Aseptic Inflammatory Reaction Research Articles

Биоптический подход к эксимерлазерной хирургии при сочетанной патологии роговицы и хрусталика

Purpose. To consider a biooptical approach to excimer laser surgery for combined pathology of the cornea and lens. Material and methods. The work is based on 20-year clinical observations of the results of excimer laser refractive, opto-reconstructive and medical surgery in combined pathology of the cornea and lens based on a biooptical approach (more than 1500 operations). Particular emphasis was placed on the cycloplegic functional test and the use of stromal saturation with 0.25% chilled to +5–7 °C isotonic riboflavin solution during photoablation. The studies used modern diagnostic devices OPD-scan, RTVue XR100 and TMS-5 and excimer ophthalmic lasers from various companies. Results. In case of combined refractive pathology of the cornea and lens, the cycloplegic test made it possible to more accurately determine the degree of ametropia, its accommodative component with compensation of corneal astigmatism, and the presence of lens astigmatism. In all cases, the determination of the volume of photorefractive ablation was calculated taking into account the contribution of the cornea and lens to the formation of ametropia and aberrations of the optical system of the eye. The diameter of the optical and transition zone during photorefractive ablation was calculated depending on the state of the pupil diameter in photopic and mesopic conditions. Obtained in the course of studies on the OPD-Scan device, objective information on the difference between the pupil width in mesopic and photopic conditions made it possible to individualize the sizes of the optical and transition zones during photorefractive ablation, to avoid the «Halo» and «Gler» effects. Photoablation with saturation of tecorneal stroma with riboflavin reduced the response of aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome, and provided earlier stabilization of optical refractive indices. Conclusion. When performing excimer laser refractive, opto-reconstructive and therapeutic operations with combined pathology of the cornea and lens, a biooptical approach is required, taking into account the leading role of the cornea and lens in the formation of the optical system of the eye and visual acuity. Keywords: biooptics, photoablation, excimer laser corneal surgery

Increased UHMWPE Particle-Induced Osteolysis in Fetuin-A-Deficient Mice.

Particle-induced osteolysis is a major cause of aseptic prosthetic loosening. Implant wear particles stimulate tissue macrophages inducing an aseptic inflammatory reaction, which ultimately results in bone loss. Fetuin-A is a key regulator of calcified matrix metabolism and an acute phase protein. We studied the influence of fetuin-A on particle-induced osteolysis in an established mouse model using fetuin-A-deficient mice. Ten fetuin-A-deficient (Ahsg−/−) mice and ten wild-type animals (Ahsg+/+) were assigned to test group receiving ultra-high molecular weight polyethylene (UHMWPE) particle implantation or to control group (sham surgery). After 14 days, bone metabolism parameters RANKL, osteoprotegerin (OPG), osteocalcin (OC), alkaline phosphatase (ALP), calcium, phosphate, and desoxypyridinoline (DPD) were examined. Bone volume was determined by microcomputed tomography (μCT); osteolytic regions and osteoclasts were histomorphometrically analyzed. After particle treatment, bone resorption was significantly increased in Ahsg−/− mice compared with corresponding Ahsg+/+ wild-type mice (p = 0.007). Eroded surface areas in Ahsg−/− mice were significantly increased (p = 0.002) compared with Ahsg+/+ mice, as well as the number of osteoclasts compared with control (p = 0.039). Fetuin-A deficiency revealed increased OPG (p = 0.002), and decreased levels of DPD (p = 0.038), OC (p = 0.036), ALP (p < 0.001), and Ca (p = 0.001) compared with wild-type animals. Under osteolytic conditions in Ahsg−/− mice, OPG was increased (p = 0.013), ALP (p = 0.015) and DPD (p = 0.012) were decreased compared with the Ahsg+/+ group. Osteolytic conditions lead to greater bone loss in fetuin-A-deficient mice compared with wild-type mice. Reduced fetuin-A serum levels may be a risk factor for particle-induced osteolysis while the protective effect of fetuin-A might be a future pathway for prophylaxis and treatment.

Рибофлавин в профилактике фиброплазии в лазерной рефракционной хирургии роговицы

Purpose: To substantiate the use of riboflavin for the prevention of subepithelial and intrastromal fibroplasia in laser refractive corneal surgery. Material and methods: The work is based on 9-year clinical observations of the results of photorefractive and phototherapeutic corneal surgery with stroma saturation with riboflavin (more than 700 operations). Keratoablation was performed after drip, aerosol or combined saturation of the stroma with 0.1 % or 0.25 % chilled isotonic riboflavin solution. Corneal OCT was performed on RTVue 100 and RTVue XR100 devices. Keratotopographic and densitometric studies were performed on a TMS-5 instrument. These devices were used with two-wavelength optical scanning in the visible green and infrared ranges to assess prophylactic crosslinking by the change in the refractive index of the cornea. Results: During photokeratoablation, corneal stroma layers saturated with riboflavin acted as spectral filters, protecting keratocytes from secondary radiation induced by ablation. This reduced the response of aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome. According to OCT and corneal densitometry data, the formation of a Bowman-like structure on the ablation surface was noted with an increase in optical density in the underlying layers of the stroma. Two-wavelength optical scanning revealed a significant increase in the refractive index. The effect of laser-induced crosslinking and the increase in optical density had a damped character and did not exceed 1/2 of the stroma thickness. These changes in the cornea were a barrier between pro-inflammatory epithelial and stromal cytokines that stimulate the development of subepithelial and intrastromal fibroplasia after photokeratoablation. Conclusion. During photokeratoablation, riboflavin-saturated layers of the corneal stroma protect deeper-lying keratocytes from secondary radiation induced by ablation, and the formation of a Bowman-like structure on the ablation surface with a damping effect of crosslinking in the superficial layers of the stroma prevents the development of fibroplasia. Keywords: Riboflavin, Mitomycin-C, fibroplasia, photoablation, excimer laser corneal surgery, laser-induced crosslinking.

Reassessment of the Clinical Significance of the Demarcation Line in the Corneal Stroma in Crosslinking

Purpose: To consider the clinical significance and features of the formation of a demarcation line in the corneal stroma with various methods of corneal crosslinking.&#x0D; Materials and Methods: Literature data on the evaluation of the effectiveness of various methods of crosslinking by the demarcation line in the corneal stroma were analyzed. The formation of a demarcation line during prophylactic and therapeutic excimer laser crosslinking was studied after various photorefractive operations, keratoconus and other pathologies of the cornea (168 operations).&#x0D; Results: With various methods of crosslinking, including prophylactic and therapeutic excimer laser corneal crosslinking, the depth of the demarcation line in the stroma varied from 1/3 to 2/3 of the corneal thickness. It was noted that the saturation of the corneal stroma with a 0.25% solution of riboflavin is accompanied by a large increasing effect of the optical density in the stroma above the demarcation line at a shallower depth of its occurrence. The severity of the aseptic inflammatory reaction after corneal crosslinking affected the optical density, shape, intensity, and depth of the demarcation line in the stroma. In some cases, the formation of a demarcation line in the stroma was noted when the stroma was saturated with riboflavin immediately after refractive keratoablation without additional UV irradiation. The demarcation line in the stroma was revealed during inflammatory processes in the corneal stroma without the participation of riboflavin and its activation by UV radiation. The study showed that the assessment of corneal crosslinking by the depth of the demarcation line is not an indicator of the photochemical process and the number of crosslinks formed in the corneal stroma.&#x0D; Conclusion: Based on the severity, shape and depth of the demarcation line, it is not possible to judge the density of crosslinks in the corneal stroma, which predetermine its strength properties after one or another method of corneal crosslinking.

Curative Effect of Foraminal Endoscopic Surgery and Efficacy of the Wearable Lumbar Spine Protection Equipment in the Treatment of Lumbar Disc Herniation.

Lumbar disc herniation is a common and frequently-occurring disease in pain clinics. The incidence rate of affliction is increasing with every passing year. Besides the aged, young people also suffer from long-term pain, which not only affects their daily routines but may also lead to serious impairment. The causes of chronic low back and leg pain caused by lumbar disc herniation are mainly related to mechanical compression, the adhesion of epidural space, intervertebral space, and aseptic inflammatory reaction. The treatment of lumbar disc herniation should follow the principle of step-by-step treatment. An appropriate treatment scheme needs to be adopted according to the patient's condition. About 80% of patients received nonsurgical treatment to get relief from the pain symptoms. However, 10% to 15% of patients still need traditional open surgery. Spinal foraminal surgery is a new method for the treatment of lumbar disc herniation, lumbar surgery failure syndrome, and lumbar spinal stenosis. However, there are only scattered clinical reports on the efficacy of spinal foraminal surgery. Based on it, this paper proposes a method to explore the efficacy of spinal foraminal mirror surgery in the treatment of lumbar disc herniation. Besides, postoperative wearable lumbar protective equipment is proposed to ensure a seamless rehabilitation effect on the patients. Statistical analysis performed using a t-test revealed that there was a significant difference between the visual analog scales (VAS) scores of the two groups after 3 and 6 months of treatment (P < 0.05). The paper analyzes and summarizes the cases with definite and poor curative effects, which not only provides the basis for clinical practice but also paves the way to multicenter clinical research.

Do We Have a Place for Non-Steroidal Anti-Inflammatory Drugs in Corneal Refractive Surgery?

Relevance. Corneal refractive surgery is a modern, dynamically developing segment of ophthalmology that provides highly predictable, safe and stable refractive results in patients with a wide range of ametropias. Corneal refractive surgery, usually is chosen by patients who lead an active lifestyle and need rapid medical and social rehabilitation, people with high requirements for the quality of life and showing increased expectations for the result of correction. Perhaps this is due to the fact that, according to a survey at the exit of the Department of refractive laser Surgery of the S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, Moscow, conducted after consulting a surgeon with a description of the course of the operation and the postoperative course, about 1 % of patients refuse surgery, fearing painful sensations in the postoperative period, and 23.4 % of the expected postoperative discomfort causes strong concerns.Purpose. To study the clinical efficacy and safety of Broxinac (0.09 % bromfenac solution) in the early postoperative period of corneal refractive surgery.Materials and methods. The study included 168 patients (168 eyes) with moderate and high myopia after PRK (24 eyes), FemtoLASIK (78 eyes) and ReLEx SMILE (66 eyes), divided into equal subgroups: in the main group, Broxinac was instilled once 30 minutes after the operation, and in the control group — placebo. In the PRK subgroup of the main group, daily instillations of Broxinac were continued until complete reepithelization. The severity of the indicators “eye pain”, “photophobia”, “lacrimation”, “foreign body sensation” was evaluated on a five-point scale, the state of the corneal epithelium when stained with fluorescein, and overall satisfaction with the operation.Results and discussion. It is established that the analgesic effect occurred on average after 4.4 ± 0.6 minutes. Broxinac had a rapid, pronounced analgesic effect in patients in the early postoperative period after keratorefractive surgery, without slowing of corneal reepithelization, and can be recommended for use in clinical practice for analgesia and relief of aseptic inflammatory reaction in the early postoperative period after FemtoLASIK and PRK. The ReLEx SMILE does not require pain relief.Conclusion. Analgesia of the early postoperative period increases patient satisfaction with the result of the operation, popularizes it and helps to attract patients who previously refused surgical correction of ametropia due to fear of painful sensations.

Self-limiting sternal tumors of childhood (SELSTOC): A diagnostic challenge

IntroductionSelf-limiting sternal tumors of childhood (SELSTOC) are rapidly growing sternal lesions that tend to resolve spontaneously. Patients have no history of infection, trauma, or neoplasms, and the most likely etiologyis an aseptic inflammatory reaction of unknown origin. The differential diagnosis includes a wide spectrum of lesions such as tumors, infections, malformations, or anatomic variants. Material and methodsWe analyzed all cases of sternal masses in pediatric patients seen between 2012 and 2019; five of these had findings compatible with SELSTOC. We retrospectively recorded patients’ race, sex, age, clinical presentation, laboratory findings, imaging tests, treatment, and follow-up. ResultsWe present five cases of rapidly growing sternal lesions whose clinical and radiological features are compatible with SELSTOC. In the absence of alarming symptoms and laboratory markers, watchful waiting could be an appropriate therapeutic approach. However, patients with some findings such as fever, elevated acute phase reactants, and/or comorbidities could require therapeutic interventions such as antibiotics or percutaneous drainage. In our series, depending on the clinical presentation and the patient’s comorbidities, different therapeutic approaches were adopted (a conservative approach in two patients, antibiotics in three patients, and percutaneous drainage in one patient). In all cases, the sternal lesion was absent at discharge and/or at later follow-up visits. ConclusionRadiologists and pediatricians must be aware of this entity and the different diagnostic and therapeutic approaches to rapidly growing sternal lesions in pediatricpatients because recognizing SELSTOC can avoid unnecessary diagnostic tests and/or disproportionate therapeutic strategies.

Фотоабляция с рибофлавином как альтернатива применению Митомицина-С в эксимерной лазерной хирургии роговицы

Purpose. To substantiate the advantages of photoablation with riboflavin as an alternative to the use of Mitomycin-C in excimer laser surgery of the cornea. Material and methods. The work is based on clinical observations of the results of 598 photorefractive and phototherapeutic operations. In all cases, keratoablation was performed after drip, aerosol, or combined saturation of the stroma with 0.1% or 0.25% isotonic riboflavin solution. Corneal OCT was performed on RTVue 100 and RTVue XR100 devices. Keratotopographic and densitometric studies were performed on a TMS-5 device. Results. With photokeratoablation of the stroma saturated with riboflavin, the response aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome decreased. In densitometry and OCT studies, an increase in optical density was noted with the formation of a membrane structure on the ablation surface and the effect of cross-linking in the stromal layers adjacent to the ablation zone. Shielding of induced secondary radiation by riboflavin and the formation of a Bowman-like membrane structure made it possible to avoid the development of an irreversible form of fibroplasia and a decrease in visual acuity. The formed membrane structure with cross-linking in the underlying stromal layers was a barrier between pro-inflammatory epithelial and stromal cytokines, which predetermine the development of fibroplasia during photokeratoablation. Conclusion. Photokeratoablation with riboflavin prevents the development of an irreversible form of fibroplasia and can be considered as an alternative to the use of Mitomycin-C in photorefractive and phototherapeutic operations on the cornea by radiation from an argon-fluorine excimer laser. Key words: Mitomycin-C, riboflavin, fibroplasia, excimer laser corneal surgery, laser-induced crosslinking.

Regeneration of human-ear-shaped cartilage with acellular cartilage matrix-based biomimetic scaffolds

Tissue engineering technology provides a promising approach for external ear reconstruction. Although the first clinical breakthrough of tissue engineered auricular reconstruction has been achieved based on polymer scaffold, the discrepant clinical efficacy among different patients triggered by residual scaffold mediated aseptic inflammatory reaction seriously hinders its further clinical application. A proper natural scaffold with low inflammatory reaction is urgently required to address this problem. Among all the natural materials, acellular cartilage matrix (ACM) is considered to be the ideal cartilage-specific microenvironmental biomimetic scaffold. However, no breakthroughs have been achieved for the regeneration of human-ear-shaped cartilage based on ACM so far. The main challenge is how to prepare ACM into a three-dimensional (3D) porous scaffold with precise human-ear shape and proper mechanical strength. In this study, ACM powder, prepared by freezing pulverization and decellularization, was successfully prepared into 3D porous scaffolds using gelatin as an auxiliary crosslinker. By optimizing proportion and concentration of ACM and gelatin, the scaffolds presented proper pore structure and degradation rate as well as good mechanical strength and biocompatibility. Furthermore, ACM/Gelatin could be fabricated into porous scaffolds with precise human-ear shape and proper mechanical strength by integrating 3D printing, polycaprolactone (PCL) inner core designing, cast molding, and freeze-drying technologies. Finally, human-ear-shaped cartilage with good elasticity and cartilage-specific extracellular matrices was successfully regenerated using the ACM/Gelatin-PCL scaffolds and auricular chondrocytes (elastic cartilage). All of these results provide important support for the application and clinical translation of human-ear-shaped cartilage.

Tumores esternales autolimitados en la edad pediátrica (SELSTOC): un reto diagnóstico

IntroductionSelf-limiting sternal tumors of childhood (SELSTOC) are rapidly growing sternal lesions that tend to resolve spontaneously. Patients have no history of infection, trauma, or neoplasms, and the most likely etiology is an aseptic inflammatory reaction of unknown origin. The differential diagnosis includes a wide spectrum of lesions such as tumors, infections, malformations, or anatomic variants. Material and methodsWe analyzed all cases of sternal masses in pediatric patients seen between 2012 and 2019; five of these had findings compatible with SELSTOC. We retrospectively recorded patients’ race, sex, age, clinical presentation, laboratory findings, imaging tests, treatment, and follow-up. ResultsWe present five cases of rapidly growing sternal lesions whose clinical and radiological features are compatible with SELSTOC. In the absence of alarming symptoms and laboratory markers, watchful waiting could be an appropriate therapeutic approach. However, patients with some findings such as fever, elevated acute phase reactants, and/or comorbidities could require therapeutic interventions such as antibiotics or percutaneous drainage. In our series, depending on the clinical presentation and the patient's comorbidities, different therapeutic approaches were adopted (a conservative approach in two patients, antibiotics in three patients, and percutaneous drainage in one patient). In all cases, the sternal lesion was absent at discharge and/or at later follow-up visits. ConclusionRadiologists and pediatricians must be aware of this entity and the different diagnostic and therapeutic approaches to rapidly growing sternal lesions in pediatric patients because recognizing SELSTOC can avoid unnecessary diagnostic tests and/or disproportionate therapeutic strategies.

Chemical peritonitis resulting from spontaneous rupture of amature ovarian cystic teratoma: acase report.

Mature cystic teratomas (dermoid cysts) are themost common germ cell tumours with 10-25% incidence of adult and 50% of paediatric ovarian tumours. Theaetiology of dermoid cysts is still unclear, although currently theparthenogenic theory is most widely accepted. Thetumour is slow-growing and in themajority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. Themain complication of adermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1-2%), infection (1%), and rupture (0.3-2%). Prolonged pressure during pregnancy, torsion with infarction, or adirect trauma are themain risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. Thediagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. We present areport of aclinical case of a35-years-old female, who was referred to thehospital due to abdominal pain spreading to her feet for three successive days. She had ahistory of anormal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed amultiloculated cystic mass measuring 16×10cm in thepelvis. In theabsence of urgency, planned surgical treatment was recommended. Thenext day thepatient was referred to thehospital again, with acomplaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. Theultrasound scan differed from theprevious one. This time, thetransvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was alarge amount of free fluid in theabdominal cavity. Thepatient was operated on-left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of thethromboembolism were administered. Thepatient was discharged from thehospital on theseventh postoperative day and was sent for outpatient observation. Ultrasound is theimaging modality of choice for adermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once arupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of thespontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.

CLEC5A: A Promiscuous Pattern Recognition Receptor to Microbes and Beyond.

CLEC5A is a spleen tyrosine kinase (Syk)-coupled C-type lectin that is highly expressed by monocytes, macrophages, neutrophils, and dendritic cells and interacts with virions directly, via terminal fucose and mannose moieties of viral glycans. CLEC5A also binds to N-acetylglucosamine (GlcNAc) and N-acetylmuramic acid (MurNAc) disaccharides of bacterial cell walls. Compared to other C-type lectins (DC-SIGN and DC-SIGNR) and TLRs, CLEC5A binds its ligands with relatively low affinities. However, CLEC5A forms a multivalent hetero-complex with DC-SIGN and other C-type lectins upon engagement with ligands, and thereby mediates microbe-induced inflammatory responses via activation of Syk. For example, in vivo studies in mouse models have demonstrated that CLEC5A is responsible for flaviviruses-induced hemorrhagic shock and neuroinflammation, and a CLEC5A polymorphism in humans is associated with disease severity following infection with dengue virus. In addition, CLEC5A is co-activated with TLR2 by Listeria and Staphylococcus. Furthermore, CLEC5A-postive myeloid cells are responsible for Concanavilin A-induced aseptic inflammatory reactions. Thus, CLEC5A is a promiscuous pattern recognition receptor in myeloid cells and is a potential therapeutic target for attenuation of both septic and aseptic inflammatory reactions.

A single intraperitoneal injection of bovine fetuin-A attenuates bone resorption in a murine calvarial model of particle-induced osteolysis

Particle-induced osteolysis, which by definition is an aseptic inflammatory reaction to implant-derived wear debris eventually leading to local bone destruction, remains the major reason for long-term failure of orthopedic endoprostheses. Fetuin-A, a 66kDa glycoprotein with diverse functions, is found to be enriched in bone. Besides being an important inhibitor of ectopic calcification, it has been described to influence the production of mediators of inflammation. Furthermore, a regulatory role in bone metabolism has been assigned. In the present study, the influence of a single dose of bovine fetuin-A, intraperitoneally injected in mice subjected to particle-induced osteolysis of the calvaria, was analyzed.Twenty-eight male C57BL/6 mice, twelve weeks of age, were randomly divided into four groups. Groups 2 and 4 were subjected to ultra-high molecular weight polyethylene (UHMWPE) particles placed on their calvariae while groups 1 and 3 were sham-operated. Furthermore, groups 3 and 4 received a single intraperitoneal injection of 20mg bovine fetuin-A while groups 1 and 2 were treated with physiologic saline. After 14days calvarial bone was qualitatively and quantitatively assessed using microcomputed tomography (μCT) and histomorphometrical approaches.Application of fetuin-A led to a reduction of particle-induced osteolysis in terms of visible osteolytic lesions and eroded bone surface. The reduction of bone thickness and bone volume, as elicited by UHMWPE, was alleviated by fetuin-A. In conclusion, fetuin-A was found to exert an anti-resorptive effect on particle-induced osteolysis in-vivo. Thus, fetuin-A could play a potentially osteoprotective role in the treatment of bone metabolic disorders.

THE MORPHOLOGICAL STUDY OF THE RABBIT EYE SCLERA FOLLOWING THE SCLERA-STRENGTHENING OPERATIONS WITH THE USE OF UV CROSS-LINKED TRANSPLANTS

Aim. The objective of the present study was the comparative evaluation of the morphological characteristics of the reaction of the ocular tissues following experimental scleroplasty with the application of the xenografts from UV-irradiated and non-irradiated pericardium. Materials and methods. To elucidate the morphological characteristics of the reaction of the eye tissues to experimental scleroplasty, we used histological sections of the 16 eyes of 8 rabbits. The animals were allocated to two groups. Those in group 1 underwent sclera-strengthening operations as described by Khatminsky with the use of UV cross-linked xenotransplants from the pericardium. Part of them was preliminarily subjected either to UV-irradiation at a wavelength of 370 nm and an irradiation power of 5 mW/cm2 for 20 minutes or to the treatment with a 0.5% aqueous solution of riboflavin during 30 minutes (the right eyes from 4 animals). The remaining rabbits comprised group 2 and were operated using the same procedure with the application of the xenotransplants from the non-irradiated pericardium. The left eyes of all the animals remained intact and serves as the controls. The enucleated eyes were subjected to the microscopic and histological examination within 2 weeks (two rabbits from each group) and 1 month after surgery. Results. The morphological study of the enucleated eyes obtained within 2 weeks after the surgical intervention gave evidence of only the mild aseptic inflammatory reaction in the form of a lean rim composed from lymphocyte-like cells buried deep in the sclera close to the transplants from the UV-irradiated pericardium. The histological studies carried out within 1 month after the operation have demonstrated the signs of formation of a connective tissue capsule. The sections through the sclera of the enucleated eyes with the use of the biological materials from the non-irradiated pericardium obtained 2 weeks after the operation at the borderline with the transplants exhibited the clearly visualized signs of aseptic inflammation with massive lympho-macrophage infiltration and the presence of a large amount of fibroblasts. Only isolated areas of the granulation tissue were identified within 1 month after the intervention. Conclusion. The histological study of the enucleated rabbit eyes conducted within 2 weeks after experimental scleroplasty has demonstrated the less pronounced reaction of the ocular tissues to the introduction of the UV-irradiated xenografts in comparison with that of the non-irradiated ones. One month after the surgical intervention with the application of the xenotransplants from the UV cross-linked pericardium, the histological signs of the formation of the capsules from the connective tissue were well apparent in the association with the mild inflammatory reaction of the ocular tissues. The animals operated with the use of the non-irradiated biological materials from the pericardium experienced massive inflammatory lympho-macrophage infiltration and exhibited only isolated areas of the developing granulation tissue.

Features of inflammatory and regenerative reaction to excimer laser refractive keratectomy with photoprotection

Aim. To study the features of inflammatory and regenerative reaction to excimer laser refractive keratectomy with photoprotection.Methods. Clinical cases of 560 excimer laser refractive keratectomies with photoprotection in 280 patients with myopia and myopic astigmatism of different severity. The observation period varied from 1 month to 2.5 years.Results. The study showed that intensity of aseptic inflammation and the type of regenerative response are influenced by the amount of evaporated corneal tissue, which correlates with the severity of myopia. Moreover, in case of equal severity of myopia and amount of evaporated tissue inflammatory and regenerative response was less prominent if excimer laser ablation was performed under the superficial corneal flap. In this case epithelial stromal corneal flap allowed reducing the negative effect of ultraviolet exposure and interaction between proinflammatory epithelial and stromal cytokines. At photorefractive ablation of corneal stroma saturated with 0.25% isotonic riboflavin solution aseptic inflammatory and regenerative response, intensity and duration of corneal syndrome decreased. Due to such technique of photorefractive keratectomy stromal layers saturated with riboflavin absorbed the secondary ultraviolet induced by ablation. Clinical observation demonstrated the need for additional photoprotection by glasses from external unltraviolet in all types of photorefractive surgeries on cornea up to full recovery of visual and optometric parameters. Use of photoprotection during excimer laser refractive ablation allowed achieving early stabilization of vision and refraction, decreasing the duration of postoperative steroidal and nonsteroidal anti-inflammatory drugs intake by one third in average.Conclusion. Local photoprotection with riboflavin during excimer laser refractive keratectomy and photoprotection by glasses from external ultraviolet reduce the risk of oxidative stress in the cornea, postoperative aseptic inflammatory and regenerative reactions, promote stabilization of visual, optic refractive parameters and improve their predictability.

Levels of interleukin IL-6 in gingival fluid during orthodontic tooth movement: Children vs. adult

During orthodontic tooth movement comes to remodeling of periodontal ligament and alveolar bone in response to mechanical loading. Mechanical loading, which comes from the orthodontic force causes aseptic inflammatory reaction within the periodontal tissue, which, in turn, initiates the biological processes associated with bone remodeling. As one of the controllers of the process of bone remodeling, during orthodontic treatment, it is mentioned to be interleukin-6 (IL-6). IL-6 stimulates the production of osteoclasts, ie. induces bone resorption to the osteoclastogenesis. The aim of this study was to investigate the influence of patient age on the production of interleukin-6 (IL-6) during the early stages of orthodontic tooth movement Participants were 10 children (mean age 13 years) and 10 adults (mean age 20 years) in which the orthodontic separator placed between the second premolar and first molar on one side and the opposite side served as controls. Samples were taken from treated and control teeth and before 24, 72, and 168 hours of placing the separator. Level of cytokines was determined by means of enzyme-linked whales. The content of IL-6 in gingival fluid of children and adults are remarkably different, when it comes to control, and when it comes to orthodontic treated teeth. IL-6 in gingival fluid control teeth of children was significantly lower than the content of cytokines in gingival fluid control adults. However, during orthodontic treatment, the content of IL-6 in gingival fluid is remarkably increased in children than in adults, in the comparative periods, where the trend changes in the content of this cytokine was the same in children and adults. The degree of increase is higher in children than adults which shows that the immune system of children reacts more quickly to local changes and the metabolic activity of periodontal ligament higher than in adult patients.

Toll-like receptors in the inflammatory response during open and laparoscopic colectomy for colorectal cancer

Surgical interventions activate a cascade of reactions that result in an aseptic inflammatory reaction. This inflammatory response initiates the organism's innate immunity. Laparoscopic surgery reduces the trauma, and patients benefit from diminished surgical trauma and maintained immune function. Cytokine levels and C-reactive protein (CRP) are related to the magnitude of surgical trauma and surgical stress. Toll-like receptors (TLRs) 2 and 4 are the first sensor-recognition receptors of the invading pathogens for the innate immune response. This study aimed to compare the inflammatory response and then the stress response during laparoscopic and open colectomy for cancer by calculating TLR-2 and TLR-4 as the first sensor-recognition receptors together with interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high-sensitivity CRP (hsCRP). A total 40 patients with colorectal cancer were randomized in two groups: group A (open colectomy, n = 20) and group B (laparoscopic colectomy, n = 20). An epidural catheter was placed in all patients 1 h preoperatively. Rupivocaine was administered perioperatively and 48 h postoperatively. Blood samples were taken for calculation of IL-6, TNF-α, hsCRP, TLR-2, and TLR-4 preoperatively and 5 min after deflation of pneumoperitoneum (group B) or 5 min after division of the colon (group A), then 6 and 24 h postoperatively. The mean operative time was 115 for group A and 142 min for group B. The mean blood loss was respectively 240 and 105 ml (P < 0.001), and the mean hospital stay was respectively 8 and 5 days (P < 0.05). The IL-6 level was significant higher in group A than in group B at 6 and 24 h postoperatively (P < 0.0001), and the hsCRP level was significant higher in group A than in group B at 24 h postoperatively (P < 0.001). The TNF-α values did not differ between the two groups. The TLR-2 level was significantly higher in group A than in group B at 5 min (P = 0.013) and 24 h (P = 0.007) postoperatively. The TLR-4 level was significant higher in group A than in group B at 5 min postoperatively (P = 0.03). The inflammatory response and the resultant stress response are significantly less during laparoscopic colectomy than during open colectomy for colorectal cancer. This is an obvious short-term clinical benefit for the patient, providing tinder for further study to investigate the long-term results of laparoscopic colectomy versus open colectomy for colorectal cancer.

Signaling mechanisms in mirror image pain pathogenesis.

It is now clear that a peripheral nerve lesion affects contralateral non-lesioned structures, and thus such a lesion can result in mirror image pain. The pathogenesis is still not exactly known, but there are some possible signaling pathways in the contralateral reaction of the nerve tissue after unilateral nerve injury. Potential signaling pathways of contralateral changes can be generally divided into humoral and neuronal mechanisms. Damage to peripheral nerves or spinal roots produces a number of breakdown products with development of an aseptic inflammatory reaction. Released immunomodulatory cytokines are believed to be transported via blood or cerebrospinal fluid into the contralateral part of the body affecting spinal roots, dorsal root ganglia or peripheral nerves. Because neurons are elements of a highly organized network, injury to the peripheral neuron results in signals that travel transneuronally into the central nervous system and affects the contralateral homonymous neurons. There is also evidence that spinal glia creates and maintain pathological pain. Additionally, there may be compensatory changes in behavior of animals with an impact on contralateral neurons, such as altered stance and motor performance or autonomic reflex changes. Although the transneuronal signaling pathway appears to be plausible, the humoral signaling pathway or other communication systems cannot be excluded at this time. Knowledge about these processes has clinical implications for the understanding of chronic neuropathic pain states, and, therefore, further studies will be necessary. Understanding signaling mechanisms in mirror image pain pathogenesis may provide novel therapeutic targets for the management of neuropathic pain.

Acute resistance exercise results in catecholaminergic rather than hypothalamic–pituitary–adrenal axis stimulation during exercise in young men

Exercise is a paradigm of a stress situation. The adaptive response to stressors comprises the activation of the hypothalamic–pituitary–adrenal (HPA) axis and components of the autonomic sympathetic system. An aseptic inflammatory reaction is triggered by exercise, involving the stimulation of the so-called proinflammatory cytokines, such as tumor necrosis factor α (TNFα), interleukin-1 (IL-1), and IL-6. The anti-inflammatory cytokines IL-2, IL-8, and IL-10 increase moderately during resistance exercise. To investigate the effect of a short bout of resistance exercise on components of the stress and inflammatory responses during the exercise period, 17 healthy, young, untrained male volunteers were studied during 3 equal consecutive cycles of resistance exercises of 30 min total duration. Blood sampling was performed at baseline and at the end of each cycle. Lactate, cortisol, catecholamines (epinephrine, norepinephrine), IL-1α, IL-1β, IL-2, IL-6, IL-8, IL-10, epidermal growth factor (EGF), and monocyte chemotactic protein-1 (MCP-1) were measured at all time-points. Circulating levels of catecholamines and lactate increased significantly (P < 0.05) whereas cortisol did not. During the time course of the exercise, circulating levels of TNFα, IL-2, and EGF increased, whereas MCP-1 decreased significantly. IL-1α, IL-1β, IL-6, IL-8, and IL-10 levels did not change significantly. Statistically significant positive linear correlations were found between areas under the curve for increases in levels of IL-2 and TNFα, TNFα and cortisol, as well as epinephrine and norepinephrine. We conclude that acute resistance exercise results in catecholaminergic, but not HPA axis stimulation during exercise, in parallel with a mild inflammatory reaction. The absence of a major inflammatory reaction and of a cortisol increase during acute resistance exercise makes this a good candidate for the exercise of sedentary individuals.

An unusual complication of Mitek suture anchor use in primary treatment of flexor digitorum profundus tendon laceration: a case report

IntroductionA case of an osteolysis by Mitek anchor-suture is presented.Case presentationA case of index finger's flexor digitorum profundus tendon primary reconstruction with the use of Mitek anchor is presented here. Within a 14 month period, Mitek suture anchor caused local foreign body reaction with osteolysis and ulceration of the palmar skin of the finger while on the other hand tendon's healing was successfully completed.ConclusionMitek anchor-sutures can cause an aseptic inflammatory reaction which represents a typical biologic response to a foreign body. Concomitant osteolysis can drive to loosening and migration of the implant.