Location Of Vessels Research Articles

Artificial intelligence applied to coronary artery calcium scans (AI-CAC) significantly improves cardiovascular events prediction.

Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) applied to CAC scans can predict non-CHD events, including heart failure, atrial fibrillation, and stroke. We applied AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) of 5830 asymptomatic individuals (52.2% women, age 61.7 ± 10.2 years) in the multi-ethnic study of atherosclerosis during 15 years of follow-up, 1773 CVD events accrued. The AUC at 1-, 5-, 10-, and 15-year follow-up for AI-CAC vs. Agatston score was (0.784 vs. 0.701), (0.771 vs. 0.709), (0.789 vs. 0.712) and (0.816 vs. 0.729) (p < 0.0001 for all), respectively. AI-CAC plaque characteristics, including number, location, density, plus number of vessels, significantly improved CHD prediction in the CAC 1-100 cohort vs. Agatston Score. AI-CAC significantly improved the Agatston score for predicting all CVD events.

Advancing Marine Surveillance: A Hybrid Approach of Physics Infused Neural Network for Enhanced Vessel Tracking Using Automatic Identification System Data

In the domain of maritime surveillance, the continuous tracking and monitoring of vessels are imperative for the early detection of potential threats. The Automatic Identification System (AIS) database, which collects vessel movement data over time, including timestamps and other motion details, plays a crucial role in real-time maritime monitoring. However, it frequently exhibits irregular intervals of data collection and intricate, intersecting trajectories, underscoring the importance of analyzing long-term temporal patterns for effective vessel tracking. While Kalman Filters and other physics-based models have been employed to tackle these issues, their effectiveness is limited by their inability to capture long-term dependence and non-linearity in the historical data. This paper introduces a novel approach that leverages Long Short-Term Memory (LSTM), a type of recurrent neural network, renowned for its proficiency in recognizing patterns over extended periods. Recognizing the strengths and limitations of the LSTM model, we propose a hybrid machine-learning algorithm that integrates LSTM with a physics-based model. This combination harnesses the physical laws governing vessel movements alongside data driven pattern mining, thereby enhancing the predictive accuracy of vessel locations. To assess the performance of standalone and hybrid models, various scenarios with different levels of complexity are generated. Furthermore, to simulate real-world data loss conditions often encountered in maritime tracking, temporal data gaps are randomly introduced into the scenarios. The competing approaches are then evaluated using both with time gap and without time gap conditions. Our results show that, although the LSTM model performs better than the physics-based model, the hybrid model consistently outperforms both standalone models across all scenarios. Furthermore, while data gaps negatively impact the accuracy of all models, the performance reduction is minimal for the physics-infused model. In summary, this study not only demonstrates the potential of combining data-driven and physics-based approaches but also sets a new benchmark for maritime vessel tracking.

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

Clinical case of an atypical variant of Labbe's vein structure in a patient with pharmacoresistant temporal epilepsy

Among the commonly recognised structural lesions that cause drug-resistant temporal lobe epilepsy, such as mesial temporal sclerosis, focal cortical dysplasia, benign intracerebral tumors, arteriovenous malformations and cavernous angiomas, researchers have recently noted other pathologies, such as, encephalocele. There are a number of publications on the connection between epilepsy and cerebral venous angiomas. However, there are no published cases of the influence of the abnormal structure and location of normal cerebral vessels on the development of epilepsy. This article presents a case of an atypically large and unusually located vein of Labbe that may have been involved in epileptogenesis and also complicated an anteromedial temporal lobectomy. Forced coagulation and excision of the Labbe vein during surgery did not lead to venous infarction and neurological deficit.

The Impact of Anchoring on Seafloor Integrity: An Integrated Assessment within a Major Bunkering Area of the Maltese Islands

International shipping is a fundamental component of the global economy. As the industry expands, the demand for high-capacity vessels increases, raising concerns about their impact on the marine environment. While awaiting access to port facilities, vessels often anchor to save fuel and prevent drifting, but this practice is a significant cause of mechanical disturbance to the seafloor and benthic habitats. Identifying and quantifying anchoring pressure is essential for better managing and mitigating the damage to the seafloor. The Automatic Identification System (AIS) can be utilized to assess anchoring pressure by transmitting vessel information (e.g., position, type and size) to other vessels and coastal stations. This research evaluates anchoring pressure in a strategically located bunkering area around the Maltese Islands using AIS data collected from an antenna at the University of Malta. An arbitrary index was developed to determine anchoring pressure, and the AIS data was used to create GIS maps showing the location and size of vessels within the bunkering area, as well as plots depicting anchoring pressure by vessel type, seasonality, and density. This study serves as a blueprint for future assessments of anchoring pressures from various maritime activities in other areas around the Maltese Islands and provides a decision support tool for national policy-making related to Descriptor 6 (Seafloor Integrity) of the Marine Strategy Framework Directive (MSFD), the Maritime Spatial Planning Directive (MSPD), and the management plan for Sites of Community Interest (SCI) and Marine Protected Areas (MPAs).

Morphological characteristics and outcomes of aortic repair of acute type A aortic dissection occurring in patients with aortic arch branching variants.

To investigate the morphological characteristics and operative outcomes of acute type A aortic dissection (ATAAD) in patients with aortic arch variants. Of 616 patients with ATAAD, 97 (15.7%) had aortic arch variants, including bovine aortic arch (BAA, n = 66), isolated left vertebral artery (ILVA, n = 25), and aberrant subclavian artery (ASA, n = 6). The characteristics and outcomes were compared between the normal branching group (control, n = 519) and the total/individual arch variant groups. Compared to the control group, arch entry was more prevalent in the BAA (18.5% vs. 31.8%) and ILVA groups (44%) (both, P < 0.05), and right common carotid arterial occlusion was less common in the arch variant group (6.7% vs. 0%, P = 0.017). The in-hospital mortality (9.2% vs. 9.3%), new-onset stroke (7.3% vs. 7.2%), and 5-year survival (81.7% vs. 78.8%) did not differ markedly between the control and arch variant groups. Arch repair was performed in 28.9% (28/97) of the arch variant group using 3-4 vessel antegrade cerebral perfusion, with 3.8% in-hospital mortality and a 15.4% stroke rate, which were comparable to those of the control group. Aortic arch variants may influence tear location and involvement of the supra-arch vessels but may not affect postoperative outcomes.

Lymphatic Mapping with Multi-Lymphosome Indocyanine Green Lymphography in Legs with Lymphedema

AbstractIt is observed that the locations of the most functional lymphatic vessels in the lymphedematous limbs can differ significantly from those in healthy limbs. The aim of this study was to elucidate the lymphatic map of lymphedematous limbs. We retrospectively analyzed 59 patients (118 limbs) with lower limb lymphedema. Fifty-five were women and four were men. The mean age and duration of lymphedema was 62.4 and 7.7 years, respectively. For the lateral thigh lymphosome, we injected indocyanine green (ICG) at the lateral knee and measured the distance (Dt) between the anterior superior iliac spine (ASIS) and the point where the lymphatic vessels crossed the reference line (the line connecting the ASIS and the patellar center). For the lateral calf lymphosome, we injected ICG at the lateral ankle and measured the distance (Dc) between the inferior patellar border and the point where the lymphatic vessels crossed the reference line (the anterior border of the tibia). In the lateral thigh, the mean Dt was 30.4 ± 0.6 cm (range, 0–41 cm) and the distribution peaked at approximately 30 cm from the ASIS. In the calf, the mean Dc was 13.1 ± 0.9 cm (range, −11 to 32 cm). The distribution of lymphatic vessel locations was highly variable. We could establish the lymphatic map in the lymphedematous legs. The distribution of lymphatic vessels in the thigh and lower legs had one and two peaks, respectively.

Histological Changes in the Blood Vessels of Ruptured Human Anterior Cruciate Ligaments.

Anterior cruciate ligament (ACL) rupture is a commonly encountered sports injury worldwide.ACL rupture is known to have poor healing capacity, hypothesized to be due to low vascularity. ACL reconstruction surgery with ligament removal and tendon graft became essential for the higher grades of ACL tears. However, ACL-reconstructed patients faced post-traumatic osteoarthritis 10-15 years after surgery. In the recent past, the tibial remnant of ACL was shown to have intrinsic healing potential. Blood vessel density and the location of blood vessels of ACL remnants have critical implications in the newly upcoming remnant-preservation ACL reconstruction surgeries that showed better healing response. This study was performed to characterize the histological features of ruptured ACL remnants in terms of blood vessels to assess the healing potential and their utility in novel surgical techniques. This was a descriptive cross-sectional study in which the tibial remnant of 24 ruptured ACL samples was evaluated for blood vessel density (per sq. mm), luminal area (sq. µm), and location of blood vessels using hematoxylin and eosin (H&E) staining with ImageJ software (U. S. National Institutes of Health, Bethesda, Maryland, USA). The blood vessel density and location of blood vessels were compared among various groups based on the duration of injury and number of injuries. Twenty-three male and one female adult patients with a mean duration of injury of 7.54 ± 5.63 months (range: 2-24 months) were included in the study. They were divided into three groups based on duration of injury: group I (2-5 months; n = 10), group II (6-8 months; n = 8), and group III (9-24 months; n = 6). The median blood vessel density (blood vessels per sq. mm) was 5.50 (3.30, 10.23) per sq. mm. There was no correlation of blood vessel density observed with duration of injury. All groups showed similar results statistically.More patients in earlier duration of injury showed very high range (10.1-40 per sq. mm) of blood vessels compared to the patients of later duration. Immature and intermediary blood vessels were identified denoting angiogenesis. Location of blood vessels varied in the groups based on duration of injury. There was no significant difference in blood vessel density and location of blood vessels between patients with single injury and those with multiple injuries. The present study demonstrates the presence of healing potential of ruptured anterior cruciate ligaments in terms of blood vessel density, luminal area, and location of blood vessels. Future studies looking into the functional outcome would enhance the understanding of utility of novel remnant-preservation surgeries in place of standard graft reconstruction surgeries.

FOXC1 and FOXC2 Ablation Causes Abnormal Valvular Endothelial Cell Junctions and Lymphatic Vessel Formation in Myxomatous Mitral Valve Degeneration.

Mitral valve (MV) disease including myxomatous degeneration is the most common form of valvular heart disease with an age-dependent frequency. Genetic evidence indicates that mutations of the human transcription factor FOXC1 are associated with MV defects, including MV regurgitation. In this study, we sought to determine whether murine Foxc1 and its closely related factor, Foxc2, are required in valvular endothelial cells (VECs) for the maintenance of MV leaflets, including VEC junctions and the stratified trilaminar ECM (extracellular matrix). Adult mice carrying tamoxifen-inducible, vascular endothelial cell (EC), and lymphatic EC-specific, compound Foxc1;Foxc2 mutations (ie, EC-Foxc-DKO and lymphatic EC-Foxc-DKO mice, respectively) were used to study the function of Foxc1 and Foxc2 in the maintenance of MVs. The EC and lymphatic EC mutations of Foxc1/c2 were induced at 7 to 8 weeks of age by tamoxifen treatment, and abnormalities in the MVs of these mutant mice were assessed via whole-mount immunostaining, immunohistochemistry/RNAscope, Movat pentachrome/Masson Trichrome staining, and Evans blue injection. EC deletions of Foxc1 and Foxc2 in mice resulted in abnormally extended and thicker MVs by causing defects in the regulation of ECM organization with increased proteoglycan and decreased collagen. Notably, reticular adherens junctions were found in VECs of control MV leaflets, and these reticular structures were severely disrupted in EC-Foxc-DKO mice. PROX1 (prospero homeobox protein 1), a key regulator in a subset of VECs on the fibrosa side of MVs, was downregulated in EC-Foxc1/c2 mutant VECs. Furthermore, we determined the precise location of lymphatic vessels in murine MVs, and these lymphatic vessels were aberrantly expanded and dysfunctional in EC-Foxc1/c2 mutant MVs. Lymphatic EC deletion of Foxc1/c2 also resulted in similar structural/ECM abnormalities as seen in EC-Foxc1/c2 mutant MVs. Our results indicate that Foxc1 and Foxc2 are required for maintaining the integrity of the MV, including VEC junctions, ECM organization, and lymphatic vessel formation/function to prevent myxomatous MV degeneration.

Intestinal vascular diseases misdiagnosed as Crohn ​disease: analysis of 13 cases

Behçet ​disease (BD), enterocolic lymphocytic phlebitis (ELP), idiopathic myointimal hyperplasia of mesenteric veins (IMHMV), and mesenteric arteriovenous dysplasia/vasculopathy (MAVD/V) are rare vascular diseases (VDs) that cause bowel ischaemia, often presenting with a histological pattern resembling chronic enteritis, leading to diagnostic confusion with Crohn ​disease (CD). In this retrospective study, we compared the clinical and pathological characteristics of these VDs with those of CD. The study cohort comprised 13 patients misdiagnosed with CD but later identified as having VDs, including five, three, two, and three patients with BD, ELP, IMHMV, and MAVD/V, respectively. Moreover, 15 patients diagnosed with CD served as the control group. Data on disease history, patient demographics, symptoms and signs, endoscopic findings, clinical diagnosis, and follow-up status were collected, and the histological features of VDs were compared with those of CD. Despite substantial overlap in clinical and pathological characteristics between VDs and CD, several histological features were helpful in differentiating the two conditions. Intestinal stenosis, multisegmental disease, transmural inflammation, inflammatory polyps, submucosal lymphangiectasia, intramural abscesses, and epithelioid granulomas were significantly more frequent in patients with CD (p<0.001). In contrast, toxic ischaemic changes and vascular lesions were significantly more frequent in patients with VDs (p<0.001). The location of diseased vessels varied widely in patients with VDs, whereas vascular changes were limited to areas with more severe inflammation in those with CD. Furthermore, inflammatory cells within diseased vessels exhibited a polarised distribution in cases of CD, manifesting in two distinct patterns: pattern 1, where the inflammatory cells are densely populated in the outer layer of the vessel wall and sparsely populated in the inner layer; pattern 2, where the inflammatory cells are densely populated on the side with the ulcer and sparsely populated on the opposite side. Vascular occlusion, which was observed in all patients with VDs, was rare in those with CD. In summary, VDs and CD can be distinguished through careful histological analysis, particularly focusing on characteristics of vascular changes, in combination with medical history.

Evaluation of Preoperative Low-flow Areas in STA-MCA Bypass Surgery Using Vascular Fusion Map Image.

The superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery requires an anastomosis of the STA to an MCA with diminished blood flow. However, identifying the precise location of the MCA with reduced flow preoperatively is challenging as it often remains nonvisualized. To address this issue, we developed a novel technique, the area target bypass (ATB) method, to infer the location of the responsible vessel for low-flow areas. The cornerstone of the ATB method lies in the utilization of the vascular fusion map (VFM). The VFM integrates 3D perfusion and 3D vascular images, enabling simultaneous evaluation of cerebral surface vessels and regions with reduced blood flow. This study aimed to assess the efficacy of the STA-MCA bypass surgery adopting the ATB method. Between August 2022 and March 2023, we conducted eight STA-MCA bypass surgeries using the ATB method. For each case, the VFM was generated using the MTT and DLY parameters, and blood flow improvement was evaluated based on the VFM score, determined by an average score from seven experts. In all cases, the target vessel was identified either preoperatively or during craniotomy, with postoperative patency of the STA-MCA bypass confirmed. Out of the eight cases, seven demonstrated improved blood flow with a VFM score exceeding 1. No complications were reported. The introduction of the ATB method has proven its potential in accurately pinpointing optimal anastomosis sites.

Nomogram to Predict 90-Day All-Cause Mortality in Acute Ischemic Stroke Patients after Endovascular Thrombectomy.

Although Endovascular Thrombectomy (EVT) significantly improves the prognosis of Acute Ischemic Stroke (AIS) patients with large vessel occlusion, the mortality rate remains higher. This study aimed to construct and validate a nomogram for predicting 90-day all-cause mortality in AIS patients with large vessel occlusion and who have undergone EVT. AIS patients with large vessel occlusion in the anterior circulation who underwent EVT from May 2017 to December 2022 were included. 430 patients were randomly split into a training group (N=302) and a test group (N=128) for the construction and validation of our nomogram. In the training group, multivariate logistic regression analysis was performed to determine the predictors of 90-day all-cause mortality. The C-index, calibration plots, and decision curve analysis were applied to evaluate the nomogram performance. Multivariate logistic regression analysis revealed neurological deterioration during hospitalization, age, baseline National Institutes of Health Stroke Scale (NIHSS) score, occlusive vessel location, malignant brain edema, and Neutrophil-to-lymphocyte Ratio (NLR) as the independent predictors of 90-day all-cause mortality (all p ≤ 0.039). The C-index of the training and test groups was 0.891 (95%CI 0.848-0.934) and 0.916 (95% CI: 0.865-0.937), respectively, showing the nomogram to be well distinguished. The Hosmer-Lemeshow goodness-of-fit test revealed the p-values for both the internal and external verification datasets to be greater than 0.5. Our nomogram has incorporated relevant clinical and imaging features, including neurological deterioration, age, baseline NIHSS score, occlusive vessel location, malignant brain edema, and NLR ratio, to provide an accurate and reliable prediction of 90-day all-cause mortality in AIS patients undergoing EVT.

Multi-phase computed tomography angiography combined with inflammation index to predict clinical functional prognosis in patients with acute ischemic stroke

In this study, we investigated the feasibility of the Alberta Stroke Program Early CT Score (ASPECTS) and multiphase computed tomography angiography (mCTA) lateral branch circulation grading combined with clinical and laboratory indicators to predict the clinical prognosis of patients with acute ischemic stroke after 90 days. The clinical data of 80 patients with acute anterior circulation ischemic stroke were retrospectively analyzed and divided into the good prognosis (37 cases) and poor prognosis groups (43 cases) according to their clinical function score at 90 days after discharge. Various factors, including basic imaging parameters (ASPECTS), occluded vessel location, affected side location and clinical indicators (time from onset to computed tomography examination, height, weight, body mass index, previous hypertension, and degree of hypertension and diabetes mellitus), laboratory blood rutine, and biochemical tests (white blood count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, hematocrit test, platelet count, international normalized ratio, blood glucose, triglycerides, uric acid, and D-dimer) were considered in the analysis. Logistic regression analysis showed that the mCTA score, hypertension, and neutrophil count were significant independent predictors. A nomogram of the mCTA score, hypertension, and neutrophil count may predict functional recovery after 90 days in patients with acute ischemic stroke.

Analysis of hemodynamic parameters on two-layered blood flow in a curved artery

Arterial stenosis is the thickening of the arterial wall due to the growth of aberrant tissues that prevent adequate blood flow in the human circulatory system and induces cardiovascular diseases. Mild stenosis, may lead to serious or permanent damage if remains uncured. There are differences in the curvature response and material composition between the outer layers and the core. There are several locations in blood vessels where they are curved, which affects the blood flow and shear stress. The Navier-Stokes equation in the cylindrical polar coordinate system has been extended by incorporating curvature term in two-layered blood flow along the axial direction with appropriate boundary conditions. Mathematical expressions for hemodynamic parameters such as velocity profile, volumetric flow rate, pressure drop, and shear stress have been calculated analytically in the case of a curve artery with stenosis. Moreover, we have analyzed the effect of stenosis on different hemodynamic parameters with the variation of core and peripheral-layer viscosity and curvature. Flow quantities are affected by the habitancy of stenosis and stipulate different blood flow behavior in both layers in the case of curved artery. This modeling technique may help researchers in medicine, mathematical biology, and bio-engineering.

AI-driven generalized polynomial transformation models for unsupervised fundus image registration.

We introduce a novel AI-driven approach to unsupervised fundus image registration utilizing our Generalized Polynomial Transformation (GPT) model. Through the GPT, we establish a foundational model capable of simulating diverse polynomial transformations, trained on a large synthetic dataset to encompass a broad range of transformation scenarios. Additionally, our hybrid pre-processing strategy aims to streamline the learning process by offering model-focused input. We evaluated our model's effectiveness on the publicly available AREDS dataset by using standard metrics such as image-level and parameter-level analyzes. Linear regression analysis reveals an average Pearson correlation coefficient (R) of 0.9876 across all quadratic transformation parameters. Image-level evaluation, comprising qualitative and quantitative analyzes, showcases significant improvements in Structural Similarity Index (SSIM) and Normalized Cross Correlation (NCC) scores, indicating its robust performance. Notably, precise matching of the optic disc and vessel locations with minimal global distortion are observed. These findings underscore the potential of GPT-based approaches in image registration methodologies, promising advancements in diagnosis, treatment planning, and disease monitoring in ophthalmology and beyond.

ТРЕБОВАНИЯ К ТОЧНОСТИ ПОЗИЦИОНИРОВАНИЯ АППАРАТУРЫ СПУТНИКОВОЙ НАВИГАЦИИ ПРИ ВНЕЗАПНОМ ОБНАРУЖЕНИИ ПРЕПЯТСТВИЙ НА ПУТИ СЛЕДОВАНИЯ БЕЗЭКИПАЖНЫХ СУДОВ

The paper considers a scientifically based approach to the formation of requirements for the accuracy of determining the location of unmanned vessels in order to prevent their collision with sudden obstacles. On the basis of probability theory, a criterion of navigational hazard of navigation is proposed, and quantitative estimates of the requirements for the accuracy of positioning of on-board satellite navigation equipment are obtained. The results of the work can be used in the organization of safe navigation and substantiation of requirements for navigation support of unmanned vessels.

Analysis of the peculiarities of the method of combining an electronic cartographic navigation information system with a ship's radar station

The article analyses the importance of radar image overlay on the screen of an electronic charting navigation information system (ECNIS) for improving safety and efficiency of navigation. Based on a review of scientific publications and professional literature, the article discusses the technical aspects of the overlay function, its advantages and limitations, and the impact on the decision-making process of a navigator. The overlay of radar information on an electronic navigation chart ensures the integration of planned and actual data on the environment, which contributes to the increase of situational awareness of the navigator. The combination of the systems makes it possible to visually compare radar targets with cartographic objects, clarify the vessel's location, control drift and orientation, and detect navigation hazards. The overlay function is especially valuable when sailing in confined waters and in conditions of limited visibility. At the same time, the use of overlay technology is associated with a number of technical difficulties and limitations related to ensuring the accuracy of overlap, harmonisation of data formats, and synchronisation of information updates. Errors in the operation of positioning systems, direction guidance, and cartography errors can lead to inconsistencies in image layers and incorrect interpretation of the navigation situation. The issues of equipment reliability, display parameters settings, competence and training of navigators are of critical importance. It is emphasised that radar image overlay on ECDIS is an effective tool for improving safety of navigation, but it does not replace traditional navigation practices and does not eliminate the need for critical evaluation of data. Over-reliance on technology, ignoring its limitations and disregard for the principles of good maritime practice can lead to erroneous decisions and have a negative impact on safety. Further prospects for the development of technology can be associated with the improvement of information processing algorithms, optimisation of human-machine interaction, and the development of training methods. The article emphasises the need for an integrated approach combining the improvement of technical systems and the human factor to fully realise the potential of the overlay function in ensuring safety of navigation. Only a balanced use of technological innovations and traditional navigational practices can guarantee the reliability and efficiency of modern navigation

Ultrasound in Microsurgery: Current Applications and New Frontiers.

Ultrasound has revolutionized reconstructive microsurgery, offering real-time imaging and enhanced precision allowing for preoperative flap planning, recipient vessel identification and selection, postoperative flap monitoring, and lymphatic surgery. This narrative review of the literature provides an updated evidence-based overlook on the current applications and emerging frontiers of ultrasound in microsurgery, focusing on free tissue transfer and lymphatic surgery. Color duplex ultrasound (CDU) plays a pivotal role in preoperative flap planning and design, providing real-time imaging that enables detailed perforator mapping, perforator suitability assessment, blood flow velocity measurement, and, ultimately, flap design optimization. Ultrasound also aids in recipient vessel selection by providing assessment of caliber, patency, location, and flow velocity of recipient vessels. Postoperatively, ultrasound enables real-time monitoring of flap perfusion, providing early detection of potential flap compromise and improved flap survival rates. In lymphatic surgery, ultra-high frequency ultrasound (UHFUS) offers precise mapping and evaluation of lymphatic vessels, improving efficacy and efficiency by targeting larger dilated vessels. Integrating ultrasound into reconstructive microsurgery represents a significant advancement in the utilization of imaging in the field. With growing accessibility of devices, improved training, and technological advancements, using ultrasound as a key imaging tool offers substantial potential for the evolution of reconstructive microsurgery.

Sequential MRI Evaluation of Lymphatic Abnormalities over the Course of Fontan Completion.

Purpose To evaluate lymphatic abnormalities before and after Fontan completion using noncontrast lymphatic imaging and relate findings with postoperative outcomes. Materials and Methods This study is a retrospective review of noncontrast T2-weighted lymphatic imaging performed at The Children's Hospital of Philadelphia from June 2012 to February 2023 in patients with single ventricle physiology. All individuals with imaging at both pre-Fontan and Fontan stages were eligible. Lymphatic abnormalities were classified into four types based on severity and location of lymphatic vessels. Classifications were compared between images and related to clinical outcomes such as postoperative drainage and hospitalization, lymphatic complications, heart transplant, and death. Results Forty-three patients (median age, 10 years [IQR, 8-11]; 20 [47%] boys, 23 [53%] girls) were included in the study. Lymphatic abnormalities progressed in 19 individuals after Fontan completion (distribution of lymphatic classifications: type 1, 23; type 2, 11; type 3, 6; type 4, 3 vs type 1, 10; type 2, 18; type 3, 10; type 4, 5; P = .04). Compared with individuals showing no progression of lymphatic abnormalities, those progressing to a high-grade lymphatic classification had longer postoperative drainage (median time, 9 days [IQR, 6-14] vs 17 days [IQR, 10-23]; P = .04) and hospitalization (median time, 13 days [IQR, 9-25] vs 26 days [IQR, 18-30]; P = .03) after Fontan completion and were more likely to develop chylothorax (12% [three of 24] vs 75% [six of eight]; P < .01) and/or protein-losing enteropathy (0% [0 of 24] vs 38% [three of eight]; P < .01) during a median follow-up of 8 years (IQR, 5-9). Progression to any type was not associated with an increased risk of adverse events. Conclusion The study demonstrated that lymphatic structural abnormalities may progress in select individuals with single ventricle physiology after Fontan completion, and progression of abnormalities to a high-grade classification was associated with worse postoperative outcomes. Keywords: Congenital Heart Disease, Glenn, Fontan, Lymphatic Imaging, Cardiovascular MRI Supplemental material is available for this article. Published under a CC BY 4.0 license.

Removal of fractured peripherally inserted central venous catheter in the leg of a neonate.

An infant with a corrected gestational age of 38 weeks, weighing 3.1 kg, was referred to our pediatric surgical department because of a fractured peripherally inserted central venous catheter in the left lower limb with the end retracting into the deep venous system. An operation was undertaken to remove the PICC. Because the central venous catheter was, unintentionally, placed in the left small saphenous vein and thus positioned in the left femoral vein, the left great saphenous vein was incised to gain access. Subsequently, the catheter could be removed successfully. Fracturing of a peripherally inserted central venous catheter is a rare occurance. Removal depends on vessel size, location and experertise.