CSF Upward Motion Is Crucial for ETV Success

Purpose: ETV is indicated for treating obstructions of major CSF pathways. The outcome evaluation often yields success rates of only +- 70% for shunt independency. Hence, compromised CSF absorption seems to occur more often than expected. We searched for parameters suitable to assess the involved CSF dynamics. Material and Methods: This was a prospective study in 58 paediatric patients (7.7 yrs. mean age) between 2000 and 2020 with aqueductal stenosis (11/58), obstruction of the aqueduct due to tumor growth (22/58),and connatal hydrocephalus (9/58). The average follow-up interval was 4.7 years. Head circumferences, Evans- and fronto-occipital horn ratios before and 3 months after ETV were obtained as Delta-indices. Furthermore ETV success score (ETVSS), the patency of the aqueduct pre- and postoperatively as well as of the stoma were assessed by flow void signs on MRI. Evaluation on MRI also included the shape of the floor of the 3rd ventricle and whether or not the septum pellucidum showed signs of perforation. Four patients were analysed pre- and postoperatively via real-time MRI. At least the educational status regarding protected or unprotected education was analyzed. Results:The prevalence of a bowing of the floor of the 3rd ventricle was 72%, and the ETVSS was 71.0%. In 26 children a septal perforations or an open aqueduct prior to ETV (19) could be identified. Mean ER and FOHR were reduced by 0.03 and 0.05 , respectively. Maintained open (flow void on postop MRI) or perforation could successfully be carried out during endoscopic surgery in 44 patients (79%). The disproportionate increase of head circumference abated in 79.4% of patients. New shunt insertion occurred in 16 patients (27.5%). Intraoperatively upward CSF flow was detected in all cases. Statistical analyses(ANOVA) showed significant results for unprotected education, postoperative ER and FOHR but not for open stoma. Conclusion: The identification of flow through the stoma on postoperative MRI seems to be a necessary but not sufficient condition for ETV success. In our study, ventricular volumes were used as parameters to determine success rates as well as unprotected education. Furthermore, enabling upward CSF flow driven by inspiration seems crucial for successful ETV.

Penggunaan Limbah Beton Sebagai Agregat Pada Campuran Stone Matrix Asphalt Halus

Limbah beton di Indonesia pada umumnya belum dipergunakan dengan baik dan dibiarkan tanpa ada penanganan yang akan menimbulkan permasalahan tersendiri bagi lingkungan, maka dari itu perluh pengolahan supaya bisa digunakan menjadi bahan yang lebih berguna. Penelitian ini bertujuan untuk mengetahui karakteristik limbah beton untuk digunakan dalam campuran Stone Matrix Asphalt, mengetahui komposisi campuran Stone Matrix Asphalt menggunakan limbah beton dan mengetahui kemampuan campuran terhadap pengaruh suhu dan air setelah perendaman. Metodologi penelitian menggunakan metode Marshall Konvensional untuk mendapatkan karakteristik limbah beton yang digunakan dalam campuran Stone Matrix Asphalt dan Marshall Immersion untuk mendapatkan nilai stabilitas Marshall Sisa. Hasil penelitian menunjukkan bahwa karakteristik agregat limbah beton memenuhi persyaratan untuk campuran perkerasan jalan. Berdasarkan rancangan komposisi campuran didapatkan komposisi campuran untuk kadar aspal 6,00% agregat kasar yaitu 69,00%, agregat halus 15,67 %, dan filler 8,33. Penggunaan campuran Stone Matrix Asphalt Halus melalui pengujian Karakteristik campuran Marshall Konvensional diperoleh nilai Stabilitas, Kelelehan (flow), Void In Mix (VIM), Void In Mix Aggeregate (VMA), memenuhi spesifikasi, hasil pengujian Marshall Immersion diperoleh indeks perendaman sebesar atau Kekuatan Sisa 92,02% artinya campuran tahan terhadap lamanya perendaman.

Choroidal thickness and choriocapillaris vascular density in myopic anisometropia

Background This study aims to examine interocular differences in the choroidal thickness and vascular density of the choriocapillaris in anisometropic myopes and to further explore the relationship between choroidal blood flow and myopia. Methods The sample comprised 44 participants with anisometropic myopia, aged 9 to 18 years, with normal best-corrected visual acuity. All participants underwent a series of examinations, including spherical equivalent refraction (SER) and axial length (AL), measured by a Lenstar optical biometer and optical coherence tomography angiography (OCTA) scanner. OCT measured the choroidal thickness, vascular density, and flow voids of the choriocapillaris, and a customized algorithm was implemented in MATLAB R2017a with the post-correction of AL. The choroidal thickness was measured at the fovea and 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mm nasally, temporally, inferiorly, and superiorly to the fovea. The vascular density and the flow voids of the choriocapillaris were measured at a 0.6-mm-diameter central circle, and the 0.6–2.5 mm diameter circle in the nasal, temporal, inferior, and superior regions. Repeated-measured ANOVAs were used to analyze the interocular differences. Partial correlations with the K value and age adjustments were used to study the relationships between the choroidal thickness, the choriocapillaris vascular density and flow voids, the SER and AL. Results The choroidal thickness of the more myopic eyes was significantly thinner than less myopic eyes (P ≤ 0.001), and the flow voids in the more myopic eyes were more than less myopic eyes (P = 0.002). There was no significant difference in the vascular density of the choriocapillaris between the more and less myopic eyes (P = 0.525). However, when anisometropia was more than 1.50 D, the vascular density of choriocapillaris in the more myopic eyes was significantly less than the less myopic eyes (P = 0.026). The interocular difference of the choroidal thickness was significantly correlated with the interocular difference in SER and AL in the center, superior, and inferior regions but not in the nasal or temporal regions. The interocular differences of the vascular density and the flow voids of the choriocapillaris were not correlated with the interocular difference of SER and AL. Conclusions The choroidal thickness is thinner in the more myopic eyes. The flow void is increased, and the vascular density of the choriocapillaris is reduced in the more myopic eyes of children with anisometropia exceeding 1.50 D.

The characteristics of choriocapillaris flow void in the unilateral polypoidal choroidal vasculopathy fellow eyes

To evaluate the morphological characteristics of flow void (FV) in the fellow eyes of the unilateral polypoidal choroidal vasculopathy (PCV). Fifty PCV fellow eyes (PCVF) and 31 age-matched normal ocular circulation controls were recruited in this retrospective study. The number of FV was analyzed according to the size in a centered 5 × 5 mm swept source optical coherence tomography angiography scans. We used indocyanine green angiography images to determine whether choroidal vascular hyperpermeability (CVH) has occurred. For the PCVF, the prevalence rate of CVH was 70% (35 of 50) The number of FVs was significantly lower in 400–25,000 μm2 (P = 0.005), 400–500 μm2 (P = 0.001), 525–625 μm2 (P = 0.001) and 650–750 μm2 (P = 0.018). compared to the controls. And showed no difference in size from 775 to 1125 μm2 between the two groups. The area under the receiver operating characteristic curve of PCVF with CVH and controls was 0.94 (95% CI 0.88–1.00) (P < 0.001). We found that the number of small FVs was significantly lower in the PCV fellow eyes than that in the eyes with control group.

Intradural lumbar radicular arteriovenous malformation mimicking perimedullary arteriovenous malformation of the conus medullaris: illustrative case

BACKGROUND Intradural radicular arteriovenous malformation (AVM) of the cauda equina is a rare entity of spinal AVMs. Because of the specific arterial supply of the conus medullaris and cauda equina, AVMs in this area sometimes present with confusing radiological features. OBSERVATIONS The authors reported a rare case of intradural radicular AVM arising from the lumbar posterior root. The patient presented with urinary symptoms with multiple flow void around the conus medullaris, as shown on magnetic resonance imaging. Digital subtraction angiography demonstrated arteriovenous shunt at the left side of the conus medullaris fed by the anterior spinal artery via anastomotic channel to the posterior spinal artery and rich perimedullary drainers. There was another arteriovenous shunt at the L3 level from the left L4 radicular artery. Preoperative diagnosis was perimedullary AVM with radicular arteriovenous fistula. Direct surgery with indocyanine green angiography revealed that the actual arteriovenous shunt was located at the left L4 posterior root. The AVM was successfully treated by coagulation of feeding branches. LESSONS Unilateral arteriovenous shunt fed by either posterior or anterior spinal artery at the conus medullaris may include AVM of the cauda equina despite abundant perimedullary venous drainage. Careful pre- and intraoperative diagnostic imaging is necessary for appropriate treatment.

THE EFFECT OF SEA WATER IMMERSION ON BUTON ASPHALT (AS-BUTON) MIXTURE

One of the causes of flexible pavement damage is being submerged in water with a high acidity, such as seawater. To overcome this condition, a study on the use of buton asphalt (as-buton) was conducted. The advantages of as-buton are that it has higher adhesion and is more resistant to temperature changes. As-buton modification by mixing Lawele as-buton Southeast Sulawesi with oil asphalt pen 60/70. This study focuses on determining the effect of the addition of as-buton to the modified asphalt mixture and the effect of seawater immersion on as-buton mixture based on the Marshall characteristic test. The percentage by weight of as-buton used is 5%, 7.5%, and 10%. The immersion was carried out in freshwater and seawater immersion for up to 24 hours at a temperature of 30°C. The result of this study show that the addition of as-buton increase the value of stability, void in mixture, Marshall quotient (MQ), and void in mineral aggregate, but reduce the flow, void filled with asphalt, and density. The increase of stability and MQ value in seawater-immersion due to the addition of as-buton was higher than that in freshwater. The stability value of the 10% modified as-buton mixture in freshwater-immersion increased by 169.338 kg (14.61%) and in seawater-immersion increased by 1261.669 kg (55.65%). The flow value in freshwater-immersion decreased by 1.9 mm (25.33%) while in seawater-immersion decreased by 1 mm (14.08%). For further research, variations in the addition of as-buton will be carried out to produces a modified asphalt mixture.

Correlations among age, sex, axial length, and subfoveal choroidal thickness in the choriocapillaris structure analyzed using multiple en face image averaging optical coherence tomography angiography

Purpose To analyze the structure of the choriocapillaris in healthy eyes by using averaged en face images acquired using swept source optical coherence tomography angiography and to examine the changes in the macular profile in relation to age, sex, axial length, and choroidal thickness. Methods This prospective, cross-sectional study included 81 eyes of 81 subjects without ophthalmologic or systemic diseases who underwent a full ophthalmologic examination, including 3 × 3-mm macular optical coherence tomography angiography. Four to nine choriocapillaris en face images were registered and averaged. The averaged images were then binarized and analyzed. Results The averaged choriocapillaris images showed a continuous capillary meshwork, whereas the unaveraged images had a granular appearance. The mean total area and size of flow voids were 0.99 ± 0.20 mm2 and 567.8 ± 201.5 μm2, respectively, and these values correlated positively with age (p = 0.002, R = 0.336 and p = 0.026, R = 0.247, respectively). Age-related gains in the mean total area and flow void size were 4.20 × 10−3 mm2 and 3.07 μm2 per year, respectively. However, the mean total area and flow void size had no significant correlation with axial length, subfoveal choroidal thickness, or sex. Conclusions Multiple averaged en face swept source optical coherence tomography angiography is more effective than a single optical coherence tomography angiography scan for better visualizing the choriocapillaris. The total area and size of flow voids within a 3 × 3-mm macular area positively correlated with age. This technique can be useful for investigating the changes arising in macular diseases.

Utilization of Maros Regency Pucak River Aggregate for Aus Layer Laston Mixture

The purpose of this test is to determine the aggregate characteristics of the Pucak river as Aus Layer Laston Mixture. So, several series of studies were used, starting from testing aggregates (coarse and fine), asphalt and filler, then making compositions to making samples of Laston Wear Layer. The results of this study are to determine the characteristics of the pavement material using aggregate from the Pucak River Maros Regency to meet the requirements of the 2018 General Bina Marga specification, to be used in road layers. Based on the Conventional Marshall test, the Stability, Meltability (flow), Void In Mix (VIM), Void In Mix Aggregate (VMA), and Foid Filled With Bitumen (FVB) all values obtained meet the General Specifications of Highways 2018. And testing Marshall Immersion in the Aus Layer Laston mixture meets the 2018 Highways General Specifications, where the value of the Marshall Remaining Stability is 94.50 ≥ 90%.

Accuracy of flow-void diameters on MR images in diagnosing uterine arteriovenous malformations in patients with pregnancy-related diseases

To evaluate the “flow void” diameter in patients with pregnancy-related diseases with and without uterine AVMs and assess the diagnostic performance of unenhanced MRI for uterine AVMs. From May 2014 to April 2019, 79 patients with pregnancy-related diseases were included, including 36 with and 43 without uterine AVMs confirmed by DSA. On MRI, the diameter of the most prominent “flow void” (hereinafter referred to as fv-D) was measured and compared between patients with and without uterine AVMs. The diagnostic performance of fv-D was estimated with receiver operating characteristic curves. The “flow void” sign was observed in patients with and without uterine AVMs (P > 0.05). The fv-D was significantly larger in patients with uterine AVMs in the myometrium and parametrium than in patients without uterine AVMs (P < 0.0001). The fv-D achieved a reliable diagnostic performance in the myometrium (sensitivity 80.6%, specificity 60.5%, negative predictive value 78.8%, positive predictive value 63%, AUC 0.727, cut-off: > 1.33 mm) and parametrium (sensitivity 97.2%, specificity 67.4%, negative predictive value 96.7%, positive predictive value 71.4%, AUC 0.881, cut-off > 2.6 mm). On MRI, fv-D could diagnose uterine AVMs. The fv-D had a much higher diagnostic efficiency in the parametrium than in the myometrium. The parametrium fv-D greatly improved the diagnostic sensitivity and provides a more accurate, noninvasive method of investigating possible uterine AVMs.