PURPOSE:The aim of the study was to describe two cases of pediatric patients with Coats disease who developed nerve fiber layer schisis. METHODS:This was an observational case series. RESULTS:Two male pediatric patients, ages 2 and 14 years, who were being treated for Coats disease were found to have nerve fiber layer schisis on optical coherence tomography. Both were treated with panretinal photocoagulation and indirect laser. The 14-year-old patient has had recurrent disease with a most recent visual acuity of 20/80 + 1 in the affected eye. The 2-year-old patient continues to be followed after receiving two rounds of panretinal photocoagulation, followed by two rounds of superotemporal laser. CONCLUSION:Nerve fiber layer schisis is a rare manifestation of Coats disease.

Introduction: Epidemiological evidence supports the utility of 24-hour ambulatory and visit-to-visit blood pressure average real variability (ARV) as a prognostic indicator of adverse cardiovascular outcomes. Quantification of blood pressure ARV as a biomarker for cardiovascular risk has recently been adopted in studies assessing beat-to-beat blood pressure. However, beat-to-beat blood pressure ARV may be influenced by pronounced parasympathetic modulation of heart period and slowing of heart rate between subsequent cardiac cycles, which could augment beat-to-beat blood pressure ARV challenging its utility as a cardiovascular risk marker. The purpose of the present study was to investigate the association between estimates of cardiac parasympathetic tone using heart rate variability (HRV) and beat-by-beat blood pressure ARV alongside other commonly used blood pressure variability metrics in a large population of young, otherwise healthy adults. Methods: Ten-minute continuous recordings of resting heart rate (HR, electrocardiogram) and beat-to-beat blood pressure (finger plethysmography) were obtained in 139 healthy young adults (88 males, 51 females; age: 22±4; BMI: 24±3). High frequency HRV (HF-HRV) and root-mean squared of successive differences (RMSSD) were used to characterize HRV alongside cardiovagal-baroreflex sensitivity in the up (cvBRSup) and down (cvBRSdown) sequences. Blood pressure variability was quantified using the ARV and standard deviation (SD) for beat-to-beat systolic (SBP) and diastolic (DBP) blood pressure across the 10-minute resting period in each participant. Bivariate correlations were employed to determine associations between measures of HRV, cvBRS, and blood pressure variability. Results: Heart rate variability was significantly associated with SBP ARV (RMSSD: r=0.416, p< 0.001; HF-HRV: r=0.401, p< 0.001), and DBP ARV (RMSSD: r=0.795, p< 0.001; HF-HRV: r=0.769, p< 0.001). Conversely, HRV was not associated with beat-to-beat BPV quantified using the SD (all p>0.263). Cardiovagal baroreflex sensitivity was associated with DBP ARV (cvBRSup: r=0.621, p< 0.001; cvBRSdown: r=0.601, p< 0.001), but not SBP ARV (cvBRSup: r=0.077, p=0.404; cvBRSdown: r=0.076, p=0.408). Modest negative associations were observed between cvBRSdown and SBP SD (r= -0.252, p=0.005), but not DBP SD (r = -0.143, p=0.118). cvBRSup was not associated with SBP SD (r=-0.159, p=0.081) or DBP SD (r=-0.063, p=0.492). Discussion: The present findings demonstrate a prominent linear association between HRV, cardiovagal baroreflex sensitivity, and beat-to-beat blood pressure ARV. As higher HRV is commonly associated with positive health outcomes, the linear association between HRV and blood pressure ARV challenges the assumption that elevated beat-to-beat blood pressure ARV serves as a robust and reliable cardiovascular risk marker, at least within young, otherwise healthy adults. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Non-Hispanic Black (BL) males and females have the highest prevalence of cardiovascular disease compared to all other racial or ethnic groups in the United States. Previous work from our laboratory has shown that beat-to-beat blood pressure variability (BPV), a known predictor of adverse cardiovascular events, was augmented in young BL males but not in young BL females. To extend this work, herein, we examined beat-to-beat BPV during early middle-age in BL females. We also assessed sympathetic baroreflex sensitivity (sBRS), an important regulator of beat-to-beat blood pressure and total peripheral resistance (TPR) variability. We tested the hypothesis that early middle-aged BL females exhibit greater beat-to-beat BPV compared to young BL females, which would be accompanied by lower sBRS and greater TPR variability. Beat-to-beat blood pressure (finger photoplethysmography), brachial blood pressure (brachial oscillometry), and muscle sympathetic nerve activity (MSNA; peroneal microneurography) were measured in 7 premenopausal early middle-aged (Age: 43±2 years, BMI: 30.0±6.2 kg/m 2 ) and 12 young (Age: 20±2 years, BMI: 24.4±3.5 kg/m 2 ) BL females during 10 minutes of quiet supine rest. Beat-to-beat BPV was determined through calculations of standard deviation (SD), range, coefficient of variation (CV), and interquartile range (IQR) for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Stroke volume (SV) was estimated using Modelflow, then cardiac output (CO = SV x Heart rate) and total peripheral resistance (TPR = MAP / CO) were calculated and CO and TPR variability were determined. sBRS was quantified by sorting all resting DBPs into 3 mmHg bins and calculating MSNA burst incidence within each bin. Weighted linear regression was then used to calculate slopes. Resting absolute SBP, DBP, and MAP were greater in middle-aged females (all P< 0.05). Beat-to-beat MAP variability was greater in middle-aged females for SD (Middle-Aged: 5.0±1.5; Young: 3.3±1.0 mmHg; P=0.009), range (Middle-Aged: 28±7; Young: 20±6 mmHg; P=0.014), and IQR (Middle-Aged: 7±2; Young: 4±2 mmHg; P=0.003), with no difference in CV (P >0.05). Further, middle-aged females trended towards having a greater TPR variability for SD (Middle-Aged: 1.4±0.4; Young: 1.0±0.4 mmHg*min/L; P=0.086) and had a greater TPR IQR (Middle-Aged: 1.9±0.6; Young: 1.3±0.5 mmHg*min/L; P=0.042), with no differences in any CO variability measure (all P >0.05). sBRS gain was not different between the groups (Middle-Aged: -3.5±0.8 bursts/100 heartbeats/mmHg; Young: -5.0±2.2 bursts/100 heartbeats/mmHg; P=0.177). All SBP variability measures were greater in middle-aged females compared to young (all P< 0.05), whereas only DBP IQR was greater in middle-aged females (P=0.0114). These preliminary data suggest that beat-to-beat BPV is greater in early middle-aged BL females than in young BL females and these differences may be driven by a greater TPR variability. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Non-Hispanic Black (BL) females have the highest prevalence of hypertension compared to all other racial or ethnic groups and the sympathetic nervous system has been widely implicated in the development of the disease. Previous research from our laboratory suggests that sympathetic transduction to blood pressure (BP) is not different between BL and non-Hispanic White (WH) young adult females. However, it remains unknown if this persists into early middle-age, the most common time of hypertension diagnosis. Therefore, the aim of this investigation was to test the hypothesis that early middle-aged BL females have greater sympathetic transduction to BP than their WH counterparts who are at a lower risk for developing hypertension. We studied 6 premenopausal BL females (age: 41 ± 4 years, BMI: 27 ± 4 kg/m 2 ) and 6 premenopausal, age and BMI matched WH females (age: 41 ± 4 years, BMI: 26 ± 3 kg/m 2 ). Muscle sympathetic nerve activity (MSNA; peroneal microneurography) and beat-to-beat blood pressure (finger photoplethysmography) were continuously recorded during 10 minutes of quiet supine rest. Signal averaging was used to quantify sympathetic transduction whereby MSNA bursts act as a trigger and beat-to-beat changes in mean arterial pressure (MAP) are followed over the subsequent 10 cardiac cycles. Peak increases in MAP over the 10 cardiac cycles were used to index sympathetic transduction. Bursts of MSNA were also divided into quartiles based on amplitude (i.e., Q1 smallest 25% of bursts; Q4 largest 25% of bursts) and peak increases in MAP were then compared across quartiles. BL females tended to have greater resting MAP than WH females (BL: 99 ± 14 mmHg; WH: 84 ± 9 mmHg; P = 0.06). Whereas there were no between group differences in resting MSNA burst frequency (BL: 24 ± 4 bursts/min; WH: 25 ± 15 bursts/min; P = 0.81) or MSNA burst incidence (BL: 36 ± 8 bursts/ 100 heart beats; WH: 39 ± 21 bursts/ 100 heart beats; P = 0.75). Peak increases in MAP following MSNA bursts tended to be greater in BL compared to WH females (BL: 3.1 ± 1.0 mmHg; WH: 2.2 ± 0.4 mmHg; P = 0.06). Both groups had graded increases in MAP with increasing burst amplitude (main effect of quartile; P < 0.001). The increase in MAP across quartiles was greater in BL females (main effect of group; P =0.04) but there was no group by quartile interaction (P = 0.66). These preliminary findings suggest that early middle-aged BL females may have greater sympathetic transduction to BP than their WH counterparts. Further studies are warranted. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

PURPOSE:To assess the perspectives of pediatric ophthalmology and retina fellows on retinopathy of prematurity (ROP) training in fellowship and future ROP practice intentions. METHODS:A 16-item web-based questionnaire was administered to pediatric ophthalmology, medical retina, and vitreoretinal surgery fellows completing fellowships between 2021 and 2023. RESULTS:A total of 74 participants responded from 142 programs contacted, a 12% response rate. Sixty-three fellows (91%) received ROP training in fellowship, though the exposure to various training components differed between pediatric ophthalmology and retina fellowships (P = 0.002). Screening examinations were performed by 100% and 68% of pediatric ophthalmology and retina fellows, respectively. The most common ROP treatment modality encountered was laser/cryotherapy across both groups, but at different rates for pediatric ophthalmology (n = 18 [72%]) and retina fellowships (n = 36 [95%]). Overall, only 7 fellows (10%) had telemedicine incorporated into their training. Pediatric ophthalmology fellows were more likely than retina fellows to indicate intent to incorporate ROP care in future practice (68% vs 30% [P = 0.004]). Thirty-nine fellows (57%) were either unsure or did not plan to provide ROP care, most commonly citing liability concerns (n = 12, 28%) as the reason. CONCLUSIONS:Although most fellows are trained in some aspect of ROP care, discrepancies remain in training across subspecialties, and few trainees have exposure to telemedicine. Continued efforts should be made to improve ROP training in fellowship to reflect the changing nature of the field.

Non-Hispanic Black (BL) adults have the highest prevalence of cerebrovascular disease in the United States compared to all other racial/ethnic groups. Exercise has been shown to be protective against cerebrovascular disease development, potentially through increases in cerebral blood flow and shear stress. To date, research demonstrating elevations in cerebral blood flow during exercise have only been performed in White (WH) adults. Thus, whether young BL adults exhibit a similar cerebral vascular hyperemic response to exercise as WH adults remains unknown. Notably, prior work has demonstrated attenuated cerebrovascular responsiveness to hypercapnia in young BL adults relative to their WH counterparts. Thus, we tested the hypothesis that young BL males demonstrate a smaller increase in cerebral blood velocity during aerobic exercise compared to WH males. We recruited 13 BL (Age: 22 ± 5 years, BMI: 25 ± 2 kg/m 2 ) and 11 WH (Age: 20 ± 2 years, BMI: 25 ± 2 kg/m 2 ) males. Middle cerebral artery mean blood velocity (MCAvmean; transcranial Doppler), heart rate (HR; ECG), blood pressure (BP; automated auscultatory), end-tidal carbon dioxide (ETCO 2 ; capnograph) and oxygen consumption (VO 2 ; ParvoMedics) were collected at rest and during semi-recumbent cycling. An incremental VO2peak test was performed and at least 48 hours after, participants returned to the lab to complete three submaximal 10-minute exercise bouts (25 watts, 50 watts, and 50%VO 2 peak) separated by at least ten minutes. Cerebral vascular conductance index (CVCi=MCAvmean/Mean arterial BP) and cerebral pulsatility index (PI=MCAv(systolic)-MCAv(diastolic)/MCAvmean) were calculated. At rest, there were no between group differences in MCAvmean (BL: 65 ± 10 vs WH: 68 ± 8 cm/s; P=0.398), CVCi (BL: 0.68 ± 0.12 vs WH: 0.74 ± 0.09 cm/s/mmHg; P=0.208), PI (BL: 0.81 ± 0.12 vs WH: 0.84 ± 0.13; P=0.545), or ETCO 2 (BL: 48 ± 3 vs WH: 47 ± 3 mmHg; P=0.396). Cardiorespiratory fitness (VO 2 peak; BL: 39.5 ± 5.1 vs WH: 39.7 ± 6.2 ml/kg/min; P=0.926) was also comparable between BL and WH males. Furthermore, there was no effect of race on the change in MCAvmean to steady state exercise at 25 watts (BL: 4.6 ± 2.4 vs. WH: 4.4 ± 3.0 cm/s; P=0.896), 50 watts (BL: 7.4 ± 2.6 vs. WH: 7.0 ± 5.2 cm/s; P=0.812) and 50%VO 2 peak (BL: 12.1 ± 5.3 vs. WH: 14.4 ± 4.5 cm/s; P=0.302) cycling bouts. Moreover, there was no effect of race on the changes in CVCi, PI and ETCO 2 during any of the exercise bouts (all P >0.05). These data suggest that cerebral vascular responses during aerobic exercise are not different between young Black and White males. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Purpose: Retinopathy of prematurity (ROP) stage is defined by the visual appearance of the vascularavascular border, which reflects a spectrum of pathologic neurovascular tissue (NVT). Previous work demonstrated that the thickness of the ridge lesion, measured using OCT, corresponds to higher clinical diagnosis of stage. This study evaluates whether the volume of anomalous NVT (ANVTV), defined as abnormal tissue protruding from the regular contour of the retina, can be measured automatically using deep learning to develop quantitative OCT-based biomarkers in ROP. Design: Single-center retrospective case series. Participants: Thirty-three infants with ROP in the Oregon Health & Science University neonatal intensive care unit. Methods: OCT B-scans were collected using an investigational ultrawidefield OCT. The ANVTV was manually segmented. A set of 3347 B-scans and corresponding manual segmentations from 12 volumes from 6 patients were used to train an automated segmentation tool using a U-Net. An additional held-out test data set of 60 B-scans from 6 infants was used to evaluate model performance. The Dice-Sorensen coefficient (DSC) comparing manual and automated segmentation of ANVTV was calculated. Scans from 21 additional infants were used for clinical evaluation of ANVTV using the visit in which they had developed their peak stage of ROP. Each infant had every B-scan in a volume automatically segmented for ANVTV (total number of segmented voxels within the 60 degrees temporal to the optic disc). The ANVTV was compared between infants with stage 1 to 3 ROP using a Kruskal-Wallis test and tracked over time in all infants with stage 3 ROP. Main Outcome Measurements: Cross sectional and longitudinal association between ANVTV and stages 1 to 3 ROP. Results: Comparing automated and manual segmentation of ANVTV achieved a DSC of 0.61 +/- 0.13. Using the U-Net, ANVTV was associated with higher disease stage both cross sectionally and longitudinally. Median ANVTV significantly increased as ROP stage worsened from 1 (0, [interquartile range: 0-0] kilovoxels) to 2 (170.1 [interquartile range: 104.2-183.6] kilovoxels) to 3 (421.4 [interquartile range: 312.3-1110.8] kilovoxels; P < 0.001). Conclusions: Automated OCT-based measurement of ANVTV was associated with clinical disease stage in ROP, both cross sectionally and longitudinally. Ultrawidefield-OCT may facilitate more objective screening, diagnosis, and monitoring in the future. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. (c) 2024 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Introduction: Heightened negative affective responsivity (NA-R) to daily stressors predicts increased cardiovascular disease (CVD)-related morbidity and mortality, but the mechanisms remain incompletely understood. Psychological stress arising from daily life is associated with greater ambulatory blood pressure variability (BPV)—a major contributor to excessive CVD risk. However, no studies have examined the link between NA-R to daily stressors and beat-to-beat BPV or explored potential underlying mechanisms. Hypothesis: We hypothesized that greater NA-R to daily stressors would be positively related to elevated beat-to-beat BPV. Given studies reporting a link between NA-R to daily stressors and chronic sympathetic overactivation, we further hypothesized that greater NA-R to daily stressors would be positively related to augmented beat-to-beat total peripheral resistance (TPR) variability. Methods: Daily stress processes and affective dynamics were assessed during routine everyday life (daily diary) for 8 consecutive days in 81 normotensive young adults (58 female; 22±5 yrs; 115±9/79±10 mmHg). On the last day of daily assessments, beat-to-beat BP (finger photoplethysmography) was measured during 20-min of supine rest. TPR and cardiac output (CO) were estimated using Modelflow. NA-R to daily stressors was operationalized as the intra-individual slope of the change in negative affect on stressor days compared to stressor-free days (multilevel modeling). Results: Negative affect was greater on stressor days compared to stressor-free days (0.7±0.4 vs. 0.4±0.4; p<0.01), providing evidence of NA-R to daily stressors. NA-R to daily stressors was positively related to BPV (e.g., mean arterial pressure coefficient of variation; b =4.1, SE=1.9; p=0.03) but was not related to either TPR ( b =1.3, SE=3.3; p=0.69) or CO variability ( b =1.5, SE=2.8; p=0.59). Conclusions: These data suggest that amplified NA-R to daily stressors may be associated with elevated beat-to-beat BPV, thereby potentially contributing to increased daily stress-related CVD risk.

A 13-year-old male patient was referred for evaluation of an optic nerve mass with decreased central vision and occasional pain. Examination revealed an afferent pupillary defect, a few vitreous cells, and an optic nerve lesion associated with a small peripapillary hemorrhage, peripapillary subretinal fluid, and scattered white lesions in the inferior retinal periphery. What would you do next?

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the United States. CVD is associated with elevations in sympathetic nerve activity (SNA), which impact the vasculature both acutely and chronically. In human studies, the ability of SNA to vasoconstrict has been examined by a signal averaging methodology assessing beat-to-beat changes in blood pressure (BP) following spontaneous bursts of SNA (i.e. sympathetic transduction to BP). Whether sympathetic transduction to BP analysis can be applied in rodent models is unknown, particularly given higher heart rates and SNA burst frequencies than humans. PURPOSE: The purpose of this study was to investigate rodent sympathetic transduction to BP using analyses which we have previously implemented in human nerve transduction research. Hypothesis: We hypothesized that sympathetic transduction would influence the vasculature in a more rapid timeframe in rodents compared to humans and that burst amplitude and burst clustering would alter the magnitude of BP responses. Methods: In recordings from Inactin-anesthetized rats (n=9, age 4-16 weeks, 6 female), we analyzed baseline, beat-to-beat mean arterial pressure (MAP) from an indwelling catheter and splanchnic SNA using silver, bipolar electrodes implanted with polyvinyl siloxane gel. SNA was rectified and integrated in LabChart software, and sympathetic transduction to BP was calculated using a customized Excel spreadsheet, modified from studies performed in humans. Briefly, SNA recordings were analyzed on a cardiac cycle basis, and each event was tracked for 30 cardiac cycles. Bursts were categorized based on occurrence pattern (i.e., in isolation versus in sequences of 2 or more consecutive bursts). Burst heights were normalized to the average of the three highest amplitudes, and bursts were sorted into quartiles (e.g., Q1 = smallest 25% of bursts, Q4 = largest 25% of bursts). Results: On average, SNA bursts which occurred in clusters of 2 or more consecutive bursts resulted in a peak increase in MAP of 1.1±0.6 mmHg (range: 0.06 to 5.2 mmHg). Conversely, cardiac cycles not associated with SNA bursts were followed by a nadir decrease in MAP of -1.2±0.4 mmHg (range: -0.05 to -2.8 mmHg). When bursts were placed into height quartiles, those with the lowest amplitude (Q1) resulted in minimal changes in MAP (peak: 0.5±0.2 mmHg; range: 0.05 to 1.8 mmHg), whereas those with the highest amplitude (Q4) produced a more robust increase in MAP (peak: 2.1±0.9 mmHg; range: 0.1 to 7.5 mmHg). Conclusion: Ourpreliminary results suggest sympathetic transduction to BP analysis may be used as a translational tool in rodents. However, these initial findings also highlight the variability of BP responses following SNA bursts and indicate a need for further exploration and standardization. Supported by HL161233 (PJM). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

ImportanceCapturing high-quality images of the entire peripheral retina while minimizing the use of scleral depression could increase the quality of examinations for retinopathy of prematurity (ROP) while reducing neonatal stress.ObjectiveTo evaluate whether an investigational handheld ultra-widefield optical coherence tomography (UWF-OCT) device without scleral depression can be used to document high-quality images of the peripheral retina for use in ROP examinations.Design, Setting, and ParticipantsThis was a prospective, cross-sectional study in the neonatal intensive care unit at a single academic medical center. Study participants were neonates in the neonatal intensive care unit who met standard ROP screening criteria (birth weight ≤1500 g; gestational age ≤30 weeks). Examinations were performed from January 2, 2023, to May 12, 2024. Data analysis was performed in July 2024.ExposureAn investigational, contact-based, 800-kHz, 140° (visual angle) UWF-OCT field-of-view handheld device was used during regular ROP examinations.Main Outcomes and MeasuresImages from each examination were captured using the UWF-OCT device, and the zone, stage, and presence of plus disease were diagnosed. If the UWF-OCT system was unable to capture diagnosis, this was recorded.ResultsA total of 507 examinations were performed on 83 neonates (mean [SD] birth weight, 905.1 [362.5] g; mean [SD] gestational age, 189.5 [19.1] days) with this system. The vascular border and disease was able to be visualized in 100% of cases, including to and beyond zone III. In some cases, images were able to clearly demonstrate the ora serrata and even the ciliary body.Conclusions and RelevanceThe UWF-OCT device was able to be safely used to perform ROP screenings and subsequent evaluations and provided volumetric imaging of the ora serrata and sometimes the ciliary body. The findings suggest that such devices may be associated with reduced technical challenges of capturing the entire peripheral retina in telemedicine programs, may reduce pain and stress for delicate neonates owing to the reduced use of scleral depression, and, with adaptation of the system, could potentially allow for peripheral imaging of the whole retina in older children and adults.

Purpose: To perform a time-driven activity-based cost analysis of retinal detachment (RD) surgery and compare it with reimbursement rates. Methods: This economic analysis at a single academic institution used time-driven activity-based costing methodology to determine the cost of rhegmatogenous RD repair with primary pars plana vitrectomy. A process flow map was created to highlight each surgical case’s operative episodes, including clinical follow-ups. Time logs were obtained from the electronic health record for each operative phase and clinical follow-up. The overhead and anesthesia costs were collected from the institution’s cost accounting system. The direct material and personnel costs were obtained from internal financial data. Results: Seventy-six cases that met the inclusion criteria were included in the cost analysis study. The time-driven activity-based cost of RD was $6247.17, and the reimbursement was $5442.91. Therefore, each procedure had a net negative loss of $804.26. To break even, the average operation time would have to be reduced from the determined average of 90.49 minutes to 64.90 minutes. Conclusions: This study found that Medicare underestimates the true cost of RD surgery. Changes in referral patterns may be motivated by reimbursement rates lower than the cost of the procedure, which could ultimately affect patient access to care.

Purpose: To describe a case of incontinentia pigmenti in which chorioretinal anastomosis occurred after laser photocoagulation, which was ultimately complicated by tractional and rhegmatogenous detachment. Methods: Observational case report. Results: A 2-month-old was referred to ophthalmology for a rash characteristic of incontinentia pigmenti due to concern for ocular involvement and was found to have peripheral avascular retina with early neovascularization. Following several rounds of panretinal photocoagulation, a chorioretinal anastomosis was noted on follow up fluorescein angiography in the left eye. Subsequently, a tractional retinal detachment formed and was treated initially with a lens sparing pars plana vitrectomy, endolaser, and scleral buckle. Despite treatment, it progressed to a combined tractional/rhegmatogenous detachment and was deemed inoperable. Conclusion: Chorioretinal anastomosis is a rare complication of laser photocoagulation.

Prior animal and cell studies have demonstrated a direct role of high-density lipoprotein (HDL) and apolipoprotein A-I (ApoA-I) in enhancing skeletal muscle mitochondrial function and exercise capacity. However, the relevance of these animal and cell investigations in humans remains unknown. Therefore, a cross-sectional study was conducted in 48 adults (67% female, 8% Black participants, age 39 +/- 15.4 yr old) to characterize the associations between HDL measures, ApoA-I, and muscle mitochondrial function. Forearm muscle oxygen recovery time (tau) from postexercise recovery kinetics was used to assess skeletal muscle mitochondrial function. Lipoprotein measures were assessed by nuclear magnetic resonance. HDL efflux capacity was assessed using J774 macrophages, radiolabeled cholesterol, and apolipoprotein B-depleted plasma both with and without added cyclic adenosine monophosphate. In univariate analyses, faster skeletal muscle oxygen recovery time (lower tau) was significantly associated with higher levels of HDL cholesterol (HDL-C), ApoA-I, and larger mean HDL size, but not HDL cholesterol efflux capacity. Slower recovery time (higher tau) was positively associated with body mass index (BMI) and fasting plasma glucose (FPG). In multivariable linear regression analyses, higher levels of HDL-C and ApoA-I, as well as larger HDL size, were independently associated with faster skeletal muscle oxygen recovery times that persisted after adjusting for BMI and FPG (all P < 0.05). In conclusion, higher levels of HDL-C, ApoA-I, and larger mean HDL size were independently associated with enhanced skeletal muscle mitochondrial function in healthy humans.

OBJECTIVE:Isolated retinal neovascularization (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity (ROP). This study aimed to further classify the clinical course and significance of these lesions (previously described as "popcorn" based on clinical appearance) in patients with ROP as visualized with ultrawidefield OCT (UWF-OCT). DESIGN:Single center, retrospective case series. PARTICIPANTS:Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit. METHODS:A prototype UWF-OCT device captured en face scans (>140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression. MAIN OUTCOME MEASURES:Differences in clinical demographics and disease progression between patients with and without IRNV. RESULTS:Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BWs) (660.1 vs. 916.8 g, P = 0.001), gestational age (GA) (24.9 vs. 26.1 weeks, P = 0.01), and were more likely to present with ROP in zone I (63.4% vs. 15.8%, P < 0.001). They were also more likely to progress to stage 3 (68.2% vs. 13.2%, P < 0.001) and receive treatment (54.5% vs. 15.8%, P = 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs. 3.73, P < 0.001) and averaged a higher VSS throughout their disease course. On multivariable logistic regression, IRNV was independently associated with progression to stage 3 (P = 0.02) and requiring treatment (P = 0.03), controlling for GA, BW, and initial zone 1 disease. CONCLUSIONS:In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Chronic kidney disease (CKD) is a major health problem affecting more than 35 million Americans. Notably, more patients with CKD die of cardiovascular complications than progress to end-stage renal disease. An overactive sympathetic nervous system is a well-known cardiovascular risk factor. Previous research has suggested elevated resting sympathetic nerve activity and a heightened α-adrenergic receptor sensitivity in patients with CKD, both of which may predispose this population to greater sympathetic transduction. Therefore, we tested the hypothesis that patients with stage III CKD have an augmented sympathetic transduction to blood pressure (BP) compared to controls without CKD. In 7 patients with stage III CKD and 8 controls muscle sympathetic nerve activity (MSNA; peroneal microneurography) and beat-to-beat BP (finometer) were continuously recorded during 10 minutes of quiet supine rest. Modelflow was used to estimate stroke volume and calculate total vascular conductance (TVC). Sympathetic transduction was quantified as the peak change in mean arterial pressure (MAP) and the nadir reduction of TVC over 10 cardiac cycles following spontaneous MSNA bursts using signal averaging. Patients with CKD and controls had similar resting MAP (CKD: 102 ± 14 mmHg; CON: 95 ± 8 mmHg; P = 0.27), MSNA burst frequency (CKD: 33 ± 10 bursts/min; CON: 31 ± 14 bursts/min; P = 0.78) and MSNA burst incidence (CKD: 53 ± 15 bursts/100 heartbeats; CON: 47 ± 24 bursts/100 heartbeats; P = 0.60). Peak increases in MAP following all bursts of MSNA were not different between patients with CKD and controls (CKD: 2.1 ± 0.7 mmHg; CON: 2.2 ± 0.9 mmHg; P = 0.83). Likewise, nadir reductions in TVC following all bursts of MSNA were not different in patients with CKD (CKD: -1.2 ± 0.6 ml/min/mmHg; CON: -1.4 ± 0.5 ml/min/mmHg; P = 0.46). Similar results were observed when considering burst patterning. MSNA bursts occurring in multiples (adjacent to other bursts) produced comparable peak MAP (CKD: 2.6 ± 0.6 mmHg; CON: 2.8 ± 1.2 mmHg; P = 0.67) and nadir TVC (CKD: -1.5 ± 0.7 ml/min/mmHg; CON: -1.9 ± 0.7 ml/min/mmHg; P = 0.25) responses between groups. There were also no differences in peak MAP and nadir TVC responses following single bursts of MSNA (bordered by cardiac cycles lacking bursts; both P > 0.30). These preliminary data suggest that, in contrast to our hypothesis, sympathetic transduction to BP is not augmented in patients with stage III CKD. This project was supported by the National Heart, Lung, and Blood Institute R01 HL-127071 (PJF). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Objective This study aimed to evaluate the reported amount of the American College of Obstetricians and Gynecologists (ACOG) recommended nutrients in commercially available, over-the-counter prenatal vitamins (PNVs) in the United States, to assess their adequacy compared with the ACOG guidelines, and to compare these supplements by cost. Study Design The top 30 online Amazon and Google shopping items found using “prenatal vitamins” in September 2022 were included for analysis if they included the words “prenatal” and “vitamin” in the label and contained multiple nutrients. Duplicates between Amazon and Google were excluded as well as vitamins that did not list all ingredients. The reported amounts of 11 key nutrients, as recommended by the ACOG, for each product were recorded, as well as supplemental form and cost per 30-day supply. A cost analysis was done of PNVs that met the ACOG recommendations for the highlighted nutrients compared with those that did not. Five out of the 11 key nutrients (folic acid, iron, docosahexaenoic acid, vitamin D, and calcium) were specifically highlighted, as deficiencies in these nutrients are known to correlate with significant clinical outcomes in pregnancy. Results A total of 48 unique PNVs were included for final analysis. Of these PNVs, none were compliant with suggested amounts of all five key vitamins and nutrients. No products met daily recommendations for calcium. Only five PNVs were compliant with recommendations with 4/5 key nutrients. Of note, 27% of PNVs did not have the recommended amount of folic acid (13/48). The median cost of PNVs that were not compliant with the four nutrients mentioned above was $18.99 (interquartile range [IQR]: $10.00–30.29), which was not statistically different from the median cost of the PNVs that did meet compliance with the four nutrients, which was $18.16 (IQR: $9.13–26.99), p = 0.55. Conclusion There were significant variations in the level of nutrients and cost of commercially available, over-the-counter PNVs in the United States. This raises concern that there should be more regulation of PNVs. Key Points