Pro-angiogenic and antibacterial copper containing nanoparticles in PLGA/amorphous calcium phosphate bone nanocomposites.

Large bone defects after trauma demand for adequate bone substitutes. Bone void fillers should be antibacterial and pro-angiogenic. One viable option is the use of composite materials like the combination of PLGA and amorphous calcium phosphate (aCaP). Copper stimulates angiogenesis and has antibacterial qualities. Either copper oxide (CuO) nanoparticles (NPs) were therefore added to PLGA/aCaP/CuO in different concentrations (1, 5 and 10 w/w %) or copper-doped tricalcium phosphate NPs (TCP with 2% of copper) were electrospun into PLGA/CuTCP nanocomposites. Bi-layered nanocomposites of PLGA/aCaP with different copper NPs (CuO or TCP) and a second layer of pristine PLGA were fabricated. Two clinical bacterial isolates (Staphylococcus aureus and Staphylococcus epidermidis) were used to assess antibacterial properties of the copper-containing materials. For angiogenesis, the chorioallantoic membrane (CAM) assay of the chicken embryo was performed. The higher the CuO content, the higher were the antibacterial properties, with 10 % CuO reducing bacterial adhesion most effectively. Vessel and cell densities were highest in the 5 % CuO containing scaffolds, while tissue integration was more pronounced at lower CuO content. The PLGA/aCaP/CuO (1 % CuO) behaved similar like PLGA/CuTCP in all angiogenic and antibacterial readouts, based on the same copper fraction. We conclude that CuO NPs or CuTCP NPs are useful components to increase angiogenic properties of nanocomposites and at the same time exhibiting antibacterial characteristics.

The possible influence of third-order shim coils on gradient-magnet interactions: an inter-field and inter-site study.

OBJECTIVE: To assess the possible influence of third-order shim coils on the behavior of the gradient field and in gradient-magnet interactions at 7 T and above. MATERIALS AND METHODS: Gradient impulse response function measurements were performed at 5 sites spanning field strengths from 7 to 11.7 T, all of them sharing the same exact whole-body gradient coil design. Mechanical fixation and boundary conditions of the gradient coil were altered in several ways at one site to study the impact of mechanical coupling with the magnet on the field perturbations. Vibrations, power deposition in the He bath, and field dynamics were characterized at 11.7 T with the third-order shim coils connected and disconnected inside the Faraday cage. RESULTS: For the same whole-body gradient coil design, all measurements differed greatly based on the third-order shim coil configuration (connected or not). Vibrations and gradient transfer function peaks could be affected by a factor of 2 or more, depending on the resonances. Disconnecting the third-order shim coils at 11.7 T also suppressed almost completely power deposition peaks at some frequencies. DISCUSSION: Third-order shim coil configurations can have major impact in gradient-magnet interactions with consequences on potential hardware damage, magnet heating, and image quality going beyond EPI acquisitions.

Rhegmatogenous retinal detachment presentation and surgery in uveitic eyes.

BACKGROUND/AIMS: To explore the occurrence, uveitis activity, features, rate of proliferative vitreoretinopathy (PVR) and outcomes following rhegmatogenous retinal detachment (RRD) in a large tertiary referral uveitis service. METHODS: Retrospective analysis of subjects attending between 2008 and 2019. Multivariate analysis of risk factors for RRD was calculated. Nelson-Aalen plots were used to demonstrate cumulative risk of RRD. Outcomes of RRD surgery and prognostic indicators were analysed. RESULTS: Two thousand four hundred and forty-seven (2447) subjects (3516 eyes) with uveitis included. The mean follow-up was 5.7 years (19 767 eye-years); 56 eyes developed a RRD (1.6%). Thirty-two eyes had surgery in our unit. Risk factors for RRD were posterior uveitis or panuveitis (HR 3.386, p<0.001), male gender (HR 2.045, p=0.029) and infectious aetiology (HR 1.942, p=0.044). PVR was present in six (18.8%) eyes at presentation, and a further four (12.5%) developed it after the primary surgery. Final follow-up data showed 16 (50%) moderate or severe visual loss, although 29 (90.6%) had anatomical reattachment without oil in situ. CONCLUSIONS: There is a high rate of RRD in uveitis eyes. This is accompanied by high rates of PVR and redetachment. Anatomical success was high, but visual outcomes remain unpredictable.

Using the hemolysis index of Abbott's Alinity c for the measurement of plasma free hemoglobin in ECMO patients.

OBJECTIVES: Quantitative measurement of plasma free hemoglobin (fHb) concentrations is essential for monitoring pediatric ECMO patients, since hemolysis has a great impact on the patient's clinical outcome. The aim of this study was to validate the hemolysis index (HI) assay on Abbott's Alinity c system as a quantitative method to measure fHb. METHODS: The performance of the HI assay, based on an automated spectrophotometric method recording the absorption at four different wavelength pairs, was evaluated using the 20 × 2 × 2 design according to the CLSI-EP05-A3 guidelines. LLOQ and LLOD were calculated according to CLSI-EP17 guidelines with CVs set to 10% and 20%, respectively. Furthermore, the method was tested for interferences with bilirubin and Intralipid®. RESULTS: Linearity was ensured over an analytical measurement range of 30-7250 mg/L and the calculated LLOQ and LLOD were 80 mg/L and 50 mg/L, respectively. Intra-run and total imprecisions ranged from 0.9-3.4% and 1.0-3.4%, respectively. The HI assay correlated well with the Harboe method (HI (mg/L) = 0.998 * fHb (mg/L) + 28 mg/L, R = 0.998, n = 50) and interference testing showed no impact of bilirubin and Intralipid® up to 709 mg/L and 5580 mg/L, respectively. CONCLUSIONS: The HI assay on Abbott's Alinity c system allows a precise and accurate determination of fHb concentrations with no significant interferences in a simple, rapid and cost-effective way.

Adaptive Lissajous scanning pattern design by phase modulation.

This paper proposes a phase modulation method for Lissajous scanning systems, which provides adaptive scan pattern design without changing the frame rate or the field of view. Based on a rigorous analysis of Lissajous scanning, phase modulation constrains and a method for pixel calculation are derived. An accurate and simple metric for resolution calculation is proposed based on the area spanned by neighboring pixels and used for scan pattern optimization also considering the scanner dynamics. The methods are implemented using MEMS mirrors for verification of the adaptive pattern shaping, where a 5-fold resolution improvement in a defined region of interest is demonstrated.

HYFI: Hybrid filling of the dead-time gap for faster zero echo time imaging.

The aim of this work was to improve the SNR efficiency of zero echo time (ZTE) MRI pulse sequences for faster imaging of short-T2 components at large dead-time gaps. ZTE MRI with hybrid filling (HYFI) is a strategy for retrieving inner k-space data missed during the dead-time gaps arising from radio-frequency excitation and switching in ZTE imaging. It performs hybrid filling of the inner k-space with a small single-point-imaging core surrounded by a stack of shells acquired on radial readouts in an onion-like fashion. The exposition of this concept is followed by translation into guidelines for parameter choice and implementation details. The imaging properties and performance of HYFI are studied in simulations as well as phantom, in vitro and in vivo imaging, with an emphasis on comparison with the pointwise encoding time reduction with radial acquisition (PETRA) technique. Simulations predict higher SNR efficiency for HYFI compared with PETRA at preserved image quality, with the advantage increasing with the size of the k-space gap. These results are confirmed by imaging experiments with gap sizes of 25 to 50 Nyquist dwells, in which scan times for similar image quality could be reduced by 25% to 60%. The HYFI technique provides both high SNR efficiency and image quality, thus outperforming previously known ZTE-based pulse sequences, in particular for large k-space gaps. Promising applications include direct imaging of ultrashort-T2 components, such as the myelin bilayer or collagen, T2 mapping of ultrafast relaxing signals, and ZTE imaging with reduced chemical shift artifacts.

Elastomer coils for wearable MR detection.

PURPOSE: To explore the use of conductive elastomer for MR signal detection and the utility of this approach for wearable detector arrays. METHODS: An elastomer filled with silver microparticles was used to form stretchable radiofrequency coils for MR detection. Their electrical performance in terms of the Qunloaded and Q ratio was assessed in the relaxed state and under repeated strain up to 40%. In a phantom imaging study, the signal-to-noise ratio yield of conductive elastomer coils was compared with that of a reference copper coil. Four elastomer coils were integrated with a stretchable textile substrate to form a wearable array for knee imaging. The array was employed for multiple-angle and kinematic knee imaging in vivo. RESULTS: The elastomer coils proved highly stretchable and mechanically robust. Upon repeated stretching by 20%, a medium-sized coil element settled at Qunloaded of 42 in the relaxed state and 32 at full strain, reflecting sample-noise dominance. The signal-to-noise ratio of elastomer coils was found to be 8% to 16% lower than that achieved with a conventional copper coil. Multiple-angle and kinematic knee imaging with the wearable array yielded high-quality results indicating robustness of detection performance against stretching and warping of the array. CONCLUSION: Conductive elastomer is a viable material for MR detection. Coils made from this material reconcile high stretchability and adequate electrical performance with ease of manufacturing. Conductive elastomer also offers inherent restoring forces and is readily washable and sanitizable, making it an excellent basis of wearable detector front ends.

High-resolution MRI of mummified tissues using advanced short-T2 methodology and hardware.

PURPOSE: Evolutionary medicine aims to study disease development from a long-term perspective, and through the analysis of mummified tissue, timescales of several thousand years are unlocked. Due to the status of mummies as ancient relics, noninvasive techniques are preferable, and, currently, CT imaging is the most widespread method. However, CT images lack soft-tissue contrast, making complementary MRI data desirable. Unfortunately, the dehydrated nature and short T2 times of mummified tissues render them practically invisible to standard MRI techniques. Specialized short-T2 approaches have therefore been used, but currently suffer severe resolution limitations. The purpose of the present study is to improve resolution in MRI of mummified tissues. METHODS: The zero-TE-based hybrid filling technique, together with a high-performance magnetic field gradient, was used to image three ancient Egyptian mummified human body parts: a hand, a foot, and a head. A similar pairing has already been shown to increase resolution and image quality in MRI of short-T2 tissues. RESULTS: MRI images of yet unparalleled image quality were obtained for all samples, reaching isotropic resolutions of 0.6 mm and SNR values above 100. The same general features as present in CT images were depicted but with different contrast, particularly for regions containing embalming substances. CONCLUSION: Mummy MRI is a potentially valuable tool for (paleo)pathological studies, as well as for investigations into ancient mummification processes. The results presented here show sufficient improvement in the depiction of mummified tissues to clear new paths for the exploration of this field.

On the signal-to-noise ratio benefit of spiral acquisition in diffusion MRI.

PURPOSE: Spiral readouts combine several favorable properties that promise superior net sensitivity for diffusion imaging. The purpose of this study is to verify the signal-to-noise ratio (SNR) benefit of spiral acquisition in comparison with current echo-planar imaging (EPI) schemes. METHODS: Diffusion-weighted in vivo brain data from three subjects were acquired with a single-shot spiral sequence and several variants of single-shot EPI, including full-Fourier and partial-Fourier readouts as well as different diffusion-encoding schemes. Image reconstruction was based on an expanded signal model including field dynamics obtained by concurrent field monitoring. The effective resolution of each sequence was matched to that of full-Fourier EPI with 1 mm nominal resolution. SNR maps were generated by determining the noise statistics of the raw data and analyzing the propagation of equivalent synthetic noise through image reconstruction. Using the same approach, maps of noise amplification due to parallel imaging (g-factor) were calculated for different acceleration factors. RESULTS: Relative to full-Fourier EPI at b = 0 s/mm2 , spiral acquisition yielded SNR gains of 42-88% and 40-89% in white and gray matter, respectively, depending on the diffusion-encoding scheme. Relative to partial-Fourier EPI, the gains were 36-44% and 34-42%. Spiral g-factor maps exhibited less spatial variation and lower maxima than their EPI counterparts. CONCLUSION: Spiral readouts achieve significant SNR gains in the order of 40-80% over EPI in diffusion imaging at 3T. Combining systematic effects of shorter echo time, readout efficiency, and favorable g-factor behavior, similar benefits are expected across clinical and neurosciences uses of diffusion imaging.

Publisher Correction: Detector clothes for MRI: A wearable array receiver based on liquid metal in elastic tubes.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Detector clothes for MRI: A wearable array receiver based on liquid metal in elastic tubes.

In modern magnetic resonance imaging, signal detection is performed by dense arrays of radiofrequency resonators. Tight-fitting arrays boost the sensitivity and speed of imaging. However, current devices are rigid and cage-like at the expense of patient comfort. They also constrain posture, limiting the examination of joints. For better ergonomics and versatility, detectors should be flexible, adapt to individual anatomy, and follow posture. Towards this goal, the present work proposes a novel design based on resonators formed by liquid metal in polymer tubes. Textile integration creates lightweight, elastic devices that are worn like pieces of clothing. A liquid-metal array tailored to the human knee is shown to deliver competitive image quality while self-adapting to individual anatomy and adding the ability to image flexion of the joint. Relative to other options for stretchable conductors, liquid metal in elastic tubes stands out by reconciling excellent electrical and mechanical properties with ease of manufacturing.

A transmit-receive array for brain imaging with a high-performance gradient insert.

PURPOSE: The aim of this work was to provide parallel imaging capability for the human head in a gradient insert of 33-cm inner diameter within the related constraints of space, encoding ambiguity, and eddy current immunity. METHODS: Eddy current behavior of the 8-channel transmit-receive array coil was investigated via heating and field deviation measurements. RF performance was evaluated using S-parameters, noise statistics, B1 maps, and g-factor maps. In vivo images of a human head and knee were acquired with Cartesian readout and TE below 0.45 ms. RESULTS: Under intense gradient use, the shield was heated up to 55°C and other coil structures to 40°C. After standard preemphasis calibration, eddy current-related field distortions caused by the developed RF coil were smaller than for a commercial receive-only coil. In the ambiguous regions of the gradient, B1+ is 20 dB lower than in the center of the FOV. Coupling between elements is below -15 dB, and noise correlation is less than 0.31 when the coil is loaded with a head. Power efficiency was 0.52 ± 0.02 µT/√W, and the SD of the flip angle was below 10% in central slices of the brain. 2D, up to fourfold acceleration causes less than 30% noise amplification. The RF coil can be used during full gradient performance. CONCLUSION: Based on the described features, the presented coil enables parallel imaging in the high-performance gradient insert.

Advances in MRI of the myelin bilayer.

Myelin plays a key role in the function of the central nervous system and is involved in many neurodegenerative diseases. Hence, depiction of myelin is desired for both research and diagnosis. However, MRI of the lipid bilayer constituting the myelin membrane is hampered by extremely rapid signal decay and cannot be accomplished with conventional sequences. Dedicated short-T2 techniques have therefore been employed, yet with extended sequence timings not well matched to the rapid transverse relaxation in the bilayer, which leads to signal loss and blurring. In the present work, capture and encoding of the ultra-short-T2 signals in the myelin bilayer is considerably improved by employing advanced short-T2 methodology and hardware, in particular a high-performance human-sized gradient insert. The approach is applied to tissue samples excised from porcine brain and in vivo in a human volunteer. It is found that the rapidly decaying non-aqueous components in the brain can indeed be depicted with MRI at useful resolution. As a considerable fraction of these signals is related to the myelin bilayer, the presented approach has strong potential to contribute to myelin research and diagnosis.

High-resolution short-T2 MRI using a high-performance gradient.

PURPOSE: To achieve high resolution in imaging of short-T2 materials and tissues by using a high-performance human-sized gradient insert with strength up to 200 mT/m and 100% duty cycle. METHODS: Dedicated short-T2 methodology and hardware are used, such as the pointwise encoding time reduction with radial acquisition (PETRA) technique with modulated excitation pulses, optimized radio-frequency hardware, and a high-performance gradient insert. A theoretical analysis of actual spatial resolution and SNR is provided to support the choice of scan parameters and interpretation of the results. Imaging is performed in resolution phantoms, animal specimen, and human volunteers at both conventional and maximum available gradient strengths and compared using image subtraction. RESULTS: Calculations suggest that increasing gradient strength beyond conventional values considerably improves both actual resolution and SNR efficiency in short-T2 imaging. Resolution improvements are confirmed in all investigated samples, in particular 2 mm slots were resolved in a hard-plastic plate with T2 ≈ 10 µs and in vivo musculoskeletal images were acquired at isotropic 200 µm resolution. Expected improvements in signal yield are realized in fine structures benefitting from high resolution but to less extent in regions of low contrast where decay-related blurring leads to signal overlap between neighboring locations. CONCLUSION: Strong gradients with high duty cycle enable short-T2 imaging at unprecedentedly high resolution, holding the potential for improving MRI of, eg, bone, tendon, lung, or teeth. Moreover, it allows direct access of tissues with T2 of tens of microseconds such as myelin or collagen.

An In-Bore Receiver for Magnetic Resonance Imaging.

In magnetic resonance imaging, the use of array detection and the number of detector elements have seen a steady increase over the past two decades. As a result, per-channel analog connection via long coaxial cable, as commonly used, poses an increasing challenge in terms of handling, safety, and coupling among cables. This situation is exacerbated when complementary recording of radiofrequency transmission or NMR-based magnetic field sensing further add to channel counts. A generic way of addressing this trend is the transition to digital signal transmission, enabled by digitization and first-level digital processing close to detector coils and sensors in the magnet bore. The foremost challenge that comes with this approach is to achieve high dynamic range, linearity, and phase stability despite interference by strong static, audiofrequency, and radiofrequency fields. The present work reports implementation of a 16-channel in-bore receiver, performing signal digitization and processing with subsequent optical transmission over fiber. Along with descriptions of the system design and construction, performance evaluation is reported. The resulting device is fully MRI compatible providing practically equal performance and signal quality compared to state-of-the-art RF digitizers operating outside the magnet. Its use is demonstrated by examples of head imaging and magnetic field recording.

Long-T2 -suppressed zero echo time imaging with weighted echo subtraction and gradient error correction.

PURPOSE: To perform direct, selective MRI of short-T2 tissues using zero echo time (ZTE) imaging with weighted echo subtraction (WSUB). METHODS: Radial imaging was performed at 7T, acquiring both ZTE and gradient echo (GRE) signals created by bipolar gradients. Long-T2 suppression was achieved by weighted subtraction of ZTE and GRE images. Special attention was given to imperfections of gradient dynamics, to which radial GRE imaging is particularly susceptible. To compensate for gradient errors, matching of gradient history was combined with data correction based on trajectory measurement. The proposed approach was first validated in phantom experiments and then demonstrated in musculoskeletal (MSK) imaging. RESULTS: Trajectory analysis and phantom imaging demonstrated that gradient imperfections were successfully addressed. Gradient history matching enabled consistency between antiparallel projections as required for deriving zeroth-order eddy current dynamics. Trajectory measurement provided individual echo times per projection that showed considerable variation between gradient directions. In in vivo imaging of knee, ankle, and tibia, the proposed approach enabled high-resolution 3D depiction of bone, tendons, and ligaments. Distinct contrast of these structures indicates excellent selectivity of long-T2 suppression. Clarity of depiction also confirmed sufficient SNR of short-T2 tissues, achieved by high baseline sensitivity at 7T combined with high SNR efficiency of ZTE acquisition. CONCLUSION: Weighted subtraction of ZTE and GRE data reconciles robust long-T2 suppression with fastest k-space coverage and high SNR efficiency. This approach enables high-resolution imaging with excellent selectivity to short-T2 tissues, which are of major interest in MSK and neuroimaging applications.

A Reconfigurable Platform for Magnetic Resonance Data Acquisition and Processing.

Developments in magnetic resonance imaging (MRI) in the last decades show a trend towards a growing number of array coils and an increasing use of a wide variety of sensors. Associated cabling and safety issues have been addressed by moving data acquisition closer to the coil. However, with the increasing number of radio-frequency (RF) channels and trend towards higher acquisition duty-cycles, the data amount is growing, which poses challenges for throughput and data handling. As it is becoming a limitation, early compression and preprocessing is becoming ever more important. Additionally, sensors deliver diverse data, which require distinct and often low-latency processing for run-time updates of scanner operation. To address these challenges, we propose the transition to reconfigurable hardware with an application tailored assembly of interfaces and real-time processing resources. We present an integrated solution based on a system-on-chip (SoC), which offers sufficient throughput and hardware-based parallel processing power for very challenging applications. It is equipped with fiber-optical modules serving as versatile interfaces for modular systems with in-field operation. We demonstrate the utility of the platform on the example of concurrent imaging and field sensing with hardware-based coil compression and trajectory extraction. The preprocessed data are then used in expanded encoding model based image reconstruction of single-shot and segmented spirals as used in time-series and anatomical imaging respectively.

When does population growth pay off? A case study of suburban land consumption to assess the Lower Austrian infrastructural cost calculator.

'To increase the number of inhabitants' is a commonly stated top objective in municipal strategies across European countries. Not differently in Austria, local policy follows a logic of growth as financial tax and redistribution systems reward according to population figures; but is demographic growth necessarily financially beneficial for a municipality, irrespective of the type of land use changes, and potentially urban sprawl, that it triggers? The Federal State of Lower Austria offers to its municipalities a strategic online planning tool to pre-assess eventual municipal infrastructural costs and tax revenues that would come with certain population increase. This study tests the Lower Austrian infrastructural cost calculator and, in so doing, seeks to add a spatial perspective to an otherwise oversimplified financial calculation of planning for growth. The case study municipality of Michelhausen formulated an ambitious objective of 25% population growth (+ 700 inhabitants) within a few years in its local development strategy, to be realised by enlarging a rural settlement area. The study will assess five possible alternatives of settlement enlargement with varying housing types for their municipal financial consequences. In conducting this case study, the infrastructural cost calculator, a strategic planning tool offered by the federal planning authority of Lower Austria to their municipalities, will be assessed for its current potential as well as possible enhancement as strategic planning instrument to support municipalities in financial questions when developing building land. Normative lessons drawn from the whole exercise directly address actors and decision-makers in local and regional planning context in Lower Austria. The study ends with a short outlook of possible learnings and transfer into other national and international planning practice contexts.

Lateral geniculate nucleus volumetry at 3T and 7T: Four different optimized magnetic-resonance-imaging sequences evaluated against a 7T reference acquisition.

PURPOSE: The lateral geniculate nucleus (LGN) is an essential nucleus of the visual pathway, occupying a small volume (60-160 mm3) among the other thalamic nuclei. The reported LGN volumes vary greatly across studies due to technical limitations and due to methodological differences of volume assessment. Yet, structural and anatomical alterations in ophthalmologic and neurodegenerative pathologies can only be revealed by a precise and reliable LGN representation. To improve LGN volume assessment, we first implemented a reference acquisition for LGN volume determination with optimized Contrast to Noise Ratio (CNR) and high spatial resolution. Next, we compared CNR efficiency and rating reliability of 3D Magnetization Prepared Rapid Gradient Echo (MPRAGE) images using white matter nulled (WMn) and grey matter nulled (GMn) sequences and its subtraction (WMn-GMn) relative to the clinical standard Proton Density Turbo Spin Echo (PD 2D TSE) and the reference acquisition. We hypothesized that 3D MPRAGE should provide a higher CNR and volume determination accuracy than the currently used 2D sequences. MATERIALS AND METHODS: In 31 healthy subjects, we obtained at 3 and 7 T the following MR sequences: PD-TSE, MPRAGE with white/grey matter signal nulled (WMn/GMn), and a motion-corrected segmented MPRAGE sequence with a resolution of 0.4 × 0.4 × 0.4 mm3 (reference acquisition). To increase CNR, GMn were subtracted from WMn (WMn-GMn). Four investigators manually segmented the LGN independently. RESULTS: The reference acquisition provided a very sharp depiction of the LGN and an estimated mean LGN volume of 124 ±â€¯3.3 mm3. WMn-GMn had the highest CNR and gave the most reproducible LGN volume estimations between field strengths. Even with the highest CNR efficiency, PD-TSE gave inconsistent LGN volumes with the weakest reference acquisition correlation. The LGN WM rim induced a significant difference between LGN volumes estimated from WMn and GMn. WMn and GMn LGN volume estimations explained most of the reference acquisition volumes' variance. For all sequences, the volume rating reliability were good. On the other hand, the best CNR rating reliability, LGN volume and CNR correlations with the reference acquisition were obtained with GMn at 7 T. CONCLUSION: WMn and GMn MPRAGE allow reliable LGN volume determination at both field strengths. The precise location and identification of the LGN (volume) can help to optimize neuroanatomical and neurophysiological studies, which involve the LGN structure. Our optimized imaging protocol may be used for clinical applications aiming at small nuclei volumetric and CNR quantification.

A search for trachoma in Timor-Leste: no evidence to justify undertaking population-based prevalence surveys.

PURPOSE: We sought evidence to justify undertaking population-based trachoma surveys in Timor-Leste, believing that in the absence of such evidence, the country could be categorized as not needing interventions to eliminate trachoma. METHODS: We undertook a systematic review of published literature on trachoma in Timor-Leste, with results updated to 28 April 2018. We also undertook a series of clinic- and field-based screening exercises, consisting of: (1) in October 2015, conjunctival examination of all children attending a school in Vila, Atauro Island; (2) from 1 November 2016 to 30 April 2017, examination for trichiasis, by specifically-trained frontline eye workers, of all individuals presenting to the ophthalmic clinics of six referral hospitals and five district eye clinics; and (3) house-to-house case searches in a total of 110 households, drawn from three communities that were reported by investigators from the 2016 Rapid Assessment of Avoidable Blindness (RAAB) to include residents with trachoma. RESULTS: Three RAABs (2005, 2009-2010, 2016) and two relevant published papers were identified. The 2016 RAAB reported one female subject to have been diagnosed with trachomatous corneal opacity. Re-examination of that individual revealed that she had ankyloblepharon, without evidence of trichiasis or entropion. No children on Atauro Island, no clinic attendees, and no individuals examined in the targeted house-to-house searches had any sign of trachoma. CONCLUSION: Trachoma is very unlikely to be a public health problem in Timor-Leste. It would not be appropriate to incur the costs of conducting formal population-based trachoma prevalence surveys here.