Baseline characteristics and treatment response predictive of nAMD outcomes with ranibizumab therapy in treatment-naive patients: the RACER subgroup analysis.

BACKGROUND: The Ranibizumab AMD Clinical Efficacy Study (RACER) conducted in treatment-naive adult Taiwanese patients with neovascular age-related macular degeneration (nAMD) suggested the importance of early and intensive dosing of ranibizumab for optimal treatment outcomes. This subgroup analysis aims to provide clinical information on treatment response that can potentially guide on maintaining the treatment or switching anti-VEGF agents in the real-world setting. METHODS: Visual acuity (VA) and central retinal thickness (CRT) were assessed in the RACER subgroup population. Subgroup analysis sets were categorised based on: (1) baseline best-corrected VA (BCVA; ≤ 48 and > 48 letters); (2) baseline CRT (≤ 325 or > 325 µm); and (3) treatment response after three monthly initial injections: < or ≥ 5-letter gain in BCVA and reduction of < or ≥ 50 µm in CRT. RESULTS: Patient age, sex, nAMD duration and number of ranibizumab injections did not differ significantly between the treatment subgroups. Poor baseline BCVA (≤ 48 letters) and baseline CRT severity (> 325 µm) were predictors of maximum BCVA gains (9.6 ± 12.9 letters [95%CI: 6.3 to 12.9] and 5.1 ± 18.3 letters [95%CI: - 0.5 to 10.8] at Months 3 and 12, respectively) and better CRT reductions (- 127.6 ± 104.2 µm and - 104.2 ± 107.4 µm at Months 3 and 12, respectively; both P < 0.001). For the subgroup showing favourable treatment improvement with BCVA gains ≥ 5 letters after three monthly initial injections, 75.6% of patients maintained follow-up at Month 12 with a mean of 6.5 ± 14.3 letter gains (95% CI: 1.2 to 11.7). The BCVA gains < 5-letter subgroup nevertheless had stable BCVA (0.4 ± 12.1 letter gains) and CRT (- 41.9 ± 61.2 µm) at Month 12, respectively. In the subgroup with ≥ 50 µm CRT reduction after three monthly initial injections, there are significantly higher BCVA improvements vs. the < 50 µm CRT reduction subgroup at Month 3 (5.0 ± 8.6 letter gains vs. 1.5 ± 11.6 letter gains, respectively; intergroup P = 0.005). CONCLUSION: Lower baseline BCVA and higher baseline CRT were associated with BCVA gains and CRT reductions throughout the 12-month study period. Early CRT improvements after three monthly initial injections were associated with BCVA gains as early as Month 3.

Locally Acquired Leptospirosis in Expedition Racer, Manitoba, Canada.

Leptospirosis is found worldwide, except in northern regions. We report a case associated with a backcountry adventure race in Manitoba, Canada. Initially, nonspecific symptomatology and diagnostic pitfalls contributed to a delay in identification. Careful attention needs to be paid to exposure to and risk for leptospirosis in northern and temperate climates.

RACER-GRASP: Respiratory-weighted, aortic contrast enhancement-guided and coil-unstreaking golden-angle radial sparse MRI.

PURPOSE: To develop and evaluate a novel dynamic contrast-enhanced imaging technique called RACER-GRASP (Respiratory-weighted, Aortic Contrast Enhancement-guided and coil-unstReaking Golden-angle RAdial Sparse Parallel) MRI that extends GRASP to include automatic contrast bolus timing, respiratory motion compensation, and coil-weighted unstreaking for improved imaging performance in liver MRI. METHODS: In RACER-GRASP, aortic contrast enhancement (ACE) guided k-space sorting and respiratory-weighted sparse reconstruction are performed using aortic contrast enhancement and respiratory motion signals extracted directly from the acquired data. Coil unstreaking aims to weight multicoil k-space according to streaking artifact level calculated for each individual coil during image reconstruction, so that coil elements containing a high level of streaking artifacts contribute less to the final results. Self-calibrating GRAPPA operator gridding was applied as a pre-reconstruction step to reduce computational burden in the subsequent iterative reconstruction. The RACER-GRASP technique was compared with standard GRASP reconstruction in a group of healthy volunteers and patients referred for clinical liver MR examination. RESULTS: Compared with standard GRASP, RACER-GRASP significantly improved overall image quality (average score: 3.25 versus 3.85) and hepatic vessel sharpness/clarity (average score: 3.58 versus 4.0), and reduced residual streaking artifact level (average score: 3.23 versus 3.94) in different contrast phases. RACER-GRASP also enabled automatic timing of the arterial phases. CONCLUSIONS: The aortic contrast enhancement-guided sorting, respiratory motion suppression and coil unstreaking introduced by RACER-GRASP improve upon the imaging performance of standard GRASP for free-breathing dynamic contrast-enhanced MRI of the liver. Magn Reson Med 80:77-89, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Coluber Constrictor Bite to the Eye: A Novel Case Report of a Wild Snake Bite to the Eye in North America and Review of Literature.

Snake bites involving the eye are an uncommon cause of ocular trauma; herein, we present one of the few known instances of a snake bite directly to the globe, specifically by the way of a Coluber constrictor, also known as the "Black Racer." In this case report, we describe a nine-year-old girl who presented immediately following a snake bite to the right eye. The patient's vision was unaffected despite visualized puncture wounds through the conjunctiva with associated near-total subconjunctival hemorrhage. The patient was taken to the operating room emergently for globe exploration. Circumferential peritomy and direct view to the sclera did not reveal any lacerations or puncture and subconjunctival vancomycin, gentamycin, and dexamethasone were administered intraoperatively. Post-operatively, the patient was discharged on a regimen of oral Cephalexin. Throughout multiple follow-ups, she continued to maintain excellent vision without sequelae. Trauma to the globe via snake bite is an exceedingly rare occurrence. Upon literature review, three out of three cases involving venomous snakes resulted in "No Light Perception" vision despite anti-venom. While nonvenomous snake bites may lend a better visual outcome, if not treated properly they may also yield poor final visual potential. Methods of treatment include oral or subconjunctival antibiotic administration with or without a steroid or cycloplegic agent. All reported cases of nonvenomous cases ultimately resulted in excellent visual potential (20/40 or better) and no reports of endophthalmitis. As such, it is evident that identifying the species of snake is of the utmost importance when considering visual prognosis. Due to very few reported incidences of globe trauma via snake bite, there is no mainstay therapy for either the venomous or nonvenomous snake bite variety. Despite this, we encourage careful pursuance of the appropriate therapy on a case-by-case basis, considering operative treatment, antivenom (if necessary), and antibiotic coverage with possible cycloplegia and steroid administration.

Revealing the Unknown: Real-Time Recognition of Galápagos Snake Species Using Deep Learning.

Real-time identification of wildlife is an upcoming and promising tool for the preservation of wildlife. In this research project, we aimed to use object detection and image classification for the racer snakes of the Galápagos Islands, Ecuador. The final target of this project was to build an artificial intelligence (AI) platform, in terms of a web or mobile application, which would serve as a real-time decision making and supporting mechanism for the visitors and park rangers of the Galápagos Islands, to correctly identify a snake species from the user's uploaded image. Using the deep learning and machine learning algorithms and libraries, we modified and successfully implemented four region-based convolutional neural network (R-CNN) architectures (models for image classification): Inception V2, ResNet, MobileNet, and VGG16. Inception V2, ResNet and VGG16 reached an overall accuracy of 75%.