Indocyanine green angiography guidance for vascular preservation in skin and nipple sparing mastectomy

PURPOSE

The skin and/or nipple-sparing approach has become an oncologically sound and desirable choice for women choosing mastectomy. Indocyanine green (ICG) perfusion imaging has been shown to reduce ischemic complications in mastectomy skin flaps. Immediate reconstruction requires a well-vascularized skin flap capable of tolerating full expansion. Identification of the perforating subcutaneous vessels to the skin envelope may allow for better and more consistent blood vessel preservation and flap perfusion.

METHODS

The authors conducted an institutional review board-approved prospective study with 41 patients to assess the feasibility of using ICG perfusion imaging to visualize, cutaneously map, and preserve the vessels that supply the skin flap and nipple-areolar complex. For each patient, the number of vessels initially mapped, the number of vessels preserved, the extent to which each vessel was preserved, and the proportion of the flap with adequate perfusion (as defined by the SPY-Q > 20% threshold) was recorded and analyzed.

RESULTS

Vessels were able to be identified and marked in a high majority of patients (90%). There was a moderate linear relationship between the number of vessels marked and the number preserved. Successful mapping of vessels was associated with lower rates of wound breakdown (p = 0.036). Mapping and preserving at least one vessel led to excellent flap perfusion (> 90%). No increase in complications was observed from utilizing ICG angiography preoperatively.

CONCLUSION

This prospective study using preoperative ICG perfusion mapping demonstrated safety, feasibility, and good prognostic outcomes.

LEVEL OF EVIDENCE

III.

New threats from an old foe: Evaluating the risk to the blood supply due to increasing incidence and endemicity of leprosy in the United States

Leprosy (i.e., Hansen's disease) is a chronic disease secondary to infection with either Mycobacterium leprae or M. lepromatosis. While the incidence of this disease is decreasing across the world, there is mounting evidence that it might be increasing, and becoming endemic, in the United States. Leprosy was once considered a potential threat to the blood supply, and while this threat has not borne out, it is worth revisiting the available data to assess whether it may pose a threat in the future. Herein, we discuss the evidence for and against the potential for transfusion-transmission of leprosy, and highlight future areas of research to further elucidate this possibility.

An integrated strategy for reducing anastomotic leakage in patients undergoing McKeown esophagectomy

Objective

To describe our experience of reducing anastomotic leakage, a problem that has not been properly solved.

Methods

Starting in January 2020, we began implementing our integrated strategy (application of an esophageal diameter-approximated slender gastric tube, preservation of the fibrous tissue around the residual esophagus and thyroid inferior pole anastomosis) in consecutive patients undergoing esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube. Additionally, the blood supply at the site of the anastomosis was evaluated with a near-infrared fluorescence thoracoscope after the completion of esophagogastric anastomosis in the integrated strategy group.

Results

Of 570 patients who were reviewed, 119 (20.9%) underwent the integrated strategy, and 451 (79.1%) underwent the conventional strategy. The rate of anastomotic leakage was 2.5% in the integrated strategy group and 10.2% in the conventional strategy group (p = 0.008). In the integrated strategy group, the site of most of the anastomotic blood supply was the residual esophagus dominant (82.4%), followed by the gastroesophageal dual-dominant (12.6%) and the gastric tube dominant (5.0%). The reconstruction route was more likely to be orthotopic in the integrated strategy group than in the conventional strategy group (89.9% vs. 38.6%, p = 0.004). Gastric dilation was identified in 3.4% of the patients in the integrated strategy group and in 21.1% in the conventional strategy group.

Conclusions

Patients who underwent our proposed integrated strategy (Zhengzhou Strategy) during McKeown esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube had a strikingly lower rate of anastomotic leakage and a relatively lower rate of postoperative complications, such as gastric tube dilation and delayed gastric emptying.

Bringing revolution through quadcopter technology in the field of supplying medicine in the Himalayan regions of Uttarakhand: Case example of Pithoragarh

BACKGROUND

Quadcopters are used in various forms in the civil arena, from crop insurance to agricultural drones, as loudspeakers for announcing government guidelines, resilience tools in infrastructure monitoring, real-time vehicle detection, etc. However, the usage of quadcopters and hexacopters in supplying medical aid to inhospitable and far-flung terrains is being studied and researched in less detail throughout the globe.

AIM

This paper focuses on the basics of quadcopter technology in supplying medicines and its advantages to the affected patients who get life-saving medicines from earlier inaccessible roads. The efficacy of quadcopters in terms of time, economy, and manpower in supplying essential and inescapable medical supplies is exponentially high, especially in the Pithoragarh Region of Uttarakhand State, where the villages are not connected to the roads.

METHODS

The road structure of the hilly terrain of Uttarakhand, India, was studied in detail to know the state of people who do not get access to life-saving drugs due to the non-availability of roads near them.

RESULTS

The result informs us that the quad/hexacopter if used in abundance can provide a glimmer of hope to people in remote places.

CONCLUSION

The quadcopter can provide hope to the residents of the Pithoragarh district of Uttarakhand, India, located in far-flung places devoid of basic medical facilities.

Transillumination method in total knee arthroplasty: new approach with old tools

PURPOSE

In this study, we evaluated the possibility of precise intraoperative localization of the lateral genicular arteries by an orthopaedic surgeon using the transillumination method.

METHODS

Twelve patients underwent cemented TKA with patella-friendly Zimmer Biomet NexGen Legacy Posterior Stabilized prostheses (without patellar resurfacing), seven right knees and five left knees. The mean age of patients in the study group was 66.636 ± 7.003 years. The minimal follow-up period was 13 months (mean-16.363 ± 2.5 months). Functional outcomes were assessed using Knee Society and a specific patellar questionnaire-Kujala Score. Intraoperative detection of insufficient patellar stability and/or patellar maltracking was based on the no-thumb technique. In pre- and postoperative period X-ray investigation, standard standing X-ray and Merchant view were used to evaluate implant position and patellofemoral congruency.

RESULTS

In this study, ten out of twelve knee joints (83.3%) had at least one artery visible by the proposed method in the lateral parapatellar area. Five out of ten knee joints had more than one artery that could be visualized and identified as an arterial vessel. Postoperative Knee Society Score showed significant improvement from a mean 51.181 ± 3.868 to a mean 88.727 ± 3.663. Mean hospital length of stay is 8.545 ± 1.863 days. X-ray assessment using standard anteroposterior, lateral, and Merchant skyline views showed appropriate implant positioning and patellofemoral congruency. The mean Kujala Score in the postoperative period (3 and 6 months) was 67.3 ± 6.75 and 75.6 ± 6.42, respectively.

CONCLUSIONS

Using the proposed transillumination method can help preserve the lateral blood supply to the patella and to avoid devascularized patella-related complications.

TRIAL REGISTRATION

Retrospectively registered on 5 of May 2023, Registration number - 3/3-1757.

Facial artery: anatomical variations in the perioral region in cadavers

BACKGROUND

In recent years, there has been an increase in reports of perioral vascular complications resulting from filler injections, such as necrosis of the lip or alar rim, occlusion, and in severe cases, blindness. Conversely, the use of perioral arterial flaps is becoming more prevalent in the treatment of cleft lips, cancer, and trauma. A thorough understanding of perioral arteries is essential to minimize complications and maximize the success of these flaps. However, the course of the facial artery (FA) in the perioral region remains incompletely understood. The aim of this study was to describe the variations of the FA in the perioral region.

METHODS

We dissected 52 embalmed and formaldehyde-fixed Vietnamese cadavers. We then studied the size and distribution of perioral arteries in 102 specimens.

RESULTS

The superior labial artery (SLA) was the most common branch, occurring in 87.25% of cadavers, followed by the inferior labial artery (ILA) at 78.43%. The SLA primarily originated above the mouth corner (cheilion), accounting for 91.01% of cases, and predominantly exhibited a tortuous course within the submucosa (78.65%). The ILA's branching pattern varied, but it was primarily located below the cheilion (91.25%). The ILA also followed a twisted path, generally within the submucosa. The ILA exhibited two patterns: the typical pattern, distributed at the vermilion border of the lower lip (8.82%), and the horizontal labiomental artery pattern, which ran horizontally in the middle of the lower lip area (69.61%). At their origin, the SLA and ILA had average external diameters of 1.29 mm and 1.28 mm, respectively.

CONCLUSION

Numerous anatomical variations in the FA in the perioral region were found. A detailed anatomic description, suggested landmarks, and angiography before the procedure will be useful to help doctors avoid complications.

Necrosis reduction efficacy of subdermal biomaterial mediated oxygen delivery in ischemic skin flaps

Inadequate tissue blood supply as may be found in a wound or a poorly vascularised graft, can result in tissue ischemia and necrosis. As revascularization is a slow process relative to the proliferation of bacteria and the onset of tissue necrosis, extensive tissue damage and loss can occur before healing is underway. Necrosis can develop rapidly, and treatment options are limited such that loss of tissue following necrosis onset is considered unavoidable and irreversible. Oxygen delivery from biomaterials exploiting aqueous decomposition of peroxy-compounds has shown some potential in overcoming the supply limitations by creating oxygen concentration gradients higher than can be attained physiologically or by air saturated solutions. We sought to test whether subdermal oxygen delivery from a material composite that was buffered and contained a catalyst, to reduce hydrogen peroxide release, could ameliorate necrosis in a 9 × 2 cm flap in a rat model that reliably underwent 40 % necrosis if untreated. Blood flow in this flap reduced from near normal to essentially zero, along its 9 cm length and subdermal perforator vessel anastomosis was physically prevented by placement of a polymer sheet. In the middle, low blood flow region of the flap, treatment significantly reduced necrosis based on measurements from photographs and histological micrographs. No change was observed in blood vessel density but significant differences in HIF1-α, inducible nitric oxide synthase and liver arginase were observed with oxygen delivery.

Semen collection and ejaculation trigger changes in the blood flow of the reproductive system in rams

The aim of this study was to determine if ejaculation modifies the testicular and accessory sex glands' blood flow after ejaculation, and if those changes differ according to the process that leads to ejaculation. Twelve adult Corriedale rams were used and assigned at random to the four procedures that lead to ejaculation: (G1) electroejaculation; (G2) artificial vagina; (G3) transrectal ultrasound-guided massage of the accessory sex glands; (G4) natural mating. Hemodynamic characteristics evaluation of the male reproductive system was conducted immediately before and at 30 and 90 min after ejaculation. The internal iliac artery peak systolic velocity (PSV) decreased (P=0.01) and supratesticular artery PSV increased (P=0.042) 90 min after ejaculation in all groups. In conclusion, ejaculation modifies the reproductive system's blood flow, with slight variations depending on the studied ejaculation methods. Additionally, ejaculation altered the internal iliac and supratesticular arteries PSV, and the supratesticular artery end-diastolic velocity (EDV) in rams. The supratesticular artery PSV was the only studied variable that differed according to the procedure that triggered the ejaculation.

Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study

BACKGROUND

Safe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach.

METHODS

This study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix: three socioeconomic settings, three components of the blood system continuum, and three levels of urgency of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions with stakeholders across the continuum to characterize ground-level deficits and potential policy, systems, and environment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact on blood transfusion availability, accounting for differences across socioeconomic settings and levels of urgency.

DISCUSSION

Identifying and prioritizing community-driven interventions to improve blood supply in low-resource settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model the response to stakeholder-proposed PSE changes may lead to identification of contextually appropriate intervention targets to meet the transfusion needs of the population.

Imaging evaluation of blood supply changes after chemotherapy of osteosarcoma and its correlation with tumor necrosis rate

Background

Analysis of the tumour necrosis rate is an important method to evaluate the effect of neoadjuvant chemotherapy for osteosarcoma. However, at present, there is no specific imaging method to evaluate this effect. The purpose of this study was to evaluate the changes in blood supply after chemotherapy by measuring the CT enhancement rate and to analyse the correlation between the CT enhancement rate and the tumour necrosis rate.

Methods

Patients with primary osteosarcoma of the extremities treated in our institute from 2016 to 2017 were analysed retrospectively. In total, 103 eligible patients were enrolled in the study, including 67 males and 36 females, with an average age of 17.7 (6-54) years. Sixty cases had tumour sites in the femur, 25 in the tibia, 10 in the humerus, and eight in other sites. All patients received neoadjuvant chemotherapy including methotrexate, cisplatin + doxorubicin and ifosfamide before surgical treatment. All patients underwent enhanced CT examination of the same tumour site before and after the neoadjuvant chemotherapy protocol. The CT value before and after chemotherapy was measured and the enhancement rate was calculated. The change in the CT enhancement rate after chemotherapy was analysed. Changes in the CT enhancement rate were compared between patients with a tumour necrosis rate greater than 90% and those with one <90%.

Results

The average CT enhancement rates before and after chemotherapy were 1.68 (median 1.63, range 1.00-2.51) and 1.39 (median 1.28, range 1.00-2.83), respectively (P < 0.01). The average CT enhancement rate after chemotherapy decreased by 15.0% (median 16.7%, range -27.5-53%): 75 cases exhibited a decrease, three cases remained unchanged, and 25 cases exhibited an increase. The average enhancement rate before chemotherapy was 1.75 (median 1.68, range 1.18-2.51) in the group with a necrosis rate >90% and 1.62 (median 1.52, range 1.00-2.41) in the group with a necrosis rate < 90% (P = 0.068). The average CT enhancement rate after chemotherapy was 1.20 (median 1.21, range 1.00-1.53) in the group with a necrosis rate > 90% and 1.53 (median 1.43, range 1.00-2.83) in the group with a necrosis rate < 90% (P < 0.01). The enhancement rate of the group with a necrosis rate > 90% decreased by 29.0% (median 28%, range -2.3-53%) (P < 0.01); the enhancement rate of the group with a necrosis rate < 90% decreased by 3.8% on average (median 0.7%, range -27.5-44.5%) (P = 0.225).

Conclusion

After receiving neoadjuvant chemotherapy, most patients with osteosarcoma of the extremities exhibited reductions in the CT enhancement rate. In cases where the tumour necrosis rate was greater than 90%, the tumour blood supply was significantly reduced. This suggests that imaging evaluations based on the CT enhancement rate can be used as a reference for evaluating the preoperative effect of chemotherapy for osteosarcoma.

Methods to predict osteonecrosis of femoral head after femoral neck fracture: a systematic review of the literature

BACKGROUND

Femoral neck fracture (FNF) is a very common traumatic disorder and a major cause of blood supply disruption to the femoral head, which may lead to a severe long-term complication, osteonecrosis of femoral head (ONFH). Early prediction and evaluation of ONFH after FNF could facilitate early treatment and may prevent or reverse the development of ONFH. In this review paper, we will review all the prediction methods reported in the previous literature.

METHODS

Studies on the prediction of ONFH after FNF were included in PubMed and MEDLINE databases with articles published before October 2022. Further screening criteria were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study highlights all the advantages and disadvantages of the prediction methods.

RESULTS

There were a total of 36 studies included, involving 11 methods to predict ONFH after FNF. Among radiographic imaging, superselective angiography could directly visualize the blood supply of the femoral head, but it is an invasive examination. As noninvasive detection methods, dynamic enhanced magnetic resonance imaging (MRI) and SPECT/CT are easy to operate, have a high sensitivity, and increase specificity. Though still at the early stage of development in clinical studies, micro-CT is a method of highly accurate quantification that can visualize femoral head intraosseous arteries. The prediction model relates to artificial intelligence and is easy to operate, but there is no consensus on the risk factors of ONFH. For the intraoperative methods, most of them are single studies and lack clinical evidence.

CONCLUSION

After reviewing all the prediction methods, we recommend using dynamic enhanced MRI or single photon emission computed tomography/computed tomography in combination with the intraoperative observation of bleeding from the holes of proximal cannulated screws to predict ONFH after FNF. Moreover, micro-CT is a promising imaging technique in clinical practice.

The effect of intentionally perforating the floor of the pulp chamber on pulpal healing after tooth replantation in mice

OBJECTIVES

Shortening the root of a mouse molar prior to tooth replantation results in early revascularization in the pulp cavity and activation of the dental pulp quiescent stem cells. This study aimed to validate the effects of pulp chamber floor perforation on pulpal healing after tooth replantation as a strategy to promote early revascularization into the pulp.

METHODS

The maxillary first molars of three-week-old Crlj:CD1 mice were extracted and repositioned into the original socket: the left teeth were immediately replanted (control group: CG), whereas the floor of the pulp chamber of the right teeth was perforated with a tungsten carbide bur before tooth replantation (experimental group: EG). The samples were collected from three days to eight weeks postoperatively. In addition to the TUNEL assay, immunohistochemistry for Nestin, CK14, and Ki-67 was conducted.

RESULTS

In the EG, early revascularization occurred with a decrease in apoptosis and an increase in cell proliferation, facilitating pulpal healing, compared with the CG. The rate of Nestin-positive perimeter in the distal root significantly increased on days 5 and 14 and the amount of Nestin-positive hard tissue increased on day 14. However, on day 7, the number of epithelial cell rests of Malassez in the EG significantly decreased, making the EG susceptible to ankylosis at the floor.

CONCLUSIONS

Intentionally perforating the floor of the pulp chamber provides a route for early revascularization, resulting in better pulpal healing after tooth replantation.

Hypertrophic breasts versus normal-sized breasts: Comparison of blood supply to the nipple-areola complex based on DCE-MRI

BACKGROUND

Understanding the blood supply to the nipple-areola complex (NAC) in hypertrophic breasts is essential to reduce the risk of NAC necrosis during reduction mammaplasty. The aim of this study was to use dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to determine the NAC blood supply of hypertrophic breasts compared with normal-sized breasts.

METHODS

DCE-MRI images of 100 Asian women (100 hypertrophic breasts and 100 normal-sized breasts) were included retrospectively. All vessels supplying the NAC were identified using axial, coronal, and sagittal maximum-intensity projection images. The diameter, length, and distance to the skin surface of source vessels were measured.

RESULTS

The number of source vessels in the hypertrophic breasts was larger than that in the normal-sized breasts. 97.0% of hypertrophic breasts had multizone blood supply to the NAC. In hypertrophic and normal-sized breasts, the proportion of vessels was highest in the supermedial zone, followed by the superolateral zone and central zone. The diameter of medial and lateral vessels was significantly increased in hypertrophic breasts. Besides, the length of source vessels in hypertrophic breasts was larger than that in normal-sized breasts.

CONCLUSIONS

Hypertrophic breasts tend to have a richer blood supply to the NAC than normal-sized breasts. The predominant vessels supplying the NAC of hypertrophic breasts are the superomedial, followed by the superolateral and central.

LEVEL OF EVIDENCE

IV.

A modified surgical method for the treatment of ONFH: quadratus femoris muscle pedicle bone grafting with preservation of the posterior superior retinacular artery

BACKGROUND

Osteonecrosis of the femoral head (ONFH) can lead to pain and loss of function of the hip joint, which places a great burden on patients and society. Surgery is the main treatment for osteonecrosis of the femoral head, and quadratus femoris muscle pedicle bone grafting has a definite therapeutic effect as one method of surgery for the treatment of ONFH. However, the posterior superior retinacular artery is often injured during quadratus femoris muscle pedicle bone graft surgery. There is evidence that this artery is extremely important to the femoral head, as injury to this artery will seriously affect the blood supply of the femoral head. Therefore, this situation restricts the clinical application of quadratus femoris muscle pedicle bone grafts. We aimed to explore a new surgical method of quadratus femoris muscle pedicle bone grafting that can preserve the integrity of the posterior superior retinacular artery.

METHODS

We modified the traditional quadratus femoris muscle pedicle bone graft and preserved the integrity of the posterior superior retinacular artery. To explore the safety and feasibility of the operation, we simulated the operation on 6 fresh frozen cadavers (12 hips) and measured the related data. We also tried this modified surgical method in the clinic and collected detailed data from the patients.

RESULTS

By simulating the modified quadratus femoris muscle pedicle bone graft on the hip joints of fresh frozen cadavers, we found that the posterior superior retinacular artery existed in all cadaver specimens and that the sources may be different (MFCA or IGA). In the modified operation, the joint capsule did not need to be cut during the operation; therefore, the integrity of the posterior superior retinacular artery was preserved. The quadratus femoris muscle was exposed via the posterior approach of the hip joint, and then the quadratus femoris muscle pedicle bone flap was chiseled. After the pedicle of the quadratus femoris muscle was loosened properly, the migration distance of the quadratus femoris muscle pedicle bone flap reached 5.89 ± 0.45 (χ ± s) cm. The bone flap was trimmed properly and placed on one side. Next, we drilled a bone tunnel from the external intertrochanteric aspect of the capsule of the hip joint, and the bone tunnel broke through the sclerosing zone and proceeded straight to the necrotic area of the femoral head. Next, the necrotic bone was removed with a ring saw and arc bone knife, autogenous bone or allogeneic bone was filled into the bone groove according to the situation, and the cancellous bone in the bone groove was tamped by percussion. Then, the bone flap was inserted into the bone groove, and appropriate pressurization was performed. The depth of the bone groove was determined by the location of ONFH. We found that the furthest distance between the bone groove and the femoral head was 4.76 ± 0.07 (χ ± s) cm and that the length of the bone flap was (4.91 ± 0.23) (χ ± s) cm. This means that when the depth of the bone groove reached the area of ONFH, the quadratus femoris muscle pedicle bone flap had a sufficient length and migration distance to be embedded in the area of ONFH and firmly fixed, and the quadratus femoris did not have much tension. The closest distance between the posterior superior retinacular artery and the bone groove was (1.11 ± 0.96) (χ ± s) cm. When the bone groove was created in this area, the edge of the bone groove had a safe distance of at least 1 cm from the posterior superior retinacular artery of the femoral head. We attempted to implement this modified operation clinically. During the procedure, the quadratus femoris muscle pedicle bone flap was embedded into the drilled bone groove and fixed with a magnesium nail. There was no sliding of the bone flap after the operation, and the posterior superior retinacular artery was intact. We followed the patient for 3 months and found that the patient recovered well with no weight-bearing by the affected limb. The duration of the modified operation was shorter than that of the traditional quadratus femoris muscle pedicle bone graft, the amount of bleeding was significantly reduced, the postoperative pain was lessened, and no special discomfort was reported. Postoperative imaging examination showed that the collapse of the femoral head had been partially corrected and that the bone flap had gradually fused with the surrounding bone.

CONCLUSIONS

Through this experimental study, we confirmed the feasibility of the modified method for quadratus femoris muscle pedicle bone grafting with preservation of the posterior superior retinacular artery. This modified operation not only retains the integrity of the posterior superior retinacular artery of the femoral head but also reduces the difficulty of the operation and shortens the surgical time, which is of great clinical significance.

Promoting blood donation through social media: Evidence from Brazil, India and the USA

Social media has the potential to encourage prosocial behaviors at scale, yet very little causal evidence exists on the impact of related efforts. Blood donation is a particularly difficult, but essential prosocial behavior that is often critically undersupplied. We examine the effect of Facebook's blood donation tool on voluntary blood donation. We partnered with four major blood banks in the United States covering 363 collection facilities in 46 states and Washington, D.C. We tracked the tool's impact on blood donations during its staggered rollout on a sample of more than 47,000 facility-date observations from March 2019 to September 2019. The tool caused an increase of 0.55 total donations per facility per day (+4.0% [95% CI: 0.04%-8.0%]), and an increase of 0.15 donations from first-time donors per facility per day (+18.9% [95% CI: 4.7%-33.1%]). Longitudinal evidence from Brazil and India suggests the share of donors who both received a message from the tool and stated they were influenced by Facebook to donate increased from 0% to 14.1% [95% CI: 12.1%-16.2%] in the first year of the tool's deployment (i.e., September 2018 to August 2019). These meaningful increases, especially from first-time donors, demonstrate that social media platforms can play an important role in fostering offline prosocial behaviors that benefit the health and well-being of societies around the world.

Vascular Supply of the Wrist

The vascular anatomy of the wrist is vital in the development of multiple disorders at the carpus. Understanding this vascular network may prevent iatrogenic injury to the blood supply and can be used by surgeons through vascularized bone grafts. Multiple surgical techniques take advantage of the vascular network. This article reviews the blood supply of the distal radius, ulna, and carpal bones and its clinical implications.

Role of osteopontin in the process of pulpal healing following tooth replantation in mice

Introduction

The role of osteopontin (OPN) following severe injury remains to be elucidated, especially its relationship with type I collagen (encoded by the Col1a1 gene) secretion by newly-differentiated odontoblast-like cells (OBLCs). In this study, we examined the role of OPN in the process of reparative dentin formation with a focus on reinnervation and revascularization after tooth replantation in Opn knockout (KO) and wild-type (WT) mice.

Methods

Maxillary first molars of 2- and 3-week-old-Opn KO and WT mice (Opn KO 2W, Opn KO 3W, WT 2W, and WT 3W groups) were replanted, followed by fixation 3–56 days after operation. Following micro-computed tomography analysis, the decalcified samples were processed for immunohistochemistry for Ki67, Nestin, PGP 9.5, and CD31 and in situ hybridization for Col1a1.

Results

An intense inflammatory reaction occurred to disrupt pulpal healing in the replanted teeth of the Opn KO 3W group, whereas dental pulp achieved healing in the Opn KO 2W and WT groups. The tertiary dentin in the Opn KO 3W group was significantly decreased in area compared with the Opn KO 2W and WT groups, with a significantly low percentage of Nestin-positive, newly-differentiated OBLCs during postoperative days 7–14. In the Opn KO 3W group, the blood vessels were significantly decreased in area and pulp healing was disturbed with a failure of pulpal revascularization and reinnervation.

Conclusions

OPN is necessary for proper reinnervation and revascularization to deposit reparative dentin following severe injury within the dental pulp of erupted teeth with advanced root development.

•

Osteopontin deficiency inhibits hard tissue formation in advanced erupted teeth.

•

Odontoblast-like cells may be different origins between mild and severe injuries.

•

Osteopontin has an important role for proper reinnervation and revascularization.

•

Osteopontin is necessary to deposit reparative dentin in advanced erupted teeth.

Evaluation of Retinal Microvascular Impairment after COVID-19 and its Clinical Correlates Using Optical Coherence Tomography Angiography

Objectives

Retinal vascular complications have been described in patients with coronavirus disease 2019 (COVID-19). This study aimed to analyze retinal microvascular changes and their correlations with clinical findings.

Materials and Methods

This case-controlled study was conducted in a university hospital. The right eyes of 52 otherwise healthy patients recovered from COVID-19 and 42 healthy controls were examined with optical coherence tomography angiography. Mann-Whitney U test was used to compare vessel density (VD) and foveal avascular zone (FAZ) parameters. Associations with treatment choices, pneumonia, and laboratory findings were analyzed.

Results

Twenty-nine patients (56%) and 18 healthy controls (43%) were men. Mean age of the COVID-19 group was 39.00±13.04 years. Twenty-two patients had pneumonia, 18 (35%) received hydroxychloroquine (HCQ), 17 (33%) received HCQ plus low-molecular-weight heparin (LMWH), and 10 (19%) received favipiravir. The patient group had lower parafoveal VD in the superficial capillary plexus (SCP) and lower parafoveal VD and perifoveal VD in the deep capillary plexus (DCP) than controls (p=0.003, p=0.004, p=0.001). FAZ area did not differ significantly (p=0.953). Perifoveal VD in the DCP was also significantly lower in the HCQ+LMWH group than the HCQ group (p=0.020) and in the presence of pneumonia (p=0.040). C-reactive protein (CRP) and ferritin levels were negatively correlated with perifoveal VD in the DCP (r=-0.445, p=0.023; r=-0.451, p=0.040). Ferritin was also negatively correlated with parafoveal VD in the SCP (r=-0.532, p=0.013).

Conclusion

Parafoveal and perifoveal VD was found to be lower in the COVID-19 group. Presence of pneumonia, need for LMWH prophylaxis, and levels of CRP and ferritin were found to be negatively associated with retinal VD. Large-scale studies are needed to evaluate the clinical importance.

Microelectrode implants, inflammatory response and long-lasting effects on NADPH diaphorase neurons in the rat frontal cortex

At present, one of the main therapeutic challenges comprises the development of technologies to improve the life quality of people suffering from different types of body paralysis, through the reestablishment of sensory and motor functions. In this regard, brain-machine interfaces (BMI) offer hope to effectively mitigate body paralysis through the control of paralyzed body parts by brain activity. Invasive BMI use chronic multielectrode implants to record neural activity directly from the brain tissue. While such invasive devices provide the highest amount of usable neural activity for BMI control, they also involve direct damage to the nervous tissue. In the cerebral cortex, high levels of the enzyme NADPH diaphorase (NADPH-d) characterize a particular class of interneurons that regulates neuronal excitability and blood supply. To gain insight into the biocompatibility of invasive BMI, we assessed the impact of chronic implanted tungsten multielectrode bundles on the distribution and morphology of NADPH-d-reactive neurons in the rat frontal cortex. NADPH-d neuronal labeling was correlated with glial response markers and with indices of healthy neuronal activity measured by electrophysiological recordings performed up to 3 months after multielectrode implantation. Chronic electrode arrays caused a small and quite localized structural disturbance on the implanted site, with neuronal loss and glial activation circumscribed to the site of implant. Electrodes remained viable during the entire period of implantation. Moreover, neither the distribution nor the morphology of NADPH-d neurons was altered. Overall, our findings provide additional evidence that tungsten multielectrodes can be employed as a viable element for long-lasting therapeutic BMI applications.

Discovery of a trans-sellar vascular supply for the pituitary gland

The vasculature of the pituitary gland is discussed briefly and the details of an anatomical discovery of the vessels supplying the pituitary gland provided. Twenty latex injected cadaveric heads were dissected. Any vessels that were found to penetrate the sella turcica and travel to the pituitary gland were documented and measured. Additionally, 25 adult skulls were evaluated for the presence, size, and sites of bony foramina in the floor of sella turcica. Trans-sellar vessels were identified in 65% of specimens. There was a mean of 1.5 vessels per specimen consisting usually of a mixture of veins and arteries. The mean diameter of these vessels was 0.3 mm and the mean length from the sella turcica to the pituitary gland was 2.3 mm. These vessels were concentrated in the most concave part of the sella turcica. In bony specimens, the mean number of trans-sellar foramina was four. The diameter of these foramina ranged from 0.3 to 0.6 mm in size. The trans-sellar foramina were concentrated near the center part of the sella turcica and had no regular pattern. The pituitary gland receives at least some blood supply and drainage via vessels traveling along the septum of the sphenoidal sinuses and through the sella turcica. Knowledge of such vessels might lead to a better understanding of the vascular supply and drainage of the pituitary gland and would be useful during skull base approaches such as trans-nasal approaches to the pituitary gland.

Optic disc blood perfusion and oxygenation in glaucoma

Purpose

To investigate the haemoglobin concentration and oxygenation in the optic disc in glaucoma patients vs. controls.

Methods

Thirty-one eyes of primary open angle glaucoma patients (mean age: 64.9 ± 2.1 years) and 31 eyes of 31 healthy controls (65.5 ± 2.0 years) were included. Perimetry, optical coherence tomography (OCT), and OCT angiography were performed. Multispectral imaging was used to record the optic disc reflectance at wavelengths 522 nm, 548 nm, 555 nm, 586 nm, and 610 nm, and haemoglobin concentration and oxygenation (SO₂) were calculated from these measures. This was done in the rest and under stimulation of neuronal activity by flicker light.

Results

The haemoglobin concentration was significantly lower (p < 0.001) in the rim (40.0 ± 6.3) and the excavation (35.7 ± 8.0) of the glaucoma patients’ discs than in controls (45.7 ± 7.5). SO₂ was not different in general, but lower in a subgroup of 18 glaucoma patients with ischaemic disc rims than in non-ischaemic ones (median 26.8%, interquartile range (IQR): 29.5% vs. 51.9%, IQR 32.0%, p = 0.02) as well as in controls (41.0%, IQR 30.6%, p = 0.01). Flicker light stimulation significantly increased the haemoglobin concentration in the controls (+ 1.3 ± 3.6, p = 0.048) as well as in the rim of glaucoma discs (+ 2.6 ± 5.0, p = 0.006) and SO₂ in the controls only (+ 15.4 ± 23.6%, p = 0.001). The haemoglobin concentration was significantly correlated with the perimetric mean defect, retinal nerve fibre layer (RNFL) thickness and para-papillary perfusion density.

Conclusions

The optic disc haemoglobin concentration and oxygenation are quantifiable from multispectral imaging and reduced in glaucoma. The correlation of haemoglobin concentration with perfusion density, RNFL thickness and visual field loss indicates its implication in glaucoma pathology.

The dorsal pancreatic artery: A meta-analysis with clinical correlations

BACKGROUND/OBJECTIVES

The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a meta-analysis to generate pooled prevalence data on the presence and origin of the dorsal pancreatic artery. Clinically important aspects of the dorsal pancreatic artery were summarised during the literature review.

METHODS

Major medical databases were searched. Data on the presence and point of origin of the dorsal pancreatic artery were extracted and quantitatively synthesised. The obtained data of anatomical based studies and computed tomography based studies were statistically analysed.

RESULTS

In total, 30 studies, comprising 2322 anatomical and computed tomography based cases were included. The dorsal pancreatic artery was present in 95.8% of cases. It originated from the splenic artery in 37.6% of cases, common hepatic artery in 18.3% of cases, coeliac trunk in 11.9% of cases and the superior mesenteric artery in 23.9% of cases. Other rare origins were present in 2.77% of cases. Multiple dorsal pancreatic arteries were found in 1,7% of cases. There was no significant difference in the presence or origin of the dorsal pancreatic artery between anatomical and computed tomography based studies.

CONCLUSION

The dorsal pancreatic artery is present in the vast majority of cases. Its origin and branching are highly variable. Multiplicity of the dorsal pancreatic artery is infrequent.

The anatomical basis for preserving the blood supply to the parathyroids during thyroid surgery, and a review of current technologic advances

BACKGROUND

Devascularization of the parathyroid glands is generally accepted as the most common mechanism for iatrogenic hypocalcemia, a frequently seen complication of both total and completion thyroidectomy procedures. Much has been written about iatrogenic hypoparathyroidism, but few papers have precisely delineated the arterial supply of the parathyroid glands and the common anatomical variations that may impact parathyroid preservation during thyroid surgery.

METHODS

We offer an illustrated review and discussion of the only two anatomic studies published in the medical literature focusing on parathyroid vasculature. In addition, we examine current techniques of parathyroid identification, preservation, and classification.

FINDINGS

A surgical technique that preserves the parathyroid arteries is vital to preserving the viability of the parathyroid gland(s) during thyroid surgery. In 1907, Halsted and Evans described a technique of ligating the distal branches of the thyroid arteries beyond the origin of the parathyroid arteries, a technique termed ultra-ligation. In 1982, Flament et al.. reported three distinct anatomical variations of the parathyroid arteries which place the parathyroid blood supply at risk for devascularization during thyroid surgery. Our review also highlights novel techniques that aid surgeons in identification and assessment of the parathyroid glands.

CONCLUSIONS

Recognition of the variations of parathyroid anatomy and their potential to lead to devascularization aids thyroid surgeons in their pursuit of parathyroid preservation. An awareness of the variety of novel parathyroid identification and preservation techniques can assist surgeons to achieve this goal.

Three-Dimensional High-Resolution Temporal Bone Histopathology Identifies Areas of Vascular Vulnerability in the Inner Ear

OBJECTIVES

Hypothesized causes of vestibular neuritis/labyrinthitis include neuroinflammatory or vascular disorders, yet vascular disorders of the inner ear are poorly understood. Guided by known microvascular diseases of the retina, we developed 2 hypotheses: (1) there exist vascular vulnerabilities of artery channels in cases of hypothetical nerve swelling for the superior, inferior, and vestibulocochlear artery and (2) there are arteriovenous crossings that could compromise vascular flow in disease states.

METHODS

Two fully mounted and stained temporal bones were used to render three-dimensional reconstructions of the labyrinth blood supply. Using these maps, areas of potential vascular compression were quantified in 50 human temporal bones.

RESULTS

Although inner ear arteries and veins mostly travel within their own bony channels, they may be exposed (1) at the entrance into the otic capsule, and (2) where the superior vestibular vein crosses the inferior vestibular artery. At the entry into the otic capsule, the ratio of the soft tissue to total space for the superior vestibular artery was significantly greater than the inferior vestibular artery/cochleovestibular artery (median 44, interquartile range 34-55 vs. 14 [9-17], p < 0.0001).

CONCLUSIONS

Three-dimensional reconstruction of human temporal bone histopathology can guide vascular studies of the human inner ear. Studies of retinal microvascular disease helped identify areas of vascular vulnerability in cases of hypothetical nerve swelling at the entrance into the otic capsule and at an arteriovenous crossing near the saccular macula. These data may help explain patterns of clinical findings in peripheral vestibular lesions.

Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report

Background

Middle segment-preserving pancreatectomy (MSPP) is an alternative to total pancreatectomy that allows for the preservation of the endocrine and exocrine functions of the pancreas. However, maintaining perfusion to the pancreatic remnant is of critical importance. We describe the first case to our knowledge in which indocyanine green (ICG) fluorescence was used to confirm perfusion to the pancreatic remnant during MSPP.

Case presentation

A 79-year-old man with diabetes mellitus was referred to our hospital for treatment of a pancreatic tumor. Computed tomography revealed a hypovascular mass in the uncus of the pancreas and dilatation of the main pancreatic duct, measuring 13 mm in the tail of the pancreas. He was diagnosed with cancer of the pancreatic uncus via endoscopic ultrasound and fine-needle aspiration revealed a mixed-type intraductal papillary mucinous neoplasm (IPMN), along with high-risk stigmata in the tail of the pancreas. We performed MSPP and the length of the pancreatic remnant was 4.6 cm. The dorsal pancreatic artery was preserved and perfusion to the pancreatic remnant was confirmed by ICG fluorescence. Histopathological examination showed a pancreatic ductal adenocarcinoma in the uncus (pT1cN1M0, pStage 2B) and IPMN in the tail of the pancreas. The postoperative course was complicated by a grade B pancreatic fistula, but this was successfully treated with conservative management. The patient was transferred to a hospital 33 days after surgery. Insulin administration was necessary, but C-peptide was detectable and blood glucose was relatively well-controlled. He did not exhibit any exocrine dysfunction when pancreatic enzyme supplementation was administered.

Conclusion

ICG fluorescence can be used to evaluate perfusion to the pancreatic remnant during MSPP.

Temporomandibular joint arterial variability

The study aimed to investigate temporomandibular joint (TMJ) arterial variability. In this prospective study, the vasculature variability was studied using a 3D volume rendering CT angiography including random patients at two hospitals. A 16-quadrant (A1-D4) evaluation grid was developed using the Frankfurt plan as main reference. For each quadrant, the number of arterial ramus or branches was scored as clearly visible (2), partially visible (1), or not visible (0). A total of 50 patients were enrolled (mean age of 62.9 ± 16.0); 21 (42%) were men, and 29 (58%) were women. The authors observed bilaterally higher arterial density in the posterior aspect of the ascending ramus of the mandible (p < 0.0001), corresponding to quadrants B2 (5.92 ± 2.27 and 6.14 ± 2.56), B3 (9.76 ± 2.97 and 11.18 ± 2.86) and B4 (7.38 ± 2.78 and 8.10 ± 2.42). A strong correlation was found between the number of vessels and the variability of the region (r = 0.87, p = 0.00001). No differences were observed between men and women. Within the limitations of the study, arterial variability was observed in the TMJ territory. The posterior zone of the condyle and ramus is the most vascularized area, with great variability, representing an increased risk for surgical bleeding. Therefore, this knowledge seems to be particularly relevant for surgeons dedicated to TMJ and other facial surgery or facial/cerebral radiologic interventions. The authors encourage future studies to include larger samples and to identify thoroughly the arterial branches in this area.

The sub-fascial pattern of the myocutaneous platysma flap - The anatomical basis and preliminary cases for oral reconstruction

To verify the feasibility of the SF-MPF for oral reconstruction, the anatomic, sonographic and histologic features of the SF-MPF were investigated and the outcome in a series of patients was evaluated. The sonographic and histologic results showed a supra-fascial arterio-venous vascular blood supply to the sub-fascial design of the MPF. The clinical course of 12 consecutive patients who underwent oral reconstruction using the SF-MPF along with ipsi- or lateral neck dissection for treatment of oral cancer showed sufficient pedicle length and reliable blood supply. The SF-MPF is a reliable and safe pedicled myocutaneous flap. Therefore, it should be considered being an additional option when a pedicled flap has to be selected.

An analysis of tumor-related skin temperature differences in malignant soft-tissue tumors

Background

Soft tissue tumors are often accompanied with elevated skin temperature; however, studies concerning the relationship between soft-tissue tumors and skin temperature elevation are scarce. We aimed to evaluate the clinical significance of skin temperature elevation in soft-tissue tumors and identify factors related to skin temperature elevation.

Patients and methods

This study comprised 118 patients at our hospital with soft-tissue tumors, excluding lipomatous tumors, whose pathological diagnosis was surgically confirmed between February 2017 and March 2021. Sixty-one and 57 patients had been diagnosed with benign lesions and malignant tumors, respectively (men, 64; women, 54; median age, 61 [range, 20–92] years). The relationship between skin temperature, monitored using a thermography camera, and the presence of soft-tissue malignancy was investigated. We reviewed clinical data to identify factors related to elevated skin temperature.

Results

Temperature differences ≥ 0.2 °C compared to the unaffected side were significantly associated with the presence of malignant tumors (p < 0.001). Logistic regression analysis indicated that intertumoral blood supply was associated with elevated skin temperature (OR 3.22, 95% CI 2.03–5.13; p < 0.001).

Conclusions

Elevated skin temperature, influenced by intertumoral blood supply, may be an important adjunct to physical findings when diagnosing malignant soft-tissue tumors.

Clinical relevance

Intertumoral blood supply influenced elevated skin temperature in malignant soft-tissue tumors. A skin temperature difference ≥ 0.2 °C compared to the unaffected side can help differentiate between benign and malignant tumors. Skin temperature differences may help in diagnosing malignant soft-tissue tumors.

The lateral transligamentous approach to the talar dome

INTRODUCTION

Anatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated 43% talar body access with a single incision and without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach.

METHODS

The lateral transligamentous approach to the talus was undertaken in 10 fresh frozen cadaveric specimens by surgeons inexperienced in the approach following demonstration of the technique. An incision was made on the anterolateral aspect of the ankle augmented by the removal of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) from their fibular insertions. A bone lever was then placed behind the lateral aspect of the talus and levered forward with the foot in equinus and inversion. A mark was made on the talar dome where an instrument could be placed 90 degrees to the talar surface. The talus was subsequently disarticulated and high-resolution images were taken of the talar dome surface. The images were overlain with a reproducible nine-grid division. Accessibility to each zone within the grid was documented using the mark made on the talar surface. ImageJ software was used to calculate the surface area exposed with each approach.

RESULTS

The mean percentage area of talar dome available through the transligamentous approach was 77.3% (95% confidence interval 73.3, 81.3). In all specimens the complete lateral talar process was accessible, along with the lateral and dorsomedial aspect of the talar neck. This approach gives complete access to Zones 1, 2, 3, 5 & 6 with partial access to Zones 4, 8 & 9.

CONCLUSION

The lateral transligamentous approach to the talus provides significantly greater access to the talar dome as compared to standard approaches. The residual surface area that is inaccessible with this approach is predominantly within Zones 4,7 and 8, the posteromedial corner.

LEVEL OF CLINICAL EVIDENCE

V.

Anatomical study of the eye arterial blood supply in adult river buffalo (Bubalus bubalis)

Obtaining information about the eye arterial supply in the buffalo can be a criterion for ocular diseases diagnosis and give a morphological basis for even more researches on the related clinical surgery of this animal. The aim of the present study was to describe the course and branches of the arteries supplying the eye in the adult river buffalo (Bubalus bubalis). In this study, the heads of eight buffaloes were prepared from the public slaughterhouse and dissected to study the eye arterial supply. This research results showed that the eye blood supply in the buffalo originates from the external ophthalmic, internal ophthalmic, superficial temporal and malar arteries. The external ophthalmic artery was given rise to branches to take part in the ophthalmic rete mirabile formation and also given off lacrimal, external ethmoidal, supraorbital and ciliary arteries as well as muscular branches to supply the eye ball and extra-ocular muscles. The internal ophthalmic artery was one of the sources of lateral posterior long ciliary artery. The superficial temporal artery was detached off some branches to supply the lateral angle of inferior and superior eyelids as well as lacrimal branch to supply lacrimal gland. The malar artery was originated from the infra-orbital artery and its branches were supplied the medial angle of inferior, superior and third eyelids. There were no obvious differences between buffalo and yak regarding arteries supplying the eyes. However, there were minor differences between buffalo and oxen, sheep and goat and there were obvious differences between buffalo and camel and giraffe.

A preliminary observational study on the vascular, nerve, and lymphatic anatomy and histology of the labia minora from cadaveric and surgical samples

INTRODUCTION AND HYPOTHESIS

To better understand details of the fine anatomy of the labia minora, present images of the vascular anatomy and characterize the nerve and lymphatic distribution of the labia minora.

METHODS

Two fixed and five fresh cadaveric specimens were perfused and dissected, and the vascular network was photographed. Labia minora samples, prepared from cadavers, and tissue resulting from labia reduction surgery underwent hematoxylin and eosin staining and S100 and D2-40 immunohistochemical staining.

RESULTS

Arteries emanated from the base to the edge of the labia minora, where there was a larger feeding artery, and the arteries were anastomosed. The veins formed anastomotic branches in the same direction as the edge of the labia minora. Arteries and veins that accessed the labia minora were successfully perfused at the same time with no obvious association. Sensory nerve endings were abundant, mostly larger with myelinated nerve trunks and Schwann cells in the central area with suggested neurovascular associations and smaller with no obvious aggregation at the edge. The medial area had 23.63 ± 11.82 nerves/view, the lateral area 21.30 ± 11.49 nerves/view (P > 0.05). The thickest nerve bundle was 3.16 ± 1.41 mm from the medial epidermis and 3.13 ± 1.47 mm from the lateral epidermis. Lymphatic vessels showed no obvious regional distribution. Labia minora were 21.77 ± 5.69 mm wide with 252.87 ± 63.01 lymphatic vessels at 3.67 ± 1.61/mm2 density. The shortest inner diameter of dilated lymphatic vessels was 161.09 ± 49.99 μm.

CONCLUSION

A larger feeding artery exists in the labia minora, which should be noticed in the pre-surgery design of labiaplasty. No difference was observed in the nerve distribution between the medial and lateral sides. Lymphedema might not be the cause of labial hypertrophy.

3D Printed Heart Models Illustrating Myocardial Perfusion Territories to Augment Echocardiography and Electrocardiography Interpretation

Visualizing the vascular territories of coronary arteries during echocardiography or electrocardiography (ECG) requires trainees to mentally relate and overlay 2D sonographic images or cardiac lead projections with 3D anatomical representations of the ventricular walls and their respective blood supply. To facilitate the acquisition of these competencies, this study focuses on the feasibility of developing low-cost, open-sourced 3D printed heart models with standard ultrasound views or ECG lead projections illustrating the myocardial perfusion territories. A 3D digital heart model was cut to reflect the typical cardiac ultrasound views. The 4-chamber view model was further punctured for the paths of the precordial and limb leads of an ECG. Painting coronary arteries on the surface and internal views of the 3D prints illustrated vessel territories. Students, residents, and staff were surveyed during bedside ultrasound simulation sessions and ECG teaching half-days. Results demonstrated clear appreciation of 3D printed models, which suggests such models can easily be implemented by other institutions to augment trainees' experience during skill acquisition.

Macular perfusion analysed by optical coherence tomography angiography after uncomplicated phacoemulsification: benefits beyond restoring vision

Background

The purpose of the study is to investigate the changes of macular perfusion by OCT-angiography (OCT-A) after uncomplicated phacoemulsification.

Methods

OCT-A was performed before cataract surgery, 1 week, 1 month, and 3 months after surgery recording superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), as well as large choroidal blood vessels and choriocapillaris (CC). Explant area (EA), vessels area (VA), vessels percentage area (VPA), total number of junctions (TNJ), junctions density (JD), total vessels length (TVL), average vessels length (AVL), total number of end points (TNEP), and mean lacunarity (ML) throughout all layers were analysed.

Results

Significant changes of vascular parameters in 55 eyes of 55 patients mostly reached plateau one week after surgery and remained stable up to 3 m after surgery, occurring in all retinal layers but not in choroid and CC. The greatest increase in VPA (22.79%), TVL (16.71%), AVL (166.71%) and JD (29.49%) was in SVC. On the contrary, the greatest change of ML (− 53.41%) appeared in DVC.

Conclusions

This is the first OCT-A study demonstrating perfusion alterations in macula after phacoemulsification due to functional hyperaemia. We presume the effect is evoked by increased light intensity stimulation of retina after cataract removal. Accordingly, phacoemulsification in elderly population could have advantageous feature in addition to restoring visual acuity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01837-2.

Assessment of blood supply and usage pre- and during COVID-19 pandemic: A lesson from non-voluntary donation

BACKGROUND

Ensuring steady stream of safe blood is the ultimate goal of blood transfusion practice. The current COVID-19 pandemic has affected almost every part of life and economy. Consequently, this study sets off to assess the effect of the pandemic on blood supply and blood transfusion in the University of Calabar Teaching Hospital.

METHODS

Data from the Donor Clinic and Blood Group Serology Unit of the University of Calabar Teaching Hospital were retrospectively extracted to evaluate supply and use of blood before and during COVID-19 pandemic.

RESULT

A total of 1638 donors were recorded within the study period. Age range 15-29 and 30-44 years constituted majority of the subjects (58.9% and 33.4%, respectively). The donor pool were male-dominated. Commercial donors (61.7%) and family replacement donors (30.6%) constituted majority of the donor pool. Most of the donor pool were students (37.1%), public servants (22.8%) and artisans (18.6%). A concomitant decrease of 26.1% and 18.9% were recorded in blood donation and request during the COVID-19 pandemic.

CONCLUSION

Blood supply was not significantly affected in our study center as both requests and donations decreased. Consideration for improving family replacement donation was advised.

Cleft lip and palate cause large variations in size and location of the posterior superior alveolar canal

OBJECTIVE

The aim of this study was to evaluate the posterior superior alveolar canal (PSAC) in patients with cleft lip and palate (CLP) as compared to patients with no cleft lip and palate (NC) using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This was a retrospective multicenter study based on two steps: (1) evaluating intra- and inter-calibration and (2) detecting the presence or absence of PSAC and its location, diameter, and anastomosis with anterior superior alveolar canal.

RESULTS

A total of 300 patients were selected for the study, out of which 150 were categorized as CLP (75 men, 75 women; mean age: 29.8 years) and 150 were categorized as NC (75 men, 75 women; mean age: 40.3 years). PSAC in patients with CLP and NC was visible in 100% of the cases, in men and women, bilaterally. PSAC location in CLP was middle and upper third of the maxillary sinus as compared to NC (lower third) (chi-squared < 0.001). PSAC mean diameter in CLP was 1.12 mm. It was larger compared to 0.6 mm in NC (t-test < 0.0001).

CONCLUSION

PSAC location in patients with CLP was predominantly in the middle and upper third of the maxillary sinus, compared with NC. PSAC mean diameter in CLP was 1.12 mm. It was larger compared to that of 0.6 mm in NC.

CLINICAL RELEVANCE

These anatomical variations in CLP are important and should be acknowledged by surgeons for the following reasons: (1) to perform pre-surgical planning, (2) to avoid bleeding, and (3) to avoid neurosensory alterations.

A neurosurgical assessment of the blood supply in the optochiasmatic system: a cadaveric-anatomic study

The chiasmal and subchiasmal surfaces are of critical importance in connection with the performance of surgical procedures owing to the critical blood supply to these areas. Recently, the perforating arteries providing the blood to the optic nerves and chiasm have gained attention as they significantly affect the morbidity from surgical approaches. Intraoperative preservation of these perforating arteries is considered critical to prevent further visual loss. Thirty autopsy specimens, including the optic apparatus, were examined for their perforating arteries feeding the optic chiasm and optic nerves. The optic nerves and chiasmal surfaces were divided into four zones based on the presence and numbers of perforating arteries as anterior superior-posterior superior surfaces and anterior inferior-posterior inferior surfaces. The superior surface of the optic chiasm was supplied by the A1 segments of the bilateral anterior cerebral arteries and by the perforating arteries originating from the anterior communicating artery. On the other hand, the inferior surface of the optic chiasm was fed by the bilateral posterior communicating arteries and by the supraclinoidal segments of the bilateral carotid arteries. We demonstrated the anatomical involvement of a large number of nourishing arteries in feeding the optic apparatus related to the perforating arteries by classifying them into zones based on the surgical approaches, which has been rarely reported in the literature.

Inventory Management and Product Selection in Pediatric Blood Banking

Blood banks need to understand patterns of use and ordering practices to provide the blood donor centers with the best information with which to develop daily scheduled deliveries of blood products. Blood use is a large component of this process through maximizing physician education about appropriate ordering practices and use of appropriate tools. Simple measures can help provide guidance on the number of available components and the need to order more from the blood donor center. Special product requests in pediatrics, such as fresh blood, leukoreduction, irradiation, and antigen-negative units can also drive inventory practices and use patterns.

Population-Based Analysis of the Impact of Demographics on the Current and Future Blood Supply in the Saarland

Background

The federal state of Saarland (SL) is experiencing the fastest demographic change in the western part of Germany. In this study, we analyzed retrospective data on the current and future supply of red blood cell concentrates (RBC) in this region and compared it to the current and future RBC demand in SL hospitals.

Methods

The projection of the SL blood supply in 2030 was modeled based on SL demographics for age distribution and donation frequency of donors, and the RBC transfusion data for in-house patients. These results were compared to published data on the transfusion demand from the state of Mecklenburg-Western Pomerania (MV).

Results

For the period January 1 to December 31, 2017, a total of 43,205 whole blood donations were collected. The donation frequency in SL never exceeded 80 per 1,000 inhabitants and was well below the numbers in MV. Thirty-one percent of the donors were responsible for 53.5% of the donations, and donors older than 45 years of age contributed highly to the total blood supply. In addition, 40,614 RBC transfusions at 10 SL hospitals were analyzed representing nearly all RBC transfusions for in-house patients in this region. RBC transfusions per 1,000 inhabitants increased with age from 24 (50-54) to 140 (80-84) years. Facing an already existing structural deficit of nearly 8,200 RBC in 2017, the projection predicts a dramatic increase in the regional deficit to >18,300 RBC in 2030.

Conclusion

Our results on RBC demand in SL are comparable but not identical to those projected for the region of MV in eastern Germany. Due to the ongoing demographic changes in Germany as a whole, regular regional monitoring of RBC demand and the age structure of blood recipients and donors should be implemented to allow for better strategic planning in blood transfusion services and hospitals.

Coronavirus disease-2019 pandemic: Maintaining an adequate and safe supply of blood and blood products

The coronavirus disease-2019 (COVID-19) pandemic has influenced all the dimensions of human lives and the functional pattern of the health care establishments as the caseload continues to rise at an alarming speed. Even though, the possibility of transmission of infection through blood is negligible, it is important to take into account that the ongoing pandemic is going to impact the supply of blood and blood products via reduction in the practice of voluntary blood donation, and the entire range of activities pertaining to the blood system. This calls for the need to assess the situation, plan for remedial measures and respond adequately to the existing problem. In conclusion, in the battle against the COVID-19 infection, it is of utmost importance that the supply of blood and its products needs to be continually maintained, and the most effective approach will be to integrate the various elements of the blood system within the public health care delivery system.

The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region

Background

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spurred a global health crisis. The safety and supply of blood during this pandemic has been a concern of blood banks and transfusion services as it is expected to adversely affect blood system activities. We aim to assess the situation in the Eastern Mediterranean Region (EMR) during the first months of the pandemic.

Materials and methods

A survey was designed to address blood supply, transfusion demand, and donor management during the coronavirus disease-19 (COVID-19) pandemic. Medical directors of different blood banks were invited to participate.

Results

A total of 16 centers participated with representation from 15/19 countries in the region. In total, 75% were from national blood banks. Most centres had a decrease in the blood supply, ranging from 26–50%. Representatives from 14 countries (93.3%) believed that public fear has contributed to a decrease in donations. Most centres (n = 12, 75%) had a reduction in transfusion demand, while those who did not, reported heavy involvement in treating patients with underlying haemoglobinopathies and haematological malignancies. Half of the centres activated their contingency plans. Four centres had to alter the blood donor eligibility criteria to meet demands. All centres implemented donor deferral criteria in relation to SARS-CoV-2, but were variable in measures to mitigate the risk of donor and staff exposure.

Conclusion

Blood services in the region faced variable degrees of blood shortages. We summarize lessons learnt during this pandemic for the blood banks to consider to plan, assess, and respond proportionately to future similar pandemics.

Characteristics of Recipients of Red Blood Cell Concentrates in a German Federal State

BACKGROUND

Annual transfusion rates in many European countries range between 25 and 35 red blood cell concentrates (RBCs)/1,000 population. It is unclear why transfusion rates in Germany are considerably higher (approx. 50-55 RBCs/1,000 population).

METHODS

We assessed the characteristics of transfusion recipients at all hospitals of the German federal state Mecklenburg-Western Pomerania during a 10-year longitudinal study.

RESULTS

Although 75% of patients received ≤4 RBCs/patient in 2015 (1 RBC: 11.3%; 2 RBCs: 42.6%; 3 RBCs: 6.3%; 4 RBCs: 15.0%), the mean transfusion index was 4.6 RBCs due to a minority of patients with a high transfusion demand. Two thirds of all RBCs were transfused to only 25% of RBC recipients. Consistently, male patients received a higher number of RBCs (2005: 54.2%; 2015: 56.8%) and had a higher mean transfusion index than female patients (mean 5.1 ± 7.2; median 2; inter-quartile range [IQR] 2-4 vs. mean 4.0 ± 5.8; median 2; IQR 2-4). The absolute transfusion demand decreased between 2005 and 2015 by 13.5% due to a composite of active reduction (clinical practice change) and population decline in the 65- to 75-year age group (lower birth rate cohort 1940-1950); however, with major differences between hospitals (range from -61.0 to +41.4%).

CONCLUSION

Transfusion demand in a population could largely be driven by patients with high transfusion demand. Different treatment practices in this group of patients probably add to the major differences in transfusion demand per 1,000 individuals between countries. The available data cannot prove this hypothesis. Implementation of a diagnosis-related group-based monitoring system is urgently needed to allow informative monitoring on the population level and meaningful comparisons between transfusion practices.

Blood supply to the caudate lobe of the liver from the right inferior phrenic artery: observation by cone-beam computed tomography during arteriography

PURPOSE

To retrospectively evaluate blood supply to the caudate lobe of the liver from the right inferior phrenic artery (RIPA) using cone-beam computed tomography during arteriography (CBCTA-RIPA).

METHODS

CBCTA-RIPA examinations during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) were collected from 2448 procedures in 787 patients. The exclusion criteria were (1) major artifacts, (2) TACE of hepatic arterial branches before performing CBCTA-RIPA, and (3) repeated CBCTA-RIPA studies in the same patient. Blood supply to three subsegments, the Spiegel lobe (SP), paracaval, and caudate process, was evaluated on CBCTA-RIPA images. The origins and routes of branches supplying the caudate lobe were also evaluated by three-dimensional vessel-tracking software.

RESULTS

Forty-seven CBCTA-RIPA examinations in 47 patients (38 with a history of TACE [repeated TACE group] and nine without it [initial TACE group]) were eligible, including five who had previously undergone hepatectomy. Seven had caudate lobe HCCs. Blood supply to the caudate lobe was demonstrated in 21 (44.7%) patients: in 50% (19/38) and 22.2% (2/9) of the repeated and initial TACE groups, respectively. The caudate arteries had previously been embolized in eight patients, the RIPA branch in three, and both in one. Forty-one proximal branches mainly supplied the dorsal part of the SP. All branches but five reached there through the inferior vena cava (IVC) ligament. The RIPA supplied eight of nine caudate lobe HCCs, totally (n = 7) or partially (n = 1).

CONCLUSION

The proximal RIPA branches mainly supply the dorsal SP through the IVC ligament, especially in the repeated TACE group.

Blood supply to the chorda tympani: A review and clinical applications

The chorda tympani (CT) is important in gustatory sensation from the anterior two-thirds of the tongue and in secretomotor innervation to the submandibular and sublingual glands. Although the blood supply to the CT is not well delineated in the literature, some studies have shown that a posterior tympanic branch of the stylomastoid artery supplies CT at its origin from the mastoid segment of the facial nerve. We review the blood supply to the CT comprehensively. A better understanding of the vasculature involved is required to prevent iatrogenic injury during middle ear surgery and complications secondary to ischemia.

Difficulties in achieving a sustainable blood supply: report from the first national seminar on blood donation in Lebanon

Background

Lebanon has a decentralized/fragmented transfusion system. The current blood supply does not meet the World Health Organization target of achieving 100% voluntary non-remunerated blood donation (VNRD). There are currently 3 types of donors/donations in Lebanon: replacement/family donations (70-75%), VNRD (20-25%), and compensated donations (5-10%). Remunerated donations are illegal.

Aims

This report summarizes the content of presentations given during the first World Blood Donor Day seminar in Lebanon in June 2017. The aim is to describe the current Lebanese blood supply system and the major road blocks and to suggest practical recommendations that may assist in achieving 100% VNRD.

Methods

The content of presentations given during the first World Blood Donor Day seminar in Lebanon in June 2017 were summarized.

Results

The seminar was attended by all major stakeholders involved in transfusion medicine (Lebanese National Committee of Blood Transfusion, Hospital Blood Banks directors, Lebanese Army Blood Bank, Lebanese Red Cross and Donner Sang Compter).

Conclusions

The Ministry of Public Health should focus on performing regular audits regarding the implementation of national guidelines. There is a need for a national blood supply committee, unifying all stakeholders in the transfusion and donation fields. Transfusion medicine should be declared by law as a public health issue and considered a priority for patient safety.

Primary healthcare practitioners and patient blood management in Africa in the time of coronavirus disease 2019: Safeguarding the blood supply

The coronavirus disease 2019 (COVID-19) pandemic has highlighted various weaknesses in global healthcare services. The blood supply in Africa is a critical element of the healthcare service that may be significantly affected by the pandemic. By implementing principles of patient blood management, primary healthcare practitioners may play an important role in the resilience of the blood supply during the COVID-19 pandemic.

Detection of vascularity of femoral head using sub-millimeter resolution steady-state magnetic resonance angiography-initial experience

OBJECTIVE

The purpose of this study was to use the steady-state (SS) magnetic resonance angiography (MRA) with a sub-millimeter resolution to detect the arteries supplying to the femoral head (FH).

MATERIALS AND METHOD

SS MRA scanning of hips was performed bilaterally in 15 healthy volunteers. A blood pool contrast agent was used. The scanning protocol included a 0.8-mm³ isotropic T1-fast field echo sequence with spectral fat suppression technique. Two highly qualified radiologists independently evaluated the medial circumflex femoral artery (MCFA), the lateral circumflex femoral artery (LCFA), and the three retinacular arteries including superior retinacular artery (SRA), inferior retinacular artery (IRA), and anterior retinacular artery (ARA). The intraosseous branches of the three retinacular arteries were also evaluated. An orthopaedic surgeon was consulted in case of disagreement. Observation by the two radiologists and support from the orthopaedic surgeon served as the end result. Agreement between the two observer radiologists was evaluated.

RESULTS

Interobserver agreement between the two radiologists was found to be substantial to perfect. Of the 30 hips, the LCFA and MCFA were detected in all hips; the SRA and IRA were detected in most hips (100%, 90%), and the ARA was detected in 13 hips (43%). The intraosseous branches of SRA and IRA were detected in 30 and 22 hips (100%, 73%), respectively, while the intraosseous branches of ARA were detected in 11 hips (37%).

CONCLUSION

The main arteries supplying the FH can be detected by the SS MRA, making it a novel method to detect the vascularity of FH.