Spontaneous retinal pigment epithelial tear in type 2 choroidal neovascularization: Repair mechanisms following anti-VEGF therapy

BACKGROUND: To report the clinical course and the multimodal retinal imaging of a spontaneous retinal pigment epithelial (RPE) tear in a type 2 choroidal neovascularization (CNV) secondary to age-related macular degeneration treated with anti-vascular endothelial growth factor (VEGF) treatment. CASE PRESENTATION: A 74 year-old man presented with visual acuity deterioration in the right eye. Multimodal retinal imaging showed a predominantly classic (type 2) CNV complicated by a spontaneous RPE tear. The patient received six intravitreal injections of anti-VEGF which resulted in improvement of the vision and stabilization of the neovascular lesion on optical coherence tomography (OCT). Longitudinal changes of the RPE-photoreceptors interface, including RPE splitting, are reported on OCT. CONCLUSION: RPE tears may spontaneously occur in type 2 CNV. Anti-VEGF treatment should be aimed at promoting RPE repair and limiting the extent of the scarring. The mechanisms of RPE repair during treatment may be documented with OCT

Objective structured practical examination (OSPE) as a tool in formative assessment of II MBBS students, in pathology

Background: Assessment drives the student learning. Regular periodical assessment not only improves learning habits, but also enhances the competence in all levels of medical education. Traditional practical examination is more subjective. It depends on examiners subjectivity, varying difficulty level of various experiments, and also internal marks variation etc. These flaws can be overcome by newer methods like OSPE. The aim of the study was to implement OSPE as a tool of internal assessment for practical skills in the II MBBS. To compare this with traditional practical examination (TPE). To obtain the students and faculty feedback regarding OSPE as a tool of assessment.Methods: A cross sectional study was carried out for 158 students in II internal pathology practical examination for six days in the second week of September 2016 at Department of Pathology, Dr. Pinnamaneni Siddhartha institute of medical sciences & Research Foundation, Chinnaoutpalli. Faculty and students were sensitized; blueprint were used to arrange twenty OSPE stations for the exercises conducted as per TPE and for the same 25 marks as per TPE. Simultaneously, all the students were subjected to both TPE and OSPE at the same time and venue. TPE was assessed by two professors and OSPE by separate eight faculty members independently without interaction with the students. The procedural stations were evaluated by using checklist and the response stations which consisted of short answers and MCQs, facilitated correction. Feedback was given to the student on their performance and feedback was obtained from the students and faculty regarding OSPE by questionnaire with Yes/No answers.Results: Performance score of students in OPSE (13.73 ±2.49) was higher as compared to TPE (9.27±1.86) which was statistically significant. Based on the response to the questionnaire, students perception towards OSPE was analyzed. Majority strongly agree OSPE to be fairer, more transparent and objective in comparison to TPE. In contrast, all the faculty members unanimously opined that OSPE was difficult to arrange, time taken and faculty versus students ratio was high for evaluation. Though, the faculty (91%) overall opined that OSPE should be included as a method of assessment.Conclusions: Present study revealed that OSPE was acceptable, feasible and reliable to the students as well as for faculty for the internal assessment in pathology. Opinions of both students and faculties strongly agreed that OPSE is more effective objective assessment tool

Biochemical basis of resistance in rice against Asian rice gall midge, Orseolia oryzae (Wood-Mason) (Diptera : Cecidomyiidae)

ABSTRACT A total of 1482 genotypes at Zonal Agricultural Research Station, V. C. Farm, Mandya and 416 genotypes at Agricultural Research Station, Kankanady, Mangalore under AICRP (Rice) were evaluated both in field and greenhouse conditions during Kharif 2006 and 2007. The estimation of biochemical constituents in rice shoot epics (30 day old plants) of selected resistant and susceptible genotypes was done to establish the relationship between various biochemical contents and to compare it with resistance and susceptibility. The studies revealed that the higher level of total phenols and total free amino acids was observed in majority of the resistant genotypes compared to susceptible entries. The amount of total sugars, reducing sugar and crude proteins in all susceptible genotypes was found higher compared to resistant genotypes. However, the amount of total sugars, reducing sugars, crude proteins and amino acids were not related to resistance

Retrieval effectiveness of written and spoken queries : an experimental evaluation

With the fast growing speech technologies, the world is emerging to a new speech era. Speech recognition has now become a practical technology for real world applications. While some work has been done to facilitate retrieving information in speech format using textual queries, the characteristics of speech as a way to express an information need has not been extensively studied. If one compares written versus spoken queries, it is intuitive to think that users would issue longer spoken queries than written ones, due to the ease of speech. Is this in fact the case in reality? Also, if this is the case, would longer spoken queries be more effective in helping retrieving relevant document than written ones? This paper presents some new findings derived from an experimental study to test these intuitions

Clinical endpoints for the study of geographic atrophy secondary to age-related macular degeneration

Purpose: To summarize the recent literature describing the application of modern technologies in the study of patients with geographic atrophy (GA) secondary to age-related macular degeneration. Methods: Review of the literature describing the terms and definitions used to describe GA, imaging modalities used to capture and measure GA, and the tests of visual function and functional deficits that occur in patients with GA. Results: In this paper, we describe the evolution of the definitions used to describe GA. We compare imaging modalities used in the characterization of GA, report on the sensitivity and specificity of the techniques where data exist, and describe the correlations between these various modes of capturing the presence of GA. We review the functional tests that have been used in patients with GA, and critically examine their ability to detect and quantify visual deficits. Conclusion: Ophthalmologists and retina specialists now have a wide range of assessments available for the functional and anatomic characterization of GA in patients with age-related macular degeneration. To date, studies have been limited by their unimodal approach, and we recommend that future studies of GA use multimodal imaging. We also suggest strategies for the optimal functional testing of patients with GA

Is Alzheimer\u2019s Disease at Least Partly a Ciliopathy?

The uninterrupted generation throughout life of the dentate gyrus [DGY] granule cells [GCs] (one site of adult neurogenesis), which initiate the encoding of novel memories, is driven by signals from the DGy GC precursors tiny, non-motile primary cilia. The hypothesis is surmised that the damage of such primary cilia be responsible of the crippling decline of memory formation in Alzheimer's Disease [AD]. Were human DGy CGs ciliated like their rodent counterparts, part of the AD cases might be indeed based upon a ciliopathy

Topographical Response of Retinal Neovascularization to Aflibercept or Panretinal Photocoagulation in Proliferative Diabetic Retinopathy Post Hoc Analysis of the CLARITY Randomized Clinical Trial

Importance Eyes with proliferative diabetic retinopathy have a variable response to treatment with panretinal photocoagulation (PRP) or anti–vascular endothelial growth factor agents. The location of neovascularization (NV) is associated with outcomes (eg, patients with disc NV [NVD] have poorer visual prognosis than those with NV elsewhere [NVE]). Objective To investigate the distribution of NV in patients with proliferative diabetic retinopathy and the topographical response of NV to treatment with aflibercept or PRP. Design, Setting, and Participants This post hoc analysis of the phase 2b randomized clinical single-masked multicenter noninferiority Clinical Efficacy and Mechanistic Evaluation of Aflibercept for Proliferative Diabetic Retinopathy (CLARITY) trial was conducted from November 1, 2019, to September 1, 2020, among 120 treatment-naive patients with proliferative diabetic retinopathy to evaluate the topography of NVD and NVE in 4 quadrants of the retina on color fundus photography at baseline and at 12 and 52 weeks after treatment. Exposures In the CLARITY trial, patients were randomized to receive intravitreal aflibercept (2 mg/0.05 mL at baseline, 4 weeks, and 8 weeks, and as needed from 12 weeks onward) or PRP (completed in initial fractionated sessions and then on an as-needed basis when reviewed every 8 weeks). Main Outcomes and Measures Main outcomes were per-retinal quadrant frequencies of NV at baseline and frequencies of patterns of regression, recurrence, and new occurrence at 12-week and 52-week unmasked follow-up. Results The study included 120 treatment-naive patients (75 men; mean [SD] age, 54.8 [14.6] years) with proliferative diabetic retinopathy (there was a 1:1 ratio of eyes to patients). At baseline, NVD with or without NVE was observed in 42 eyes (35.0%), and NVE only was found in 78 eyes (65.0%); NVE had a predilection for the nasal quadrant (64 [53.3%]). Rates of regression with treatment were higher among eyes with NVE (89 of 102 [87.3%]) compared with eyes with NVD (23 of 43 [53.5%]) by 52 weeks, with NVD being more resistant to either treatment with higher rates of persistence than NVE (20 of 39 [51.3%] vs 29 of 100 [29.0%]). Considering NVE, the regression rate in the temporal quadrant was lowest (32 of 42 [76.2%]). Eyes treated with aflibercept showed higher rates of regression of NVE compared with those treated with PRP (50 of 52 [96.2%] vs 39 of 50 [78.0%]; difference, 18.2% [95% CI, 5.5%-30.8%]; P = .01), but no difference was found for NVD (11 of 17 [64.7%] vs 12 of 26 [46.2%]; difference, 18.6% [95% CI, −11.2% to 48.3%]; P = .23). Conclusions and Relevance This post hoc analysis found that NVD is less frequent but is associated with more resistance to currently available treatments than NVE. Aflibercept was superior to PRP for treating NVE, but neither treatment was particularly effective against NVD by 52 weeks. Future treatments are needed to better target NVD, which has poorer visual prognosis. Trial Registration isrctn.org Identifier: ISRCTN3220758

Explicit filtering to obtain grid-spacing-independent and discretization-order-independent large-eddy simulation of compressible single-phase flow

In large-eddy simulation (LES), it is often assumed that the filter width is equal to the grid spacing. Predictions from such LES are grid-spacing dependent since any subgrid-scale (SGS) model used in the LES equations is dependent on the resolved flow field which itself varies with grid spacing. Moreover, numerical errors affect the flow field, especially the smallest resolved scales. Thus, predictions using this approach are affected by both modelling and numerical choices. However, grid-spacing-independent LES predictions unaffected by numerical choices are necessary to validate LES models through comparison with a trusted template. First, such a template is created here through direct numerical simulation (DNS). Then, simulations are conducted using the conventional LES equations and also LES equations which are here reformulated so that the small-scale-producing nonlinear terms in these equations are explicitly filtered (EF) to remove scales smaller than a fixed filter width; this formulation is called EFLES. First, LES is conducted with four SGS models, then EFLES is performed with two of the SGS models used in LES; the results from all these simulations are compared to those from DNS and from the filtered DNS (FDNS). The conventional LES solution is both grid-spacing and spatial discretization-order dependent, thus showing that both of these numerical aspects affect the flow prediction. The solution from the EFLES equations is grid independent for a high-order spatial discretization on all meshes tested. However, low-order discretizations require a finer mesh to reach grid independence. With an eighth-order discretization, a filter-width to grid-spacing ratio of two is sufficient to reach grid independence, while a filter-width to grid-spacing ratio of four is needed to reach grid independence when a fourth- or a sixth-order discretization is employed. On a grid fine enough to be utilized in a DNS, the EFLES solution exhibits grid independence and does not converge to the DNS solution. The velocity-fluctuation spectra of EFLES follow those of FDNS independent of the grid spacing used, in concert with the original concept of LES. The reasons for the different predictions of conventional LES or EFLES according to the SGS model used, and the different characteristics of the EFLES predictions compared to those from conventional LES are analysed