Pretreatment brain CT perfusion thresholds for predicting final infarct volume in distal medium vessel occlusions.

BACKGROUND AND PURPOSE: Quantitative CT perfusion (CTP) thresholds for assessing the extent of ischemia in patients with acute ischemic stroke (AIS) have been established; relative cerebral blood flow (rCBF) <30% is typically used for estimating estimated ischemic core volume and Tmax (time to maximum) >6 seconds for critical hypoperfused volume in AIS patients with large vessel occlusion (LVO). In this study, we aimed to identify the optimal threshold values for patients presenting with AIS secondary to distal medium vessel occlusions (DMVOs). METHODS: In this retrospective study, consecutive AIS patients with anterior circulation DMVO who underwent pretreatment CTP and follow-up MRI/CT were included. The CTP data were processed by RAPID (iSchemaView, Menlo Park, CA) to generate estimated ischemic core volumes using rCBF <20%, <30%, <34%, and <38% and critical hypoperfused volumes using Tmax (seconds) >4, >6, >8, and >10. Final infarct volumes (FIVs) were obtained from follow-up MRI/CT within 5 days of symptom onset. Diagnostic performance between CTP thresholds and FIV was assessed in the successfully and unsuccessfully recanalized groups. RESULTS: Fifty-five patients met our inclusion criteria (32 female [58.2%], 68.0 ± 12.1 years old [mean ± SD]). Recanalization was attempted with intravenous tissue-type plasminogen activator and mechanical thrombectomy in 27.7% and 38.1% of patients, respectively. Twenty-five patients (45.4%) were successfully recanalized. In the successfully recanalized patients, no CTP threshold significantly outperformed what is used in LVO setting (rCBF < 30%). All rCBF CTP thresholds demonstrated fair diagnostic performances for predicting FIV. In unsuccessfully recanalized patients, all Tmax CTP thresholds strongly predicted FIV with relative superiority of Tmax >10 seconds (area under the receiver operating characteristic curve = .875, p = .001). CONCLUSION: In AIS patients with DMVOs, longer Tmax delays than Tmax  > 6 seconds, most notably, Tmax  > 10 seconds, best predict FIV in unsuccessfully recanalized patients. No CTP threshold reliably predicts FIV in the successfully recanalized group nor significantly outperformed rCBF < 30%.

Green, Open Spaces and Transport for Healthy and Sustainable Cities in Asian Developing Countries

@#Introduction: This paper presents the case studies of the green, open spaces and transport issues in three cities of the Asian region based on the work of participants from the Workshop of Health in Urban Planning. Methods: Three case studies were collected from the participants of Thailand, India, and Indonesia, and compiled under the theme. Results: The first case study presents findings from the Thailand’s Survey on Physical Activity (SPA), and various strategies taken by the Thai government to improve physical activity levels among the Thai population and children, including improved accessibility, walkability; and reconstruction of school curricula. The second case study is an empirical study of the geographical extent and type of green spaces accessible to the urban population, and their usage in the city of Varanasi, India, in the wake of Yoga practice popularity. The third case study discusses the insufficient transport infrastructures, along with the influx of visitors from outside the city as the cause of severe traffic congestions and emissions in Bandung city, Indonesia. The governments’ action plans and recommendations for improvements of the city environment are discussed. Conclusion: Integrating health into urban and transport planning needs co-operations from multiple stakeholders including the government, private sectors, and the communities, especially from the early phase of development.

Systemic effects after intravitreal injection of bevacizumab in new born rabbit eyes.

PURPOSE: To determine the systemic impact of intravitreal injection of bevacizumab (IVB), an anti-vascular endothelium growth factor antibody, in newborn rabbits. MATERIALS AND METHODS: We used four groups of rabbits. Group 1 rabbits received a single injection of IVB starting from the age of 6 weeks. Group 2 rabbits received a single injection of balanced salt solution (BSS, 0.025 ml) and served as controls for group 1. Group 3 rabbits received two consecutive injections of IVB at the ages of 6 and 10 weeks. Group 4 rabbits received two consecutive injections of BSS at the ages of 6 and 10 weeks and served as controls for group 3. During the experiment, a complete blood count (CBC), clinical biochemistry, weight gain, food intake, body temperature, blood pressure, pulse, and mortality were measured in the animals. Two months after IVB injection, the animals were sacrificed, and histology of the major organs was checked. Immunohistochemistry was assessed to explore the neurons in the central nervous system (CNS). RESULTS: We found there were no morphological or functional changes in the eyes following IVB injection. Furthermore, there were no differences in CBC, biochemistry, or other measured parameters among the four groups of animals. We checked the histology of the major organs and neurons in the CNS and they did not reveal significant differences among the four groups of animals. CONCLUSIONS: Conclusively, IVB of either one or two injections (0.625 mg) in newborn rabbit eyes is well tolerated and does not cause noticeable systemic organ pathology.

Clopidogrel-Associated Thrombotic Thrombocytopenic Purpura following Endovascular Treatment of Spontaneous Carotid Artery Dissection.

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disease secondary to platelet aggregation. We present a patient who developed profound thrombocytopenia and anemia 8 days following initiation of therapy with clopidogrel after stent placement for carotid artery dissection. She did not have a disintegrin and metalloproteinase with thrombospondin domain 13 (ADAMTS 13) deficiency. Management included steroids and therapeutic plasma exchange. Clopidogrel has rarely been associated with TTP. Unlike other causes of acquired TTP, the diagnosis of early clopidogrel-associated TTP is largely clinical given the infrequent reduction in ADAMTS 13 activity.

Lens subluxation after plasmin and SF6 injections in rabbit eyes.

PURPOSE: To investigate the rate of lens subluxation following plasmin and/or SF6 injections in eyes, and whether a subsequent elevated level of vascular endothelial growth factor (VEGF) and vitreous tap would aggravate subluxation. METHODS: Four groups of rabbits were used. Group 1 received an intravitreal injection (IVI) of plasmin and SF6 in the right eye; group 2 received an IVI of plasmin in the right eye; group 3 received an IVI of SF6 in the right eye; and group 4 received an IVI of balanced salt solution in the right eye. After treatment, IVIs of VEGF were given and vitreous tap was performed three times, followed by clinical observation of lens subluxation and scanning electronic microscope evaluation of the zonular fibers. RESULTS: After IVIs of plasmin and SF6, and VEGF and vitreous tap had been performed one to three times, lens subluxation was noted in 0%, 43%, 71%, 71%, and 86% of the eyes in group 1. After IVIs of plasmin, VEGF, and vitreous tap had been performed one to three times, lens subluxation was noted in 11%, 22%, 44%, 44%, and 67% of the eyes in group 2. The eyes in group 3 and 4 did not show signs of lens subluxation after VEGF IVIs and vitreous tap. Histology confirmed zonular fiber damage in the eyes treated with plasmin. CONCLUSIONS: The incidence of lens subluxation increased following plasmin injections in the eyes, and this was aggravated by the subsequent high VEGF level in the eyes and vitreous tapping. Zonular fibers were disrupted following plasmin treatment. These effects should be kept in mind when using plasmin enzymes in patients with vitreoretinal abnormalities.

Indicators of microbial beach water quality: preliminary findings from Teluk Kemang beach, Port Dickson (Malaysia).

This study aims to determine the concentrations of total coliforms and Escherichia coli (E. coli) in beach water, Teluk Kemang beach. This study was also aimed to determine relationship between total coliforms, E. coli and physicochemical parameters. As perceived health symptoms among beach visitors are rarely incorporated in beach water studies, this element was also assessed in this study. A total of eight water sampling points were selected randomly along Teluk Kemang beach. Total coliforms concentrations were found between 20 and 1940 cfu/100ml. E. coli concentrations were between 0 and 90 cfu/100ml. Significant correlations were found between total coliforms and E. coli with pH, temperature and oxidation reduction potential. Skin and eyes symptoms were the highest reported though in small numbers. Microbiological water quality in Teluk Kemang public beach was generally safe for recreational activities except sampling location near with sewage outfall.

Altered expression of Raet1e, a major histocompatibility complex class 1-like molecule, underlies the atherosclerosis modifier locus Ath11 10b.

RATIONALE: Quantitative trait locus mapping of an intercross between C57.Apoe⁻/⁻ and FVB.Apoe⁻/⁻ mice revealed an atherosclerosis locus controlling aortic root lesion area on proximal chromosome 10, Ath11. In a previous work, subcongenic analysis showed Ath11 to be complex with proximal (10a) and distal (10b) regions. OBJECTIVE: To identify the causative genetic variation underlying the atherosclerosis modifier locus Ath11 10b. METHODS AND RESULTS: We now report subcongenic J, which narrows the 10b region to 5 genes, Myb, Hbs1L, Aldh8a1, Sgk1, and Raet1e. Sequence analysis of these genes revealed no amino acid coding differences between the parental strains. However, comparing aortic expression of these genes between F1.Apoe⁻/⁻ Chr10SubJ((B/F)) and F1.Apoe⁻/⁻ Chr10SubJ((F/F)) uncovered a consistent difference only for Raet1e, with decreased, virtually background, expression associated with increased atherosclerosis in the latter. The key role of Raet1e was confirmed by showing that transgene-induced aortic overexpression of Raet1e in F1.Apoe⁻/⁻ Chr10SubJ((F/F)) mice decreased atherosclerosis. Promoter reporter constructs comparing C57 and FVB sequences identified an FVB mutation in the core of the major aortic transcription start site abrogating activity. CONCLUSIONS: This nonbiased approach has revealed Raet1e, a major histocompatibility complex class 1-like molecule expressed in lesional aortic endothelial cells and macrophage-rich regions, as a novel atherosclerosis gene and represents one of the few successes of the quantitative trait locus strategy in complex diseases.

Efficient vitreolysis by combining plasmin and sulfur hexafluoride injection in a preclinical study in rabbit eyes.

PURPOSE: To investigate the efficacy of plasmin and sulfur hexafluoride (SF(6)) on the vitreoretinal junction, as well as the long-term safety in the eye and effect on the recipient's general health after application in the eye. METHODS: The study design included four groups of rabbits with three animals in each group. Group 1 received an intravitreal injection (IVI) of plasmin and SF(6) in the right eye; group 2 received an IVI of plasmin in the right eye; group 3 received an IVI of SF(6) in the right eye; and group 4 received an IVI of balanced salt solution in the right eye, which served as a normal control. Long-term safety (up to approximately three months) after plasmin and/or SF(6) injection was evaluated morphologically by clinical examination, histology, and immunohistochemistry, and functionally by electroretinograms (ERGs). General health evaluations after intravitreal injection included the assessment of weight gain, food intake, body temperature, and complete blood count analysis. RESULTS: Plasmin plus SF(6) injection resulted in complete posterior vitreous detachment (PVD), whereas plasmin or SF(6) injection alone resulted in only partial PVD. Balanced salt solution did not induce PVD. Eighty days after intravitreal injection, there were no major differences among the eyes of the three groups of animals compared with the normal control animals upon clinical evaluation, or regarding retinal morphology and ERGs. The lenses examined remained clear for up to 80 days following the intravitreal injection of plasmin plus SF(6), except one eye in the plasmin-treated group. ERGs decreased transiently one week after intravitreal injection in groups 1 through 3, but animals recovered fully to normal status afterward. General health was not affected after the injection of plasmin plus SF(6). CONCLUSIONS: Efficient vitreoretinal separation could be achieved, and an acceptable long-term safety profile was noted after plasmin plus SF(6) injection in the eye. No major ocular toxicity or systemic toxicity was found after the injection of plasmin plus SF(6). These results provide good support for the future clinical use of plasmin plus SF(6) for treatment of a variety of vitreoretinopathies.

Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome.

Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among health care providers in Taiwan. From September 2000 to March 2006, surveillance of 455 patients with multiple organ dysfunction syndrome with unclear cause or clinical suspicion of leptospirosis was performed. Diagnosis was further confirmed by microscopic agglutination test or isolation of Leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. Forty-two patients were confirmed as having leptospirosis, which accounted for 9.2% of total patients with multiple organ dysfunction syndrome. Forty-nine excluded cases were identified for a case-control analysis for clinical distinction. The most common presentations of leptospirosis were fever (97.6%), acute kidney injury (85.7%), and jaundice (61.9%). The leptospirosis group showed lower urine specific gravity (cutoff value, 1.0145) and enlarged kidney size (cutoff value, 11.05 cm) as compared with the excluded cases by multivariate logistics regression. Delayed antibiotic administration prolongs the duration of hospitalization (R2 = 0.486, P < 0.01). No mortality has been found in the leptospirosis group after initiation in 2003 of rapid immunoglobulin M serology assay that showed considerably high sensitivity and specificity. Leptospirosis accounts for a salient cause of multiple organ dysfunctions in Taiwan. Early awareness of leptospirosis by distinct presentations, followed by prompt antibiotics therapy, can dramatically save the patients. The easily performed rapid immunoglobulin M serology assay is suitable as a rapid screening test for the diagnosis of leptospirosis.

The mouse atherosclerosis locus at chromosome 10 (Ath11) acts early in lesion formation with subcongenic strains delineating 2 narrowed regions.

OBJECTIVE: Ath11, an atherosclerosis susceptibility locus on proximal chromosome 10 (0 to 21 cM) revealed in a cross between apolipoprotein E deficient C57BL/6 (B6) and FVB mice, was recently confirmed in congenic mice. The objectives of this study were to assess how Ath11 affects lesion development and morphology, to determine aortic gene expression in congenics, and to narrow the congenic interval. METHODS AND RESULTS: Assessing lesion area over time in congenic mice showed that homozygosity for the FVB allele increased lesion area at 6 weeks persisting through to 24 weeks of age. Staining of aortic root sections at 16 weeks did not reveal obvious differences between congenics. Aortic expression-array analysis at 6 weeks revealed 97 genes that were >2-fold regulated, including 1 gene in the quantitative trait locus interval, Aldh8a1, and 2 gene clusters regulated by Hnf4alpha and Esr1. Analysis of lesion area in 11 subcongenic strains revealed 2 narrowed regions, 10a (21 genes), acting in females, and 10b (7 genes), acting in both genders. CONCLUSIONS: Ath11 appears to act early in lesion formation, with significant effects on aortic gene expression. This quantitative trait locus is genetically complex, containing a female-specific region 10a from 0 to 7.3 megabases (21 genes) and a gender-independent region 10b from 20.1 to 21.9 megabases (7 genes).

Estimation of premorbid general fluid intelligence using traditional Chinese reading performance in Taiwanese samples.

AIMS: The aims of the present study were to (i) investigate if traditional Chinese word reading ability can be used for estimating premorbid general intelligence; and (ii) to provide multiple regression equations for estimating premorbid performance on Raven's Standard Progressive Matrices (RSPM), using age, years of education and Chinese Graded Word Reading Test (CGWRT) scores as predictor variables. METHODS: Four hundred and twenty-six healthy volunteers (201 male, 225 female), aged 16-93 years (mean +/- SD, 41.92 +/- 18.19 years) undertook the tests individually under supervised conditions. Seventy percent of subjects were randomly allocated to the derivation group (n = 296), and the rest to the validation group (n = 130). RESULTS: RSPM score was positively correlated with CGWRT score and years of education. RSPM and CGWRT scores and years of education were also inversely correlated with age, but the declining trend for RSPM performance against age was steeper than that for CGWRT performance. Separate multiple regression equations were derived for estimating RSPM scores using different combinations of age, years of education, and CGWRT score for both groups. The multiple regression coefficient of each equation ranged from 0.71 to 0.80 with the standard error of estimate between 7 and 8 RSPM points. When fitting the data of one group to the equations derived from its counterpart group, the cross-validation multiple regression coefficients ranged from 0.71 to 0.79. There were no significant differences in the 'predicted-obtained' RSPM discrepancies between any equations. CONCLUSION: The regression equations derived in the present study may provide a basis for estimating premorbid RSPM performance.

Activation of PXR induces hypercholesterolemia in wild-type and accelerates atherosclerosis in apoE deficient mice.

The nuclear hormone receptor pregnane X receptor (PXR; also called SXR) functions as a xenobiotic sensor to coordinately regulate xenobiotic metabolism via transcriptional regulation of xenobiotic-detoxifying enzymes and transporters. Although many clinically relevant PXR ligands have been shown to affect cholesterol levels, the role of PXR in cholesterol homeostasis and atherosclerosis has not been thoroughly investigated. Here, we report that activation of PXR by feeding the PXR agonist pregnenolone 16alpha-carbonitrile (0.02%) for 2 weeks to wild-type (WT) mice significantly increased total cholesterol levels and atherogenic lipoproteins VLDL and LDL levels, but had no effect in PXR knockout (PXR(-/-)) mice. Chronic PXR activation in atherosclerosis prone apolipoprotein E deficient (ApoE(-/-)) mice was found to decrease HDL levels and increase atherosclerotic cross-sectional lesion area at both the aortic root and in the brachiocephalic artery by 54% (P < 0.001) and 116% (P < 0.01), respectively. PXR activation significantly regulated genes in the liver involved in lipoprotein transportation and cholesterol metabolism, including CD36, ApoA-IV, and CYP39A1, in both WT and ApoE(-/-) mice. Furthermore, PXR activation can increase CD36 expression and lipid accumulation in peritoneal macrophages of ApoE(-/-) mice. In summary, PXR activation in WT mice increases levels of the atherogenic lipoproteins VLDL and LDL, whereas in ApoE(-/-) mice, PXR increases atherosclerosis, perhaps by diminishing levels of the antiatherogenic ApoA-IV and increasing lipid accumulation in macrophages.

The quality of hemodialysis in patients with mental retardation.

BACKGROUND: Mentally retarded renal failure patients receiving hemodialysis (HD) comprise a small group of HD patients. There was no previous study describing how to manage these patients during HD and if they could achieve adequate dialysis quality. METHODS: We reported seven cases of mentally retarded patients with renal failure among 1224 patients receiving hemodialysis. Demographic and medical data were obtained from chart reviews and hospital information system. Parameters for dialysis quality were calculated. RESULTS: These mentally retarded patients ranged from 19 to 34 years of age (mean: 27.5 +/- 5.0 year-old), with six females and one male. The HD duration ranged from 24 to 84 months (mean: 54.6 +/- 27.2 months). The most common problem the medical stuff would encounter when they care mentally retarded dialysis patients is the maintenance of a smooth HD process due to the non-cooperation of these patients. Physical restriction or sedative agents such as diazepam, alprazolam, or chloral hydrate were prescribed in these patients for their irritability during HD session. All seven patients had good family support and care. The dialysis adequacy and nutritional parameters of these patients all met the guidelines suggested by the National Kidney Foundation Dialysis Outcome Quality Initiative (K/DOQI). CONCLUSION: Mentally retarded uremic patients can have good dialysis quality.

The protective effect of A20 on atherosclerosis in apolipoprotein E-deficient mice is associated with reduced expression of NF-kappaB target genes.

Up-regulation of inflammatory responses is considered a driving force of atherosclerotic lesion development. One key regulator of inflammation is the A20 (also called TNF-alpha-induced protein 3 or Tnfaip3) gene, which is responsible for NF-kappaB termination and maps to an atherosclerosis susceptibility locus revealed by quantitative trait locus-mapping studies at mouse proximal chromosome 10. In the current study, we examined the role of A20 in atherosclerotic lesion development. At the aortic root lesion size was found to be increased in C57BL/6 (BG) apolipoprotein E-deficient (ApoE(-/-)) mice haploinsufficient for A20, compared with B6 ApoE(-/-) controls that expressed A20 normally (60% in males and 23% in females; P < 0.001 and P < 0.05, respectively). In contrast, lesion size was found to be decreased in F(1) (B6 x FVB/N) mice overexpressing A20 by virtue of containing an A20 BAC transgene compared with nontransgenic controls (30% in males, P < 0.001, and 17% in females, P = 0.02). The increase in lesions in the A20 haploinsufficient mice correlated with increased expression of proatherosclerotic NF-kappaB target genes, such as vascular cell adhesion molecule 1, intercellular adhesion molecule 1, and macrophage-colony-stimulating factor, and elevated plasma levels of NF-kappaB-driven cytokines. These findings suggest that A20 diminishes atherosclerosis by decreasing NF-kappaB activity, thereby modulating the proinflammatory state associated with lesion development.

A cell behavior screen: identification, sorting, and enrichment of cells based on motility.

BACKGROUND: Identifying and isolating cells with specific behavioral characteristics will facilitate the understanding of the molecular basis regulating these behaviors. Although many approaches exist to characterize cell motility, retrieving cells of specific motility following analysis remains challenging. RESULTS: Cells migrating on substrates coated with fluorescent microspheres generate non-fluorescent tracks as they move and ingest the spheres. The area cleared by each cell allows for quantitation of single cell and population motility; because individual cell fluorescence is proportional to motility, cells can be sorted according to their degree of movement. Using this approach, we sorted a glioblastoma cell line into high motility and low motility populations and found stable differences in motility following sorting. CONCLUSION: We describe an approach to identify, sort, and enrich populations of cells possessing specific levels of motility. Unlike existing assays of cell motility, this approach enables recovery of characterized cell populations, and can enable screens to identify factors that might regulate motility differences even within clonal population of cells.

Rheological characteristics of intermediate moisture blends of pregelatinized and raw wheat starch.

Rheological properties of intermediate moisture (35-45% wet basis) doughs from pregelatinized and raw wheat starch blends of various ratios were characterized using off-line capillary rheometry and online slit-die extrusion. In the case of capillary rheometer, viscosity of blends decreased by up to 50% as pregel starch concentration increased from 5 to 45%, whereas tests could not be conducted beyond 45% pregel starch concentration. For slit-die extrusion, viscosity was at a minimum at 60% pregel concentration, and it decreased by as much as 65% as pregel concentration increased from 0 to 60%. As pregel concentration increased (from 5 to 45% for the rheometer and from 0 to 60% for the extruder), the amount of water available in the system for gelatinization of existing raw starch granules decreased due to the stronger water-binding capacity of pregelatinized starch. This led to decreased additional conversion in the rheometer and extruder, which in turn caused a decrease in the volume fraction of starch and a reduction in viscosity.

Expression of infectious laryngotracheitis virus glycoproteins in Escherichia coli and their application in enzyme-linked immunosorbent assay.

Three glycoproteins of infectious laryngotracheitis virus (ILTV), gC, gE, and gp60, were expressed in Escherichia coli as fusion proteins with a 6-histidine tag at their amino termini. The proteins expressed, designated as r-gC, r-gp60, and r-gE, all retain their antigenicity, as revealed by Western blot with chicken antiserum against ILTV. However, only r-gp60 and r-gE, but not r-gC, were found to be soluble. The soluble r-gp60 and r-gE were purified by a nickel column and then used as the enzyme-linked immunosorbent assay (ELISA) antigen for detecting ILTV-specific antibodies. The diagnostic potential of r-gE and r-gp60 ELISA was assessed with the use of sera prepared from vaccinated or unvaccinated chickens of either specific-pathogen-free (SPF) or field origins. The result shows that r-gp60 and r-gE ELISA could discriminate vaccinated SPF chickens from unvaccinated ones 2 wk postvaccination. Moreover, r-gp60 and r-gE ELISA could also discriminate vaccinated field flocks from unvaccinated ones. This result indicates that r-gp60 and r-gE might serve as an alternative ELISA antigen for detecting ILTV-specific antibodies. Moreover, r-gp60 or r-gE ELISA might play an important role in the eradication of infectious laryngotracheitis (ILT) in the future when the gp60- or gE-deleted marker vaccine of ILT is available.

Selection of scleral buckling for primary retinal detachment.

PURPOSE: Rhegmatogenous retinal detachment (RRD) may be caused by a flap tear or by an atrophic hole along the lattice degeneration. The aim of this study was to see whether different types of scleral buckling could achieve comparable reattachment rates in eyes with specific types of RRD. PATIENTS AND METHODS: 128 eyes with RRD were assigned to receive 1 of 3 buckling procedures according to the following guidelines: retinal detachments caused by flap tears were treated with radial segmental buckling; retinal detachments caused by atrophic holes with limited lattice degeneration were treated with circumferential segmental buckling, and retinal detachments caused by multiple breaks with extensive lattice degeneration were treated with encircling buckling. RESULTS: 56 eyes received radial segmental buckling, 36 eyes received circumferential segmental buckling, and 36 eyes received encircling buckling. The reattachment rates in these three groups were 83.9, 86.1, and 88.9%, respectively (no statistically significant difference). The visual outcomes were comparable in all groups. Younger age, an increased requirement for subretinal fluid drainage, longer operation time, and myopic shift were noted in the encircling group. CONCLUSIONS: Comparable reattachment rates could be achieved in all three groups according to our guidelines. Segmental buckling is appropriate for two thirds of RRD in this study and has fewer complications than encircling buckling. Every retinal detachment behaves differently and should be subjected to its optimal buckling procedure to achieve the best results and to avoid unnecessary operative complications.