Short-Term Outcomes of Switching to Ranibizumab in Polypoidal Choroidal Vasculopathy Resistant to Aflibercept Therapy.

BACKGROUND: To evaluate the short-term outcomes of switching to ranibizumab in aflibercept-resistant polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective study included 18 eyes diagnosed with aflibercept-resistant PCV. All patients were treated with two to four consecutive ranibizumab injections at 4-5-week intervals. The best-corrected visual acuity (BCVA), and central retinal thickness (CRT) values before and after switching to ranibizumab were compared. The proportion of eyes showing ≥100 µm decrease in retinal thickness and/or complete resolution of fluid after switching was identified. RESULTS: The mean number of aflibercept injections before switching was 5.7 ± 3.3. After switching, a mean of 2.8 ± 0.6 consecutive ranibizumab injections was performed. The mean logarithm of minimal angle of resolution (logMAR) BCVA was 0.41 ± 0.26 (Snellen equivalents = 20/51) before switching, and 0.40 ± 0.30 (20/50) after switching (p = 0.574). The mean CRT was 422.2 ± 152.4 µm before switching, and 400.7 ± 182.0 µm after switching (p = 0.236). A decrease in CRT of ≥100 µm, and/or complete resolution of fluid was noted in three eyes (16.7%). CONCLUSIONS: Switching to ranibizumab in aflibercept-resistant polypoidal choroidal vasculopathy was not effective in most patients, suggesting the need for further investigation to seek more effective treatment options for this condition.

Optical properties and 14C ages of stream DOM from agricultural and forest watersheds during storms.

Forest and agricultural land use affects the concentration and composition of dissolved organic carbon (DOC) in streams and rivers. To elucidate the impacts of forest and agricultural land use on stream DOC during storm events, we investigated DOC concentration ([DOC]), optical properties of dissolved organic matter (DOM), and Δ14C-DOC in both forest- and agriculture-dominated headwater streams in South Korea in the summer of 2012. One forested and five agricultural streams were investigated. During storms, the peak [DOC] of forest stream increased to 5.8 mg L-1, approximately two times larger than that of the most agricultural stream (3.2 mg L-1), demonstrating the weaker storm responses of the [DOC] of agricultural streams to hydrological change. Five PARAFAC components were identified, including three terrestrial humic-like substances (C1, C2, C3), one microbial humic substance (C4), and one microbial protein-like substances (C5). The mean (C4+C5)/(C1+C2+C3) of all storm events at the most agricultural stream was 1.5 times larger than that of the most forested stream, suggesting that more protein-like DOM is exported from agricultural watersheds. Whereas a forest stream was primarily composed of terrestrially derived and 14C-enriched modern DOC, the 14C-age of the most agricultural stream was up to ∼1000 years old. The results suggest that agricultural practices could decrease the old organic carbon pools from soils. However, how quickly the aged DOC can be degraded to CO2 in streams is unknown, warranting future investigation on lability of the aged DOC and their effects on CO2 evasion from rivers and estuaries downstream.

Determination of boldenone in postmortem specimens including blood and urine samples using LC-MS/MS.

Boldenone (BOLD), one of androgenic anabolic steroids (AAS), although banned in humans, is still available illegally. AAS abuse has previously been associated with various cardiovascular adverse events including acute myocardial infarction, arrhythmia, and sudden death. In this study, the concentration of BOLD was determined in postmortem specimens from the corpse of a human male who intentionally injected BOLD undecylenate into his shoulder muscle. In addition, the endogenous levels of BOLD in the blood and urine samples of young human males have been reported. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with solid-phase extraction (SPE) was developed and validated for the analysis of BOLD in blood, muscular tissue and urine samples. The validation parameters including linearity, accuracy, precision, matrix effect, and recovery were satisfactory. The concentrations of BOLD in the blood of 20 young human males who didn't take BOLD were under the limit of quantitation (LOQ, 0.5 ng/mL). Additionally, the mean level of BOLD in the urine samples was 3.19 ± 1.65 ng/mL (range: 0.37˜6.02 ng/mL). The concentrations of BOLD in the victim's blood from the femoral vein and heart were 140.44 and 25.74 ng/mL, respectively. On the other hand, those in the muscular tissue from the injection site and the urine sample were 142.3 ng/g and 3474 ng/mL, respectively.

Identification of trichothecene-type mycotoxins in toxic mushroom Podostroma cornu-damae and biological specimens from a fatal case by LC-QTOF/MS.

In some autopsy cases, there are unknown natural toxins that are suspected to cause serious damage to the person. However, without reference materials, it is almost impossible to identify the suspicious natural toxins by GC-MS or LC-MS. In this case, a man drank mushroom -liquor with a meal at his home. Seven hours later, he was transported to the emergency room, and 12hours later, he died. In the ingested mushroom-infused-liquor, there were pieces of mushroom that were estimated to be Podostroma cornu-damae (Hypocreaceae) based on their morphological characteristics. To identify the species, chemical component analysis was conducted using LC-QTOF-MS/MS. Monoisotopic mass, fragment ions, and isotope distributions were obtained from the LC-QTOF-MS/MS analysis. In addition, fragment ions and structure matching were tested for target compound confirmation. In this analysis, several toxic trichothecene-type mycotoxins were identified including roridin D, roridin E, roridin Q, satratoxin G, satratoxin H, satratoxin H 12'-acetate, satratoxin H 13'-acetate, satratoxin H 12',13'-diacetate, and verrucarol. At autopsy, heart blood, peripheral blood, and the stomach contents were collected, and only satratoxin H was detected in these samples. This is the first finding of a trichothecene-type mycotoxin in a human biological sample from an expected case of P. cornu-damae intoxication. We demonstrated that LC-QTOF-MS/MS analysis was an effective method for mushroom intoxication cases in the absence of reference materials. Additionally, the experience, knowledge, and analytical methods we obtained in this study will be great assets for solving other cases of possible natural toxin intoxication.