Environmental Sustainability and MRI: Challenges, Opportunities, and a Call for Action.

The environmental impact of magnetic resonance imaging (MRI) has recently come into focus. This includes its enormous demand for electricity compared to other imaging modalities and contamination of water bodies with anthropogenic gadolinium related to contrast administration. Given the pressing threat of climate change, addressing these challenges to improve the environmental sustainability of MRI is imperative. The purpose of this review is to discuss the challenges, opportunities, and the need for action to reduce the environmental impact of MRI and prepare for the effects of climate change. The approaches outlined are categorized as strategies to reduce greenhouse gas (GHG) emissions from MRI during production and use phases, approaches to reduce the environmental impact of MRI including the preservation of finite resources, and development of adaption plans to prepare for the impact of climate change. Co-benefits of these strategies are emphasized including lower GHG emission and reduced cost along with improved heath and patient satisfaction. Although MRI is energy-intensive, there are many steps that can be taken now to improve the environmental sustainability of MRI and prepare for the effects of climate change. On-going research, technical development, and collaboration with industry partners are needed to achieve further reductions in MRI-related GHG emissions and to decrease the reliance on finite resources. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.

Diversity of Viruses Infecting Eukaryotic Algae.

Algae are photosynthetic organisms that drive aquatic ecosystems, e.g. fuelling food webs or forming harmful blooms. The discovery of viruses that infect eukaryotic algae has raised many questions about their influence on aquatic primary production and their role in algal ecology and evolution. Although the full extent of algal virus diversity is still being discovered, this review summarizes current knowledge of this topic. Where possible, formal taxonomic classifications are referenced from the International Committee on Taxonomy of Viruses (ICTV); since the pace of virus discovery has far surpassed the rate of formal classification, however, numerous unclassified viruses are discussed along with their classified relatives. In total, we recognized 61 distinct algal virus taxa with highly variable morphologies that include dsDNA, ssDNA, dsRNA, and ssRNA genomes ranging from approximately 4.4 to 560 kb, with virion sizes from approximately 20 to 210nm in diameter. These viruses infect a broad range of algae and, although there are a few exceptions, they are generally lytic and highly species or strain specific. Dedicated research efforts have led to the appreciation of algal viruses as diverse, dynamic, and ecologically important members of the biosphere, and future investigations will continue to reveal the full extent of their diversity and impact.

A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy.

PURPOSE: To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system. DESIGN: Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis. SUBJECTS: We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses. INTERVENTION: Pneumatic retinopexy was compared with PPV in all analyses. MAIN OUTCOME MEASURES: The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications. RESULTS: In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR. CONCLUSIONS: Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Pars Plana Vitrectomy Port Sizes: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND OBJECTIVE: The uptake of small-gauge (SG; ie, 23-gauge [23-G], 25-gauge [25-G], and 27-gauge [27-G]) pars plana vitrectomy (PPV) has grown. We aim to investigate the advantages and disadvantages of various PPV port sizes in a meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS: A systematic literature search was performed for RCTs comparing PPV port sizes for any indication. Weighted mean differences (WMDs) and risk ratios (RRs) were calculated, and meta-analysis was performed with random-effects models. RESULTS: A total of 1,678 eyes from 22 RCTs were included. Risk-of-bias assessment found some concerns in 13 studies. Compared with 20-gauge PPV, there was no significant difference in the final or change in best-corrected visual acuity (BCVA; five studies analyzed each) relative to that of SG PPV. SG PPV was associated with a significantly greater incidence of hypotony (RR = 3.79; 95% confidence intervals [CI], 2.02 to 7.10; P < .0001; six studies) and choroidal detachment (RR = 5.65; 95% CI, 1.01 to 31.71; P = .05; three studies). Compared with 25-G PPV, there was no significant difference in BCVA at any time point with 23-G (two studies), and significantly more frequent port suturing was required with 23-G (RR = 0.46; 95% CI, 0.25 to 0.84; P = .01; two studies). Compared with 25-G PPV, 27-G was associated with a significantly better final BCVA (WMD = -0.06 logMAR; 95% CI, -0.11 to -0.01; P = .02; five studies) and a significantly lengthened surgery (WMD = 4.11 minutes; 95% CI, 0.18 to 8.05; P = .04; three studies). CONCLUSIONS: There was no significant difference in visual or surgical outcomes following 20-gauge PPV relative to SG PPV (Grading of Recommendations, Assessment, Development, and Evaluation recommendation: low certainty), and there was an increased risk of postoperative complications with SG PPV (moderate certainty). Compared with 25-G PPV, 23-G required more frequent port suturing (moderate certainty), whereas 27-G may be associated with a better final BCVA but longer surgery (low and moderate certainty, respectively). [Ophthalmic Surg Lasers Imaging Retina. 2022;53:152-158.].

Genome and Environmental Activity of a Chrysochromulina parva Virus and Its Virophages.

Some giant viruses are ecological agents that are predicted to be involved in the top-down control of single-celled eukaryotic algae populations in aquatic ecosystems. Despite an increased interest in giant viruses since the discovery and characterization of Mimivirus and other viral giants, little is known about their physiology and ecology. In this study, we characterized the genome and functional potential of a giant virus that infects the freshwater haptophyte Chrysochromulina parva, originally isolated from Lake Ontario. This virus, CpV-BQ2, is a member of the nucleo-cytoplasmic large DNA virus (NCLDV) group and possesses a 437 kb genome encoding 503 ORFs with a GC content of 25%. Phylogenetic analyses of core NCLDV genes place CpV-BQ2 amongst the emerging group of algae-infecting Mimiviruses informally referred to as the "extended Mimiviridae," making it the first virus of this group to be isolated from a freshwater ecosystem. During genome analyses, we also captured and described the genomes of three distinct virophages that co-occurred with CpV-BQ2 and likely exploit CpV for their own replication. These virophages belong to the polinton-like viruses (PLV) group and encompass 19-23 predicted genes, including all of the core PLV genes as well as several genes implicated in genome modifications. We used the CpV-BQ2 and virophage reference sequences to recruit reads from available environmental metatranscriptomic data to estimate their activity in fresh waters. We observed moderate recruitment of both virus and virophage transcripts in samples obtained during Microcystis aeruginosa blooms in Lake Erie and Lake Tai, China in 2013, with a spike in activity in one sample. Virophage transcript abundance for two of the three isolates strongly correlated with that of the CpV-BQ2. Together, the results highlight the importance of giant viruses in the environment and establish a foundation for future research on the physiology and ecology CpV-BQ2 as a model system for algal Mimivirus dynamics in freshwaters.

Corrigendum: Genome and Environmental Activity of a Chrysochromulina parva Virus and Its Virophages.

[This corrects the article DOI: 10.3389/fmicb.2019.00703.].