Abnormal Accumulation Of Fluid Research Articles

Comprehensive Morphometric Analysis to Identify Key Neuroimaging Biomarkers for the Diagnosis of Adult Hydrocephalus Using Artificial Intelligence.

Hydrocephalus involves abnormal cerebrospinal fluid accumulation in brain ventricles. Early and accurate diagnosis is crucial for timely intervention and preventing progressive neurological deterioration. The aim of this study was to identify key neuroimaging biomarkers for the diagnosis of hydrocephalus using artificial intelligence to develop practical and accurate diagnostic tools for neurosurgeons. Fifteen 1-dimensional (1-D) neuroimaging parameters and ventricular volume of adult patients with non-normal pressure hydrocephalus and healthy subjects were measured using manual image processing, and 10 morphometric indices were also calculated. The data set was analyzed using 8 machine, ensemble, and deep learning classifiers to predict hydrocephalus. SHapley Additive exPlanations (SHAP) feature importance analysis identified key neuroimaging diagnostic biomarkers. Gradient Boosting achieved the highest performance, with an accuracy of 0.94 and an area under the curve of 0.97. SHAP analysis identified ventricular volume as the most important parameter. Given the challenges of measuring volume for clinicians, we identified key 1-D morphometric biomarkers that are easily measurable yet provide similar classifier performance. The results showed that the frontal-temporal horn ratio, modified Evan index, modified cella media index, sagittal maximum lateral ventricle height, and coronal posterior callosal angle are key 1-D diagnostic biomarkers. Notably, higher modified Evan index, modified cella media index, and sagittal maximum lateral ventricle height, and lower frontal-temporal horn ratio and coronal posterior callosal angle values were associated with hydrocephalus prediction. The results also elucidated the relationships between these key 1-D morphometric parameters and ventricular volume, providing potential diagnostic insights. This study highlights the importance of a multifaceted diagnostic approach incorporating 5 easily measurable 1-D neuroimaging biomarkers for neurosurgeons to differentiate non-normal pressure hydrocephalus from healthy subjects. Incorporating our artificial intelligence model, interpreted through SHAP analysis, into routine clinical workflows may transform the diagnostic landscape for hydrocephalus by standardizing diagnosis and overcoming the limitations of visual evaluations, particularly in early stages and challenging cases.

Elephantiasis and its cure: case report

Introduction: Lymphedema is a clinical condition stemming from a lymphatic system failure. The insufficiency of the lymphatic system can causes the abnormal accumulation of protein-rich fluid in the interstitial, which triggers a adverse consequence such a and fibrosis. This study describes a case of a patient who has been cured of elephantiasis for ten years but continues to have lymphedema. Description case: Patient information: A 78-year-old woman had a history of bilateral lower limb lymphedema, clinical diagnosis that had been worsening throughout her life bilateral despite undergoing treatment and had progressed to stage III (elephantiasis). Clinical findings: The patient was sent to the Clínica Godoy-Sao Jose do Rio Preto-Brazil ten years ago and reported having undergone several forms of treatment, but without impeding the progression of the condition. Therapeutic intervention: The patient was submitted to intensive treatment for three weeks, during which time a 21-kilogram reduction in weight and a 66-cm reduction in circumference occurred. After three weeks, the patient began undergoing treatment at home with laced compression stockings. At the follow-up evaluation, electrical bioimpedance analysis, perimeter measurements and volumetry were performed, which revealed the reduction in lymphedema to standards of normality. The patient has completed 10 years of treatment and has maintained the results using compression stockings. Conclusion: Elephantiasis is curable, but lymphedema is not. Like any other chronic disease, constant treatment is needed to maintain the results.

Hydrops fetalis due to loss of function of hNav1.4 channel via compound heterozygous variants.

Hydrops fetalis, characterized by abnormal fluid accumulation in fetuses, presents a significant risk of stillbirth and neonatal mortality. Although the etiology of nonimmune hydrops fetalis (NIHF) is multifaceted, recent studies have highlighted genetic factors as crucial determinants. This study focused on a family with three consecutive stillbirths, each with pronounced hydrops fetalis. Using whole-exome sequencing (WES), we identified compound heterozygous variants of the SCN4A gene encoding the voltage-gated sodium channel of the skeletal muscle (hNav1.4), c.2429T>A p.L810Q and c.4556T>C p.F1519S, in all three deceased infants. A functional analysis conducted using the whole-cell patch-clamp technique revealed loss-of-function defects in both variant channels, with F1519S exhibiting a complete loss of ionic current and L810Q showing a reduced channel opening. These findings support the pathogenicity of SCN4A variants in NIHF and underscore the significance of functional studies in elucidating genotype-phenotype correlations. Furthermore, our study emphasizes the diagnostic value of WES in cases of NIHF in where standard genetic testing fails to identify causative variants.

Ascitis en el paciente no cirrótico

Ascites, defined as the abnormal accumulation of fluid in the peritoneal cavity, is mainly due to cirrhosis and portal hypertension (PHT). However, in 20% of cases, it is not related to these diseases. Given its varied etiology, it is essential to study it in order to determine therapeutic management. The pathophysiology of non-cirrhotic ascites is not usually related to cirrhosis-associated PHT, and understanding these mechanisms facilitates the etiologic diagnosis. Symptoms include abdominal distension, weight gain, postprandial fullness, and even dyspnea. The physical examination may be normal in cases of very mild ascites. An increase in abdominal circumference may be identified in more advanced or severe cases and signs associated with the underlying disease may also appear. The International Club of Ascites classification categorizes it according to the amount and abdominal distension. The initial evaluation includes a medical history, physical examination, abdominal ultrasound, and ascitic fluid analysis. Diagnostic paracentesis is crucial for identifying the cause, analyzing characteristics of the fluid such as its appearance and content, especially the protein concentration and the serum ascites albumin gradient, which will allow differentiating the different causes. In Western countries, the most frequent causes are tumor and heart diseases while in developing countries, infectious diseases, especially tuberculosis, are the most prevalent.

Natural antibodies targeting LPS in pleural effusions of various etiologies.

Respiratory infection, cancer, and heart failure can cause abnormal accumulation of fluid in the pleural cavity. The immune responses within the cavity are orchestrated by leucocytes that reside in the serosal-associated lymphoid tissue. Natural antibodies (NAbs) are abundant in the serum (S) having a major role in systemic and mucosal immunity; however, their occurrence in pleural fluid (PF) remains an open question. Our aim herein was to detect and measure the levels of NAbs (IgM, IgG, IgA) targeting lipopolysaccharides (LPS) in both the pleural fluid and the serum of 78 patients with pleural effusions (PEs) of various etiologies. The values of anti-LPS NAb activity were extracted through a normalization step regarding the total IgM, IgG, and IgA levels, all determined by in-house ELISA. In addition, the ratios of PF/S values were analyzed further with other critical biochemical parameters from pleural fluids. Anti-LPS NAbs of all Ig classes were detected in most of the samples, while a significant increase of anti-LPS activity was observed in infectious and noninfectious compared with malignant PEs. Multivariate linear regression confirmed a negative correlation of IgM and IgA anti-LPS PF/S ratio with malignancy. Moreover, anti-LPS NAbs PF/S measurements led to increased positive and negative predictive power in ROC curves generated for the discrimination between benign and malignant PEs. Our results highlight the role of anti-LPS NAbs in the pleural cavity and demonstrate the potential translational impact that should be further explored.NEW & NOTEWORTHY Here we describe the detection and quantification of natural antibodies (NAbs) in the human pleural cavity. We show for the first time that IgM, IgG, and IgA anti-LPS natural antibodies are detected and measured in pleural effusions of infectious, noninfectious, and malignant etiologies and provide clinical correlates to demonstrate the translational impact of our findings.

Effectiveness of Mannitol Use on Clinical Outcomes of Severe Traumatic Brain Injury Patients.

Head injuries are considered as a silent epidemic due to the high incidence rate throughout the world. The main cause of morbidity and mortality in patients with head injury is cerebral edema which is defined as abnormal fluid accumulation in the brain parenchyma. Mannitol is a hyperosmolar solution given to reduce fluid volume in the brain. Increased high intracranial pressure can affect prognosis and can be evaluated by assessing clinical outcomes in patients with severe traumatic brain injury using the Glasgow Outcome Discharge Scale (GODS) instrument. Observational analytical study with a cross sectional design on 50 patients with severe traumatic brain injury at dr. Zainoel Abidin General Hospital Banda Aceh to determine the effect of mannitol use on the clinical outcomes of severe traumatic brain injury patients which used t test analysis. The mean value of the group that received mannitol had a higher GODS score than the group that did not receive mannitol. The results of the T test between groups obtained a p value of 0.000 which is smaller than 0.05, so it can be concluded that the use of mannitol has an effect on the GODS score in Severe traumatic brain injury patients. The results showed that the mean GODS value in patients who received mannitol was higher than those who did not receive mannitol. This concludes that the administration of mannitol is effective in improving the clinical outcomes of patients with severe traumatic brain injury at dr. Zainoel Abidin General Hospital Banda Aceh.

Neonatal perspective on central lymphatic disorders

Lymphatic disorders presenting in the first year of life are difficult to identify and manage given the broad range of underlying etiologies. Neonatal lymphatic disease arising from congenital or acquired conditions results in the abnormal accumulation of lymph fluid in the pleura (chylothorax), peritoneum (chylous ascites) and skin (edema/anasarca). There is also increasing recognition of lymphatic losses through the intestine resulting in protein-losing enteropathy (PLE). While the incidence of lymphatic disorders in neonates is unclear, advances in genetic testing and lymphatic imaging are improving our understanding of the underlying pathophysiology. Despite these advancements, medical management of neonatal lymphatic disorders remains challenging and variable among clinicians.

Efficacy and Safety of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunting for the Treatment of Hydrocephalus: A Meta-Analysis

<i>Introduction</i>: Hydrocephalus, characterized by abnormal cerebrospinal fluid (CSF) accumulation, presents significant challenges requiring timely intervention to prevent neurological complications. Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) are primary surgical options, yet their relative efficacy and safety remain debated. This meta-analysis aims to compare ETV and VPS for hydrocephalus treatment, providing evidence-based insights to guide clinical decision-making. <i>Objectives</i>: To compare the efficacy of ETV and VPS in achieving symptom relief and radiological resolution of hydrocephalus. To evaluate the safety profiles of ETV and VPS by assessing perioperative and postoperative complication rates. To examine long-term outcomes following ETV or VPS placement. To conduct subgroup analyses based on patient characteristics influencing treatment effectiveness and safety. <i>Methods</i>: A comprehensive literature search was conducted in PubMed and Scopus databases to identify relevant studies comparing ETV and VPS for hydrocephalus treatment. Inclusion criteria encompassed comparative studies reporting efficacy and safety outcomes in pediatric and adult populations. Data extraction and quality assessment were performed using standardized protocols. Meta-analysis was conducted using appropriate statistical methods, with sensitivity and subgroup analyses conducted to assess robustness and variability. <i>Results</i>: Symptom improvement was comparable between ETV and VPS, with lower major complications associated with ETV. Mortality and postoperative complications favored ETV, although VPS exhibited lower CSF leakage risk. Overall success rates were similar, but ETV demonstrated superior safety profiles. Subgroup analyses revealed variations based on patient characteristics. <i>Conclusion</i>: ETV and VPS are effective in achieving symptomatic relief and radiological resolution of hydrocephalus, with ETV demonstrating superior safety profiles. Shared decision-making considering patient factors is crucial in selecting the most appropriate treatment approach. Further research is warranted to refine treatment algorithms and optimize outcomes for hydrocephalus patients.

Rare Complication of Fournie’s gangrene following Alcohol Sclerotherapy for Hydrocele: A Case Report

We present a rare case of an 80-year-old male with a longstanding, asymptomatic right hydrocele seeking repair. Hydrocele, characterized by an abnormal accumulation of serous fluid between the parietal and visceral layers of the tunica vaginalis, is a common condition affecting adult males. While surgical removal remains the gold standard treatment, alternative non-invasive approaches such as sclerotherapy have been explored due to their reported high success rates ranging from 85% to 96%. In this case, the patient underwent a combination of aspiration (340 mL of fluid) and sclerotherapy using 60 mL of absolute alcohol as the sclerosing agent. Following the sclerotherapy procedure, the patient experienced the development of a scrotal wound within 72 hours, which progressed to a necrotic point with associated hyperemia at 96 hours. Subsequently, the patient presented with an unusual necrosis in the scrotal sac, rapidly progressing to Fournier’s gangrene, requiring surgical debridement three surgical debridements seven days post-procedure, followed by antibiotic therapy and 35 hyperbaric sessions. Remarkably, the patient’s condition progressed painlessly, and complete closure of the necrotic lesion was achieved. However, this case underscores the importance of cautious evaluation when considering alcohol sclerotherapy in elderly patients, despite its minimally invasive nature. It serves as a reminder of the potential complications that can arise from non-surgical approaches for hydrocele management and highlights the need for careful patient selection and follow-up in such cases.

Characterization of central-involved diabetic macular edema using OCT and OCTA.

To characterize the occurrence of diabetic macular edema and the presence of abnormal retinal fluid accumulation in nonproliferative diabetic retinopathy (NPDR). In this two-year prospective study, a total of 122 eyes with diabetes type 2 underwent optical coherence tomography (OCT) and OCT-Angiography in association with OCT-Fluid imaging, a novel algorithm of OCT analysis allowing quantification of abnormal accumulation of fluid in the retina through low optical reflectivity ratios (LOR). Early Treatment Diabetic Retinopathy Study (ETDRS) grading for diabetic retinopathy (DR) severity assessment was performed using 7-field color fundus photography. Best corrected visual acuity was also recorded. During the 2-year follow-up, 23 eyes (19%) developed central-involved diabetic macular edema (CI-DME) and 2 eyes (2%) developed clinically significant macular edema (CSME). In the two-year period of the study, eyes that developed CI-DME showed a progressive increase in central retinal thickness (CRT) (β = 7.7 ± 2.1 µm/year, p < 0.001) and in LOR values (β = 0.009 ± 0.004 ratio/year, p = 0.027). The increase in CRT and abnormal retinal fluid, represented by increased LOR ratios, are associated with increased retinal perfusion in the deep capillary plexus (DCP) (skeletonized vessel density, p = 0.039). In contrast, the eyes with CSME showed decreased retinal perfusion and abnormal fluid located in the outer layers of the retina. CI-DME and CSME appear to represent different entities. Eyes with CI-DME show increases in abnormal retinal fluid associated with increased retinal vascular perfusion in the DCP. Eyes with CSME are apparently associated with decreased retinal vascular perfusion in the DCP and abnormal fluid in the outer retina.

Falciform technique in laparoscopic revision of distal catheter obstruction: an evaluation

Background: Ventriculoperitoneal (VP) shunting is a cornerstone treatment for hydrocephalus, a condition characterized by the abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. Despite its efficacy, this procedure is associated with various complications, among which distal catheter obstruction poses significant challenges. This study aimed to evaluate the effectiveness of the “falciform technique” in laparoscopic revision of distal catheter obstructions, offering a novel approach to mitigate this prevalent issue. Materials and Methods: This study retrospectively analyzed 28 patients with ventriculoperitoneal shunt distal catheter obstructions who underwent laparoscopy-assisted shunt revision between January 2016 and June 2022. All of these were done using the “falciform technique” with the fixation of the distal catheter to the falciform ligament in supra-hepatic space. Results: The most common etiology of primary shunt surgery was hydrocephalus, followed by intracranial hemorrhage (ICH) (42.9%) and traumatic brain injury (TBI) (32.1%). Normal pressure hydrocephalus (NPH) occurs in 14.3% of cases. Fifteen patients (53.6%) required revision surgery within 1 year of index surgery. Thirteen patients (46.4%) underwent revision surgery more than one year after the index surgery, either as a first revision or subsequent revision. The average surgery time was 32.1±14.7 minutes and hospital stay was 4.2±1.8 days. After a mean follow-up period of at 20.3±8.7 months, except for 3 patients who died from other causes (2 patients due to pneumonia and 1 due to exhaustion), there were no shunt-related complications in the remaining 25 patients. Conclusion: Laparoscopy with the application of “falciform technique” is a safe and highly effective method in distal catheter obstruction revision following ventriculoperitoneal shunt.

Nonimmune hydrops fetalis in a primigravida in the third trimester: A case report

Background: Hydrops fetalis is abnormal fluid accumulation within at least two fetal compartments, which may include pericardial effusion, pleural effusions, ascites, and skin edema. In the absence of red cell alloimmunization, hydrops fetalis is nonimmune (NHIF) and affects approximately 1 in 2000 pregnancies. Case presentation: A 33-year-old primigravida presented to the high-risk clinic for further management following an abnormal obstetric scan. Her antenatal follow-up was uneventful. She was blood group O, and rhesus positive. Physical examination was unremarkable. Abdominal examination revealed a fundal height of 32 weeks, which corresponded to her date. The first obstetric scan performed in the third trimester revealed a live baby with features of hydrops fetalis. Management included couple counseling, multidisciplinary discussion with a fetomaternal specialist, dexamethasone injection for fetal lung maturation, and expectant management. Discussion: The parents agreed to keep the pregnancy to term and plan for vaginal and cesarian deliveries reserved for obstetric indications. Nonimmune hydrops fetalis is associated with severe perinatal morbidity and significant maternal risk. The main causes of NIHF are chromosomal, fetal infection, and fetal cardiovascular problems. Conclusion: NIHF is rare, and a high index of suspicion is required for antenatal diagnosis. This affords parents tailored information and choices and supports multidisciplinary care with the additional aim of recognizing cases where fetal therapy may be appropriate, including timing for delivery.

Continuous Laser Versus Micropulse Laser in the Treatment of Central Serous Chorioretinopathy: A Retrospective Study.

Central serous chorioretinopathy (CSCR) is a retinal disorder characterized by complex mechanisms leading to abnormal fluid accumulation under the retina. While management remains controversial, laser therapy has been successfully used. This study compares the efficacy of continuous laser (CL) and micropulse laser (ML) therapy in treating CSCR, focusing on reduction in macular thickness and improvement in visual acuity. A retrospective cohort study was conducted, including patients with CSCR treated with either CL or ML. The primary outcome measured was the reduction in average macular thickness (AMT), alongside secondary outcomes like changes in best corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). The study evaluated 121 patients with CSCR, treated either with CL or ML. The primary outcome showed that the mean reduction in AMT was 51.14 µm (±20) in the CL group and 29.88 µm (±22) in the ML group, without a statistically significant difference (p=0.10). For the secondary outcomes, the improvement in BCVA was comparable in both groups, with CL at 0.15 (±0.1) and ML at 0.12 (±0.1) and no significant difference (p=0.41). However, in SFCT reduction, CL showed greater efficacy with a mean reduction of 32.19 µm (±15) compared to ML's 4.85 µm (±18), which was statistically significant (p=0.0004). The degree of SRF resolutionshowed no significant difference between the treatments (p=0.065). Both CL and ML are effective in the management of CSCR, with CL being more effective in reducing SFCT. These findings suggest the need for personalized treatment strategies based on individual patient characteristics and underline the complexity of CSCR management.

Unveiling Insights: A Comprehensive Review of the Role of Medical Thoracoscopy in Pleural Effusion Assessment.

Pleural effusion, characterized by abnormal fluid accumulation in the pleural cavity, poses diagnostic and therapeutic challenges across various medical conditions. This comprehensive review explores the role of medical thoracoscopy in assessing pleural effusions, providing insights into its historical context, procedural intricacies, diagnostic performance, safety considerations, and clinical applications. Medical thoracoscopy, a minimally invasive endoscopic procedure, offers advantages such as high diagnostic yield, therapeutic interventions, real-time assessment, and a minimally invasive nature. The review critically analyzes the procedure's advantages and disadvantages, including technical expertise, risk of complications, resource intensity, and patient selection criteria. Comparative analyses with alternative diagnostic modalities highlight the unique benefits of medical thoracoscopy in specific clinical scenarios. The diagnostic yield of medical thoracoscopy is examined, considering sensitivity and specificity in various contexts. Patient selection criteria, complications, and safety measures are discussed, emphasizing the importance of careful consideration in integrating thoracoscopy into clinical practice. The review further explores its clinical applications, including differentiating exudative and transudative effusions, identifying specific etiologies, and its role in treatment planning. In conclusion, medical thoracoscopy emerges as a valuable tool in the comprehensive management of pleural effusions, offering a nuanced approach to diagnosis and treatment. The evolving landscape of diagnostic modalities underscores the continued significance of medical thoracoscopy and potential advancements in the field.

Anesthetic Strategies in Cerebral Edema: Navigating Neurological Challenges Amid Trauma, Tumors and Therapeutic Advances

Cerebral edema, characterized by abnormal fluid accumulation in brain tissue leading to increased intracranial pressure, poses significant challenges for anesthesiologists. This review delves into the pathophysiology, clinical manifestations, diagnostic approaches, pharmacological strategies, and anesthesiological considerations associated with cerebral edema. Disruptions in the blood-brain barrier, alterations in cerebral blood flow, cellular swelling, and aquaporin dysregulation contribute to the complexity of cerebral edema. Clinical presentations vary, encompassing cognitive changes, seizures, and neurological deficits. Accurate diagnosis relies on clinical assessments and neuroimaging, with MRI and CT scans playing pivotal roles. Pharmacological interventions, including osmotic agents, corticosteroids, diuretics, and barbiturates, target specific causes and symptoms. Anesthesiological challenges encompass ICP monitoring, choice of anesthetic agents, maintenance of cerebral perfusion, fluid management, temperature control, and collaboration with neurosurgical teams. This multidisciplinary approach ensures optimal patient care and emphasizes ongoing research collaboration for refining therapeutic strategies. This comprehensive review provides valuable insights for clinicians managing cerebral edema, offering a roadmap for tailored interventions and highlighting the need for continued advancements in understanding and treating this critical condition.&#x0D; Material and method: ​​&#x0D; The literature review applied standard criteria and focused on PubMed articles using keywords: cerebral edema, pathophysiology, aquaporin, blood-brain barrier, anesthesiology, cerebral edema treatment, corticosteroids

Pattern and outcome of paediatric pleural effusion seen at Usmanu Dafodiyo University Teaching Hospital, Sokoto: A 5-year retrospective study

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural cavity which present with spectrum of clinico-aetiological manifestations often requiring multidisciplinary approach.&#x0D; Objectives: This study set out to determine the prevalence, aetiology, clinical presentation, treatment modalities and outcome of pleural effusion in children.&#x0D; Materials and Methods: This was a retrospective study where records of children with diagnosis of pleural effusion admitted at UDUTH, Sokoto were obtained between January 2017 and December 2022 and reviewed. Diagnosis was based on clinical presentation and radiological confirmation of pleural effusion. Data was analyzed with SPSS version 20.0.&#x0D; Results: A total of 49 cases were retrieved. The prevalence of pleural effusion was 0.54% (9,056). It was more prevalent in males with ratio of 2.5:1 (χ² = 9.833, P = 0.007). The median age was 9 years (IQR 7). The most common cause of pleural effusion was pneumonia 26 (53.1%) followed by tuberculosis 16 (32.6%), malignancy 3 (6.1%), cardiac and renal causes accounted for 2 (4.1%) each. Cough (100.0%), difficulty in breathing (100.0%), tachypnea (100.0%), respiratory distress (100.0%), and desaturation (98.0%) were the common presentations. Most (77.5%) of them presented with right sided pleural effusion. The majority (93.9%) had closed thoracostomy tube drainage. The outcome showed majority (83.7%) of the cases been discharged, with a median duration of hospital stay of 22days (IQR 17). However, mortality rate for the malignant causes was 100.0%.&#x0D; Conclusion: Infections were the major cause of paediatric pleural effusion with relatively good outcome. Surgical intervention and multidisciplinary team approach are needed to reduce the morbidity and mortality in patients with pleural effusion especially for the malignant causes.

Racial and ethnic differences in infant survival for hydrocephaly-Texas, 1999-2017.

Congenital hydrocephaly, an abnormal accumulation of fluid within the ventricular spaces at birth, can cause disability or death if untreated. Limited information is available about survival of infants born with hydrocephaly in Texas. Therefore, the purpose of the study was to calculate survival estimates among infants born with hydrocephaly without spina bifida in Texas. A cohort of live-born infants delivered during 1999-2017 with congenital hydrocephaly without spina bifida was identified from the Texas Birth Defects Registry. Deaths within 1 year of delivery were identified using vital and medical records. One-year infant survival estimates were generated for multiple descriptive characteristics using the Kaplan-Meier method. Crude hazard ratios (HRs) for one-year survival among infants with congenital hydrocephaly by maternal and infant characteristics and adjusted HRs for maternal race and ethnicity were estimated using Cox proportional hazard models. Among 5709 infants born with congenital hydrocephaly without spina bifida, 4681 (82%) survived the first year. The following characteristics were associated with infant survival: maternal race and ethnicity, clinical classification (e.g., chromosomal or syndromic), preterm birth, birth weight, birth year, and maternal education. In the multivariable Cox proportional hazards model, differences in survival were observed by maternal race and ethnicity after adjustment for other maternal and infant characteristics. Infants of non-Hispanic Black (HR: 1.28, 95% CI: 1.04-1.58) and Hispanic (HR: 1.31, 95% CI: 1.12-1.54) women had increased risk for mortality, compared with infants of non-Hispanic White women. This study showed infant survival among a Texas cohort differed by maternal race and ethnicity, clinical classification, gestational age, birth weight, birth year, and maternal education in infants with congenital hydrocephaly without spina bifida. Findings confirm that mortality continues to be common among infants with hydrocephaly without spina bifida. Additional research is needed to identify other risk factors of mortality risk.

Gansui Banxia decoction modulates immune-inflammatory homeostasis to ameliorate malignant ascites in rats

Background“Gansui Banxia decoction” (GBD) is a classical traditional Chinese medicine formula for treating abnormal accumulation of fluid, such as malignant ascites (MA). Although GBD has shown definite water-expelling effects, its exact underlying mechanism has not been elucidated. PurposeThis study aimed to investigate the drug effects of GBD on MA rats and its underlying mechanisms. MethodsThe main chemical composition was determined by ultra-high performance liquid chromatography. The drug effects of GBD was evaluated in the established cancer cell-induced MA rat model. The symptoms were analyzed, and biological samples were collected for detecting immune and inflammation-related indicators by enzyme-linked immunosorbent assays, western blot, and flow cytometry. ResultsGBD increased urine discharge, decreased ascites production, and alleviated cachexia. After GBD treatment, the expression of TLR4, MyD88, and NF-кB and the release of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were reduced. In addition, GBD increased G1 phase arrest and inhibit excessive proliferation of cells in bone marrow while alleviating G1 phase arrest and increasing proliferation of cells in the thymus. Correspondingly, the development and maturation of T cells also changed. GBD increased the proportion of mature T-cells (CD4+CD8− and CD4−CD8+ single-positive (SP) T-cells), and decrease the proportion of immature cells (CD4+CD8+ double-positive (DP) T-cells and CD4−CD8− double-negative (DN) T-cells) in the blood or tumor microenvironment (TME, the ascites microenvironment). Finally, we further analysis of immune cell subsets, GBD decreased the proportion of immunosuppressive T-cells in the blood (CD4+CD25+Foxp3+T-cells) and TME (CD8+CD25+Foxp3+T-cells), and increased the proportion of anti-tumor immune cells (CD8+CD28+T-cells and NK cells) in the TME. ConclusionThese findings indicated that the drug effects of GBD were attributed to regulating the immune-inflammatory homeostasis, thereby mitigating the destruction of cancer cells and reducing the generation of ascites, which provided theoretical support for the clinical rational application and extended the scientific connotation of “water-expelling” of GBD.

Formulation and evaluation of controlled porosity oral osmotic pump tablets of furosemide

Oedema is an abnormal accumulation of fluid in the interstitium located beneath the skin and in the cavities of the body which can cause severe pain. Furosemide has been shown to be effective and safe in patients with hypertension and/ or coronary heart disease. Osmotic pump tablets deliver the drug in an optimized manner to maintain drug concentration within the therapeutic window and minimize toxic effects. The major objective of the study was to prepare and evaluate oral controlled porosity osmotic pump tablets of furosemide, to reduce the dosing frequency and thereby side effects, and to release the drug for a prolonged period in a controlled manner that is independent of pH and hydrodynamic activity. Pre-formulation studies and pre-compression parameters of tablet blends of osmotic pump tablets of furosemide were carried out. Oral-controlled porosity osmotic pump tablets of furosemide were prepared and subjected to different evaluation tests. Precompression parameters indicated that granules have a good flow property. All the formulations showed good mechanical strength. All the nine formulations showed a drug release of more than 60% in the 12th hour. Optimised formulation showed a drug release of 99.21% in 12th hr. Stability studies conducted indicate that the product is stable.

An Observational Study for the Clinical Correlation of Sama-Snayugata Vata (Non-Specific Chronic Synovitis) with the Analysis of the Synovial Fluid

This study delves into the intricate interplay between the Ayurvedic concept of Sama-Snayugata Vata, characterized by the vitiation of Vata dosha affecting the musculoskeletal system, and the analysis of synovial fluid in the context of knee effusion. Synovial fluid, a crucial component within diarthrodial joints, serves to nourish, lubricate, and protect the joint structures. Under normal circumstances, its biochemical composition closely mirrors that of plasma. However, pathological conditions, such as arthritis, can lead to alterations in its constituents, offering insights into underlying joint pathology. Central to this study is the Ayurvedic concept of Shleshmadhara Kala, representing a phase characterized by optimal nourishment and lubrication of bodily tissues, essential for joint health and functionality. The Janu Sandhi, or knee joint, exemplifies this interplay, where the integrity of tendons and ligaments (Snayu) is crucial. Conditions like knee effusion, marked by abnormal synovial fluid accumulation, disrupt this equilibrium, leading to clinical manifestations and impairments. This observational study aims to comprehensively explore the correlation between Shleshmadhara Kala and the Snayu of the Janu Sandhi in the pathogenesis of Sama-Snayugata Vata, particularly in the context of knee effusion. Insights gained from this research will provide a foundation for devising effective therapeutic strategies, with the goal of restoring Vata dosha balance, rejuvenating affected tissues, and ultimately alleviating the manifestations of this condition. This investigation holds promise for enhancing our understanding of non-specific chronic synovitis and refining treatment modalities for improved patient outcomes.