Periarterial stem villous edema is associated with hypercoiled umbilical cord and stem obliterative endarteritis

To assess clinicopathologic correlations of a novel placental lesion featuring a distinct ring-like periarterial edema of stem villi (PASE). A retrospective case-control statistical comparison (Yates χ2 or analysis of variance) of 30 clinical and 41 placental features of 100 consecutive placentas with PASE and 100 gestational age-matched cases without PASE, extracted from 2403 placentas from high-risk pregnancies signed out by the author since year 2006. The PASE was seen in 4.2% of placentas, average gestational age 35.9 weeks (range, 24 - 42 weeks). Frequencies of stem obliterative endarteritis and hypercoiled umbilical cord (coiling index > 0.3) were 23% vs 5% (p = 0.005), and 20% vs 9% (p = 0.04) in the study group and comparative group, respectively. There were no statistically significant differences (p > 0.05) between the groups in clinical or other placental variables. The PASE may be linked to chronically abnormal blood flow in umbilical cord arteries and their stem branches and may be a histological placental sign of non-obliterative umbilical cord compromise.

Wide‑field swept‑source OCT angiography of the periarterial capillary‑free zone before and after anti‑VEGF therapy for branch retinal vein occlusion

Background:The aim of the study was to investigate the changes in the periarterial capillary-free zone(paCFZ)after anti-vascular endothelial growth factor(VEGF)therapy in patients with branch retinal vein occlusion(BRVO)by widefield swept-source optical coherence tomography angiography(SS-OCTA)and assess their associations with clinical outcomes.Methods:In this retrospective observational study of 54 treatment-naive BRVO patients with macular edema,we reviewed the findings of 12×12 mm^(2)SS-OCTA at baseline,3,6,and 12 months after intravitreal ranibizumab injections.The paCFZ and major retinal artery areas were measured on SS-OCTA images.The paCFZ area to artery area(P/A)ratio was calculated.Results:The paCFZ areas and P/A ratios of first-and second-order arteries were significantly greater in BRVO eyes than in contralateral eyes(all P<0.01),but there were no differences in the first-and second-order artery areas(P=0.20 and 0.25,respectively).The paCFZ areas and P/A ratios decreased significantly at 3,6,and 12 months after anti-VEGF therapy(all P<0.01).The baseline P/A ratio was significantly correlated with the baseline best-corrected visual acuity(BCVA),central retinal thickness,and their improvements at 3,6,and 12 months(all P<0.05).Baseline BCVA and P/A ratios of first-and second-order arteries were independently associated with the final BCVA in multivariate linear regression.Conclusions:Wide-field SS-OCTA shows that anti-VEGF therapy can lead to a significant improvement in the paCFZ parameters in BRVO.Smaller baseline P/A ratios on SS-OCTA tend to predict better visual outcomes at 12 months after anti-VEGF therapy.

The lymphatic drainage systems in the brain:a novel target for ischemic stroke?

Recent studies have proposed three lymphatic drainage systems in the brain,that is,the glymphatic system,the intramural periarterial drainage pathway,and meningeal lymphatic vessels,whose roles in various neurological diseases have been widely explored.The glymphatic system is a fluid drainage and waste clearance pathway that utilizes perivascular space and aquaporin-4 protein located in the astrocyte endfeet to provide a space for exchange of cerebrospinal fluid and interstitial fluid.The intramural periarterial drainage pathway drives the flow of interstitial fluid through the capillary basement membrane and the arterial tunica media.Meningeal lymphatic vessels within the dura mater are involved in the removal of cerebral macromolecules and immune responses.After ischemic stroke,impairment of these systems could lead to cerebral edema,accumulation of toxic factors,and activation of neuroinflammation,while restoration of their normal functions can improve neurological outcomes.In this review,we summarize the basic concepts of these drainage systems,including drainage routes,physiological functions,regulatory mechanisms,and detection technologies.We also focus on the roles of lymphatic drainage systems in brain injury after ischemic stroke,as well as recent advances in therapeutic strategies targeting these drainage systems.These findings provide information for potential novel strategies for treatment of stroke.