ILM Flap Repositioning for Persistent Macular Hole

We present a case of a persistent macular hole which was initially treated by pars plana vitrectomy with the inverted ILM flap technique. In a second procedure, the internal limiting membrane (ILM) flap was mobilized from its perifoveal adherence to the retina and peeled back to its adherence at the foveal ring. The eye was filled with 25% C2F6 gas. Three weeks after the second procedure, closure of the hole was observed. Best corrected visual acuity increased from 20/400 to 20/50. We assume that contractile elements within the ILM may cause perifoveal adhesion and centrifugal effects preventing macular hole closure. If macular hole closure does not occur after surgery with an inverted ILM flap, it is worth to peel back the existing flap again towards the foveal edge in order to induce hole closure and preserve the benefits of flap surgery. If the flap is only attached to the foveal ring, centripetal contraction could lead to annular closure of the macular hole. If the flap is lost, alternative surgical methods for refractory MHs should be considered

Principal morphomic and functional components of secondary mitral regurgitation

Objectives: The aim of this work was to identify the key morphological and functional features in secondary mitral regurgitation (sMR) and their prognostic impact on outcome. Background: Secondary sMR in patients with heart failure and reduced ejection fraction typically results from distortion of the underlying cardiac architecture. The morphological components which may account for the clinical impact of sMR have not been systematically assessed or correlated with clinical outcomes. Methods: Morphomic and functional network profiling were performed on a cohort of patients with stable heart failure optimized on guideline-based medical therapy. Principal component (PC) analysis and subsequent cluster analysis were used to condense the morphomic and functional data first into PCs with varimax rotation (PCVmax) and second into homogeneous clusters. Clusters and PCs were tested for their correlations with clinical outcomes. Results: Morphomic and functional data from 383 patients were profiled and subsequently condensed into PCs. PCVmax 1 describes high loadings of left atrial morphological information, and PCVmax 2 describes high loadings of left ventricular (LV) topology. Based on these components, 4 homogeneous clusters were derived. sMR was most prominent in clusters 3 and 4, with the morphological difference being left ventricular size (median end-diastolic volume 188 mL [interquartile range: 160 mL-224 mL] vs 315 mL [264 mL-408 mL]; P < 0.001). Clusters were associated with mortality (P < 0.001), but sMR remained independently associated with mortality after adjusting for the clusters (adjusted HR: 1.42; 95% CI: 1.14–1.77; P < 0.01). The detrimental association of sMR with mortality was mainly driven by cluster 3 (HR: 2.18; 95% CI: 1.32-3.60; P = 0.002), the “small LV cavity” phenotype. Conclusions: These results challenge the current perceptions that sMR in heart failure with reduced ejection fraction results exclusively from global or local LV remodeling and are suggestive of a potential role of the left atrial component. The association of sMR with mortality cannot be purely attributed to cardiac morphology alone, supporting other complementary key aspects of mitral valve closure consistent with the force balance theory. Unsupervised clustering supports the association of sMR with mortality predominantly driven by the small LV cavity phenotype, as previously suggested by a conceptional framework and termed disproportionate sMR

Effect of suspended solids in secondary wastewater effluent on DOC removal by enhanced coagulation

Wastewater recycling is increasingly seen as a sustainable solution to meet the increasing water demand. However, organic matters and suspended solids (SS) affects its treatment, distribution and use in many different ways, including fouling of membrane when membrane process is adopted. Enhanced coagulation can effectively remove both SS and organic matters, consequently increasing the performance of membrane. However, it is still unknown how dissolved organic carbon (DOC) removal is affected by the presence of SS, especially when microbes and bio-molecules are present in the effluent. Thus, this study aims to investigate the impact of SS on DOC removal by enhanced coagulation (with ferric chloride), from secondary wastewater effluent (SWWE). Results indicated two-stage DOC removal for a single coagulation pH over lower and higher doses of coagulant. In the first stage, DOC removal was compromised when SS was present at concentrations as low as 8.8 mg/L, suggesting removal of SS prior to coagulation is important for effective DOC removal and sludge reduction

Process for reconstructing brainstem nuclei and fiber tracts in 3D from 7T MRI.

<p>The brainstem region outlined in blue (A) was cropped (B) from each coronal 7T SWI MR image. (C) An affine deformation algorithm based on user-defined seed points was used to warp contours from a rhesus macaque brain atlas to the MRI of each subject. The PPN is outlined in white. (D) Algorithm-defined contours from nuclei and fiber tracts within brainstem were outlined on each slice and then (E, F) lofted to create surface renderings.</p

Imaging PAG with comparisons between MRI modalities and immunolabeled histology.

<p>Coronal SWI, T1, and T2 images were matched to corresponding histological slices stained with AChE from the same animal (M3 and M4). The corresponding warped atlas was overlaid on both the SWI and the histology. On the right, matched coronal SWI slices are shown for all other animals. Histograms for all coronal MRI slices were not altered, but stretched to encompass the entire spectrum (0–255).</p

Brainstem tractography displayed with warped nuclei in four rhesus macaques.

<p>Tractography is shown for SCP (red), LL (purple), and ML (green). SCP is shown to course through PPN (grey) and around RN (gold).</p

Process to compute subject-specific diffusion tractography.

<p>The method combines the warping algorithm and diffusion tractography methods in FSL to identify fiber tracts. Colored regions are the segmented ROIs used in FSL to identify both ML and SCP tracts.</p