Vascular Injection Research Articles

Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020

ObjectifÉvaluer le volume de chirurgies ophtalmiques reportées en Ontario en lien avec la pandémie de COVID-19 entre mars et décembre 2020, proposer des stratégies pour traiter les dossiers en attente et calculer le délai nécessaire pour y arriver. NatureÉtude transversale. ParticipantsOntariens admissibles à l'Assurance-santé de l'Ontario entre 2017 et 2020. MéthodesOn a eu recours à des modèles de prévision de séries chronologiques et à la théorie des files d'attente pour estimer le nombre de dossiers en attente de chirurgies ophtalmiques en lien avec la pandémie de COVID-19 et calculer le délai nécessaire pour rattraper le retard. RésultatsOn estime à 92 150 (intervalle de prévision à 95 % : 71 288–112 841) le nombre de chirurgies ophtalmiques qui auraient dû être réalisées au bloc opératoire entre le 16 mars et le 31 décembre 2020. Quelque 90 % des interventions retardées visaient le traitement de cataractes, et un nombre inquiétant (4 %) comportaient un décollement de rétine. Près de la moitié des chirurgies en attente dans la province (48 %; 44 542 sur 92 150) touchaient des patients de Santé Ontario Ouest. De plus, on estime à 23 755 (intervalle de prévision à 95 % : 14 656–32 497) le nombre d'injections d'anti-VEGF (facteur de croissance endothélial vasculaire) qui n'ont pas été administrées. On estime à 248 semaines (intervalle de confiance à 95 % : 235–260) et à 128 semaines (intervalle de confiance à 95 % : 121–134) le délai pour rattraper ce retard à l’échelle provinciale si l'on ajoute 10 % et 20 %, respectivement, de temps de bloc opératoire par semaine, d'après le volume hebdomadaire des chirurgies ophtalmiques en 2019. ConclusionsLes données de l'Ontario révèlent que l'importance des retards au chapitre des chirurgies ophtalmiques pour l'année 2020 seule soulève de vives inquiétudes quant à la capacité de répondre aux besoins des patients à cet égard. À mesure que se poursuit la pandémie, les retards sont appelés à augmenter. Il est urgent de trouver une stratégie de compensation et de mettre en place des démarches pour mieux gérer les répercussions collatérales de la pandémie sur les retards en matière de chirurgie ophtalmique.

Роль симпатичних стовбурів в іннервації кровоносних судин заднього середостіння у плодів людини

The purpose of the study was to establish patterns of variation of the branches of the right and left sympathetic trunks in the thoracic aorta azygos and hemiazygos veins during the fetal period of human ontogenesis. Materials and methods. An anatomical study was performed on 47 human fetuses using macromicroscopic preparation of neurovascular branches under the control of binocular magnifier, vascular injection, application contrasting of prepared vessels and nerves, making 3D reconstruction models of the posterior mediastinum structures and morphometry. Results. The anatomical variability of nodes and branches of the thoracic right and left sympathetic trunks involved in the innervation of the thoracic aorta, azygos and hemiazygos veins has been established in the human fetuses of different age groups. The segmental-metameric distribution of the visceral branches of the thoracic sympathetic trunk was revealed, as well as the preservation of the segmental sympathetic innervation of the thoracic aorta, azygos and hemiazygos veins both on the left and on the right. Despite the significant progress in the study of morphological features of innervation of posterior mediastinum organs and structures, the active development of fetal surgery in recent years raises a number of questions related to the sources of sympathetic innervation of the thoracic aorta, azygos and hemiazygos veins. Conclusion. The sources of innervation of the thoracic aorta, azygos and hemiazygos veins in human fetuses are: thoracic nodes and internodal branches of the right and left sympathetic trunks; large visceral nerves; branches of the esophageal, pulmonary and cardiac plexuses; vagosympathetic trunks; collateral trunk. The number of branches to the thoracic aorta from the left sympathetic trunk is 4-16, and from the right sympathetic trunk – 3-14. The largest number of branches that enter the wall of the thoracic aorta, from the left sympathetic trunk skeletotopically determined at the level of III-VI thoracic segments, and from the right sympathetic trunk – at the level of IV-VI thoracic segments. Different skeletotopic levels of the branches of the right and left large visceral nerves are involved in the innervation of the thoracic aorta – from V to X thoracic segments. It is noted that the right and left sympathetic trunks are almost equally involved in the innervation of the azygos and hemiazygos veins. The number of sympathetic branches to the azygos vein ranges from 4 to 7, and the number of sympathetic branches to the hemiazygos vein is usually 2-4

BRIDGE ARCH-SHAPED SUBRETINAL FLUID IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Evolution and Outcomes.

To study factors leading to bridge arch-shaped subretinal fluid (SRF) on optical coherence tomography in wet age-related macular degeneration and evaluate its anatomical and functional outcomes. In this single-center, retrospective study, patients with bridge arch-shaped SRF and choroidal neovascular membrane (CNVM) were included. Overall, 623 eyes in 431 patients with chronic CNVM were identified, and 24 eyes (4%) in 21 patients showed bridge arch-shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type-1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean early treatment diabetic retinopathy letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch-shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti-vascular endothelial growth factor injections given before developing bridge arch-shaped SRF was 6.5 ± 7.09. During the development of bridge arch-shaped SRF, visual acuity reduced by -20.57 ± 31.13 letters (P = 0.033) and fibrotic Type-2 CNVM (n = 18, 75%) was noted. Retinal pigment epithelium tear was noted in 8 eyes (33%). At the final visit, further reduction in visual acuity of -7.136 ± 13.73 early treatment diabetic retinopathy letters (P = 0.011) after developing bridge arch-shaped SRF was seen. Mean number of injections given after developing bridge arch-shaped SRF was 4.76 ± 3.76. Bridge arch-shaped SRF is an uncommon finding seen in eyes with Type-2 chronic CNVMs. Presence of retinal pigment epithelium breach and tear and nonaggressive treatment regimen with intravitreal anti-vascular endothelial growth factor injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favorable therapeutic response.

Emotional and physical experiences of people with neovascular age-related macular degeneration during the injection process in Germany: a qualitative study

ObjectivesIn order to better understand the continued barriers to the provision of vascular endothelial inhibitor therapy, this study aims to investigate patients’ experiences with neovascular age-related macular degeneration (nvAMD) in...

Oxidative Crosstalk with Venular Capillary Mitochondria Mediates Barrier Failure in Acute Lung Injury

OBJECTIVE. To elucidate mechanisms underlying alveolar‐capillary crosstalk in the context of lipopolysaccharide (LPS)‐induced Acute Lung Injury (ALI), which causes The Acute Respiratory Distress Syndrome (ARDS).HYPOTHESISOxidative crosstalk between alveolar epithelium and adjacent endothelium causes mitochondrial injury and barrier failure in Acute Lung InjuryMETHODS. We instilled LPS (5mg/kg) by the intranasal (i.n.) route in anesthetized mice. We evaluated microvascular endothelia of isolated blood‐perfused mouse lungs by confocal microscopy, and ALI by bronchoalveolar lavage (BAL) 48h later. For microscopy, we gave the potentiometric mitochondrial dye MTDR, and the reactive oxygen species (ROS) indicator DCF by intravascular infusion. We determined the role of endothelial uncoupling protein 2 (UCP2) by (1) UCP2 knockdown in endothelia by vascular siRNA injection, and (2) endothelial‐specific knockout of UCP2. We transfected alveolar epithelium by i.n. instillation of catalase‐expressing plasmid, or depleted neutrophils by intraperitoneal injection of anti‐Gr1 antibody, 24 hours before i.n. LPS. We quantified barrier permeability through BAL protein content.RESULTS. Confocal imaging indicated that baseline fluorescence intensity of both endothelial MTDR and DCF was steady, indicating that endothelial mitochondrial potential and endothelial ROS were stable. However, 48 hours after LPS instillation, MTDR fluorescence decreased in venular capillaries more than in alveolar capillaries (n=4, p<0.05), indicating endothelial mitochondrial depolarization. Simultaneously, DCF fluorescence increased in venular capillaries more than in alveolar capillaries (n=4, p<0.05), indicating an increase in endothelial ROS. LPS instillation increased BAL protein (n=4, p<0.05). Knockdown of endothelial UCP2 expression, or expression of transfected catalase in the alveolar epithelium blocked LPS‐induced endothelial mitochondrial depolarization and BAL protein increase (p<0.05). Endothelial‐specific knockout of UCP2, but not neutrophil depletion, blocked LPS‐induced BAL protein increase (p<0.05).CONCLUSIONS. We show here for the first time that the hyper‐permeable responses of LPS‐induced ALI result from mitochondrial depolarization in venular capillaries. Transfer of H2O2 from alveoli, not neutrophils activated UCP2, causing proton influx into the mitochondrial matrix. Our findings reveal a novel mechanism of LPS‐induced ALI, implicating mitochondria‐oxidant coupling in barrier failure. Thus, UCP2 presents a potential therapeutic target for ARDS.

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 .

Latex-injected, non-decapitated, saturated salt method-embalmed cadaver technique development and application as a head and neck surgery training model.

Published cerebrovascular injection techniques have mostly used decapitated, fresh cadavers or heads embalmed with 10% formaldehyde. There have been no reports using vascular-injected cadavers for head and neck surgical training models or using vascular injections in saturated salt method-embalmed cadavers. Thus, we performed vascular labeling of five saturated salt method-embalmed cadavers without decapitation. Latex mixed with red ink was injected into the common carotid artery via a 3D-printed vascular adapter. The injection force was provided by a peristaltic pump. Thyroidectomy, submandibular gland excision, neck dissection, parotidectomy, and mandibulotomy were performed on both sides of each cadaver (n = 10). The consistency of the cadavers was softer than fresh ones. Subcutaneous tissues were well preserved, and muscles were moist and elastic. Five physicians graded the resemblance of the heads and necks of the latex-injected, saturated salt method-embalmed, non-decapitated of five cadavers compared to living humans using a Likert scale from 0 (no resemblance) to 5 (maximum resemblance). Fifty-two percent of the head and neck region resemblance scale ratings were four or five. Although the cadavers were practical for head and neck surgical simulations, the brain parenchyma was only partially preserved and unsuitable for use. The most distal arterial branches reached by the injected latex were measured. The external caliber of the smallest vessels reached were lacrimal arteries (mean caliber ± SD, 0.04 ± 0.04 mm; 95% CI [0, 0.09]). There were no significant differences in the mean caliber of the smallest vessels reached between the left- and right-sided arterial branches (all p < 0.05).

The Pandemic Is Not Associated with Endophthalmitis Decrease after Anti–Vascular Endothelial Growth Factor Injections

Based on an analysis of 4,206,234 anti-VEGF intravitreal injections in the IRIS Registry database, there was no observed difference in rates of presumed endophthalmitis after intravitreal injections pre-pandemic vs. during the pandemic in 2020.

Anatomic variability of the nerves of the triceps surae in early human fetuses

Background. Establishing fetal anatomical variability of intramuscular nerves and their connections plays an important role in the search for and development of new methods for the diagnostic and treatment posterior region of the leg. Objective – to find out the topographic and anatomical features of the innervation of the triceps surae in human fetuses 4-6 months. Methods. The study was performed on 46 human fetuses 81.0-230.0 mm crown-rump length (CRL) length using macromicroscopic preparation, vascular injection, and morphometry. Results. In early human fetuses, the anatomical variability of the distribution of intramuscular nerves in the thickness of the triceps surae was established, which is due to the variability of the structure and topography of the tibial nerve, structural and functional organization of triceps surae, arterial branching and interneural connections in the thickness of the heads of the gastrocnemius and soleus in fetuses of different and the same age groups, and sometimes in the same fetus. Conclusion. The main source of innervation of the triceps surae is the tibial nerve, which can be presented by a single trunk, main and additional trunks, or several independent trunks. The nerves in the thickness of the triceps are unevenly distributed. The highest concentration of muscular branches of the tibial nerve is determined in the medial head of the gastrocnemius and the medial part of the soleus. Information on fetal topography of intramuscular nerves in the thickness of the right and left triceps surae, as well as forms of their anatomical variability, both in fetuses of different and the same age and sometimes in the same fetus, due to structural-functional organization of the components of the triceps surae, the type of branching of arteries and nerves in the thickness of the heads of the gastrocnemius and soleus. Atypical variants of the topography of the tibial nerve and common fibular nerve in early fetuses, as well as interneural connections in the thickness of the components of the triceps surae, are more common on the right lower leg.

The cell surface hyaluronidase TMEM2 is essential for systemic hyaluronan catabolism and turnover

As a major component of the extracellular matrix, hyaluronan (HA) plays an important role in defining the biochemical and biophysical properties of tissues. In light of the extremely rapid turnover of HA and the impact of this turnover on HA biology, elucidating the molecular mechanisms underlying HA catabolism is key to understanding the in vivo functions of this unique polysaccharide. Here, we show that TMEM2, a recently identified cell surface hyaluronidase, plays an essential role in systemic HA turnover. Employing induced global Tmem2 knockout mice (Tmem2iKO), we determined the effects of Tmem2 ablation not only on the accumulation of HA in bodily fluids and organs, but also on the process of HA degradation in vivo. Within 3 weeks of tamoxifen-induced Tmem2 ablation, Tmem2iKO mice exhibit pronounced accumulation of HA in circulating blood and various organs, reaching levels as high as 40-fold above levels observed in control mice. Experiments using lymphatic and vascular injection of fluorescent HA tracers demonstrate that ongoing HA degradation in the lymphatic system and the liver is significantly impaired in Tmem2iKO mice. We also show that Tmem2 is strongly expressed in endothelial cells in the subcapsular sinus of lymph nodes and in the liver sinusoid, two primary sites implicated in systemic HA turnover. Our results establish TMEM2 as a physiologically relevant hyaluronidase with an essential role in systemic HA catabolism in vivo, acting primarily on the surface of endothelial cells in the lymph nodes and liver.

Vasa nervorum of epicardial nerves and valves of small veins investigated in porcine heart by two types of vascular injections.

The morphology of the vascular supply of peripheral branches of cardiac nerves has not been systematically described until now. The aim of this study was to describe the architectonics of the vasa nervorum of epicardial nerves in porcine hearts by using two injection techniques. Twenty-three hearts from young healthy pigs were used. In 10 hearts India ink solution was injected into the origin of the anterior interventricular branch. In another 10 hearts India ink solution was injected retrogradely through the coronary sinus. The hearts were then analyzed using a magnifying glass and light microscopy. The arterial injection showed the entirety of the rich venous components of the vasa nervorum, which often consisted of paired veins accompanying the epicardial nerves. The thickness of the nerves ranged from 50 to 815 μm. The vasa nervorum drained into larger subepicardial veins. In seven of the hearts prepared with venous injections the vasa nervorum of epicardial nerves were visualized in the same detail as in the arterial preparations and India ink solution filled the right ventricle via the smallest cardiac veins. The histological analysis of these seven hearts showed complete dehiscence and functional insufficiency of small and larger veins valves. In the other three hearts prepared with venous injections the valves were competent, which prevented retrograde filling of larger and smaller veins. The results obtained expand the current knowledge on epicardial nerves vasa nervorum and provide anatomical evidence behind the mechanism of retrograde application of cardioplegic solutions in cardiac surgery.

Delaying and preventing diabetic retinopathy

Abstract Diabetic retinopathy is a neurovascular complication of diabetes which is an avoidable cause of sight loss. Since the introduction of screening for diabetic retinopathy in the UK along with improving treatments for both diabetes and diabetic retinopathy it is no longer the leading cause of blindness in the UK. Screening detects diabetic retinopathy at an early stage when optimisation of blood glucose, blood pressure and cholesterol are effective in reducing the progression of diabetic retinopathy. Once proliferative diabetic retinopathy or diabetic macular oedema develops treatment includes laser photocoagulation, intravitreal vascular endothelial growth factor inhibitor injections, steroid injection and vitrectomy. With screening to detect diabetic retinopathy, improved therapies and technologies to help people manage diabetes and treatments for diabetic retinopathy sight loss is preventable for the majority of people. Copyright © 2021 John Wiley &amp; Sons.

Safety of Receiving Anti–Vascular Endothelial Growth Factor Intravitreal Injection in Office-Based vs Operating Room Settings

Compared with the operating room (OR), office-based intravitreal injection (IVI) is considered a more cost-effective and convenient approach, yet clinical outcomes of IVIs with anti-vascular endothelial growth factor (VEGF) agents in different settings (office-based vs OR) have not been systematically evaluated. To evaluate the safety outcomes of IVI with anti-VEGF agents in the OR vs office-based setting. PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to July 2020. Eligible studies reporting on patients who received IVIs with anti-VEGF drugs with a clearly stated injection setting of the office or OR. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A meta-analysis was conducted to determine the rates of endophthalmitis (EO) and culture-positive EO. Rates of EO and culture-positive EO following anti-VEGF IVIs in the OR and office-based setting. Thirty-one studies with a total of 1 275 815 injections were included. Comparative analysis suggested no difference between rates of EO after IVIs performed in the office and OR settings (odds ratio, 3.06; 95% CI, 0.07-139.75; P = .57; I2 = 80%) were identified, yet a higher rate of culture-positive EO was found in the office setting (odds ratio, 21.52; 95% CI, 2.39-193.55; P = .006; I2 = 0%). The pooled rates of EO following anti-VEGF IVIs were 0.03% (95% CI, 0.03-0.04) and 0.02% (95% CI, 0.01-0.04) in office and OR settings, respectively, and the pooled rates of culture-positive EO were 0.01% (95% CI, 0.01-0.02) and 0.01% (95% CI, 0-0.02). The pooled rates of other ocular and systemic adverse events were low. The rate of clinically suspected or culture-positive EO following anti-VEGF IVIs was low whether the procedure was performed in the office or OR setting. Bacterial spectrum could differ between the 2 settings. This meta-analysis could not determine if it is more appropriate to give treatment in the OR for safety reasons in low-income compared with higher-income regions in the world.

Surgical anatomy of the superior gluteal artery and internal iliac vein in individuals of the brahimorphic somatotype

Objective:to determine the variants of the syntopy of the internal iliac vein (IIV) and superior gluteal artery (SGA) in individuals of the brachimorphic somatotype.Materials and methods.The material for research was 29 dead bodies of males (from 25 to 82 years) and 11 dead bodies of females (from 28 to 78 years) who had died of causes not related to pelvic pathology. The vascular injection, preparation methods, and statistical processing of the obtained data were used to achieve the objective.Results.It has been found that, regardless of gender, the frequency of variants of the spatial localization of IIV and SGA, in which it is relatively safe to perform a. glutea superior ligation, is approximately equal, which is ≈ 24 % for men and ≈ 23 % for women.Conclusion.The performed study has showed that the variants of IIV and SGA syntopy, in which it is advisable to perform IIA ligation, are much more common than types of the spatial localization of v. iliacainterna and a. glutea superior in which selective ligation of SGA is possible.

Surgical anatomy of the anastomoses of the iliolumbar artery

Objective: to determine the variants of topography and quantity of the anastomoses of the iliolumbar artery.Materials and methods. The material of the research was 206 dead bodies of men (aged 22–82 at the time of death) and 113 dead bodies of women (aged 32–93 at the time of death) who had died of accidental causes not related to pelvic pathology. The vascular injection method, preparation method were used to achieve the objective of the study. The statistical processing of the obtained data was performed.Results. It has been found that the formation of the anastomoses of the iliolumbar artery is most often found in its proximal and middle thirds, significantly rarely — in its distal third. We have revealed no statistically significant differences between the average diameters of the iliolumbar artery and the average diameters of its anastomoses in men.Conclusion. The performed research has demonstrated that the anastomoses of the iliolumbar artery in men and women have a definite pattern of origination.

Endoscopic-mediated, biliary hydrodynamic injection mediating clinically relevant levels of gene delivery in pig liver

Gene therapy could provide curative therapies to many inherited monogenic liver diseases. Clinical trials have largely focused on adeno-associated viruses (AAVs) for liver gene delivery. These vectors, however, are limited by small packaging size, capsid immune responses, and inability to redose. As an alternative, nonviral, hydrodynamic injection through vascular routes can successfully deliver plasmid DNA (pDNA) into mouse liver but has achieved limited success in large animal models. We explored hydrodynamic delivery of pDNA through the biliary system into the liver of pigs using ERCP and a power injector to supply hydrodynamic force. Human factor IX (hFIX), deficient in hemophilia B, was used as a model gene therapy. Biliary hydrodynamic injection was well tolerated without significant changes in vital signs, liver enzymes, hematology, or histology. No off-target pDNA delivery to other organs was detected by polymerase chain reaction. Immunohistochemistry revealed that 50.19% of the liver stained positive for hFIX after hydrodynamic injection at 5.5 mg pDNA, with every hepatic lobule in all liver lobes demonstrating hFIX expression. hFIX-positive hepatocytes were concentrated around the central vein, radiating outward across all 3 metabolic zones. Biliary hydrodynamic injection in pigs resulted in significantly higher transfection efficiency than mouse vascular hydrodynamic injection at matched pDNA per liver weight dose (32.7%-51.9% vs 18.9%, P< .0001). Biliary hydrodynamic injection using ERCP can achieve higher transfection efficiency into hepatocytes compared with AAVs at magnitudes of less cost in a clinically relevant human-sized large animal. This technology may serve as a platform for gene therapy of human liver diseases.

Анатомічна мінливість гілок системи підколінної артерії у плодів людини 4-6 місяців

The study of topographical variations of the branches of the popliteal artery in human fetuses from a macroscopic point of view in modern anatomy is considered relevant and promising. The need to study the anatomy of the terminal branches of the popliteal artery in fetuses of different ages is due to the rapid development of fetal surgery and the improvement in the performance of surgical procedures on the structures of the knee and lower leg areas, since the establishment of the anatomical variability of the vessels of the lower extremities allows choosing the optimal tactics of surgical intervention. In the literature, there are fragmentary data on the fetal topography of the popliteal artery and its branches. The purpose of the study. The study aimed to establish the topographic and anatomical features of the branches of the anterior and posterior tibial arteries in human fetuses of 4-6 months. Material and methods. The study of the fetal anatomy of the popliteal artery was carried out on 34 preparations of human fetuses (81.0-230.0 mm parietococcygeal length) using the methods of anatomical preparation, vascular injection, and morphometry. Results and discussion. In 21 examined fetuses, the classic variant of the branching of the anterior and posterior tibial arteries was observed both on the right and on the left extremity. In other fetuses, atypical variants of the origin and topography of the branches of the popliteal artery were found. The most interesting, from our point of view, was the anatomical variants of the terminal branches of the popliteal artery in fetuses of 160.0, 180.0, and 195.0 mm parietococcygeal length. A high variant of the branch of the peroneal artery from the popliteal artery; a rare variant of doubling the peroneal artery is trifurcation of the popliteal artery into the anterior and posterior tibial and peroneal arteries, doubling of the branches of the tibioperoneal trunk, as well as the formation of anastomoses between them were revealed. Among the most frequent atypical variants of the onset of the peroneal artery in the studied human fetuses was its branch from the tibioperoneal trunk. Conclusion. To obtain a clear idea of the spatial orientation of the peroneal artery in human fetuses, fetal surgeons should distinguish three segments in the peroneal artery trunk: segment I of the peroneal artery (it is proximal part) is the passage of the peroneal artery trunk in the ankle-popliteal canal; segment ІІ (middle part) corresponds to the topography of the peroneal artery in the inferior muscular-peroneal canal; the third segment of the peroneal artery (distal part) is a segment of its trunk from the point of exit from the inferior muscular-peroneal canal to the level of its division into terminal branches

Trends in Retinopathy of Prematurity Screening and Treatment: 2008-2018.

Retinopathy of prematurity (ROP) is the leading avoidable and treatable cause of childhood blindness in the United States. The objective of this study was to evaluate trends of ROP screening, incidence, and treatment in US NICUs over the last 11 years. Using standardized data submitted by NICUs from US Vermont Oxford Network member hospitals from 2008 to 2018 on very low birth weight infants hospitalized at the recommended age for ROP screening, we assessed trends in the proportion of eligible infants who received ROP screening, incidence, and treatment of ROP using logistic regression models. This study included 381 065 very low birth weight infants at 819 US NICUs participating in Vermont Oxford Network. Over time, more eligible infants received ROP screening (89% in 2008 to 91% in 2018, trend P < .001). Among those screened, overall ROP (stages 1-5, 37% in 2008 to 32% in 2018), severe ROP (stages 3-5, 8% in 2008 to 6% in 2018), and retinal ablation (6% in 2008 to 2% in 2018) declined and anti-vascular endothelial growth factor injections (1% in 2012 to 2% in 2018) increased (all trend P < .001). Among US hospitals from 2008 to 2018, the proportion of ROP screening among infants hospitalized at the recommended age increased, less overall and severe ROP were reported, less retinal ablation was performed, and more anti-vascular endothelial growth factor treatment was used. Despite increased ROP screening over time, 10% of infants were not screened, representing an opportunity for improvement in health care delivery.

Outcomes of Patients With Active Diabetic Macular Edema at the Time of Cataract Surgery Managed With Intravitreal Anti–Vascular Endothelial Growth Factor Injections

To investigate the outcomes of cataract surgery in patients with active diabetic macular edema (DME) who are receiving active treatment with intravitreal anti-vascular endothelial growth factor (VEGF) injections in the perioperative period. Retrospective clinical cohort study. We reviewed all patients who underwent cataract surgery and were receiving intravitreal anti-VEGF injections from January 1, 2012 through December 31, 2017. Thirty-seven eyes underwent cataract surgery and received ≥1 intravitreal anti-VEGF injection for a diagnosis of DME within 6 months before surgery. Outcome measures included the development of subretinal or intraretinal fluid in the 6 months after surgery, timing of injections, number of injections, best-corrected visual acuity, and central subfield thickness. There was a significant improvement between pre- and postoperative best-corrected visual acuity when comparing all eyes (Ps < .0001) and no significant difference in central subfield thickness before and after surgery (P > .05). There were 30 eyes (81.1%) that had fluid on the preoperative optical coherence tomography scan. Seventeen eyes (45.9%) developed new or worsening postoperative DME. Comparing the eyes that did or did not develop worsening DME, there were no differences in postoperative visual acuities (P > .05). Eyes that did develop new fluid had significant increases in postoperative central subfield thickness at both 1 month (350 vs 320 μm, P=.036) and 6 months (342 vs 305 μm, P=.013). In a real-world setting, patients with cataracts and actively treated DME may undergo cataract surgery but may see a worsening of DME not immediately affecting the best-corrected visual acuity.

Minimally invasive medial hip approach for femoral head fixation: How much can we see and what is the anatomical at risk? – A cadaveric injection study

IntroductionMost Pipkin I and II femoral head fractures are treated with either an anterior or a posterior approach. A medial hip approach is commonly used in children, and some surgeons have suggested it for femoral head fixation. The objectives of this study were to identify the structures at risk with the medial hip approach and to demonstrate the areas of the femoral head exposed using this approach. MethodsThe first part of this study involved vascular injection conducted in four fresh human cadavers using the medial hip approach. The surgical technique was described and the structures at risk, mainly arteries, were identified. The second part was done in 14 hips to identify and measured the maximum exposure area of the femoral head with the medial hip approach. ResultsThe structures at risk with the medial hip approach were the medial femoral circumflex artery (MFCA) after it branches from the deep femoral artery and runs posteromedially across the femoral neck medial to the iliopsoas tendon and the deep branch of the MFCA lies over the posterior hip capsule. The femoral head exposure area in anterior view with anteroinferior articular cartilage exposure was 4.57 ± 1.09 cm2. In the medial view with the hip in internal rotation and in external rotation, the inferomedial articular cartilage exposure was 2.50 ± 1.52 cm2 and 6.48 ± 2.29 cm2, respectively, and the combined area of exposure was 9.49 ± 2.86 cm2 . In the posterior view, the posteroinferior articular exposure was 1.69 ± 1.16 cm2. The medial hip approach allowed visualization of the small area of the posteroinferior articular cartilage in all specimens. The percentages of visualization of the femoral head articular cartilage in anterior view, medial view and posterior view were 50.07% ± 13.53, 45.56% ± 12.76 and 18.07% ± 11.27%, respectively. ConclusionsThe structures at risk with the medial hip approach is the MFCA along the anterior acetabular rim and the deep branch on the posteromedial aspect of the femoral neck. It is an alternative which provides excellent access in Pipkin I and some part of Pipkin II, but it requires that the MFCA be protected by the use of meticulous surgical techniques.