Sealed Unilateral Full-Thickness Macular Hole with Amniotic Membrane Graft in a Patient with Alport Syndrome: A Case Report

We present a case of unilateral full-thickness macular hole (MH) successfully repaired with an amniotic membrane (AM) graft in a patient with Alport syndrome. A 58-year-old Asian female with past medical history of Alport syndrome diagnosed at early stage, presented with a 5-week history of vision loss in her right eye. Examination of her eyes showed normal retinal vessels and an MH measuring 1,300 μm in basal diameter, 806 μm in minimum linear diameter, and 490 μm in height in the right eye and macular thinning with laser scars inferiorly in the left eye. The patient underwent 23-g pars plana vitrectomy with intraocular lens explantation. After multiple unsuccessful attempts in inducing a posterior vitreous detachment around the optic nerve and in the posterior pole, a 1 mm AM graft placed on the MH and the edges tucked under the edges of the hole using a bimanual technique. Five months after surgery, the MH remained sealed with improved final vision. MHs are rare manifestations of Alport syndrome, and surgical treatment of Alport syndrome-associated MHs is challenging. However, further studies to explore new techniques using AM are needed

The role of retinal imaging in the management of abusive head trauma cases

Background: As retinal hemorrhage (RH) is the most frequent and reliable finding of abusive head trauma (AHT), an ophthalmology consultation should be systematically required in suspected cases. Full retinal examination through pharmacologically dilated pupil can detect the type and pattern of RHs, helping to distinguish abusive from non-abusive head trauma. Methods: We performed a retrospective analysis of a case series of 6 infants (aged 0.6-10 months) with AHT who were admitted to the Emergency Department of Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome with severe intracranial hemorrhages. Children underwent full multidisciplinary assessment including dilated fundus examination, optical coherence tomography (OCT) and digital wide-field fundus photography (DWFFP – in our case RetCam). In our paper we report the clinical presentation, the ocular findings and outcome at discharge. Results: The mean age at the hospital admission was 6.28 months. In all infants, intracranial hemorrhages were found. Preretinal and intraretinal hemorrhages were detected, collecting good-quality retinal images. Conclusions: Imaging of retinal hemorrhages represents a fundamental moment of AHT diagnosis and documentation. Although RetCam is the gold standard for the acquisition of retinal images in suspected cases, OCT is extremely valuable in forensic evaluation since it can detect even small macular hemorrhages. Therefore, the combination of RetCam and OCT imaging can give relevant hints for the diagnosis of AHT, allowing to evaluate the extent, spread and morphology of RHs

Sensitivity analysis of multilayer earth models

An accurate electrical model of the earth is useful for many applications related to electric traction and distribution systems: stray currents, step voltages, lightning phenomena. There exist methods to correlate apparent resistivity measurements with a multilayer earth model, generally based on iterative optimization algorithms, but all suffer from a general sensitivity to the starting point. In this work, after a general presentation of the problem and of the experimental method to obtained measured values of the apparent resistivity, some reference problems are considered to evaluate the robustness of the solution methods

Distribution of stray current based on 3-Dimensional earth model

An accurate electric model of the earth is important for many applications related to electric traction and distribution systems like the stray current. As the DC electrified traction system is the potential source of the stray current, the operation of traction vehicles such as trains and trams makes the emergence of stray currents in the area of rails and under the rails. These leakage currents can adversely affect pipelines or cable lines near the rail [7][11]. There exist numerous models which have been modeled this phenomena [2][4][11], all models are based on one Dimensional earth structure, actually the nature of the earth underneath of the railways could not be represented as a homogeneous medium. The characteristics of the soil vary depending on the location and locally with depth, and a homogeneous earth model might be inadequate. [1] shows that even the multi-layered earth models are not reliable to be the base of the calculation of several applications related to the earth and grounding systems and it is required an accurate earth model which can give a better overview of whole structure of the underneath ground. In this work after a general presentation of the existing and proposed earth model, it is presented a comparison between the calculation of the stray current propagation based on one and 3-Dimensional earth model

Fountain-code Aided File Transfer in Vehicular Delay Tolerant Networks

We propose a mechanism for facilitating file transferring in Vehicular Delay Tolerant Networks. The proposed architecture includes using Fountain coding in the application layer, UDP in the transport layer and a proposed DTN routing algorithm in the network layer. It is assumed that files are coded based on a sample of Fountain codes which does not need in-order reception of packets. As a result, there is no need of using close-loop reliable protocols such as TCP, hence suffering from their different overheads; as a result, UDP can be used in the transport layer. In the network layer, we propose a novel DTN routing algorithm based on AODV and Store-Carry and Forward policy. This algorithm (named as AODV-DTN) uses a cross layer interaction between the network and the application layer. Results of extensive simulations study for highway scenarios show that the proposed architecture leads to a better performance in terms of file delivery ratio and byte throughput when compared with FOUNTAIN and classic FTP scenarios. Furthermore, the negative effect of increasing file size is mitigated in comparison to other alternatives. It is also shown that for delay tolerant and long-distanced inter-RSU communications the proposed architecture behaves sufficiently well

A Priority-Based MAC Protocol for Energy Consumption and Delay Guaranteed in Wireless Body Area Networks

Wireless body area networks (WBANs) consist of tiny sensors that placed around or implant in the human body. These nodes can permanently monitor the health of patients. WBANs require medical applications for remote monitoring and health care. In WBANs, the main challenge is delay and limitations of energy consumption to prolong the network lifetime. In this context, a MAC protocol has been provided to guarantee energy consumption and delay reduction based on priority of data traffic. The design of this protocol consisted of four sections: First, the patient data traffic is prioritized and classified, which included normal data, periodic data, and emergency data. Second, the superframe structure is improved according to IEEE 802.15.4 and the priorities for the data are optimized. Third, the energy consumption and delay have been reduced by using the radio wake-up mechanism and through controlling the node modes. Four, for checking the node modes, the state diagram and the asymmetric hidden Markov method have been exploited to model the limited capacity of the buffers. This protocol has been simulated using NS-3, and simulation and evaluation results indicated that lower energy consumption and delay as well as improved network lifetimes compared to the previous methods. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Retinal detachment associated with retinal dialysis: clinical features and outcomes of surgery in a ten-year study

To report the surgical approaches and outcomes in patients undergoing surgery for retinal detachment associated with retinal dialysis. Retrospective, consecutive case series All patients who underwent surgery for retinal detachment secondary to retinal dialysis between January 1, 2012 and January 1, 2022. Retrospective consecutive case series. Best-corrected visual acuity, single-operation success rate. The study cohort included 60 eyes of 58 patients with a mean age of 26.4 (SD, 13.0) years. Males comprised 49 (84.5%) patients. Known trauma occurred in 35 (61.4%) cases. Initial surgical management included scleral buckling (SB) in 49 (81.7%) eyes and combined SB and pars plana vitrectomy (PPV) in 11 (18.3%) eyes. Preoperative best-corrected visual acuity (BCVA) correlated with BCVA at last follow-up visit (r = 0.66; P < 0.001). At last visit, the SB group had a mean logMAR BCVA of 0.36 (20/46) and at 6 months a single-operation success rate of 76.9% while the SB/PPV group had a mean BCVA of 1.08 (20/238) and single-operation success rate of 77.8% (P = 0.04, P = 0.96). Six eyes in the SB/PPV group received silicone oil tamponade. In eyes with at least 1 year of follow-up, 4 (14.8%) in the SB group and 6 (100%) in the SB/PPV group developed a visually-significant cataract requiring cataract surgery (P < 0.001). Retinal detachment associated with retinal dialysis is typically associated with trauma and more often occurs in young male patients. The current study confirms that SB without PPV is an effective initial treatment strategy for most patients with retinal dialysis and has a low rate of cataract formation