HYPERREFLECTIVE FOCI NOT SEEN AS HYPERPIGMENTARY ABNORMALITIES ON COLOR FUNDUS PHOTOGRAPHS IN AGE-RELATED MACULAR DEGENERATION

PURPOSE

To investigate the prognostic value of quantifying optical coherence tomography (OCT)-defined hyperreflective foci (HRF) that do not correspond to hyperpigmentary abnormalities (HPAs) on color fundus photographs (CFPs)-HRF (OCT+/CFP-) -when considered in addition to HPA extent, for predicting late age-related macular degeneration development. This study sought to understand the impact of HRF (OCT+/CFP-) extent on visual sensitivity.

METHODS

Two hundred eighty eyes from 140 participants with bilateral large drusen underwent imaging and microperimetry at baseline, and then 6-monthly for 3-years. The extent of HPAs on CFPs and HRF (OCT+/CFP-) on OCT was quantified at baseline. Predictive models for progression to late age-related macular degeneration, accounting for drusen volume and age, were developed using HPA extent, with and without HRF (OCT+/CFP-) extent. The association between HPA and HRF (OCT+/CFP-) extent with sector-based visual sensitivity was also evaluated.

RESULTS

Incorporating HRF (OCT+/CFP-) extent did not improve the predictive performance for late age-related macular degeneration development ( P ≥ 0.32). Increasing HPA and HRF (OCT+/CFP-) extent in each sector were independently and significantly associated with reduced sector-based visual sensitivity ( P ≤ 0.004).

CONCLUSION

The addition of HRF (OCT+/CFP-) extent to HPA extent did not improve the prediction of late age-related macular degeneration development. HRF (OCT+/CFP-) extent was also independently associated with local reductions in visual sensitivity, after accounting for HPAs.

Hyperpigmentary abnormalities in age-related macular degeneration: association with progression and impact on visual sensitivity

BACKGROUND/AIMS

To investigate the additional prognostic value of quantifying the extent of colour fundus photography (CFP)-defined hyperpigmentary abnormalities (HPAs) compared with their presence alone for predicting progression to late-stage age-related macular degeneration (AMD) and to understand their association with visual sensitivity in individuals with intermediate AMD.

METHODS

140 participants with bilateral large drusen underwent multimodal imaging and microperimetry at baseline and then every 6 months for up to 3 years. Baseline CFPs were graded for the presence of HPAs and their extent was quantified. Optical coherence tomography (OCT) scans were used to quantify drusen volume. Predictive models for progression to late AMD (including OCT signs of atrophy) were developed using either HPA presence or extent. The association between HPA extent with mean visual sensitivity (both overall and sector based) was also evaluated. All models were adjusted for the confounders of baseline age and drusen volume.

RESULTS

The predictive performance for late AMD development was not significantly different for HPA presence or extent (p=0.92). Increasing HPA extent in each sector, but not its overall extent in an eye, was associated with reduced sector-based visual sensitivity (p<0.001 and p=0.671, respectively).

CONCLUSION

In a cohort with bilateral large drusen, quantifying HPA extent did not improve the prediction of late AMD development compared with presence alone. HPA extent was associated with more local, rather than generalised, reductions in visual sensitivity. These findings suggest that quantification of HPA extent adds little to the prediction of AMD progression, but that it provides an imaging biomarker of visual dysfunction.

A semi-automated pipeline for quantifying drusen-like deposits in human induced pluripotent stem cell-derived retinal pigment epithelium cells

Age-Related Macular Degeneration (AMD) is a highly prevalent form of retinal disease amongst Western communities over 50 years of age. A hallmark of AMD pathogenesis is the accumulation of drusen underneath the retinal pigment epithelium (RPE), a biological process also observable in vitro. The accumulation of drusen has been shown to predict the progression to advanced AMD, making accurate characterisation of drusen in vitro models valuable in disease modelling and drug development. More recently, deposits above the RPE in the subretinal space, called reticular pseudodrusen (RPD) have been recognized as a sub-phenotype of AMD. While in vitro imaging techniques allow for the immunostaining of drusen-like deposits, quantification of these deposits often requires slow, low throughput manual counting of images. This further lends itself to issues including sampling biases, while ignoring critical data parameters including volume and precise localization. To overcome these issues, we developed a semi-automated pipeline for quantifying the presence of drusen-like deposits in vitro, using RPE cultures derived from patient-specific induced pluripotent stem cells (iPSCs). Using high-throughput confocal microscopy, together with three-dimensional reconstruction, we developed an imaging and analysis pipeline that quantifies the number of drusen-like deposits, and accurately and reproducibly provides the location and composition of these deposits. Extending its utility, this pipeline can determine whether the drusen-like deposits locate to the apical or basal surface of RPE cells. Here, we validate the utility of this pipeline in the quantification of drusen-like deposits in six iPSCs lines derived from patients with AMD, following their differentiation into RPE cells. This pipeline provides a valuable tool for the in vitro modelling of AMD and other retinal disease, and is amenable to mid and high throughput screenings.

Oesophageal carcinosarcoma: a rare neoplasm of the oesophagus

Oesophageal carcinosarcoma (OCS) is a rare oesophageal cancer, expressing both carcinomatous and sarcomatous elements. Although believed to have a better prognosis, no standard guidelines exist for its diagnosis and management. We report a case of a 60-year male presenting with progressive dysphagia and weight loss. Endoscopy and contrast-enhanced computed tomography of the chest revealed a large polypoidal intraluminal growth at the mid-oesophagus. Endoscopic biopsy revealed a sarcoma of the oesophagus. The patient underwent McKeown minimally invasive oesophagectomy. Final histopathology was suggestive of OCS. Postoperatively, the patient received adjuvant chemoradiation. At 20-month follow-up, he was asymptomatic with no radiological evidence of recurrence.

Differential expression of inflammatory cytokines, prostaglandin synthases and secretory leukocyte protease inhibitor in the endometrium and circulation in different graded CEH-pyometra in bitch

Cystic endometrial hyperplasia (CEH)-pyometra (CEH-P) is one of the most common reproductive disorders in bitches, posing a risk to both future fertility and life. The aims of the current study were to elucidate the differential expression patterns of inflammatory mediators at transcript and protein levels in the endometrium and to assess the concentrations of key inflammatory mediators in the peripheral circulation of bitches with different graded CEH-P. A total of 25 client-owned intact mixed breed bitches of 3-10 years presented to the outpatient department of RVP-TVCC of the institute were considered for the study. Of which, 22 cases suggestive of pyometra and 3 cases of CEH obtained during routine elective ovariohysterectomy were subjected to histopathological examination. Uteri were categorized into CEH (n = 3), moderate CEH-P (mCEH-P, n = 9), severe CEH-P (sCEH-P, n = 6) and atrophic pyometra (AT-P, n = 7). A group of age matched (n = 12) bitches without pyometra served as control. Endometrial transcripts such as IL6, IL8, PTGS2, PGFS, and SLPI were expressed differentially in the CEH and CEH-P bitch. In addition, a strong immunoreactivity (IR) of IL6, IL8, PTGS2, and mPGES1 was recorded in the sCEH-P uterus, while expression of IL10 was noticed in AT-P. In circulation, serum IL6 was the most relevant marker with high sensitivity of 96.2% and specificity of 84.6% at a cut off concentration 8.5 pg/mL followed by SLPI with 95.2% sensitivity, and 84.6% specificity at cut off concentration of 1.3 ng/mL. Serum IL10, PGFM and SLPI concentration in the peripheral circulation were 1.5-2.23 fold higher in mCEH-P, 0.87-2.5 fold higher in sCEH-P and 2.9-3.5 fold higher in AT-P than that of control. It is concluded that monitoring the serum concentration of IL6, IL10 and SLPI would be useful adjunct to the established hematobiochemical parameters in the management of pyometra in the bitch with critical illness.

A Deep Learning Framework for the Detection and Quantification of Reticular Pseudodrusen and Drusen on Optical Coherence Tomography

Purpose

The purpose of this study was to develop and validate a deep learning (DL) framework for the detection and quantification of reticular pseudodrusen (RPD) and drusen on optical coherence tomography (OCT) scans.

Methods

A DL framework was developed consisting of a classification model and an out-of-distribution (OOD) detection model for the identification of ungradable scans; a classification model to identify scans with drusen or RPD; and an image segmentation model to independently segment lesions as RPD or drusen. Data were obtained from 1284 participants in the UK Biobank (UKBB) with a self-reported diagnosis of age-related macular degeneration (AMD) and 250 UKBB controls. Drusen and RPD were manually delineated by five retina specialists. The main outcome measures were sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC), kappa, accuracy, intraclass correlation coefficient (ICC), and free-response receiver operating characteristic (FROC) curves.

Results

The classification models performed strongly at their respective tasks (0.95, 0.93, and 0.99 AUC, respectively, for the ungradable scans classifier, the OOD model, and the drusen and RPD classification models). The mean ICC for the drusen and RPD area versus graders was 0.74 and 0.61, respectively, compared with 0.69 and 0.68 for intergrader agreement. FROC curves showed that the model's sensitivity was close to human performance.

Conclusions

The models achieved high classification and segmentation performance, similar to human performance.

Translational Relevance

Application of this robust framework will further our understanding of RPD as a separate entity from drusen in both research and clinical settings.

Reticular Pseudodrusen on the Risk of Progression in Intermediate Age-Related Macular Degeneration

PURPOSE

To examine the association between reticular pseudodrusen (RPD) and progression to late age-related macular degeneration (AMD) in individuals with intermediate AMD.

DESIGN

Prospective cohort study.

METHODS

Two hundred eighty eyes from 140 participants with bilateral large drusen underwent multimodal imaging (MMI), including optical coherence tomography (OCT), near-infrared reflectance (NIR), fundus autofluorescence, and color fundus photography (CFP), at 6-monthly intervals up over a 36-month follow-up period. The presence of RPD per eye was determined based on either a combined MMI criterion, or each individual imaging modality, and their extent measured on combined OCT and NIR imaging. The association between the presence of RPD on different imaging modalities, and their extent, with the development of late AMD (including OCT-defined atrophy) was evaluated.

RESULTS

The presence of RPD on MMI, or any of its individual modalities, at baseline was not significantly associated with an increased rate of developing late AMD, with or without adjusting for risk factors for AMD progression (age, drusen volume on OCT, and pigmentary abnormalities on CFP; all P ≥ 0.205). The extent of RPD present was also not significantly associated with an increased rate of developing late AMD, with or without adjustment for risk factors for AMD progression (both P ≥ 0.522).

CONCLUSIONS

In this cohort with bilateral large drusen, the presence of RPD was not significantly associated with an increased risk of developing late AMD. Additional longitudinal studies in all stages of AMD are needed to understand the implications of RPD on vision loss in this condition.

Exploring Reticular Pseudodrusen Extent and Impact on Mesopic Visual Sensitivity in Intermediate Age-Related Macular Degeneration

Purpose

To explore the impact of the extent of reticular pseudodrusen (RPD) on mesopic visual sensitivity in individuals with intermediate age-related macular degeneration (AMD).

Methods

In total, 570 eyes from 285 participants with bilateral large drusen underwent microperimetry testing to assess the visual sensitivity of the central 3.6-mm region and multimodal imaging to determine the extent of RPD in the central 20° × 20° region (at the eye level). Mean visual sensitivity within five sectors in the central 3.6-mm region sampled on microperimetry and the extent of RPD in these sectors were derived. Linear mixed models were used to examine the association between the extent of RPD on overall mean visual sensitivity and sector-based mean sensitivity.

Results

An increasing extent of RPD at the eye level and within sectors was associated with a significant reduction in overall and sector-based mean sensitivity, respectively (P < 0.001 for both). However, when both RPD parameters were considered together in a multivariable model, only an increasing extent of RPD at the eye level (P < 0.001) and not within each sector (P = 0.178) was independently associated with reduced sector-based mean sensitivity.

Conclusions

Mesopic visual sensitivity is generally reduced in eyes with large drusen and coexistent RPD compared to eyes without RPD, with greater reductions with an increasing extent of RPD. However, reduced sector-based visual sensitivities are explained by the overall extent of RPD present, rather than their extent within the sector itself. These findings suggest that there are generalized pathogenic changes in eyes with RPD accounting for the observed mesopic visual dysfunction.

Low genetic confirmation rate in South Indian subjects with a clinical diagnosis of maturity-onset diabetes of the young (MODY) who underwent targeted next-generation sequencing for 13 genes

PURPOSE

To screen for maturity-onset diabetes of the young (MODY) variants in subjects with an early age of onset and positive family history of diabetes mellitus.

METHODS

60 subjects with onset of diabetes between 3 and 30 years of age and parental history (onset < 35 years) of diabetes were recruited after excluding autoimmune, pancreatic and syndromic forms of diabetes. Detailed pedigree chart and clinical data were recorded. MODY genetic testing (MODY 1-13) was performed and variant classification was done adhering to the ACMG guidelines.

RESULTS

Baseline characteristics of subjects were as follows: mean age of onset of diabetes 19.9 ± 7 years, mean duration of diabetes 6.3 ± 6.8 years, BMI 23.3 ± 3 kg/m² and C-peptide 1.56 ± 1.06 nmol/l. Four out of sixty (6.6%) were positive for variants classifiable as pathogenic/likely pathogenic: one patient with HNF4Ac.691C > T, (p.Arg231Trp), two with HNF 1A c.746C > A(p.Ser249Ter) and c.1340C > T(p.Pro447Leu), and one with ABCC8 c.4544C > T (p.Thr1515Met). MODY 1 and MODY 3 variants were documented in the paediatric age group (< 18 years).

CONCLUSION

A genetic diagnosis of MODY could be confirmed in only 6.6% (4/60) of patients clinically classifiable as MODY. This is less than that reported in clinically diagnosed MODY subjects of European descent. Newly published population data and more stringent criteria for assessment of pathogenicity and younger age of onset of type 2 diabetes in Indians could have contributed to the lower genetic confirmation rate. Apart from variants in the classical genes (HNF1A, HNF4A), a likely pathogenic variant in a non-classical gene (ABCC8) was noted in this study.

A clinical perspective on the expanding role of artificial intelligence in age-related macular degeneration

In recent years, there has been intense development of artificial intelligence (AI) techniques, which have the potential to improve the clinical management of age-related macular degeneration (AMD) and facilitate the prevention of irreversible vision loss from this condition. Such AI techniques could be used as clinical decision support tools to: (i) improve the detection of AMD by community eye health practitioners, (ii) enhance risk stratification to enable personalised monitoring strategies for those with the early stages of AMD, and (iii) enable early detection of signs indicative of possible choroidal neovascularisation allowing triaging of patients requiring urgent review. This review discusses the latest developments in AI techniques that show promise for these tasks, as well as how they may help in the management of patients being treated for choroidal neovascularisation and in accelerating the discovery of new treatments in AMD.

Expression of kisspeptin and its receptor in different functional classes of ovarian follicle in the buffalo (Bubalus bubalis)

Recently, we reported the differential expression of kisspeptinergic system in the bubaline hypothalamus and corpus luteum. Here, we document the expression of kisspeptin (Kp) and its receptor (Kiss1r) in the ovarian follicles of the buffalo with respect to the functional status. Follicles of ≥10 to ≤13 mm diameter (n = 45) were retrospectively categorized into active (n = 18), intermediate (n = 16) and atretic (n = 11) follicles based on the concentrations of intrafollicular progesterone (P₄) and estradiol (E₂). The P₄:E₂ ratio was significantly lower in the active follicle (0.43 ± 0.08) than that of the intermediate (3.46 ± 0.53) and atretic (28.4 ± 10.6) follicles (P < 0.05). Relative fold change in the transcripts of kisspeptin (Kiss1), Kiss1r, gonadotrophin receptors, steroid acute regulatory protein (StAR), cytochrome P450 family 11 subfamily A member 1 (CYP11A1), cytochrome P450 Family 19 subfamily A member 1 (CYP19A1), insulin like growth factor -1 (IGF-1), apoptotic factors (caspase 3 and B-cell lymphoma 2, BCL2) was calculated using qPCR in the follicular wall of the three categories of follicle (n = 8/group). In another experiment, histological sections of the ovary (n = 41) were used to group the follicles as described above and immunostaining of Kp, Kiss1r and aromatase was done. A significant upregulation of StAR, CYP11A1 and CYP19A1 in the active follicles supported the endocrine basis of follicular classification. The transcripts of Kiss1 and Kiss1r were upregulated by 19.45 fold and 4.25 fold, respectively in the active follicle as compared to other groups. Immunolocalization studies revealed that Kp and Kiss1r were localized to the basal and antral granulosa cells (GC) of the active and intermediate follicles; however, the staining intensity was stronger in the former group. Strong expression of CYP19A1 in the GC layer of active follicle supported the histological basis of defining the functional status of the follicle. It is concluded that the follicular compartment of the bubaline ovary expressed the constituents of kisspeptinergic system. The expression of Kp and Kiss1r was influenced by the functional status of the follicle with intense localization in the GC layer of the active follicles.

Reticular pseudodrusen: A critical phenotype in age-related macular degeneration

Reticular pseudodrusen (RPD), or subretinal drusenoid deposits (SDD), refer to distinct lesions that occur in the subretinal space. Over the past three decades, their presence in association with age-related macular degeneration (AMD) has become increasingly recognized, especially as RPD have become more easily distinguished with newer clinical imaging modalities. There is also an increasing appreciation that RPD appear to be a critical AMD phenotype, where understanding their pathogenesis will provide further insights into the processes driving vision loss in AMD. However, key barriers to understanding the current evidence related to the independent impact of RPD include the heterogeneity in defining their presence, and failure to account for the confounding impact of the concurrent presence and severity of AMD pathology. This review thus critically discusses the current evidence on the prevalence and clinical significance of RPD and proposes a clinical imaging definition of RPD that will help move the field forward in gathering further key knowledge about this critical phenotype. It also proposes a putative mechanism for RPD formation and how they may drive progression to vision loss in AMD, through examining current evidence and presenting novel findings from preclinical and clinical studies.

Bioefficacy evaluation of chalcone derivatives against Meloidogyne graminicola infecting rice, Oryza sativa L

A series of chalcones (1-14) were synthesized, characterized (using IR and 1H NMR techniques), and evaluated with an objective to manage rice root-knot nematode (RRKN) (Meloidogyne graminicola) both under pluronic gel and field conditions. Out of these fourteen compounds, 1-(4-fluoro-phenyl)-3-phenyl-propenone (13) and 1,3-diphenyl-propenone (14) showed promising and dose dependent activity at 10, 20, and 40 mg L^-1. A significant reduction in penetration of second stage juveniles (J₂s) in rice roots was observed in compounds 13 (9.5-12.0 J₂s/plant) and 14 (10.5-13.4 J₂s/plant) compared to control plants (PB1121) (13.5-23.6 J₂s/plant) in pluronic gel study. The results of field trials indicated that 14, showed significantly (P ≤ 0.05) better plant growth on 28 days after sowing (DAS) compared to 13. Both 13 and 14 reduced gall formation significantly than carbofuran 3 G @1 kg a.i./ha. However, lower concentrations were less effective in field in reducing the gall formation. Also, a significant reduction in the number of galls was observed when soil was drenched with 14 @ 40 mg L^-1. However, root dipping was not as effective as soil drenching. The study revealed that both the chalcones have the potential for effective management of RRKN in fields, and can be a better alternative to carbofuran.

557 A Novel Peer-Led Anatomage-Based Teaching Programme for Medical Students

Introduction

Anatomical knowledge is an essential part of surgical practice. However, its delivery lacks a standardised approach across medical school curricula. A student-led anatomy programme was implemented at a single institution, using near-peer teaching and Anatomage virtual dissection. This study aims to describe the methodology of this programme and determine the benefit of a near-peer taught anatomy course.

Method

The programme was organised by senior medical students, utilising Anatomage virtual dissection and techniques in line with Bigg’s constructive alignment. Attendees were asked to complete questionnaires with Likert scales (0-10) and open answer text to determine learners’ benefit. Both quantitative and qualitative analyses are presented.

Results

73 students attended eight sessions from January to March 2020. Students reported a statistically significant (p &lt; 0.01) increase in confidence after the sessions of 3.74±1.83. The quality and relevance of the teaching also scored highly (9.32±0.89 and 9.47±0.86 respectively). Qualitatively, students praised the "informal learning environment”, the structure of the sessions, the handout provided, and the interactivity of anatomage technology.

Conclusions

This study demonstrates how virtual dissection technology and near-peer teaching can derive significant benefit to undergraduate students, in line with previously published data.

Idiopathic hypertrophic cranial polyneuropathy: a rare cause of orbital pain

Hypertrophic cranial polyneuropathy (HCP) is sporadically encountered in clinical practice. Aetiologies of HCP have been classified as autoimmune, infectious and demyelinating. However, an accurate diagnosis remains elusive in some cases despite rigorous investigations. These cases represent idiopathic HCP. Given the high clinical variance in presenting symptoms, HCP often leaves medical practitioners in a diagnostic quandary. Here, we seek to expand current knowledge by reporting the first documented case of idiopathic HCP presenting atypically with unilateral orbital pain and exclusively involving the bilateral trigeminal nerves.

In Silico Ventilation Within the Dose-Volume is Predictive of Lung Function Post-radiation Therapy in Patients with Lung Cancer

Lung cancer is a leading cause of death worldwide. Radiation therapy (RT) is one method to treat this disease. A common side effect of RT for lung cancer is radiation-induced lung damage (RILD) which leads to loss of lung function. RILD often compounds pre-existing smoking-related regional lung function impairment. It is difficult to predict patient outcomes due to large variability in individual response to RT. In this study, the capability of image-based modelling of regional ventilation in lung cancer patients to predict lung function post-RT was investigated. Twenty-five patient-based models were created using CT images to define the airway geometry, size and location of tumour, and distribution of emphysema. Simulated ventilation within the 20 Gy isodose volume showed a statistically significant negative correlation with the change in forced expiratory volume in 1 s 12-months post-RT (p = 0.001, R = - 0.61). Patients with higher simulated ventilation within the 20 Gy isodose volume had a greater loss in lung function post-RT and vice versa. This relationship was only evident with the combined impact of tumour and emphysema, with the location of the emphysema relative to the dose-volume being important. Our results suggest that model-based ventilation measures can be used in the prediction of patient lung function post-RT.

Is higher power shorter duration radiofrequency energy is better than lower power longer duration strategy in catheter ablation of atrial fibrillation A meta-analysis

Background

An ideal strategy for radiofrequency ablation (RFA) of atrial fibrillation (AF) in the left atrium should be efficient enough to achieve transmural lesions in left atrium with no or minimal collateral tissue damage. Resistive heating of high power short duration (HPSD) RFA has been found to result in lesions larger in width but lesser in depth compared to lower power longer duration (LPLD) RFA in some experimental studies.

Purpose

This meta-analysis was performed to compare procedural, short-term and long-term outcomes of HPSD versus LPLD RFA of AF.

Methods

PubMed, Embase and Cochrane databases were systematically reviewed. Five observational studies meeting criteria were included in the meta-analysis. All the studies scored six or more points in the New-castle Ottawa scale. There were considerable variations in the ablation strategies across the studies. However, radiofrequency power more than 40W was considered as high power. Hypergeometric model with exact likelihood function was utilized for statistical analysis.

Results

Baseline parameters and ablation details have been depicted in Table 1. 740 patients with HPSD and 287 patients with LPLD ablation strategies, were followed up from 6 to 30 months. Total procedural time (P value &lt;0.0001) and ablation time (P value &lt;0.0001) were significantly lower in the HPSD group than LPLD group. However, the fluoroscopy time was similar (P value = 0.09) in both the groups (Table 2). There were no occurrences of atrio-esophageal fistula or pulmonary venous stenosis in any of the studies. Cardiac tamponade (P value = 0.56), stroke (P value = 0.70) and AF recurrences (P value = 0.81), were similar in both groups (Table 2).

Conclusion

Newer HPSD and conventional LPLD RFA, both the strategies are very safe procedure for treatment of RFA with low to no procedural complications. AF recurrence rates were reasonably high irrespective of ablation strategies, however, no strategy scored statistically better over the other one. Large randomized multi-centric studies with long-term follow up are needed to test the theoretical advantage of HPSD ablation over the traditional ablation strategy of AF.

Funding Acknowledgement

Type of funding source: None

Effect of progesterone administration during growing phase of first dominant follicle on follicular wave pattern in buffalo heifers

In buffaloes, like other domestic mammals, antral follicles develop in a wave-like pattern. Factors predictive of a particular follicular wave pattern are yet to be identified. In this study, we examined the preponderance of 2- versus 3-wave patterns in 46 interovulatory intervals (IOIs) from 36 buffalo heifers, in which a subset of 10 heifers was scanned for 2 consecutive IOIs to record the repeatability of follicular wave pattern. Two-wave pattern was detected in 63.0% and 3-wave follicular pattern in 27.0% IOIs. The dominant follicles (DF) of both wave 1 as well as the ovulatory wave attained a smaller (P < 0.05) maximum diameter in 3-wave cycle as compared to 2-wave cycle. The mean duration of IOI was significantly shorter in 2-wave compared to three-wave cycles (20.5 ± 0.3 vs. 22.3 ± 0.2 days; P < 0.05). Out of 10 buffalo heifers, 7 displayed non-alternating patterns and 3 had alternating follicular wave patterns. We also tested the hypothesis that progesterone administration during early IOI results in increased preponderance of 3-wave pattern and heifers inseminated after ovulation of the third wave DF will have greater fertility. Sixteen heifers subjected to progesterone treatment from D0 (day of ovulation) in a decreasing dose until D5 were compared with control heifers (n = 10). Progesterone treatment significantly reduced the maximum diameter of DF of wave 1 (P < 0.001), whereas the mean duration of IOI remained unchanged (P > 0.05) between the two groups. Progesterone administration during early IOI significantly increased the proportion of 3-wave cycles as compared to control (P < 0.05). The hypothesis that progesterone administration during IOI results in increased preponderance of 3-wave pattern was supported. However, no change in fertility was recorded in progesterone-treated heifers (7 pregnant out of 16; 43.8%) as compared to untreated control heifers (4 out of 10 heifers; 40.0%). In summary, progesterone administration in buffalo heifers during the growing phase of wave 1 resulted in greater preponderance of 3-wave follicular patterns, with no significant effect on fertility.

Expression of Kisspeptin and its receptor in the hypothalamus of cyclic and acyclic buffalo (Bubalus bubalis)

Kisspeptin (Kiss1), neurokinin-B (NKB) and dynorphin (Dyn) neurons regulate the surge and pulsatile centres of gonadotropin releasing hormone (GnRH) in the hypothalamus and are modulated by the ovarian steroids. Accordingly, we studied the temporospatial expression of Kiss1, its receptor and other genes that regulate GnRH in the preoptic area (POA) and arcuate (ARC) regions of hypothalamus at different phases of bubaline estrous cycle. Brain of buffalo (n = 32) was collected immediately after exsanguination and categorized into early luteal (EL), mid luteal (ML), follicular (FL) stages and acyclic (n = 8/group). Total RNA was extracted from the POA and ARC of each stage and real time PCR amplification of Kiss1, Kiss1r, NKB, NKB receptor (NKBR), Dyn, Dyn receptor (OPRK1), GnRH1, ERα, PR, LEPR and GHSR was done using GAPDH as endogenous control and acyclic stage as calibrator group. Further, immunolocalization of Kiss1 and Kiss1r was done on the hypothalamus. In the POA, significant up-regulation of Kiss1 and NKB with a concomitant down-regulation of Dyn transcripts was recorded at FL stage. There was, however, down-regulation of Kiss1 and Kiss1r during the EL perhaps due to the loss of estradiol as a consequence of ovulation. On the other hand, in the ARC, there was a significant up-regulation of Kiss1 and Dyn at FL and ML, while NKB transcript was consistently down-regulated at any stage of estrous cycle. In the POA, expression of ERα was not modulated; however, PR was down-regulated in the EL. In the ARC, the ERα expression was significantly up-regulated in the EL, whereas, PR was moderately expressed irrespective of the stage of estrous cycle. The immunolocalization study revealed the presence of Kiss1 and Kiss1r in the POA and ARC in the cyclic buffalo with relative abundance at FL. The transcriptional profile of the genes suggests that there is estrous cycle stage specific expression of Kiss1, Kiss1r and other GnRH regulating genes in the POA and ARC regions of hypothalamus in the buffalo. Up-regulation of Kiss1r in the POA during ML and ARC during EL indicates the involvement of kisspeptinergic system in the regulation of low LH pulse frequencies during the early and mid luteal phases in the cyclic buffalo.

Bleb-associated endophthalmitis: Proportion, presentation, management and outcomes in Victoria, Australia

IMPORTANCE

Bleb-associated endophthalmitis is a potentially vision-threatening complication of trabeculectomy. With improvements in surgical technique and changing patterns of intraoperative antimetabolite use, a re-evaluation of the incidence of bleb-associated endophthalmitis is warranted.

BACKGROUND

To investigate changes in the incidence, presentation, management and outcomes of bleb-associated endophthalmitis between 1997 and 2015 in Victoria, Australia.

DESIGN

A retrospective cohort analysis.

PARTICIPANTS

Consecutive cases of bleb-associated endophthalmitis managed at the Royal Victorian Eye and Ear Hospital (RVEEH) between 1997 and 2015.

METHODS

Medical record review of consecutive cases of bleb-associated endophthalmitis and statistical analysis were performed.

MAIN OUTCOME MEASURES

Visual acuity, including loss of light perception, intraocular pressure, and need for further surgery.

RESULTS

Sixty-seven eyes with bleb-associated endophthalmitis (BAE) were identified. Of these, 41 had trabeculectomy performed in Victoria during the study period, over which time 11 129 trabeculectomies were performed. The proportion of BAE was stable over time (0.4%). The mean age at presentation was 73.7 ± 12.1 years old and the majority of patients were Caucasian (79.1%). The mean duration between glaucoma filtration surgery and the development of bleb-associated endophthalmitis was 3 years (Interquartile Range = 0.4-6.0 years). The cultures were positive in 71.6% of cases. Approximately 1 in 8 patients required enucleation. The final visual acuity was poor with a Snellen Visual Acuity (VA) of 6/60 or worse in two-thirds of patients.

CONCLUSIONS AND RELEVANCE

Bleb-associated endophthalmitis is an uncommon complication following glaucoma filtration surgery. The proportion has remained stable over time. Visual outcomes remain poor.

Agreement study between color and IR retinal images based on retinal vasculature morphological parameters

Background

Color fundus photography have been extensively used to explore the link between retinal morphology changes associated with various disease i.e. Diabetic Retinopathy, Glaucoma. The development of multimodal imaging system that integrates Infrared Scanning Laser Ophthalmoscope (IR-SLO) and Optical Coherence Tomography (OCT) could help in studying these diseases at an early stage. The aim of this study was to test the agreement between the retinal vasculature parameters from the Infrared images obtained from optical coherence tomography and color fundus imaging.

Methods

The IR and Color retinal images were obtained from 16 volunteer participants and seven retinal vessel parameters, i.e. Fractal Dimension (FD), Average Angle (ABA), Total Angle Count (TAC), Tortuosity (ST), Vessel/Background ratio (VBR), Central Retinal Arteriolar Equivalent (CRAE) and Central Retinal Venular Equivalent (CRVE) were extracted from these retinal images using Retinal Image Vasculature Assessment software (RIVAS) and Integrative Vessel Analysis (IVAN).

Results

The Bland Altman plot was used to investigate the agreement between the two modalities. The paired sample t-test was used to assess the presence of fixed bias and the slope of Least Square Regression (LSR) line for the presence of proportional bias.

The paired sample t-test showed that there was no statistically significant difference between Color and IR based on retinal vessel features (all p values > 0.05). LSR also revealed no statistically significant difference in the retinal vessel features between Color and IR.

Conclusion

This study has revealed that there is a fair agreement between Color and IR images based on retinal vessel features. This research has shown that it is possible to use IR images of the retina to measure the retinal vasculature parameters which has the advantage of being flash-less, can be used even if there is opacity due to cataract, and can be performed along with OCT on the same device.

Line Immunoassay: A Rapid Test for Screening TORCH Complex in Antenatal Patients with Bad Obstetric History

TORCH {Toxoplasma gondii, Rubella, Cytomegalovirus (CMV), the Herpes Simplex Virus (HSV)} infection causes pregnancy wastage at any stage of gestation. Serological assays can be an important tool for diagnosis. It includes ELISA which is highly specific & sensitive with certain drawbacks like time consuming and for each genus separate test have to be done. Line-Immunoassay (LIA), a newer, cheaper and reliable technique on contrary is done on single panel strip. The present retrospective study was conducted with the aim to evaluate the efficacy of Line Immunoassay for detection of TORCH IgM antibodies. A total of 630 samples from the pregnant women with Bad Obstetric History (BOH) attending OPD and IPD of Obstetrics and Gynecology Department of Maharishi Markandeshwar Institute of Medical Science & Research (MMIMSR), Mullana, Ambala, Haryana, India from 2011 to 2015 were subjected to Line-Immunoassay and ELISA for detection of IgM antibodies against TORCH agents in Department of Microbiology. The analysis for TORCH complex showed 32.85% positivity by LIA while 36.03% by ELISA. The diagnostic accuracy of LIA when ELISA considered gold standard was also exhibited which showed Sensitivity of 90.75%, Specificity of 99.75% while PPV & NPV were 99.52%, 95.05% respectively. The statistical analysis showed results were statistically insignificant (p value >0.05). Comparison of detection of TORCH IgM antibodies by ELISA & Line-Immunoassay express good sensitivity & specificity requiring significantly less time and low cost by Line-Immunoassay, concludes that Line-Immunoassay may be used as screening test.

Organic zinc and copper supplementation on antioxidant protective mechanism and their correlation with sperm functional characteristics in goats

Trace minerals feeding had significant effects on sperm production and fertility with better absorption and proper utilization within the body for optimum reproductive function. Several studies have shown that more influenced trace elements in the diets of animals are copper (Cu) and zinc (Zn). Bucks showing deficiency of this mineral might affect the quality of semen production which in turn would affect the fertility. This experiment was thus designed to test the effects of organic Cu and Zn supplementation on antioxidants enzyme activities and sperm functional attributes in fresh semen of bucks. Forty bucks (n = 40, Aged 5 months) were assigned to ten groups of four animals in each group, supplemented (for a period of 8 months) with different levels of organic Zn: 20 mg (T2), 40 mg (T3) and 60 mg (T4), organic Cu: 12.5 mg (T5), 25 mg (T6), 37.5 mg (T7) and combined organic Zn and Cu: 20 + 12.5 mg (T8), 40 + 25 mg (T9), 60 + 37.5 mg (T10), respectively, per kg dry matter and no additional mineral diet (control; T1). One hundred and sixty semen samples were collected through electro-ejaculator and analysed for sperm quantity, quality, acrosome intactness and plasma membrane integrity and correlated with the catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase enzyme activities in seminal plasma. The results indicated organic Cu and zinc supplemented bucks produced more sperm cells, had higher sperm concentrations, maintained higher (p < .01) sperm livability, plasma membrane and acrosome integrities, more motility and velocity. The increased antioxidant enzyme activities, reduced oxidative stress and lowered lipid peroxidation were positively correlated (p < .05) with the sperm functional attributes. In conclusion, organic Cu and Zn supplement to male goats showed protective roles against oxidative damage and maintained better fresh semen characteristics.

Evidence of local structural influence on the shape driven magnetic anisotropy in electronically excited Ni nanoparticles embedded in SiO2 matrix

The reliance of modern electronic era on ultrafast data recording has made the search for novel tools to tune nano-scale magnetic-anisotropy (MA) never-ending. We demonstrate a strong correlation between the spin-spin interactions, local atomic structure and the MA of Ni nanoparticles (NPs) embedded inside SiO₂ matrix under swift heavy ion (SHI) irradiation. In contrast to traditional understandings, MA in Ni NPs along with their aspect ratio, first increases upto 5 × 10¹³ ions/cm² SHI fluence (5e13) and gets reduced at highest fluence. Using angle dependent Extented-Xray-Absorption-Fine-Structure (EXAFS) and ab initio molecular dynamics (MD) simulations, we show that the anisotropy induced in local atomic structure upon irradiation is dependent on atomic spin-spin interactions, which gets reduced at highest fluence. The chosen model cluster (Ni₃₈) used in our MD simulations is duly validated by comparing the pair-correlation-function of the structure with the EXAFS-Fourier-Transform. The lattice temperatures for the films irradiated at different fluences, as calculated from thermal-spike-model, are used for the respective MD runs. We conclude that the enhanced disorder in both the local atomic environment and spin alignment destroys the MA at the highest fluence in SHI irradiated Ni NPs. The findings therefore provide rich conceptual insights for designing magnetic devices using SHI-induced phenomena.

Human milk oligosaccharide categories define the microbiota composition in human colostrum

Human milk oligosaccharides (HMOs) are structurally diverse unconjugated glycans with a composition unique to each lactating mother. While HMOs have been shown to have an impact on the development of infant gut microbiota, it is not well known if HMOs also already affect milk microbial composition. To address this question, we analysed eleven colostrum samples for HMO content by high-pressure liquid chromatography and microbiota composition by quantitative PCR. Higher total HMO concentration was associated with higher counts of Bifidobacterium spp. (ρ=0.63, P=0.036). A distinctive effect was seen when comparing different HMO groups: positive correlations were observed between sialylated HMOs and Bifidobacterium breve (ρ=0.84, P=0.001), and non-fucosylated/non-sialylated HMOs and Bifidobacterium longum group (ρ=0.65, P=0.030). In addition to associations between HMOs and bifidobacteria, positive correlations were observed between fucosylated HMOs and Akkermansia muciniphila (ρ=0.70, P=0.017), and between fucosylated/sialylated HMOs and Staphylococcus aureus (ρ=0.75, P=0.007). Our results suggest that the characterised HMOs have an effect on specific microbial groups in human milk. Both oligosaccharides and microbes provide a concise inoculum for the compositional development of the infant gut microbiota.

Genome-wide gene expression pattern underlying differential host response to high or low pathogenic H5N1 avian influenza virus in ducks

The differences in the influenza viral pathogenesis observed between different pathogenic strains are associated with distinct properties of virus strains and the host immune responses. In order to determine the differences in the duck immune response against two different pathogenic strains, we studied genome-wide host immune gene response of ducks infected with A/duck/India/02CA10/2011 and A/duck/Tripura/103597/2008 H5N1 viruses using custom-designed microarray. A/duck/India/02CA10/2011 is highly pathogenic virus (HP) to ducks, whereas A/duck/Tripura/103597/2008 is a low pathogenic (LP) virus strain. Comparative lung tissue transcriptome analysis of differentially expressed genes revealed that 686 genes were commonly expressed, 880 and 1556 genes are expressed uniquely to infection with HP and LP virus, respectively. The up-regulation of chemokines (CCL4 and CXCR4) and IFN-stimulated genes (IFITM2, STAT3, TGFB1 and TGFB3) was observed in the lung tissues of ducks infected with HP virus. The up-regulation of other immune genes (IL17, OAS, SOCS3, MHC I and MHC II) was observed in both infection conditions. The expression of important antiviral immune genes MX, IFIT5, IFITM5, ISG12, β-defensins, RSAD2, EIF2AK2, TRIM23 and SLC16A3 was observed in LP virus infection, but not in HP virus infection. Several immune-related gene ontology terms and pathways activated by both the viruses were qualitatively similar but quantitatively different. Based on these findings, the differences in the host immune response might explain a part of the difference observed in the viral pathogenesis of high and low pathogenic influenza strains in ducks.

Ovulatory and fertility response using modified Heatsynch and Ovsynch protocols in the anovular Murrah buffalo (Bubalus bubalis)

We studied the effect of modified Heatsynch and Ovsynch protocols on the ovulatory response (OR), estrus induction rate (EIR) and conception rate (CR) in the anovular postpartum Murrah buffalo (n = 35). In the modified Heatsynch protocol (Group I; n = 12), buffaloes were given two GnRH at 2 h interval on treatment day 0, PGF (PGF2α) on day 7 and estradiol (E₂) 1 mg on day 8. Two FTAI were done at 20 h intervals after E₂ administration. In the modified Ovsynch protocol (Group II; n = 15), GnRH was given on day 0, 7 and 16 with a PGF on day 14. Two FTAI were done; one at last GnRH and the other 20 h later. Group III served as untreated negative control (n = 8). During the treatment, ovarian changes were monitored by transrectal ultrasonography and plasma progesterone (P₄) and E₂. Administration of two GnRH at 2 h interval neither increased the OR nor strengthened the subsequent P₄ priming. Interestingly, in group I, none of the buffalo ovulated to E₂ though the EIR was 100% indicating the occurrence of behavioral, but not ovulatory estrus. Administration of GnRH 7 day prior to the commencement of Ovsynch protocol (Group II) did not improve the CR (21.4%), though the OR was 71.4%. No significant difference was found in the diameter of largest follicle between the ovulated and non-ovulated buffalo in response to GnRH suggesting that follicle of ≥9.5 mm is necessary but not sufficient to induce ovulation in the anovular buffalo. In both the protocols, the plasma P₄ was higher on day 7 in those buffaloes that ovulated to GnRH. Buffaloes treated with modified Ovsynch regimens were 5.27 times more likely to become pregnant than modified Heatsynch protocol. It is concluded that modified Ovsynch protocol is superior to modified Heatsynch protocol in terms of OR and CR.

Evidence for age-dependent air-space enlargement contributing to loss of lung tissue elastic recoil pressure and increased shear modulus in older age

As a normal part of mature aging, lung tissue undergoes microstructural changes such as alveolar air-space enlargement and redistribution of collagen and elastin away from the alveolar duct. The older lung also experiences an associated decrease in elastic recoil pressure and an increase in specific tissue elastic moduli, but how this relates mechanistically to microstructural remodeling is not well-understood. In this study, we use a structure-based mechanics analysis to elucidate the contributions of age-related air-space enlargement and redistribution of elastin and collagen to loss of lung elastic recoil pressure and increase in tissue elastic moduli. Our results show that age-related geometric changes can result in reduction of elastic recoil pressure and increase in shear and bulk moduli, which is consistent with published experimental data. All elastic moduli were sensitive to the distribution of stiffness (representing elastic fiber density) in the alveolar wall, with homogenous stiffness near the duct and through the septae resulting in a more compliant tissue. The preferential distribution of elastic proteins around the alveolar duct in the healthy young adult lung therefore provides for a more elastic tissue.NEW & NOTEWORTHY We use a structure-based mechanics analysis to correlate air-space enlargement and redistribution of elastin and collagen to age-related changes in the mechanical behavior of lung parenchyma. Our study highlights that both the cause (redistribution of elastin and collagen) and the structural effect (alveolar air-space enlargement) contribute to decline in lung tissue elastic recoil with age; these results are consistent with published data and provide a new avenue for understanding the mechanics of the older lung.

Outcome of Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis

Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused by obstruction of the pancreatic duct system by stones or strictures. This results in increased intraductal pressure and parenchymal ischemia. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease. We want to share our experience of surgical drainage of pancreatic duct in chronic pancreatitis in our hospital. We studied 20 cases operated in our hospital between January 2010 and October 2015. Patients were selected with pre-operative ultrasonography. Dilatation of the main pancreatic duct by at least 7 mm proximal to the obstruction were recruited for operation. We did Roux-Y lateral pancreato-jejunostomy (LPJ) for patients with obstruction of the pancreatic duct due to stricture or intraductal stones or both. We did additional distal pancreatectomy in case of stone in the tail area.We did one Frey's operation for stone and fibro-calcification of the head. We evaluated their symptoms, their duration, post-operative hospital stay and complications following surgery. We studied their pain control, recurrence and mortality during this period. We followed these patients for more than 5 years. We found 16 out of 20 patients got complete remission of the abdominal pain with no progression of their disease. Ultrasonic evidence of chronic pancreatitis have improved or resolved. Ductal diameter has decreased. They did not develop diabetes or malabsorbtion. One had a recurrence of stone in the head within a year. Three died during this follow-up period. One died three months after LPJ due to massive gangrene of the small intestine distal to LPJ and jejuno-jejunostomy and subsequent short bowel syndrome. Other two developed carcinoma of the pancreas within one year and six months after LPJ respectively. Rate of pain free survival is about 75% and recurrence is 5%. Mortality during this follow up period is 15%. In this small series, we found that surgery if done early, can have good remission of abdominal pain and can slow the progression of chronic pancreatitis in majority of patient. Patient with chronic calcific pancreatitis and diabetes are likely to have unfavorable outcome even after decompressive surgery.

p53 immunohistochemical staining patterns in oral squamous cell carcinoma

Background: Mutation of p53 gene is one of the most common events in oral carcinogenesis. Accumulation of p53 protein has also been detected in premalignant lesions.Materials and Methods:  This study included 40 biopsy samples, which were received in department of pathology, Sarojini Naidu Medical College, Agra, to ascertain p53 expression by immunohistochemically, in patients with oral squamous cell carcinomas and to correlate its expression with histological grade, different sites in oral cavity and tobacco intake/smoking habits.Results: Out of 40 biopsies of oral mucosa, 03 showed normal oral mucosa and 37 were diagnosed as squamous cell carcinoma (SCC), most patients were in 5th and 6th decade and majority (86.5%) of oral SCC were males with buccal mucosa being the most common site. There was a statistically significant difference in p53 expression between oral SCC and normal oral mucosa (p value <0.05). Of total 37 cases, 12 cases were well differentiated type, 16 moderately differentiated and 09 of poorly differentiated type of SCC. In each category, about two thirds were positive for p53 staining. Out of total 37 cases of oral SCC, 64.9% were positive and 35.1% were negative for p53 expression, 34 cases had positive history of tobacco intake/smoking habits, of which 23 cases were positive while 11 cases were negative for p53 staining.Conclusion: Abnormal p53 protein was detected in 64.9% of oral squamous cell carcinoma, but not in normal oral mucosa. p53 expression was associated with malignant transformation of oral mucosa.