere microbiome and how domestication may have impacted rhizosphere microbiome assembly and functions via habitat expansion and via changes in crop management practices, root exudation, root architecture, and plant litter quality. We also propose a “back to the roots” framework that comprises the exploration of the microbiome of indigenous plants and their native habitats for the identification of plant and microbial traits with the ultimate goal to reinstate beneficial associations that may have been undermined during plant domestication.

Six-month results of intravitreal aflibercept injections for patients with polypoidal choroidal vasculopathy

BackgroundThis study aims to evaluate the therapeutic effect of intravitreal aflibercept injection for polypoidal choroidal vasculopathy (PCV).MethodsEighteen eyes of 17 consecutive patients with PCV received three consecutive monthly intravitreal injections...

Submacular Hemorrhage in Polypoidal Choroidal Vasculopathy Treated by Vitrectomy and Subretinal Tissue Plasminogen Activator

To evaluate vitrectomy with subretinal tissue plasminogen activator (t-PA) injection, and air tamponade, followed by intravitreal anti-vascular endothelial growth factor (VEGF) therapy for submacular hemorrhage in polypoidal choroidal vasculopathy (PCV). Prospective, interventional case series. setting: Two clinics. Fifteen eyes of 15 consecutive patients (mean age 72 ± 7 years) with submacular hemorrhage attributable to PCV. PCV diagnosis with unorganized submacular hemorrhage greater than 500μm thick. Submacular hemorrhage attributable to macular diseases (eg, high myopia, typical age-related macular degeneration, retinal angiomatous proliferation, and angioid streaks). Vitrectomy with 4000 IU t-PA injected subretinally and fluid/air exchange. Patients remained facedown for 3days after surgery. Anti-VEGF drugs were administered as exudative changes required. Submacular hemorrhage displacement from the macula and changes in best-corrected visual acuities (BCVAs). Mean time from onset to surgery was 9.5 ± 4.5 (range, 5-21) days. Mean follow-up period was 9.4± 3.1 (range, 6-17) months. Surgery successfully displaced submacular hemorrhages from the macula in all eyes. Mean BCVA at baseline (0.98 ± 0.44) had improved significantly both 1month after surgery (0.41± 0.25, P < .01) and at final visits (0.23 ± 0.25, P < .001). In all eyes, exudative retinal changes relapsed after surgery but were completely resolved by anti-VEGF injections. No complications occurred in any patients. Treating submacular hemorrhage with vitrectomy and subretinal t-PA injection, followed by intravitreal anti-VEGF therapy, is a promising strategy for improving visual acuity in PCV patients warranting further investigation.

Effect of switching therapy to pegaptanib in eyes with the persistent cases of exudative age-related macular degeneration.

Purpose of this study was to evaluate the efficacy of switching to pegaptanib monotherapy for persistent cases of exudative age-related macular degeneration (AMD).Out of 296 eyes of 296 patients treated with ranibizumab or ranibizumab combined with photodynamic therapy (PDT), 50 eyes of 50 AMD patients were found to be resistant to these treatments. Over a 12-month period, intravitreal pegaptanib (IVP) 0.3 mg was administered at intervals of 6 weeks until the exudation disappeared prospectively. All patients were examined with the following tests: best-corrected visual acuity (BCVA) and central retinal thickness (CRT), determined at the initial visit, before the first IVP (baseline), and at 12 months. The factors responsible for achieving dry macula with IVP were examined statistically.The rate of persistent cases with intravitreal ranibizumab (IVR) and/or PDT was 17.0%. The mean number of IVPs administered was 5.4 (range, 2–9). Logarithm of the minimal angle of resolution BCVA at 12 months was stable or improved by ≥0.3 in 49 eyes (98.0%), with a significant improvement noted between the baseline and final BCVA (P = 0.01, paired t test). The CRT (mean ± standard deviation) was 446.9 ± 150.6 µm at the initial visit, 414.5 ± 146.5 µm at baseline, and 318.7 ± 99.0 µm at 12 months. There was a significant decrease in the mean CRT between the measurements at baseline and at 12 months after the first IVP (P = 0.002, Bonferroni correction). At 12 months, the exudative change was completely resolved in 27 eyes (54.0%) and reduced in 21 eyes (42.0%). The number of previous IVR treatments was significantly correlated with dry macula at 12 months.After switching therapy to pegaptanib in persistent cases of AMD, most patients maintained or improved their BCVA and exhibited a positive treatment response at 12 months.

Intravitreal bevacizumab for retinal capillary hemangioblastoma: A case series and literature review

ObjectiveTo evaluate the long-term outcomes of intravitreal bevacizumab for peripheral and juxtapapillary retinal capillary hemangioblastoma (RCH). DesignWe conducted a retrospective noncomparative interventional case series. ParticipantsThere were 4 patients (5 eyes) presenting with RCH. MethodsFive eyes with RCH presented with exudative changes and visual loss. Three eyes of 2 patients with peripheral RCH were treated with cryotherapy and 2 intravitreal injections of bevacizumab (0.5 mg). Two eyes with juxtapapillary RCH were treated with 3 intravitreal injections of bevacizumab. The main outcome measures were changes in best-corrected visual acuity (BCVA), lesion size, exudation, and retinal thickness. ResultsIn peripheral RCH, improvement of BCVA from counting fingers to 20/400 was obtained in 1 eye. One patient with bilateral RCH maintained a vision of 20/20 in 1 eye with complete anatomic regression of the 3 small peripheral RCH lesions. The fellow eye with fibrotic bands from the RCH to the optic nerve head developed a tractional retinal detachment after the first injection and was treated with pars plana vitrectomy. In patients with juxtapapillary RCH, bevacizumab injections resulted in an improvement of BCVA from 20/80 to 20/20 in 1 eye, whereas the second eye did not show an improvement of BCVA despite a regression of the tumour. ConclusionsIntravitreal anti–vascular endothelial growth factor agents, alone or in combination with other treatment modalities, may improve visual acuity. Further trials evaluating the dose, the number of injections, and the route of administration will be important in advancing antiangiogenic therapies for RCH.

Study of Subretinal Exudation and Consequent Changes in Acute Central Serous Chorioretinopathy by Optical Coherence Tomography

To investigate the characteristics of subretinal exudation and consequent morphologic changes in acute central serous chorioretinopathy (CSC) using spectral-domain optical coherence tomography (OCT). Prospective, observational, cross-sectional case series. Patients with CSC with symptom duration of fewer than 3 months underwent visual acuity measurement, fundus observation and spectral-domain OCT examinations and then were evaluated for subretinal exudation and other changes. A total of 123 patients (123 eyes) were included, all showing various retinal pigment epithelium (RPE) abnormalities on OCT. OCT also showed subretinal exudation (65 eyes, 52.8%); retinal dipping (14 eyes, 11.4%); and photoreceptor layer defects (88 eyes, 71.5%). Without exception, the locations of these pathologic changes were closely related to the abnormal sites in the RPE. Those with subretinal exudation showed shorter durations of symptoms, whereas those with photoreceptor layer defects showed longer durations. In most eyes with retinal dipping, exudation connected it to RPE abnormalities. The defects of the photoreceptor layer, which involved the photoreceptor outer segment in 68 eyes, the photoreceptor inner segment in 20 eyes, and the outer nuclear layer as well, were likely to be the consequence of retinal dipping. OCT findings suggested that in eyes with acute CSC subretinal exudation, which indicated fibrin leakage through the RPE defects, might cause retinal dipping, thus leading to photoreceptor layer defects, and that spectral-domain OCT could provide a better understanding of the pathologic changes in acute CSC.

Combined treatment for Coats’ disease: retinal laser photocoagulation combined with intravitreal bevacizumab injection was effective in two cases

BackgroundThe exact pathogenetic mechanisms of Coats’ disease remain unknown. In this report, we show two cases of Coats’ disease that achieved a favorable prognosis with the combined treatment of intravitreal bevacizumab (IVB) injection prior to photocoagulation, although both initially resisted photocoagulation therapy.Case presentationsCase 1 was a 15-year-old boy with initial visual acuity of 0.4 OD. At the temporal retina, aneurysms and abnormal telangiectatic vessels were observed. Hard exudates and an exudative retinal detachment extended to the fovea. He was diagnosed as having Coats’ disease at stage 3A and we performed laser photocoagulation as an initial approach to treat peripheral aneurysms and telangiectatic vessels. After the treatment, the exudative retinal detachment was eased and visual acuity improved to 1.0; however, recurrence occurred after 5 months. The exudative change was resistant against laser photocoagulation therapy and we therefore added IVB as an adjuvant before photocoagulation. Fourteen days after IVB injection phased laser photocoagulation was given to cover the abnormal capillaries, aneurysms and the leakage area spotted in FA. A good prognosis was obtained with decreased exudation and improved visual acuity.Case 2 was an 11-year-old boy with decreased visual acuity of 0.15 OS at the initial visit. Hard exudates, retinal edema and serous retinal detachment were seen at the macula and peripheral retina. Fluorescein angiography revealed telangiectatic capillaries at the temporal retina. Our diagnosis was Coats’ disease at stage 3A. Extensive photocoagulation was performed as an initial treatment to the lesion. However, the exudative change was severe and resistant against the photocoagulation treatment. Therefore, we added IVB as an adjuvant before photocoagulation. Exudative change in the retina seemed to be eased 7 days after IVB injection, therefore, phased laser phototherapy was added to cover the abnormal capillaries. After the combination therapy, exudative change was remarkably ameliorated and better visual acuity was achieved.ConclusionBevacizumab is considered an effective adjuvant for Coats’ disease with exudative change resistant to retinal photocoagulation therapy.

E08. Highlights in benign and pre-invasive breast disease

E08. Highlights in benign and pre-invasive breast disease

Improved Adherence to Vision Self-monitoring with the Vision and Memory Stimulating (VMS) Journal for Non-neovascular Age-related Macular Degeneration during a Randomized Controlled Trial.

ObjectiveAn educational, interactive journal [Vision and Memory Stimulating (VMS) journal] was developed to boost patient confidence and promote long-term adherence with weekly vision self-monitoring in age-related macular degeneration (AMD) patients at risk for vision loss from new-onset neovascularization.MethodsIn a multicenter randomized controlled trial, 198 subjects with intermediate stage, non-neovascular AMD received the VMS journal or followed usual care (e.g. their doctor’s instructions for vision monitoring; Amsler grid). At 6 and/or 12 months post-enrollment, 157 subjects completed a questionnaire on vision self-monitoring.ResultsAt 6 and 12 months, respectively, 85% and 80% of the VMS journal subjects reported vision monitoring at least weekly, which represent statistically significant 7.1 and 4.2 times greater odds than the 50% of controls who monitored weekly at both follow-up times (p<0.001). At 6 and 12 months, respectively, 29% and 25% of controls indicated that they had not checked their vision in the past 6 months, while only 1.5% and 5% of the VMS journal subjects reported no vision self-monitoring. At 6 and 12 months, respectively, only 15% and 13% of the VMS journal subjects vs. 53% and 44% of the controls reported that they did not feel confident that they were taking care of their sight by self-monitoring (p<0.001). Usual care controls had statistically significant 6.7 and 5.0 times greater odds of reporting non-confidence at 6 and 12 months, respectively. There was no statistically significant change in weekly vs. less frequent self-monitoring between the groups (p=0.68), with 81% of all subjects reporting no change in frequency between 6 and 12 months.ConclusionsThese findings support the efficacy of the VMS journal for increasing vision self-monitoring adherence and confidence, in addition to promoting persistence in weekly monitoring over the course of a year in AMD subjects at risk for exudative retinal changes.

Morphological changes in the liver in patients with pulmonary tuberculosis and HIV infection on a background of chronic hepatitis "C"

The purpose of the study. The establishment of the features of the course and morphological manifestations of tissue responses in liver in chronic hepatitis "C" in patients with disseminated pulmonary tuberculosis on a background of HIV infection. Materials and methods. The results of the pathomorphological studies carried out on autopsy material of 11 observations of patients with diagnoses of TB associated with HIV and hepatitis "C" are reported. The comparison group was consisted of 3 patients with HIV and hepatitis "C" and one patient with generalized hematogenous tuberculosis and chronic hepatitis "C". The results of the study. Changes in the liver in the combination of TB with HIV and hepatitis "C" have a different intensity, depending on the stages of combined pathology. At the early stages of HIV infection (2B), in presence of localized tuberculosis, there is possible rapid progression of hepatitis "C" into cirrhosis of liver, which becomes the main cause of death. For the later stages of HIV infection ( 4B-5 ) there is typical the development of generalized forms of tuberculosis with the appearance of confluent caseous necrotic lesions in all organs and tissues. In these cases in the structure of the liver there are determined severe circulatory disorders, pronounced dystrophic and necrotic changes in the parenchyma, inflammatory responses caused both generalized tuberculosis and hepatitis "C". In generalization of disseminated lungs tuberculosis in the liver, monocytoid response and lymphopenia are established to take place, and at the late stage (4B - 5) stage of HIV infection there is noted aplasia of elements of lymphoid series and diffuse plazmatization. The correlation between the severity of the process and the intensity of exudative changes was revealed. Conclusion: The liver disorders in patients with HIV infection, tuberculosis and hepatitis "C" may determinative in the outcome of the disease and should be considered when choosing a scheme of etiotropic and pathogenetic treatment and the staging of therapy.

Exogenous nutrient manipulations alter endogenous extractability of carbohydrates in decomposing foliar litters under a typical mixed forest of subtropics

Litter decomposition is a major driver of nutrient availability and carbon (C) cycling in forest ecosystems, and may be susceptible to perturbation by exogenous nutrient inputs from anthropogenic activity. The role of resource limitation in this process is unclear, although some models suggest the macronutrients nitrogen (N) and phosphorus (P) stimulate early-stage decomposition while availability of labile C restricts later-stage decomposition. We studied this interplay in a subtropical mixed forest in southern China through in situ incubations of litter samples over a 540-day period. Litter samples were amended with labile C (+C, as sucrose), N (+N, as NH4NO3), P (+P, as NaH2PO4), all three inputs (+CNP), or no inputs (CK). Litter mass and nutrient content were measured at 90-day intervals, while extractable carbohydrate profiles of the litter samples were assayed at 90, 270, and 450days of incubation. The +P and +CNP treatments showed greater reductions in litter mass, as well as a larger P pool throughout the incubation. The +N treatment had a larger N pool, but otherwise did not differ from the no input control CK. The concentration of accessible carbohydrate fractions remained constant or increased from 90 to 450days of incubation, while less accessible fractions thought to be lignocellulose and hemi-cellulose decreased during that period. Total extractable carbohydrates decreased in the +P treatment, but was not significantly different among other treatments. Our results suggest that mixed forest systems in southern China are likely to be minimally perturbed in the short term by exogenous N addition, and that decomposition activity is not regulated by labile C availability over the time period studied. Moreover, increased C inputs due to climate change-induced changes in litter deposition and root exudation will likely have a smaller impact on subtropical forest management than anthropogenic disturbances such as P fertilization.

Clinical efficacy of new aloe vera‐ and myrrh‐based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double‐blind, vehicle‐controlled study

To evaluate the clinical efficacy, and safety of newly customized natural oral mucoadhesive gels, containing either aloe vera or myrrh as active ingredients, in the management of minor recurrent aphthous stomatitis (MiRAS). Ninety subjects with MiRAS were recruited from Oral Medicine Clinic, at Faculty of Dentistry, King Abdulaziz University, Saudi Arabia, for this randomized, double-blind, placebo-controlled study. Two new natural gels, containing aloe vera and myrrh, were prepared in a concentration of (0.5% w/w), in addition to a plain mucoadhesive gel used as a placebo. Patients with fresh ulcers (<48-h duration) were instructed to apply either one of the three gels four times a day for a period of 5 days. Clinical efficacy was investigated in the form of changes in ulcer size, pain intensity, erythema, and exudation at days 4 and 6 of study entry. Participants were interviewed for the emergence of any side effects. 76.6% of patients using aloe gel showed complete ulcer healing, 86.7%, and 80% of them revealed subsidence of erythema and exudation, respectively, especially at day 6 visit, whereas 76.7% of myrrh-treated patients revealed almost absence of pain at day 6. No side effects were encountered with the use of any of the three gels. The new formulated aloe- and myrrh-based gels proved to be effective in topical management of MiRAS. Aloe was superior in decreasing ulcer size, erythema, and exudation; whereas myrrh resulted in more pain reduction.

EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR AND INTRAVITREAL ANTI-VEGF THERAPY WITH BEVACIZUMAB IN VASOPROLIFERATIVE RETINAL TUMORS

To examine whether vasoproliferative retinal tumors (VPRTs) express vascular endothelial growth factor and respond to intravitreal bevacizumab injection. Retrospective interventional case series. Intravitreal bevacizumab 1.25 mg was administered to 9 patients with VPRT-associated neovascularization or exudative retinal changes. The changes of the tumor size, best-corrected visual acuity, and central retinal thickness were evaluated before and after treatment. Immunohistochemistry with anti-vascular endothelial growth factor antibody in an excised tissue of VPRT during pars plana vitrectomy was performed. In two patients with small tumors (within two disk diameters), the tumors disappeared or regressed with only one injection of intravitreal bevacizumab injection. Larger tumors regressed after additional laser photocoagulation and/or cryotherapy without recurrence of exudative retinal changes in six eyes, although these did not regress by intravitreal bevacizumab injection alone. The mean logarithm of the minimal angle of resolution value of best-corrected visual acuity and central retinal thickness at the final visit were significantly improved compared with those of pretreatment (P = 0.02 and P = 0.03, respectively). Immunoreactivity for vascular endothelial growth factor was strongly detected in the resected tumor tissue. These results suggest that vascular endothelial growth factor derived from VPRTs causes retinal neovascularization or exudative retinal changes associated with VPRTs. Intravitreal bevacizumab may be a useful therapeutic option for these complications secondary to VPRTs.

‘Proactive’ versus ‘reactive’ anti-VEGF therapies for neovascular age-related macular degeneration: pros and cons

. While the former gradually impairs the central vision, the latter causes rapid and severe vision loss. Anti-VEGF drugs, involving ranibizumab (Lucentis), bevaci -zumab (Avastin) and aflibercept (Eylea), improve visual outcomes in patients with neovascular AMD. However, exudative changes often recur and sometimes resist anti-VEGF therapies. Monthly injections are most promising to improve and sustain visual acuity