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Niles, IL, Nov. 9, 2015 – Shure announced today that they have named Livella Brand Group as its sales representative for the Central Region of the United States. Livella Brand Group, a new rep firm located in Gardner, KS, will manage sales for the complete Shure line of professional audio products to dealers and systems integrators in Nebraska, Iowa, Missouri, Kansas, and Southern Illinois.
"We searched high and low for the best representation in this territory and are very excited to work with this creative and promising company," said Jim Schanz, Director of Sales, Pro/Systems Group, U.S. and Canada. "Livella Brand Group is a new rep firm, but its foundation is based on the experience of Adam Livella, who is very knowledgeable of the audio industry and has a strong reputation in the territory," added Abby Kaplan, Director of Sales, Retail Group, U.S. and Canada. "To have this new firm completely committed to Shure as they grow their business is an exciting opportunity."
"Livella Brand Group is thrilled to begin this strategic relationship with Shure as Shure celebrates their 90th year as an industry leader in professional audio," said Adam Livella, President of Livella Brand Group. "Our company was created to provide premium representation for manufacturers like Shure that have turned a passion for excellence into an obsession. Livella Brand Group will serve the reseller network by exceeding expectations in all areas of communication and customer service."
© Lee Hartman & Sons Inc. All rights reserved.
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A group of local officials has begun an extensive review of the middle school's heating system, which was damaged recently after running out of oil.
Superintendent Joseph Wood said Friday that he hopes the group will decide within a month on a plan for permanent repairs of the system and how to pay for the project.
"We still have a lot of research to do. We have to determine where we go from here," Wood said.
The group met Thursday for the first time and was given a report on the system failure by Patrick T. Hankard, director of building maintenance.
"The goal was to bring the people together . . . give everyone a perspective of what happened," Wood said.
The group includes Wood, Hankard, the town attorney, town manager, a private contractor and members of the town council, board of education and public building commission.
The heating system stopped working last month when it ran out of fuel. The school was supposed to receive about 10,000 gallons of heating oil; instead, the fuel was delivered by mistake to a nearby elementary school.
As a result, the school's boilers shut down and, with temperatures well below freezing, water froze in portions of the heating elements. The problem caused thousands of dollars in damage to the heating system and forced officials to close the school for two days.
Wood has not determined the cost of the project.
The group will decide whether to sue the oil delivery company or put in an insurance claim, Wood said.


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Intravitreal anti-vascular endothelial growth factor (VEGF) agents can treat macular edema (ME) in branch retinal vein occlusion (BRVO). However, refractory ME, the mechanism of which is not well elucidated, occurs frequently. Sixty-six eyes with ME secondary to BRVO were enrolled in this retrospective observational case-control study. Twenty eyes received a sub-Tenon's capsule injection of triamcinolone acetonide (STTA), 22 eyes an intravitreal anti-VEGF injection (ranibizumab), 16 eyes were switched from STTA to ranibizumab, 4 eyes underwent vitrectomy and 4 eyes were untreated. Multiple regression analysis and multivariate logistic regression analysis were conducted, respectively, to identify independent predictors of visual acuity (VA) prognosis and risk factors for refractory ME longer than 1 year. The mechanism of refractory ME and therapeutic approaches for identified risk factors also were investigated. Thirty-four (52%) eyes had refractory ME for over 1 year. Microaneurysms were identified as risk factors for refractory ME, leading to poor final VA. Ranibizumab suppressed microaneurysm formation and refractory ME, with early administration more effective. For already formed microaneurysms, laser photocoagulation reduced additional treatments. Microaneurysms may cause refractory ME in BRVO. Alternative therapy to suppress microaneurysms should be considered to prevent refractory ME in patients with BRVO.
Branch retinal vein occlusion (BRVO) usually results from a thrombus at the arteriovenous crossings where a thickened artery compresses the underlying venous wall, resulting in elevated venous pressure and consequent macular edema (ME), retinal ischemia and rupture of the retinal wall with intraretinal hemorrhage1. In the chronic phase, after absorption of the intraretinal hemorrhage, several retinal vascular abnormalities can develop, such as capillary non-perfusion, capillary dilation, microaneurysms, telangiectatic vessels and collateral vessels2. In most patients, ME is the predominant cause of visual loss in the acute and chronic phases.
The Branch Vein Occlusion Study (BVOS) group investigated the effects of grid laser treatment in patients with ME following BRVO3. However, the visual improvement after laser treatment occurred slowly and was limited, indicating the need for more effective treatments that provide rapid and complete visual restoration.
Elevated intraocular levels of vascular endothelial growth factor (VEGF) have been reported in patients with RVOs4,5. Intravitreal sustained release of VEGF in rabbits and primates caused vascular leakage and ME6. Recent prospective, randomized and multicenter clinical trial such as the BRAVO7,8,9, HORIZON10 and RETAIN11 studies showed the effectiveness of anti-VEGF therapy in patients with ME secondary to BRVO. These results were far superior to that in the BVOS. Therefore, anti-VEGF therapies are now the first choice for treating ME in BRVO. However, the ME recurs frequently despite the anti-VEGF therapy and additional injections are administered without investigating the origin of the ME. The mechanism of refractory ME has not been well studied.
In the current study, we sought to determine the risk factors for refractory ME in patients with BRVO. The mechanism and alternative therapeutic approaches also were investigated.
Baseline characteristics
Table 1 shows the patients' baseline characteristics. Sixty-six eyes of 66 patients (32 men, 34 women; mean age, 73 ± 8.4 years) (mean ± standard deviation [SD]) with ME secondary to BRVO were enrolled. The baseline best-corrected logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was 0.32 ± 0.31 (mean ± SD) and the baseline central retinal thickness (CRT) was 440 ± 140 (mean ± SD) μm. Twenty eyes were treated with a sub-Tenon's capsule injection of triamcinolone acetonide (STTA), 22 eyes with an intravitreal injection of an anti-VEGF agent (ranibizumab, Lucentis, Genentech, Inc., South San Francisco, California, USA), 16 eyes were switched from STTA to an anti-VEGF agent, 4 eyes with vitrectomy and 4 eyes were untreated. Laser photocoagulation for the non-perfusion area and/or retinal neovascularization was performed in 35 (53%) eyes.
Regarding the ocular findings associated with BRVO, a non-perfusion area larger than 5 disc diameters was observed in 23 (35%) eyes, superficial capillary telangiectasias in 30 (45%) eyes, deep capillary telangiectasias in 40 (61%) eyes, microaneurysms in 46 (70%) eyes and collateral vessels in 56 (85%) eyes.
Factors prognostic of the final VA
Age, gender, diabetes mellitus, hypertension, BRVO subtype, baseline VA, baseline CRT, size of non-perfusion areas, microaneurysms, collateral vessels, time of initial treatment, treatment type and laser photocoagulation were analyzed as factors predictive of the final VA. Univariate regression analysis found that the baseline VA (P < 0.001; β, 0.59), refractory ME (P = 0.001; β, 0.28), older age (P = 0.002; β, 0.02) and major BRVO (P = 0.031; β, 0.19) (Table 2) were factors correlated with the final VA. Multivariate regression analysis of these factors detected the baseline VA (P < 0.001; β. 0.52 (95% confidence interval [CI] 0.29–0.75) and refractory ME (P = 0.019; β, 0.19 (95% CI, 0.03–0.35) (Table 2) as factors predictive of the final VA.
Risk factors for refractory ME
Univariate logistic regression analysis detected microaneurysms (P < 0.001; odds ratio [OR], 18.1), older age (P = 0.001; OR, 1.1), collateral vessels (P = 0.019; OR, 12.9) and laser photocoagulation (P = 0.03; OR. 3.1) as risk factors for refractory ME (Table 3). Multivariate logistic regression analysis of these factors detected microaneurysms (P = 0.007; OR, 11.0; 95% CI. 2.25–85.9) and older age (P = 0.01; OR, 1.1; 95% CI, 1.04–1.27) (Table 3).
Time of microaneurysm formation after BRVO onset
With these results, we speculated that microaneurysm formation caused refractory ME in patients with BRVO. Most microaneurysms, which seem to be a microvascular response to VEGF, originated from hypoxic retinal tissue in the inner nuclear layer and border zones12. In BRVO eyes, RVOs initiate retinal ischemia and ME. We could identify the time of microaneurysm formation after BRVO onset in 37 eyes of 46 eyes with microaneurysms. In 19 (51%) of 37 eyes, microaneurysms were detected within 6 months after BRVO onset and in 31 (84%) eyes within 9 months (Fig. 1B) (average formation time, 6.1 ± 3.1 [mean ± SD] months. Figure 1A shows representative optical coherence tomography (OCT) angiography images. Microaneurysms were observed on month 6.
Microaneurysm formation, refractory ME and VA prognosis (difference among the three treatment groups)
Significantly (P < 0.01) fewer occurrence of microaneurysms was seen in eyes treated with anti-VEGF agents (41%), while in eyes treated with STTA and switch therapy from triamcinolone to anti-VEGF agents, microaneurysms were observed in 90% and 81%, respectively. Moreover, anti-VEGF agents significantly (P < 0.01) reduced the number of microaneurysms compared with the STTA-treated group (Fig. 2A). These results supported that over-expression of VEGF leads to microaneurysm formation.
When we checked the frequency of refractory ME associated with each treatment, in eyes treated with anti-VEGF therapy, less refractory ME was seen (18%) compared with STTA (57%) and switch therapy (81%). Regarding the VA prognosis, anti-VEGF agent-treated eyes significantly improved, while eyes treated with STTA and switch therapy did not do so (Fig. 2B). The percentage of eyes with better than 0.5 decimal VA at the final visit was 65% (13 of 20 eyes) in the STTA group, 82% (18 of 22 eyes) in the anti-VEGF group and 69% (11 of 16 eyes) in the switch therapy group. At the final visit, the CRT in each group decreased significantly (P < 0.01) (Fig. 2C). However, frequently recurring ME might result in a poor final visual prognosis in eyes treated with STTA and switch therapy (Fig. 2B).
Prompt anti-VEGF therapy reduces the number of microaneurysms and frequency of refractory ME
We compared the number of microaneurysms between prompt (within 3 months after BRVO onset) and delayed (over 3 months after BRVO onset) anti-VEGF therapy. Thirty-eight eyes (including eyes with switch therapy) were treated with intravitreal ranibizumab injections, i.e., 15 eyes with prompt anti-VEGF therapy and 23 eyes with delayed anti-VEGF therapy. Prompt anti-VEGF therapy significantly (P < 0.05) reduced the number of microaneurysms (Fig. 3A). The incidence rates of refractory ME were 20% with prompt anti-VEGF therapy and 65% with delayed anti-VEGF therapy (P < 0.01). The total number of injections in the prompt anti-VEGF therapy group was not more than that in the delayed anti-VEGF therapy group (Fig. 3B).
Eleven of 34 eyes with refractory ME underwent direct laser photocoagulation at the microaneurysms. The average time after BRVO onset was 34 ± 9.8 (mean ± SD) months. The VAs after direct laser photocoagulation did not improve significantly, but the CRT decreased significantly (P < 0.05) (Fig. 4). Moreover, eight of 11 eyes treated with direct laser photocoagulation did not need additional treatments. Figure 4 shows a representative case. Microaneurysms were not observed at baseline, whereas numerous microaneurysms causing ME were detected 14 months after BRVO onset (Fig. 4). Direct laser photocoagulation targeting the microaneurysms resolved the ME (Fig. 4C).
In the current study, we found that refractory macular edema in patients with BRVO was associated with microaneurysms formation and resulted in poor final visual acuity. We also found that microaneurysms were formed at about 6 months after the disease onset and blockage of VEGF reduced the microaneurysms formation, leading to better final visual prognosis. If the anti-VEGF agents were administered earlier, the effect was more powerful. Furthermore, for already formed microaneurysms, direct laser photocoagulation was effective in reducing additional treatments.
Previous randomized multicenter studies have reported that ME in BRVO can be treated with anti-VEGF drugs7,8,9,10,11. However, refractory ME persists despite frequent anti-VEGF drugs injections. Once the ME becomes refractory, the final visual prognosis worsens (Table 2). The patients need frequent hospital visits with more associated costs. Therefore, detecting the risk factors for refractory ME is critical to gain an understanding of the pathology of ME in BRVO and may lead to alternative therapeutic approaches. Furthermore, if alternative therapy can reduce refractory ME, the patients might be free from the treatment burden earlier.
In the current study, we evaluated microvascular abnormalities in BRVO eyes using multimodal imaging with fundus photographs, OCT, fluorescein angiography (FA) and OCT angiography, then found that microaneurysm formation may be a risk factor for refractory ME in patients with BRVO. If so, alternative therapy targeting the microaneurysms or suppressing microaneurysm formation may reduce the treatment burden.
The other prognostic factor for the final VA was the baseline VA, which was reported previously13,14. We also analyzed the cause of poor baseline VA, but that was unclear (data not shown). Another risk factor for refractory ME was age, possibly because the endothelium of the blood vessels would be damaged as the patients age. Previous animal studies failed to exhibit persistent ME because the animals had healthy vascular systems15,16,17, suggesting that aging vessels are needed for ME to persist.
We have used STTA as the first-choice treatment for ME associated with BRVO until ranibizumab was approved for use in August 2013 in Japan. After approval, anti-VEGF therapy (ranibizumab) was used alternatively as a first-choice treatment in our hospital. Therefore, in the current study, several treatments were performed for ME associated with BRVO.
Interestingly, anti-VEGF therapy suppressed the number of microaneurysms compared with STTA injections. Over-expression of VEGF was reported in BRVO eyes4,5. Furthermore, it was reported that over-expressed VEGF resulted in microaneurysm formation in an animal study18. Blockage of VEGF might reduce microaneurysm formation due to continuous VEGF expression in BRVO eyes.
We also found the average time of microaneurysm formation after BRVO onset (Fig. 1). In diabetic retinopathies, microaneurysms were considered as early findings in the disease course. However, as we showed in the current study, microaneurysms in BRVO were not that common at the onset of BRVO and gradually formed over time after venous occlusion. The formation of microaneurysms in BRVO might differ from that in diabetic retinopathy. Briefly, venous obstruction leads to turbulent blood flow, elevated venous pressure and overload of drainage capacity that might cause ME in the acute phase19. Chronic increased retinal venous blood flow velocity causes shear stress on the venous endothelium and endothelial injury20,21. High shear stress gradients and turbulent blood flow can cause reactive proliferative changes in the endothelial cells and endothelial damage22. In this scenario, over-expression of VEGF might cause microaneurysm formation, leading to refractory ME. Therefore, it takes time for microaneurysm to form after BRVO onset. It is clear that earlier blockage of VEGF suppressed the number of microaneurysms (Fig. 3), resulting in a lower incidence of refractory ME. Although delayed (over 3 months after BRVO onset) all treatment was unrelated to refractory ME in the current study (Table 3), we speculated that it might be, because the eyes treated with STTA within 3 months of BRVO onset also were included in the multivariate logistic regression analysis. Some cases with BRVO have resolution of ME and improvement in VA without intervention23. Therefore, in these cases, intervention is sometimes postponed until the VA deteriorates. However, a clinically relevant improvement beyond 20/40 was uncommon without intervention23. Moreover, it is unknown which cases would have resolution of ME without treatment. Early treatments with another anti-VEGF drug (bevacizumab, Avastin, Genentech Inc.) have been reported as predictive of functional and visual improvements24,25. Taken together, we think that ME in BRVO should be treated as soon as possible before microaneurysms form.
Interestingly, the total number of injections in the prompt anti-VEGF therapy group was not more than that in the delayed anti-VEGF therapy group. We speculated this occurred because earlier blockage of VEGF inhibited microaneurysm formation causing refractory ME, which might shorten the disease duration. A previous randomized multicenter study reported that the effect of delayed treatment with ranibizumab was comparable to that of prompt treatment10. However, the improvements in VA were six and two letters less in the Early Treatment Diabetic Retinopathy Study VA than prompt treatment at months 12 and 24, respectively. In the HORIZON study10 with ranibizumab, the incidence of refractory ME was not compared between the prompt- and delayed-treatment groups. Microaneurysm formation itself might cause the difference in visual improvement.
We previously reported that microaneurysms in BRVO eyes formed at the edge of the non-perfusion area and in the collateral vessels26. In the current study, collateral vessel formation was associated with refractory ME in univariate logistic regression analysis (Table 3). Collateral vessels usually lead to spontaneous resolution of ME19. However, once microaneurysms form in the collateral vessels, they might cause refractory ME, suggesting that collateral vessels might have an opposite effect on ME.
We also found that the microaneurysms causing refractory ME were treatable by direct laser photocoagulation. While the VA did not improve after direct laser photocoagulation, the CRT decreased and fewer treatments were needed. In the current study, direct photocoagulation was performed 34 months after BRVO onset. Sakimoto et al. reported that application of direct laser photocoagulation 20 months after BRVO onset improved vision in patients with chronic ME secondary to BRVO27. Earlier application of direct photocoagulation might improve the VA. Another benefit of direct photocoagulation was the reduction in the additional treatments. The RETAIN study11 reported that frequent injections of ranibizumab were still needed for unresolved ME 4 years after BRVO onset. Therefore, it is important not only for patients to have a lower treatment burden but also to have reduced medical expenses. We previously reported that indocyanine green angiography (ICGA)-guided laser photocoagulation was effective in idiopathic macular telangiectasia and diabetic ME28,29, both of which can cause ME due to microaneurysms. The same method might be applicable in patients with refractory ME in BRVO.
The current results are important to understand the pathology in ME with BRVO and detect the cause of the refractory ME. Earlier administration of anti-VEGF agents and direct photocoagulation targeting the microaneurysms might decrease the treatment burden and medical expenses.
The current study had several limitations. First, this study was a retrospective observational study and the intervention was not controlled. Second, the sample size was small. Further studies with larger samples or prospective, randomized and multicenter clinical trials are needed to confirm these results and decrease the treatment burden.
The institutional Review Board of Nagoya City University Graduate School of Medical Sciences approved this single-center, retrospective, observational and case-control study. The research methods and analysis adhered to the tenets of the Declaration of Helsinki. All patients visited Nagoya City University Hospital from March 1, 2005, through October 1, 2014 and were followed for longer than 1 year (mean follow-up period, 38 months; range, 12–125 months). All patients underwent a complete ophthalmic examination including measurement of the best-corrected VA, indirect ophthalmoscopy, fundus photography, OCT (Cirrus HD-OCT, Carl Zeiss Meditec, Jena, Germany), FA (indocyanine green angiography [ICGA]), and/or OCT angiography (RTVue XR Avanti, AngioVue, Optovue Inc., Fremont, California, USA). FA was performed using a wide-field laser ophthalmoscope Optos 200Tx and/or confocal scanning laser ophthalmoscopy (Heidelberg Retina Angiograph 2, Heidelberg Engineering, Heidelberg, Germany). Visual acuity was measured using a standard Japanese decimal chart and converted to logarithm of minimal angle of resolution (logMAR) to perform statistical analyses. Refractory ME was defined as ME which persisted or recurred over 1 year after the disease onset. Microaneurysm formation was judged using ophthalmoscopy, fundus photographs, FA, and/or OCT angiography. The counting of microaneurysms was done at one year after BRVO onset. All patients provided their past medical history including diabetes mellitus and hypertension. Patients were excluded when the captured images were inadequate for evaluation because of ocular movement or cataract as were those who had not been followed longer than 1 year.
STTA (20 mg/0.5 ml) (Kenacort, Bristol-Myers Squibb, Tokyo, Japan) was injected into the sub-Tenon's capsule as a first-choice treatment for ME associated with BRVO from March 2005 through July 2013. The intravitreal anti-VEGF drug ranibizumab was used as an alternative first-choice from August 2013 and thereafter, when ranibizumab was approved for use to treat ME associated with BRVO in Japan. After that, STTA was switched to intravitreal ranibizumab injections when STTA did not result in reducing ME. Vitrectomy was performed when STTA was ineffective and before ranibizumab was approved for use. Patients who did not want treatment were observed without intervention. Additional treatments were applied for recurrent ME when the CRT exceeded 250 μm. Scatter laser photocoagulation was performed for retinal neovascularization and/or non-perfusion areas larger than 5 disc diameters detected by FA. Grid laser photocoagulation was not performed for macular edema in this current study.
Direct laser photocoagulation for microaneurysms
FA and/or ICGA were performed before direct laser photocoagulation. Direct laser photocoagulation was applied to microaneurysms using a multicolor laser system (Novus Varia, Lumenis, Salt Lake City, UT, USA) with the following settings: wavelength, 561 nm; power, 100–200 mW; spot size, 50–100 μm; and duration, 0.02–0.05 sec. Additional laser photocoagulation was applied for residual microaneurysms causing ME.
Statistical analyses were performed using Project R (R Core Team 2015, Vienna, Austria) and the significance level was set at P < 0.05. Univariate analyses were performed to detect factors predictive of the final VA and risk factors for refractory ME, then the factors with P values less than 0.05 were selected for multivariate regression analyses. Post hoc Bonferroni correction was used to compare the number of microaneurysms among the three treatment groups. Fischer's exact test was used to confirm the relation between refractory ME and prompt anti-VEGF therapy. Changes in the logMAR VA or CRT were assessed using one-way repeated-measures analysis of variance (ANOVA) and post hoc Bonferroni correction. Two-way repeated-measures ANOVA was used to investigate differences in the clinical courses of the VA and CRT among the groups. The paired t-test was used to compare the numbers of microaneurysms between the prompt- and delayed-treatment groups and the logMAR VA and CRT before and after direct laser photocoagulation.
Study approval
The Institutional Review Board of Nagoya City University approved the study protocol. Each patient provided written informed consent following a detailed explanation of the procedures.
Additional Information
How to cite this article: Tomiyasu, T. et al. Microaneurysms cause refractory macular edema in branch retinal vein occlusion. Sci. Rep. 6, 29445; doi: 10.1038/srep29445 (2016).
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Campochiaro, P. A., Sophie, R., Pearlman, J., Brown, D. M. et al. Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab: the RETAIN study. Ophthalmology. 121, 209–219 (2014).
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Kondo, M., Kondo, N., Ito, Y. et al. Intravitreal injection of bevacizumab for macular edema secondary to branch retinal vein occlusion: results after 12 months and multiple regression analysis. Retina. 29, 1242–1248 (2009).
Rehak, J., Dusek, L., Chrapek, O. et al. Initial visual acuity is an important prognostic factor in patients with branch retinal vein occlusion. Ophthalmic Res. 45, 204–209 (2011).
Hamilton, A. M., Kohner, E. M., Rosen, D. et al. Experimental retinal vein occlusion in rhesus monkeys. I. Clinical appearances. Br J Ophthalmol. 63, 377–387 (1979).
Rosen, D. A., Marshall, J., Kohner, E. M. et al. Experimental retinal vein occlusion in rhesus monkeys. II. Retinal blood flow studies. Br J Ophthalmol. 63, 388–392 (1979).
Hockley, D. J., Tripathi, R. C. & Ashton, N. Experimental retinal vein occlusion in rhesus monkeys. III. Histopathological and electron microscopical studies. Br J Ophthalmol. 63, 393–411 (1979).
Tolentino, M. J., Miller, M. J., Gragoudas, E. S. et al. Intravitreous injections of vascular endothelial growth factor produce retinal ischemia and microangiography in an adult primates. Ophthalmology. 103, 1820–1828 (1996).
Christoffersen, N. L. & Larsen, M. Pathophysiology and hemodynamics of branch retinal vein occlusion. Ophthalmology. 106, 2054–2062 (1999).
Kumar, B., Yu, D. Y., Morgan, W. H., Barry, C. J., Constable, I. J. & McAllister, I. L. The distribution of angioarchitectural changes within the vicinity of the arteriovenous crossing in branch retinal vein occlusion. Ophthalmology. 105, 424–427 (1998).
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The authors thank Fumie Shibuya, Yasuyo Matsuda, Sayaka Oshio and Ayano Maruyama (Nagoya City University Graduate School of Medical Sciences) for contributing to data collection. The authors thank Medical International for professional medical English editing. Y. Hirano is supported by a Grant-in-Aid for Scientific Research (C) 15K10875 from the Japan Society for the Promotion of Science, Mochida Memorial Foundation, Takeda Science Foundation and Suzuken Memorial Foundation. The other authors have no proprietary/financial interests.
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Tomiyasu, T., Hirano, Y., Yoshida, M. et al. Microaneurysms cause refractory macular edema in branch retinal vein occlusion. Sci Rep 6, 29445 (2016). https://doi.org/10.1038/srep29445
Further reading
<p>Morphologic Classifications and Locations of Microaneurysms and Clinical Relevance in Branch Retinal Vein Occlusion</p>
Clinical Ophthalmology (2020)
Suspended scattering particles in motion using OCT angiography in branch retinal vein occlusion disease cases with cystoid macular edema
Scientific Reports (2020)
Current practice in the management of branch retinal vein occlusion in Japan: Survey results of retina specialists in Japan
Japanese Journal of Ophthalmology (2019)
Retina (2019)
Retina (2019)
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Good things can happen when marbling leads selection criteria
by Steve Suther
December 16, 2019
What happens to a commercial Angus herd after 23 years of selection led by marbling? No worries, really, just premium opportunities.
That's the nutshell from veteran Iowa State University animal scientist Dan Loy, whose team recently authored a white paper based on data from their quality-selected Angus herd.
In November, Loy reminded producers at the Angus Convention in Reno, "Reproduction in the cow herd is very complex. There's a genetic component—that's the big box across the top—but it's impacted by the environment and nutrition at different stages—there are a lot of moving parts."
Noting past studies and literature reviews, he then focused on ISU's Angus cow herds, first set up in 1996 as a means to use ultrasound-based selection for either high marbling or high yield. In 2002, the latter herd was dispersed when American Angus Association's statistical tools had improved. The breed's expected progeny difference (EPD) for marbling (MARB) has guided the 400-cow herd at the fescue-based McNay Farms in southcentral Iowa since then (see sidebar).
Loy compared the Angus MARB versus the ISU herd's EPD over time, simplified with trend lines that currently show the average ISU cows now higher than 1 while the Angus average nears 0.6.
Looking at interactions with other EPDs, he pointed out the Iowa cows lagged behind on heifer pregnancy early on.
"We've been improving that through the years so that, currently, we're about breed average," he said, adding the same can be said for the milk and weaning weight EPDs.
An unusual feature of the Iowa herd is the internally raised crop of breeding bulls. They allow for "a unique dataset," Loy said, that includes the ability to track the scrotal circumference EPD, slightly above breed average, and within the Angus breed, slightly positive in its correlation to marbling.
The ISU herd phenotype in terms of carcass performance can be seen in the finished steers and heifers marketed in the last five years, currently at 93% or more qualified for the Certified Angus Beef ® (CAB®) brand, including 57% Prime.
"I like to say Prime is the new Choice," Loy remarked, "because working with feedlot nutritionists, and in the research, you always see quality expressed in terms of percent Choice.
"With these cattle, that's a meaningless number, because they're all Choice," he said. A guiding principle now is, "We just need to figure out how not to screw that up."
Average ribeye area, fat thickness and yield grade within the ISU herd "very typical of the industry," Loy said, although the carcass weights are a little lighter.
The research setting and quality goals open research doors into the timing of marbling deposition as well as how brood cows deplete and build up intramuscular fat during a production year.
Serial harvest of steers has found weanling steers that could already grade Choice.
"We know marbling starts much earlier in life that was thought, and it's a slower process," Loy said. The ISU team has just started monitoring marbling levels in cows during gestation to see how much it may draw down or increase with body condition scores.
Other datasets include calving intervals and reproductive success over time, compared to marbling. Simple correlations found significant, slightly positive relationships with heifer pregnancy, number of calves produced and even numerically favorable in terms of calving interval.
"So that's in the right direction," Loy noted.
"Overall, it's kind of like a broken record and a little bit boring, but we found very little relationship between marbling and reproduction," he concluded.
Leading up to ISU herd data analysis
Genetic improvement in beef cattle means jumping hurdles or "antagonisms" among the traits.
When animal scientist Dan Loy signed on with Iowa State University (ISU) as a feedlot specialist 40 years ago, he brought along a commercial Angus background. Best practices for the herds supplying feedlots then were crossbreeding and balanced selection for maternal and growth traits.
Stockmen had to use single-trait "heifer bulls," because there weren't many bulls with calving ease along with growth. If anybody paid attention to marbling, they probably noticed some bulls above average there had little else to recommend them.
Science charted and measured the antagonisms for decades, and the Certified Angus Beef ® (CAB®) brand sponsored a literature review at Kansas State University in 1999, updated in 2007. That was revisited by researchers at Virginia Tech in 2013. The consensus has always found little or no correlation between marbling and other traits.
That lack of correlation says marbling, maternal function and growth should all fit together in the same cow.
Before those studies, in 1996, Loy and ISU began gathering data on calves from the University's two Angus herds, built on either marbling or ribeye emphasis. Early on, results were not much publicized and after six years, the ribeye herd was discontinued when an ultrasound technician moved on.
It took many years to build up enough volume to achieve significance in data from the McNay Farms herd near Chariton, Iowa. But that time has come with the white paper's publication, now available online.
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Flavor's secret ingredient
As a moderately to highly heritable trait, marbling is something that cattlemen have a lot of ability to manage. It also happens to be one of the major contributors to beef flavor. Texas Tech University meat scientist Jerrad Legako spoke about the topic at the 2020 American Society of Animal Science meetings.
Eager to learn, ready to teach
It's a call to serve, the same that led John Grimes to run for the American Angus Association board of directors. The sun now setting on his second three-year term, he reflects on his leadership as Certified Angus Beef® board chairman. The head of Maplecrest Farms in Hillsboro, Ohio, says there's no instant gratification in the cattle business, with constant change cattlemen have to be nimble.


text: Eclipse Community Forums - RDF feed https://www.eclipse.org/forums/ Eclipse Community Forums Setting POM among Eclipse projects https://www.eclipse.org/forums/index.php/mv/msg/235267/715989/#msg_715989 I have 3 Eclipse projects, one is a war, and the other 2 are jar. I updated POM of the war project to depend on the 2 projects (having their own POMs). Yet, when looking at the Maven Dependencies, the lines for these 2 projects have no content. Yet, the dependencies of the POM in one of them are all applied to the war project. The war resulting from this seem to be okay - but I cannot be sure that indeed that it is so. Another problem, is that I moved one Interface file from the war project to the third jar project. Yet, The target classes still include the Interface class file with the same path as originally, although that file is long gone from the file system. Yet, the war execution fails with Class Not Found for the moved (and renamed) interface, even though the jar file of that project is in the .war file generated for the war project. Many thanks, - Uri]]> Uri Shani 2011-08-16T07:19:57-00:00


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Dear Flora, Do you need aUS student visa or an Italy student visa? Hope these IP address could help u...
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3 floors villa with a total of 9 bedrooms and 11 bathrooms (6 bedrooms + 3 apartments - 1 studio + 2 with one bedroom), garage and swimming pool. This property consists of: Middle Floor - On the middle floor we have a large entrance hall, large living room with fireplace and air conditioning and with access straight to the outside terrace, open plan equipped kitchen with pantry and dining room also with access to the balcony overlooking the pool and with an independent entrance. 2 bedrooms, 1 of which is en-suite and 1 bathroom. Both bedrooms with access to the outside balcony, air conditioning and fitted wardrobes. Top floor - 4 bedrooms, all en suite, one being quite large. all rooms with direct access to the balcony, fitted wardrobes and air conditioning. The upper floor also has an independent entrance and a wide corridor that connects all rooms. CAVE - It has 3 apartments (1 studio + 2 with one bedrooms, all with kitchenette, bathrooms and independent entrances), large garage, laundry and tech room. Outside we have a large terrace with a salt water pool and barbecue area, also with independent access to the public road and a terrace at the entrance of the property with a leisure area. Pre installation for central vacuum, pre installation for heat pump for the pool, solar panels with ENERGY thermodynamic energy system in which they do not depend on weather conditions and guarantee hot water up to 55º for 24 hours a day. Parking for several cars inside the property. Located in a central area, close to schools, supermarkets and the beach. Perfect opportunity for investment in vacation rental and long term. AREA: 510 M2; PLOT AREA: 617 M2. Schedule your visit.Property Details
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Date: August 9 to 12, 2019
Country: Denmark
Since its first reception in 2001, the event has become the largest opera festival in northern Europe promoting Aalborg as a cultural hub. Aiming to reach out to a wider audience base, the festival features opera performances in unconventional locations such as city factories, canteens and pedestrian streets aside concert halls and theatres. Located at the famous university city in North Jutland, guests will be embraced by a rich cultural ambience amidst grandeur of historical architecture, including the Aalborghus Castle and Budolfi Church. Be sure to also check out its modern glamour- best represented by the famous Aalborg Tower and Kunsten Museum of Modern Art and more attractions.
Date: August 9 to 12, 2019
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Albert Okumagba
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So right here it's. After weeks of cautious planning and slightly scheming you've got lastly acquired the eye of that scorching man you've got been drooling over for months. He is beginning to speak to you slightly extra and providing you with that eye contact that you have been wanting. Issues are on the precise path however you additionally know that there are others vying for his consideration too. So what do you do to get him to have eyes for under you?
To start with, if you wish to wrap this man up, it is vital to know your strengths and use them to your profit. When you're an excellent cook dinner be taught his favourite dish and make him a meal of his favorites that depart him coming again for extra. When you're a gifted author, compose a cute, humorous poem that'll depart him laughing. This can make him consider you each time he thinks about that poem. These are simply a few examples however the hot button is to know what you are good at and use it to your benefit to impress him.
Additionally bear in mind once you're attempting to make a man your one and solely that you must costume the half. This doesn't suggest that it's a must to be in a miniskirt and stilettos each time you see him. That might be slightly bizarre. Simply do not forget to take the time to look good on a regular basis. Keep in mind nobody needs to hook up with a slob. So take the time to placed on slightly make-up even when it is solely blush and lip gloss and it is okay to have your hair in ponytail so long as it is nicely groomed.
Need to actually get a guys consideration? Play up your widespread pursuits. Everybody is aware of most guys love sports activities. When you're an avid soccer fan, you've got already scored large factors with most guys. Plus if the 2 of you want the identical group that might put you excessive. It doesn't matter what the widespread pursuits, be sure you use them to your benefit. Not solely will this make you favorable in your man's eyes, it can additionally give the 2 of you heaps to speak about. Everybody is aware of it is rather a lot simpler to be with somebody when you will have issues in widespread with.
Lastly the principle factor that you must bear in mind relating to making the man of your desires your one and solely is to be actual. Most guys can scent a faux girl from miles away and there may be nothing that is extra of a flip off. Be your self in all conditions. This won't solely assist to cement a critical relationship however you will additionally know that it is the actual you that your man's in love with and never some faux model of a lady you suppose your man needs to be with. Apart from should you faux to be another person, the true you'll all the time come to mild sooner or later and time and you could possibly stand to lose your man if he finds out you've got been mendacity to him all alongside. Save your self some bother and potential heartache by being actual from the very starting.
So now that you have your guys consideration and also you need to go in and stake your declare on him that you must play it sensible. The underside line is should you acquired his consideration within the first place then it is apparent his curiosity is piqued. Simply be your self however on the high of your sport. In different be you at your easiest. It might take some time and endurance but when he is sensible (which I am positive he's should you like him proper) he'll come to his senses and snap you in a flash.


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New drivers tearing up the roads as well as 'L' plates
That's according to new research by the Co-operative Insurance, which finds that over a quarter (26%) of drivers display bad speeding behaviours within a week of passing their test, with 10% breaking speed limits within 24 hours of becoming a legal driver.
Of the drivers who speed, two-fifths (43%) admit to regularly breaking the limit by 5%, nearly a quarter (24%) regularly break the speed limit by 10% and a tenth (10%) of drivers regularly exceed the speed limit by 20%.
The 17-24 age group are the most likely to display bad speeding behaviours, with four-fifths (81%) admitting to doing so. Drivers aged over 55 are the safest when it comes to speed, with over a third (37%) saying they never display these behaviours. Men (74%) are marginally more likely to speed than women (72%).
Despite this, the research reveals that two-thirds of drivers (67%) believe that their driving has improved since they passed their test, with nearly three quarters (72%) of drivers thinking that passengers who drive with them regularly would agree.
The research also shows that over a quarter (28%) of drivers believe they wouldn't be able to pass their driving test if they took it today, with drivers aged 25-34 (30%) most pessimistic about their chances. The main reason for this is because they have adopted bad driving habits (45%) with more drivers under 24 (53%) believing this to be true of them than any other age group.


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The was article is provided by Peter Stewart, Senior Marketing Manager at Waverton Investment Management, for Beacon Gainer, private wealth advisory services group.
On Wednesday 11 November Waverton, alongside Spring Capital, welcomed Matthew Goodwin to speak and take questions from a virtual audience. Matthew is known for his work on political risk, geopolitics and regularly gives talks to financial institutions and media organisations.
We've summarised the key points from Matthew's presentation below, and you can view the full video discussion here
An election that did not resolve anything
Matthew began with his reading of the election as a reminder of how American politics and society has become increasingly polarised. Unsurprisingly, exit poll data showed that the most important issue for Trump supporters was the economy, while for Biden's supporters it was the pandemic response and social issues such as racial inequality and access to healthcare.
Contrary to the dominant narrative, Trump's appeal did not narrow, it broadened. The theory that populism's base being solely a dwindling number of non-college educated white males appears to have been debunked by a surge in votes from Hispanic and African Americans. This speaks to a broader shift in political dividing lines, where geography and values are replacing income and social class as deciding factors, underpinned by education and age.
Regardless of the fact that President Trump is yet to formally concede, the likely outcome of the election is that the Democrats will gain the White House and maintain control of the House of Representatives. The Republicans should hold on to the Senate however, and although this will not be confirmed until after the run-off elections in Georgia on January 5, Matthew believes it is unlikely that the Democrats will win both seats as required to win control of the upper chamber. When combined with a somewhat divided Democratic Party and a non-favourable Supreme Court, it appears as though Biden will be a constrained president.
Biden's initial agenda
Biden's early executive orders are likely to receive significant scrutiny given the political gridlock in Washington. His priorities will include re-joining the Paris Climate Agreement, eliminating limits on international student visas and reaffirming the country's commitment to NATO and the World Health Organisation. Broadly speaking, Biden is likely to bring about a renaissance of multilateralism.
Interestingly, aspects of Biden's agenda will perpetuate economic protectionism however, and many of his policies would not have been out of place in Trump's playbook. These 'Made in America' policies will protect goods and services produced domestically. Biden has also promised to review the relationship with China, but it's unlikely this will mean a significant change of direction from the previous administration.
The future of the Republican Party
If Trump decides not to run for a second term in 2024, Matthew believes the next Republican will either be a member of his immediate family or at the very least, need Trump's seal of approval. Given the broad appeal of his policies (he received the most votes for any incumbent president), the next party nominee will likely maintain the balance of leaning left on the economy, and right on culture.
What does this mean for Brexit Britain?
President Biden will be welcomed by many around the world as restoring the liberal and multilateral political order. However, it is clear that Biden opposes Brexit and there is a risk that Brexit and the pursuit of a free-trade agreement could become a proxy battle on Trumpism in Congress. Given the number of democrats attempting to draw a line under the Trump administration, this should be a concern for Prime Minister Johnson.
You can view the full video discussion here


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This Creamy Cabbage Soup is scrumptious and really easy to make. It's filled with cabbage, carrots, potatoes, celery, onions, ham, and an incredible creamy broth. Plenty of vitamins and taste.
Source by cincyshopper
We carefully select our recipes and present them to you.Do not hesitate to comment under the recipes you like. Your comments are very valuable to us.
Article Categories:recipes


text:
Here is the armillary Mount for smartphone.
Ideal to keep your phone for a pleasant use.
For phones with a maximum height of 162.5 mm and a drop of 78.5 mm.
Iphone SE, 6s, 6s+, 7, 7+, 8, 8+ and X.
Samsung Galaxy S7, A8, S8, Note 7 and 8.
Huawei P20, P2 pro, P20 lite, Mate 10 pro, Y5, Y6, Y7.
Designed to be placed on a desk, this stand has a hole for a Kodak type screw (UNC 1/4", 20 tpi).
Each piece is laid for a comfortable 3d impression.
We recommend the use of a layer height of 0.2 mm to maintain good accuracy.
Base; 1 part
Exterior Gear; 1 part
Interior Gear; 1 part
Shaft Roller; 4 parts
Exterior Roller; 2 parts
Interior Roller; 2 parts
Pinion; 4 parts
Shaft Pinion; 2 parts
Shaft Scroll; 2 shares
Interior Bar; 1 part
Interior Slide; 2 parts
Exterior Bar; 1 part
Exterior Slide; 2 parts
Rod 2 parts
Claw; 1 share
Claw Button; 1 part
inter-piece adjustments are calculated to obtain functions at each assembly.
here are detailed the different game expected, personally they were obtained by sanding (grain 200 and 400).
the diameters 12 mm receiving the shafts of the pinions must allow free rotation of the shaft.
they are drawn at a diameter of 12.1 mm for a shaft at 11.9 mm.
the 10 mm diameters receiving the shafts of the rollers must be tightened as they stiffen the base. they are drawn at 10.05 mm
for a 10 mm shaft.
The hole in the base of the base has a UNC thread 1/4 "20 tpi (screw kodak) for mounting on a camera tripod.
The pinion,
the diameter is drawn at 12 mm to tighten slightly on the shaft, the drive is ensured by the key.
they handle the game of gears. Those labeled outside, go down the base and inside at the top. Their inside diameter is drawn at 10.2 mm
to rotate freely on the shaft diameter 10 mm.
The bars,
the diameter of the ends must rotate effortlessly on the gears. it is 7.9 mm for a diameter of 8 mm on the gears.
the center diameter measures 7 mm for one and 7.3 mm for the other to ensure a completely free movement.
The slides,
the inner square measures 8.3 mm on one side and slides freely on the bars whose square section measures 7.9 mm.
Two of the slides receive a connecting rod on the diameter 12 mm.
The rods,
their hole diameter 12.2 mm split rises on the diameter 12 of the slide.
the 5.1 x 15.5 mm rectangular slot fits on the 5 x 15 mm rectangle of the connecting rod.
The hole in the middle of the base is threaded in 1/4'UNC pitch (Kodak screw).
Extruder: 200 ° C and bed: 55 ° C
Layer height: 0.2 mm
Vertical shells, perimeter: 3
Horizontal shells, solid layer top: 3 and bottom: 3
Fill density: 30%
No support material
Speed perimeters: 45 mm / s
Sur Patreon: https://www.patreon.com/fabrice_jeanpierre
Sculpteur numérique Freelance
Matérialisation des univers 3D jeu, film, conception.
Numérisation d'architecture et botanique.
Suivre :
Page translated by automatic translation. See the original version.
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text:
Optimal control of the COVID-19 pandemic: controlled sanitary deconfinement in Portugal
Cristiana J. Silva, Carla Cruz, Delfim F. M. Torres, Alberto Munuzuri, Alejandro Carballosa, Ivan Area, Juan Nieto, Rui Fonseca-Pinto, Rui Passadouro da Fonseca, Estevao Soares dos Santos, Wilson Abreu, Jorge Mira
Received date: 6th October 2020
The COVID-19 pandemic has forced policy makers to decree urgent confinements to stop a rapid and massive contagion. However, after that stage, societies are being forced to find an equilibrium between the need to reduce contagion rates and the need to reopen their economies. The experience hitherto lived has provided data on the evolution of the pandemic, in particular the population dynamics as a result of the public health measures enacted. This allows the formulation of forecasting mathematical models to anticipate the consequences of political decisions. Here we propose a model to do so and apply it to the case of Portugal. With a mathematical deterministic model, described by a system of ordinary differential equations, we fit the real evolution of COVID-19 in this country. It is complemented with an analysis of the Portuguese social network, which allows detecting changes in public opinion and provides a feedback to update the model parameters. With this, we apply control theory to maximize the number of people returning to ``normal life' and minimizing the number of active infected individuals with minimal economical costs while warranting a low level of hospitalizations. This work allows testing various scenarios of pandemic management (closure of sectors of the economy, partial/total compliance with protection measures by citizens, number of beds in intensive care units, etc.), ensuring the responsiveness of the health system, thus being a public health decision support tool.
This is an abstract of a preprint hosted on a preprint server, which is currently undergoing peer review at Scientific Reports. The findings have yet to be thoroughly evaluated, nor has a decision on ultimate publication been made. Therefore, the results reported should not be considered conclusive, and these findings should not be used to inform clinical practice, or public health policy, or be promoted as verified information.


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In the trading room today: Is the EUR Likely to Head Lower after the Bounce? With the EUR managing to bounce higher despite of the drop following the European Central Bank rate cut and a stronger U.S. nonfarm payrolls data, we explore the potential for a continuation of the single currency's decline after the price correction of its recent losses, we analyze the support and resistance areas in the EUR/USD currency pair, we note the weakness in the GBP/USD pair, we keep an eye on the USD/JPY pair, we highlight the market's reaction to the Japanese Current Account Balance and Economic Sentiment, we discuss new forecasts from Deutsche Bank and Bank of New York-Mellon, and prepare for the trading session ahead.
Forex Charts
Market Watch


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Vote Mykel Chukwuyerem Parish Ajaere For The Office Of National President, Association Of Movie Producers Nigeria.
Nollywood is about to redefine it's commercial value, while maintaining it's identity in spite of several factors impeding its growth. I acknowledge efforts of industry leaders, who have over the years worked tirelessly to ensure a sustainable film industry for Nigeria. It will also do our industry a lot of good, if government authorities could enable industry structures through funding or grants for production and distribution of indigent films projects. Indeed to project our cinematography and Nigeria's culture: to also inform and educate us about our perception of the world and vise versa.
There's no doubt the world expects so much from us as a powerful black nation, but how do we maintain our current status as the biggest black film industry in the world? How do we help filmmakers make a living from their films?
My mission is to help make film production lucrative again for the Nigerian film producer by leveraging on my extensive network and global affiliation to renowned creative industry practitioners to realise this. Favourable policies, access to funding, global co-production, distribution and opportunities is what I offer members of Amp.
Unlike Tom Cruise, my Mission is Possible.
I am Mykel Chukwuyerem Parish Ajaere and I am running for the office of National president, Association of movie producers Nigeria.
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"No other great literary work, perhaps, has ever dared its reader so boldly to slam it shut and fling it out the window."
– David Melville.
George MacDonald was a prolific author of the 19th century. He was predecessor to and had a significant impact on later popular authors – including C.S. Lewis (The Chronicles of Narnia), Madeleine L'Engle (A Wrinkle in Time), and J.R.R. Tolkien (Lord of the Rings).
One of his last works, Lilith, is both loved and hated. Some have found it too confusing, others amazingly profound. MacDonald felt the novel was nearly divinely inspired while his wife resisted publication of the novel finding it much too dark.
Lilith is now available in a contemporary and annotated edition via Amazon for $2.99. Will you take the plunge?
"It is best to be candid…Lilith is without doubt an extremely beautiful book, but it is also extremely baffling, and we are not ashamed to admit that the proper interpretation of many passages in it eludes us…magic mirrors; lands that exist and exist not…giants; tiny lovers…and so on, and so on–we have more often than not been exceedingly perplexed…the manner of rendering…is astonishingly well done, and it is easy to see the handicraft of a man who is the master of both prose and poetry…This book undoubtedly is an example of fine literature."
– The Literary World, Oct. 4, 1895
The quote from David Melville is from his article "Beautiful Terrors–George MacDonald and Lilith" in The Bottle Imp, Issue 8 (Nov. 2010).
The quote from The Literary World is found in Vol. 52 (1895).


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What is Binear?
it is simply a bj. if you say it fast with out care it sorta sounds like it. its not just any bj its a long dedicated one from a true dedicated ho. if you want it done fast just say to the bitch you want a fucking binear.
origin: springfield high school / pa
Yo i copped this binear from this party it was slippery and sloppy.
Random Words:
1. An SEO spammer's black hat attempt to undermine a competing web site's search enginepage rank. The term derives from the name..