Mean Vascular Density Research Articles

Exendin-4 promotes ischemia-reperfusion flap survival by upregulating Gpx4 to inhibit ferroptosis

BackgroundEffective drugs for preventing or treating skin flap necrosis remain elusive. In this study, we investigated the potential protective effect of exendin-4 against skin flap ischemia-reperfusion injury (IRI) through the inhibition of ferroptosis. MethodA rat abdomen was constructed with an island skin flap, and the superficial vascular pedicle of the abdominal wall was closed using a vascular clamp, which was removed after 8 h. Before surgery, RSL3 and ferrostatin-1 solutions were intraperitoneally injected. After the surgery, subcutaneous injections of exendin-4 were administered daily. The number of inflammatory cells, mean vascular density, collagen fiber content, and apoptosis and ferroptosis indicators were quantified 24 h after reperfusion. Survival, contraction rate, and blood perfusion of the skin flap were evaluated on days 1, 3, 5, and 7 after reperfusion. ResultsThe flap survival rate was significantly higher in the exendin-4 group than that in the injury group, whereas the contraction rate was lower. Compared with the injury group, the exendin-4 group showed less inflammatory cell infiltration, higher vascular density, and less collagen fiber loss. At the molecular level, the exendin-4 group demonstrated opposite or elevated expression of apoptosis and ferroptosis indicators than those in the injury group, with significantly increased glutathione peroxidase 4 (Gpx4). Ferroptosis inhibitors and agonists enhanced and reversed the protective effects of exendin-4, respectively. ConclusionExendin-4 alleviates skin flap IRI by upregulating Gpx4 expression to inhibit ferroptosis. Therefore, exendin-4 may serve as a novel clinical treatment for skin flap IRI.

Exploring Morphometry of Endometrial Glands and Blood Vessels in Reproductive Age Women With Abnormal Uterine Bleeding.

Background Abnormal uterine bleeding (AUB) is one of the most common problems encountered in gynaecological practice. Defective endometrial angiogenesis has been implicated in various benign and malignant disorders of the endometrium. Aim This study aims to assess morphometry of endometrial glands and blood vessels in patients with AUB. Material and methods This is a one year retrospective cross sectional analysis of endometrial samples received with the diagnosis of AUB in reproductive age group. All samples were routinely processed and stained. Sections were analysed for morphometry of blood vessels and endometrial glands. Results A total of 374 cases were included. Most common histological group was proliferative followed by secretory phase. A significant difference was noted in mean vascular density, diameter, mitotic scores and height of glandular epithelium in different benign and malignant groups. Conclusion This study highlights the fact that glandular and vascular morphometry can be used to differentiate between various proliferative disorders of the endometrium. In the current era of new anti-angiogenic therapies, endometrial angiogenesis and changes in vascular morphology can be targeted, thus improving treatment modalities and patient care.

Novel role of CD34+ stromal cells/telocytes in oral submucous fibrosis development and its malignant transformation

BackgroundTelocytes are interstitial cells widely distributed in the extracellular matrix of numerous tissues distinguished by their long, thin, and moniliform projections. Telocytes have a role in the stimulation of angiogenesis and contribute to the development and progression of fibrosis. AimThe current study aimed to assess and compare the telocyte distribution in normal mucosa, oral submucous fibrosis (OSF), and OSCC associated with OSF (OSCCOSF). Materials and MethodsFormalin-fixed and paraffin-embedded tissue blocks of 30 OSF cases, 15 OSCCOSF cases, and 15 normal oral mucosae were obtained. Immunohistochemical staining was done with antibodies to CD34 to assess the vasculature and telocytes. The mean vascular density (MVD) and mean telocyte density were compared between the groups using the Kruskal-Walli test. ResultsA statistically significant high MVD (3.4 ± 1.22) and mean telocyte density (3.8 ± 1.35) was observed in OSCCOSF cases while it was lowest in advanced OSF cases. MVD was higher in early OSF cases than in normal mucosa. ConclusionThis study showed a decrease in CD34-positive telocytes in OSF, indicating that telocyte loss promotes the development of fibrosis.Increased angiogenesis coexisted with an increase in telocytes in OSCCOSF.

Correlation between Vascularity and Advancing Histological Grades of Oral Submucous Fibrosis with a Plausible Role in Malignisation: Systematic review of a persisting matter of conflict.

This study aimed to quantify the vascularity in histological grades of oral submucous fibrosis (OSMF) and to determine if there is any connection between vasculogenesis and malignisation. Recent studies show no significant change in vascularity as the stage advances as opposed to the conventional concept. A comprehensive database search until December 2022 was conducted for published articles on vascularity in OSMF following preferred reporting items for systematic reviews and meta-analyses guidelines. A total of 98 articles were screened of which 13 were included for systematic evaluation. The study included 607 cases, with a definite predilection for the male gender. Of the 13 studies, 11 evaluated mean vascular density. In more than half of the studies, the vascularity decreased as the stage advanced. Similar results were obtained for endothelial cells/μm2, mean vascular area percentage and mean vascular area. The present review supports the prevailing concept that vascularity decreases with the advancement of the OSMF stage. This denies the systemic absorption of carcinogens into the circulation with resultant longer exposure of compromised epithelium and malignisation.

Association between obstructive coronary disease and diabetic retinopathy: Cross-sectional study of coronary angiotomography and multimodal retinal imaging

AimsTo investigate the association between diabetic retinopathy (DR) and coronary artery disease (CAD) using coronary angiotomography (CCTA) and multimodal retinal imaging (MMRI) with ultra-widefield retinography and optical coherence tomography angiography and structural domain. MethodsSingle-center, cross-sectional, single-blind. Patients with diabetes who had undergone CCTA underwent MMRI. Uni and multivariate analysis were used to assess the association between CAD and DR and to identify variables independently associated with DR. ResultsWe included 171 patients, 87 CAD and 84 non-CAD. Most CAD patients were males (74 % vs 38 %, P < 0.01), insulin users (52 % vs 38 %, p < 0.01) and revascularized (64 %). They had a higher prevalence of DR (48 % vs 22 %, p = 0.01), microaneurysms (25 % vs 13 %, p = 0.04), intraretinal cysts (22 % vs 8 %, p = 0.01) and areas of reduced capillary density (46 % vs 20 %, p < 0.01). CAD patients also had lower mean vascular density (MVD) (15.7 % vs 16.5,%, p = 0.049) and foveal avascular zone (FAZ) circularity (0.64 ± 0.1 vs 0.69 ± 0.1, p = 0.04). There were significant and negative correlations between Duke coronary score and MVD (r = −0.189; p = 0.03) and FAZ circularity (r = −0,206; p = 0.02). CAD, DM duration and insulin use independently associated with DR. ConclusionsCAD patients had higher prevalence of DR and lower MVD. CAD, DM duration and insulin use were independently associated with DR.

Non-invasive ultrasound localization microscopy (ULM) in azoospermia: connecting testicular microcirculation to spermatogenic functions.

Rationale: Azoospermia is a significant reproductive challenge. Differentiating between non-obstructive azoospermia (NOA) and obstructive azoospermia (OA) is crucial as each type requires distinct management strategies. Testicular microcirculation plays a profound role in spermatogenic functions. However, current diagnostic methods are limited in their ability to effectively elucidate this crucial connection. Methods: We employed ultrasound localization microscopy (ULM) to visualize testicular microcirculation in NOA and OA patients and quantified the testicular hemodynamic parameters. Pearson correlation analysis was conducted to investigate the inner connection between parameters of testicular microcirculation and clinical spermatogenic functions. We conducted multiple logistic regression analysis to establish a new diagnostic model that integrates follicle-stimulating hormone (FSH) and mean vascular diameter to distinguish NOA from OA. Results: Our findings demonstrated significant differences in vascular parameters between NOA and OA, with NOA characterized by lower mean vascular diameter (p < 0.001), vessel density (p < 0.001), and fractal number (p < 0.001). Testicular volume showed a moderate positive correlation with mean vascular diameter (r = 0.419, p < 0.01) and vessel density (r = 0.415, p < 0.01); Mean vascular diameter exhibited negative correlations with both FSH (r = -0.214, p < 0.05) and age (r = -0.240, p < 0.05); FSH (r = -0.202, p < 0.05) and luteinizing hormone (LH) (r = -0.235, p < 0.05) were negatively correlated with mean blood flow velocity. The diagnostic model demonstrated an area under the curve (AUC) of 0.968. We also reported a method to map the vascular pressure distribution derived from the blood flow velocity generated by ULM. Conclusions: ULM provides a non-invasive and detailed assessment of testicular microvascular dynamics. The ULM-derived vascular parameters are able to connect testicular microcirculation to spermatogenic functions. The combination of FSH and mean vascular diameter enhances diagnostic precision and holds potential for distinguishing NOA from OA.

Comparison of different hydroxyapatite composites for bone tissue repair: In vitro and in vivo analyses.

The material used for bone tissue repair needs to be simultaneously osteoconductive, osteoinductive, and osteogenic. To overcome this problem, researchers combine hydroxyapatite (HA) with natural materials to improve properties. This paper compares the effects of angiogenesis and osteogenesis with different composites through in vivo experiments and characterization analysis. Chitosan/nHA (CS/nHA) and sodium alginate/nHA (SA/nHA) microspheres were synthesized via reverse-phase emulsification crosslinking and analyzed using scanning electron microscopy (SEM), energy dispersion spectroscopy (EDS), and X-ray diffraction (XRD). Implanted into mouse thigh muscles, their angiogenic and osteogenic potentials were assessed after 8 and 12 weeks through various staining methods and immunohistochemistry. The mean vascular density (MVD) of CS/nHA, CaP/nHA, and SA/nHA groups was (134.92±35.30) n/mm2, (159.09±22.14) n/mm2, (160.31±42.23) n/mm2 at 12 weeks, respectively. The MVD of the CaP/nHA and SA/nHA groups were significantly higher than that of the CS/nHA group. The collagen volume fractions (CVF) were 34.13%, 51.53%, and 54.96% in the CS/nHA, CaP/nHA, and SA/nHA groups, respectively. In addition, the positive expression area ratios of OPN and CD31 in the CaP/nHA and SA/nHA groups were also significantly higher than those in the CS/nHA group. The ability of SA/nHA composite microspheres in osteogenesis and angiogenesis is clearly superior to that of the CS/nHA group and is comparable to that of CaP/nHA, which has superior osteogenesis ability, indicating that SA/nHA composite microspheres have greater application prospects in bone tissue engineering.

Inhibitory effect of ink derived from Indian Loligo duvauceli squid against HIF1α induced angiogenesis

Squids are one of the most important commercial marine resources having high human consumption and market value. An Indian squid, Loligo duvauceli is a valuable species among them. They contain ink sacs which are discarded before using them for consumption. This study for the first time reports its potent ability to inhibit angiogenesis in vitro and in vivo. The melanin-free extract (MFI) of squid ink was assessed for antiproliferative effect on cancer and human umbilical vein endothelial (HUVEC) cell lines. Its antiangiogenic activity was investigated in HUVEC-based tube formation and chick chorioallantoic membrane (CAM) assays. The MFI displayed a prominent reduction in the mean vascular density of the CAM membrane, the viability of HUVEC cells, and its tube formation on the Matrigel base. Influence on the expression of angiogenesis effector genes HIF 1 α, vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptors (VEGFR), and COX 2 in HUVEC cell line denoted prominent downregulation of HIF 1 α, VEGF, and VEGFR gene expression. Overall, the results indicated a remarkable potential of L. duvauceli ink to serve as a negative mediator of angiogenesis with probable selective HIF1α induced molecular mechanism for exerting its effect. This waste product of sea food processing industry thus presented itself as a promising natural candidate for arresting angiogenesis.

Evaluation of macular choroidal and microvascular network changes by activity scores and serum antibodies in thyroid eye patients and healthy subjects.

To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease (TED) patients at different stages and the relationship of those changes with risk factors, serum antibodies and the severity of TED. A total of 85 participants were enrolled. All participants underwent ophthalmology and endocrinology examinations. Subfoveal choroidal thickness (SFCT), superficial (s) and deep (d) foveal avascular zone (FAZ) area, mean (m) and central (c) superficial vascular density (SVD), deep vascular density (DVD) measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography (OCT)/OCT angiography (OCTA) DRI OCT Triton. Multiple linear regression analysis was used to explore the associations between SFCT, FAZ area, SVD, DVD and the relevant factors of TED. Those with active TED patients had higher c-DVD and m-DVD levels (P<0.05), however there is no statistically significant difference in SFCT between active and stable TED patients. Among the serum antibodies, it was observed that s-FAZ and d-FAZ increased, c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies (TRAB) level, whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin (hTG). There was no significant difference in SFCT, FAZ, SVD and DVD measurement at gender, between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma. The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density. It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.

Abstract 11425: Association Between Obstructive Coronary Disease and Diabetic Retinopathy: A Cross-Sectional Study of Coronary Angiotomography and Digital Retinal Images

Introduction: Diabetic retinopathy (DR) and obstructive coronary artery disease (OCAD) are the main microvascular and macrovascular complications of diabetes mellitus (DM), respectively. The assessment of DR by means of spectral domain optical coherence tomography (SD-OCT) and angiography (OCTA) conferred a remarkable progress. Objective: investigate if SD-OCT and OCTA can detect DR that is associated with OCAD, determined by coronary angiotomography (CCTA) Hypothesis: DR, assessed by OCTA and OCT-SD, is associated with OCAD, assessed by CCTA Methods: In this single-center, cross-sectional, single-blind study, patients with DM who had undergone CCTA in the previous 3 years (independent indication) were eligible. They were divided according to the presence of OCAD in two groups and underwent SD-OCT and OCTA. The association between OCAD and DR was evaluated through uni and multivariate analysis and another analysis was performed to identify variables independently associated with the presence of DR. Results: We included 171 patients, 87 OCAD and 84 without OCAD. Age (66 vs 64 y,p=0.28), DM duration (12 vs 13 y, p=0.5) and HbA1c (7.5% vs 6,9%,p=0.08) did not differ. Patients with OCAD were more frequently men (74% vs 38%, P&lt;0.01), had a higher prevalence of insulin use (52% vs 38%, p&lt;0.01) and 64% had already undergone some type of revascularization. SD-OCT and OCTA revealed a higher prevalence of DR (48% vs 22%,p=0.01). The main findings were: microaneurysms (25% vs 13%,p=0.04), intraretinal cysts (22% vs 8%, p=0.01) and areas of reduced capillary density in the superficial retinal plexus (46% vs 20%,p&lt;0.01).We also found lower mean vascular density (MVD) (15.7 vs 16.5, p=0.049) and lower circularity of the foveal avascular zone(FAZ) (0.64±0.1 vs 0.69±0.1, p= 0.04).There were significant and negative correlations between Duke coronary score and MVD (r=-0.189; p=0.03) and circularity of the FAZ (r=-0,206; p= 0.02). In an adjusted model, presence of OCAD increased the chance of DR (OR 4.05 [1.4 -11.6], p&lt;0.01). OCAD, DM duration and insulin use were independently associated to DR. Conclusions: OCAD was associated with a greater chance of presenting DR. OCAD, longer DM duration and insulin use were independently associated to the presence of DR.

Quantitative classification of melasma with photoacoustic microscopy: a pilot study.

The classification of melasma is critical for correct clinical diagnosis, treatment selection, and postoperative measures. However, preoperative quantitative determination of melasma type remains challenging using conventional Wood's lamp and optical dermoscopy techniques. Using photoacoustic microscopy (PAM) to simultaneously obtain the two diagnostic indicators of melanin and blood vessels for melasma classification and perform quantitative analysis to finally achieve accurate classification, rather than relying solely on physicians' experience. First, the patients were classified by experienced dermatologists with Wood's lamp and optical dermoscopy. Next, the patients were examined in vivo using the PAM imaging system. Further, the horizontal section images ( plane) of epidermal melanin and dermal vascular involvement were extracted from the 3D photoacoustic imaging results, which are important basis for PAM to quantitatively classify melasma. PAM can quantitatively reveal epidermal thickness and dermal vascular morphology in each case and obtain the quantitative diagnostic indicators of melanin and blood vessels. The mean vascular diameter in lesional skin () of epidermal M+V-type was much larger than that in non-lesional skin (), and the mean vascular density in lesional skin was more than three times that in non-lesional skin. Importantly, vascular diameter and density are important parameters for distinguishing M type from M+V type. PAM can obtain the data of epidermal thickness, pigment depth, subcutaneous vascular diameter, and vascular density, and realize the dual standard quantitative melasma classification by combining the parameters of melanin and blood vessels. In addition, PAM can provide new diagnostic information for uncertain melasma types and further refine the typing.

The use of optical coherence tomography angiography to measure changes in iris vasculature after strabismus surgery

ABSTRACT Introduction Anterior segment ischemia (ASI) is a rare but potentially sight-threatening complication of strabismus surgery. Preoperative imaging of the iris vasculature may be appropriate in patients at high risk of ASI. In clinical practice, this is currently done through invasive fluoresceine or indocyanine green (ICG) angiography and in study context through laser speckle contrast imaging. The purpose of this study is to investigate the use of noninvasive optical coherence tomography angiography (OCTA) as a screening tool for ASI in strabismus surgery. Methods A prospective interventional trial was conducted from September until November 2021 at the Leuven University Hospitals. Patients scheduled for strabismus surgery to one or more rectus muscles underwent OCTA preoperatively and at day two postoperatively. The vascular density was calculated for all images with sufficient quality. Information on risk factors for ASI was collected. A two-sided t-test was used for pairwise comparison pre- and postoperatively. Filling defects were qualitatively assessed. Results Eighteen patients were included. In only seven muscles of five patients, images of sufficient quality on both image acquisition moments were suitable for statistical analysis. The mean age of these patients was 45.2 years and 40% were women. A mean vascular density of 53,099% preoperatively and a mean density of 50,782% postoperatively with a mean decrease of 2.316% (p = .318, 95% confidence interval [−2.886; 7.516]) was found. No filling defects were identified. Discussion The small final number of images contributing to statistical analysis shows that current application of the OCTA technique is hampered by poor image quality and poor repeatability. We identified difficulties in the image acquisition process and variable pupil size due to iris muscle contractions as the two main reasons. We believe that adjustments in the OCTA software such as pupil tracking and tracking of iris vasculature can largely overcome these limitations. Furthermore, there is a need for a normative database to allow good quantitative comparison and risk stratification. We conclude that OCTA could be suitable for screening in prevention of ASI with both qualitative and quantitative analysis if adjustments are made.

Vessel density changes in choroid, chorio-capillaries, deep and superficial retinal plexues on OCTA in normal ageing and various stages of age-related macular degeneration.

To study vessel density (VD) on optical coherence tomography angiography at choroid, chorio-capillaries (CC) and various retinal levels in normal population and various stages of dry AMD and how these changes progress with increase in severity of the disease. Prospective, observational, cross-sectional study was done on 252 eyes of 132 patients (males: 61, females: 71) presenting to tertiary-care centre in Central India between February 2021 and January 2022. For study purpose, eyes were divided into five groups according to the size and number of the drusen, viz, Group 1: No AMD (< 50years), Group 2: No AMD (> 50years), Group 3: Early AMD, Group 4: Intermediate AMD and Group 5: Advanced AMD. In all eyes, VD was measured at choroid, CC, deep capillary plexus (DCP) of retina and superficial capillary plexus (SCP) of retina. The mean age in case cohort is 61.90 ± 7.97years. The mean vascular density differed significantly across diagnosis types in all the quadrants (p < 0.05) at choroid, CC and DCP level. At SCP level, the differences were significant across the groups except at the central quadrant. Vessel density was found to be more in early AMD cohort when compared to No AMD (> 50years) cohort at SCP and DCP level, while it showed continuous reduction later in intermediate and advanced AMD cohort. With increase in the severity of disease, significant reduction in VD is also seen in retinal plexuses, along with the changes in choroid and CC. These VD maps may play a role as non-invasive biomarkers for healthy and diseased ageing.

Characteristics of Unexposed Proliferative Diabetic Retinopathy: An Optical Coherence Tomography Angiography Study

Purpose: To compare optical coherence tomography angiography (OCTA) findings between severe non-proliferative diabetic retinopathy (NPDR) and unexposed proliferative diabetic retinopathy (PDR), and identify predictive factors.Methods: Patients newly diagnosed with severe NPDR or unexposed PDR between January 2018 and December 2021 were reviewed retrospectively. Unexposed PDR was diagnosed using fluorescein fundus angiography, because new vessels could not be observed in the poster pole or clearly distinguished in the retinal periphery on wide fundus photography. Clinical features at the time of diagnosis, and OCTA measurements (mean vascular density, superficial capillary plexus (SCP) foveal avascular zone (FAZ) area, and mean retinal thickness), were compared between the two groups. Factors that could predict unexposed PDR were investigated using multivariate analysis with a generalized estimating equation.Results: A total of 61 severe NPDR and 23 unexposed PDR eyes were included. The unexposed PDR had significantly larger SCP-FAZ areas (&lt;i&gt;p&lt;/i&gt; = 0.031) and lower total and parafoveal mean inner retinal thicknesses (&lt;i&gt;p&lt;/i&gt; = 0.014 and &lt;i&gt;p&lt;/i&gt; &lt; 0.001, respectively). However, there were no differences in mean vascular density between the groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Multivariate analysis showed that SCP-FAZ area and parafoveal mean inner retinal thickness were significant predictors of unexposed PDR (&lt;i&gt;p&lt;/i&gt; = 0.027 and &lt;i&gt;p&lt;/i&gt; = 0.001, respectively).Conclusions: In severe NPDR patients, unexposed PDR may be considered a differential diagnosis when the SCP-FAZ area is large or the parafoveal mean inner retinal thickness is small.

Investigation of changes in retinal vascular parameters and choroidal vascular index values during the early recovery period of COVID-19: The COVID-OCTA study

BackgroundCOVID-19 effects microvasculature in many tissues. This study investigated whether the choroidal structure is also affected. MethodsThis cross-sectional study included 80 patients with COVID-19 and the same number of age- and gender-matched healthy individuals. All participants' right eye measurements were examined. Optical coherence tomography angiography (OCTA) was used for imaging. Otherwise, two independent researchers used the Choroidal vascular index (CVI) for choroidal parameters calculation. ResultsSuperior and deep flow values were lower in the COVID-19 group than in the control group, and vascular density (VD) values were lower in all regions in this group. Except for the superior mean VD, there was no statistically significant difference (p = 0.003). However, the COVID-19 group had significantly lower subfoveal choroidal thickness (SFChT) measurements than the control group (p = 0.001). In addition, no significant difference was observed between the groups in evaluating mean CVI values (p>0.05). ConclusionNoninvasive diagnostic tools such as OCTA and EDI-OCT can be used to monitor early changes in diseases affecting microvessels, such as from COVID-19.

Microstructural Changes in the Macula Following Cataract Surgery in Patients with Type 2 Diabetes Mellitus Detected Using Optical Coherence Tomography Angiography.

Ophthalmologists treat diabetic macular edema before cataract surgery to reduce possible complications. Despite improvements in diagnostic techniques, whether cataract surgery per se causes the progression of diabetic retinopathy with macular edema remains unclear. This study aimed to evaluate the impact of phacoemulsification on the central retina and its correlation with diabetes compensation as well as changes in the retina before surgery. Thirty-four type 2 diabetes mellitus patients who underwent phacoemulsification cataract surgery were included in this prospective longitudinal study. Of them, 29.4% had macular edema before surgery, and 70.6% had a normal macular structure. All patients underwent ophthalmic examinations, including optical coherence tomography angiography, at baseline and at one and three months after surgery. The Mann-Whitney test was performed to compare the area of the foveal avascular zone, perimeter of the foveal avascular zone, and mean vascular density in the para- and perifoveal deep and superficial capillary plexuses. All parameters were measured before and at one and three months after surgery. Multiple linear regression models with adjustments for glycated hemoglobin and duration of diabetes mellitus were constructed to assess the association between the area of the foveal avascular zone and diabetic macular edema. Significant differences in the area of the foveal avascular zone, perimeter of the foveal avascular zone, and perifoveal density in the deep capillary plexus were observed at all three time points. In the fully adjusted linear regression model, those without diabetic macular edema had a reduced probability for changes in the foveal avascular zone at one and three months after surgery (effect estimate β = -0.20 [95% CI -0.31; -0.09] and β = -0.13 [-0.22; -0.03] for one and three months, respectively) compared with those with diabetic macular edema. Cataract surgery itself does not cause significant and permanent increase in diabetic macular edema three months post-surgery. On the contrary, in a group with diabetic macular edema before the surgery, central retinal thickness tended to stabilize three months after surgery. If the duration of diabetes is shorter and diabetes is better compensated, the possibility of changes in the foveal avascular zone is reduced.

Dynamic Changes in Microvascular Density Can Predict Viable and Non-Viable Areas in High-Risk Neuroblastoma.

Despite aggressive treatments, the prognosis of high-risk NB remains poor. Surgical oncology needs innovative intraoperative devices to help surgeons discriminate malignant tissue from necrotic and surrounding healthy tissues. Changes within the tumor vasculature could be used intraoperatively as a diagnostic tool to guide surgical resection. Here, we retrospectively analyzed the mean vascular density (MVD) of different NB subtypes at diagnosis and after induction chemotherapy using scanned histological samples. One patient was prospectively enrolled, and an ex vivo photoacoustic imaging (PAI) scan was performed on two representative sections to assess its capacity to discriminate different tumor regions. We found that post-chemotherapy, viable areas of differentiating NBs and ganglioneuroblastomas are associated with higher MVD compared to poorly differentiated NBs. Early necrotic regions showed higher MVD than late necrotic and viable regions. Finally, calcified areas showed significantly lower MVD than any other histological component. The acquired PAI images showed a good high-resolution ex vivo 3D delineation of NB margins. Overall, these results suggest that a high-definition preclinical imaging device such as PAI could potentially be exploited to guide surgical resection by identifying different vasculature signatures.

Ocular sequelae in severe COVID-19 recovered patients of second wave.

Purpose:To evaluate the retinal microvascular changes in patients, recovered from severe COVID-19 during the second wave of the pandemic in North India.Methods:In this observational cross-sectional study, 70 eyes of 35 patients who recovered from severe COVID-19 during the second wave underwent detailed ophthalmic evaluation 4–6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied.Result:The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell-inner plexiform layer (GC-IPL) was significantly reduced in comparison to controls (P < 0.001).Conclusion:Severe COVID-19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature.

Intraoperative Intradermal Application of Stromal Vascular Fraction into the Abdominal Suture Line: Histological Analysis of Abdominal Scar Tissue.

Stem cell therapy is a promising new approach to wound healing. Stromal vascular fraction is a heterogeneous collection of cells, including adipose-derived stem cells, which are traditionally isolated using a manual collagenase-based technique. To our knowledge, this is the first human study that histologically assesses the potential of intraoperative intradermal injection of stromal vascular fraction on skin regeneration. In this controlled study, 20 patients undergoing deep inferior epigastric perforator flap breast reconstruction and bilateral flank liposuction were included. Stromal vascular fraction was injected intradermally into one side of the abdominal suture line, while the other side served as a control. Outcome measures included analysis of stromal vascular fraction by flow cytometry, histological analysis of scar tissue, and scar photography. Cell yield for application and cell viability were 55.9 ± 28.5 × 106 and 75.1% ± 14.5%, respectively. Age and body mass index were positively correlated with the number of cells for application and adipose-derived stem cells. Mean vascular density, elastic fiber content, collagen maturity (scar index), epidermal thickness, and number of rete ridges all showed higher values on the treated side. Furthermore, the injected number of adipose-derived stem cells and pericytes positively correlated with vascular density. It is safe to speculate that intradermal stromal vascular fraction injection at the beginning of the healing process increases vascular density, collagen maturity and organization, elastic fiber content, epidermal thickness, epidermal-dermal anchoring of the scarring skin and is therefore responsible for improved skin regeneration. It is a viable and safe method that can be used as an adjunctive treatment in plastic surgery procedures where suboptimal wound healing is anticipated. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optical cohorence tomography angiography findings in carotid artery stenosis.

To investigate vascular density (VD) changes in the superficial (SCP) and deep capillary plexus (DCP), radial peripapillar capillary plexus (RPCP), Foveal avascular zone (FAZ) and thickness changes of peripapillary retinal nerve fiber layer (ppRNFL) and choroid (CT) using optical coherence tomography angiography (OCTA) ipsilateral eyes of patient with internal carotid artery stenosis (ICAS) and to compare the obtained values with kontralateral eyes of patients with İCAS and healthy individuals. This prospective cross-sectional case-control study was conducted in 43 patients with a diagnosis of unilateral ICAS and 47 age- and sex-matched healthy subjects. The patients were divided into three groups. Group 1 consisted of ipsilateral eyes of patients with ICAS, group 2 consisted of contralateral eyes of patients with CAS and group 3 comprised healthy individuals without ICAS, All participants underwent a comprehensive ophthalmologic examination including OCTA. FAZ, Superficial parafoveal and superficial superior VD were significantly lower in group 1 compared to group 2 (p = < 0.001, p = 0.018 and 0.021, respectively). Group 1 also had lower superficial superior (p = 0.038), superficial inferior (p = 0.034), deep superior (p = 0.034), and deep inferior (p = 0.012) VD compared to group 3. There was no significant difference between the groups in terms of ppRNFLT, whereas CT and RPC mean, superior, and inside-disc VD values were significantly lower in group 1 compared to both group 2 and 3 (p < 0.05). OCTA measurements may be useful in preventing irreversible ocular complications by detecting early structural changes in patients with ICAS before the development of symptomatic ocular ischemic syndrome.