Contralateral Site Research Articles

Quantitative validation of sensory mapping in persistent postherniorrhaphy inguinal pain patients undergoing triple neurectomy.

Neurectomy of the inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy inguinal pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique. Longitudinal (preoperative, immediate postoperative, and late postoperative) dermatomal sensory mapping and a comprehensive QST protocol were conducted in CPIP patients with unilateral, predominantly neuropathic inguinodynia presenting for triple neurectomy (n=13). QST was conducted in four areas on the affected, painful side and in one contralateral comparison site. QST variables were compared according to sensory mapping outcomes: (o)/normal sensation, (+)/pain, and (-)/numbness. Diagnostic ability of the sensory mapping outcomes to detect QST-assessed allodynia or hypoesthesia was estimated through calculation of specificity and sensitivity values. Preoperatively, patients exhibited mechanical hypoesthesia and allodynia and pressure allodynia and hyperalgesia in painful areas mapped (+) (p<.05); sensory mapping outcome (+) demonstrated high ability to detect mechanical allodynia [sensitivity 0.74 (95% CI 0.61-0.86), specificity 0.94 (0.84-1.00)] and pressure allodynia [sensitivity 0.96 (0.89-1.00), specificity 1.00 (1.00-1.00)], but not thermal allodynia. Postoperatively, mapped areas of numbness (-) were associated with mechanical and thermal hypoesthesia (p<.05); (-) showed high sensitivity and specificity to detect mechanical and cold hypoesthesia. Sensory mapping provides an accurate clinical neuropathic assessment with strong correlation to QST findings of preoperative mechanical and pressure allodynia, and postoperative mechanical and thermal hypoesthesia in CPIP patients undergoing neurectomy.

In vivo Evaluation of Zirconia Abutments in Implant supported Restorations in Partially Edentulous Patients

ABSTRACTDental implants have been a universally accepted option for prosthetic rehabilitation of partially edentulous patients. Titanium implants abutments exhibit a dull grayish hue and give an unnatural appearance. Abutments based on zirconia are one of the alternatives to titanium abutments. To date, few comparative studies have reported on esthetic and biological outcomes of implant-supported restorations with zirconia abutments.PurposeTo clinically evaluate the esthetic performance of zirconia abutments in implant-supported restorations.Materials and methodsA total of 24 anterior implant sites were chosen for the placement of implants. A delayed loading protocol was followed; 12 zirconia abutments were placed along with 12 titanium abutments in the contralateral sites. Biological and esthetic variables were recorded by a periodontist and prosthodontist. The patients were followed 2 weeks, 1, 3, and 6 months postinsertion.ResultsAll the data for Copenhagen index score and visual analog scale scores were evaluated by the prosthodontist at follow-up appointments; the means were tabulated. The data were statistically analyzed using Statistical Package for the Social Sciences software utilizing paired t-test; p value was found to be significant for all parameters except distal papilla and symmetry, which showed p = 0.257 and p = 0.110 respectively.ConclusionAccording to the results of this study, esthetic performances of zirconia abutment in implant-supported restorations were determined to be higher than those values associated with titanium abutments.How to cite this articleKapri A, Gupta A, Joshi S. In vivo Evaluation of Zirconia Abutments in Implant supported Restorations in Partially Edentulous Patients. J Contemp Dent 2017;7(1):35-42.

Changes in Tear Film Characteristics in Patients With Idiopathic Dacryoadenitis.

To evaluate the tear-film meniscus with optical coherence tomography (OCT) in patients with idiopathic dacryoadenitis and to determine its relationships with the clinical tests. Sixteen patients with unilateral idiopathic dacryoadenitis were included in the study. Patients with idiopathic dacryoadenitis with affected sites (group 1), with contralateral sites (group 2) and healthy participants (group 3) completed the ocular surface disease index before optical coherence tomography determination of tear meniscus height and tear meniscus area. These were followed by measurements of tear breakup time, fluorescein staining, and Schirmer test. Finally, surgical debulking or incisional biopsies were conducted. Tear meniscus height and tear meniscus area were the lowest in patients with affected sites (group 1) among the 3 groups (p < 0.05). Breakup time was the shortest in group 1 (p < 0.05). In the group 1, breakup time, fluorescein staining score, and histopathological phases were significantly correlated with tear meniscus height and tear meniscus area (p < 0.05). Tear function was significantly disturbed in idiopathic dacryoadenitis. Tear menisci volumes measured by optical coherence tomography may assess the tearing function in patients with idiopathic dacryoadenitis.

An evaluation of field cancerization in patients with oral cancer by “Mirror Image” biopsy

Aim: The present study was conducted with the aim to define the incidence and type of field change in clinically apparent normal mucosa of new patients with unilateral oral squamous cell carcinoma (OSCC). Materials and Methods: Biopsy was carried out from clinically apparent normal oral mucosa on the contralateral site (mirror image site) in 38 consecutive newly diagnosed patients with unilateral OSCC. The mirror image tissue was analyzed histologically for abnormal features of dysplasia by two oral pathologists. Results: According to observer 1, 22 (57.89%) mirror image biopsies showed dysplasia of which 19 (50%) mirror image biopsies showed mild dysplasia and 3 (7.89%) mirror image biopsies showed moderate dysplasia. According to observer 2, 17 (44.74%) mirror image biopsies showed dysplasia of which 16 (42.11%) mirror image biopsies showed mild dysplasia and 1 (2.63%) mirror image biopsy showed moderate dysplasia. Conclusions: Histological observation of dysplasia at mirror image site was noted in about half of a sample of cases. Results displayed vulnerability to field change of oral mucosa chronically exposed to carcinogens. It acknowledges the risk for development of second or multiple primary tumors.

Periodontal and endodontic pathology delays extraction socket healing in a canine model.

PurposeThe aim of the present exploratory study was to evaluate extraction socket healing at sites with a history of periodontal and endodontic pathology.MethodsThe mandibular 4th premolar teeth in 5 adult beagle dogs served as experimental units. Periodontal and endodontic lesions were induced in 1 premolar site in each animal using wire ligatures and pulpal exposure over 3 months (diseased sites). The contralateral premolar sites served as healthy controls. The mandibular 4th premolar teeth were then extracted with minimal trauma, followed by careful wound debridement. The animals were sacrificed at days 1, 7, 30, 60, and 90 post-extraction for analysis, and the healing patterns at the healthy and diseased extraction sites were compared using radiography, scanning electron microscopy, histology, and histometry.ResultsDuring the first 7 days of healing, a significant presence of inflammatory granulation tissue was noted at the diseased sites (day 1), along with a slightly accelerated rate of fibrin clot resolution on day 7. On day 30, the diseased extraction sites showed a greater percentage of persistent fibrous connective tissue, and an absence of bone marrow formation. In contrast, healthy sites showed initial signs of bone marrow formation on day 30, and subsequently a significantly greater proportion of mature bone marrow formation on both days 60 and 90. Radiographs exhibited sclerotic changes adjoining apical endodontic lesions, with scanning electron microscopy showing collapsed Volkmann canals protruding from these regions in the diseased sites. Furthermore, periodontal ligament fibers exhibited a parallel orientation to the alveolar walls of the diseased sites, in contrast to a perpendicular arrangement in the healthy sites.ConclusionsWithin the limitations of this study, it appears that a history of periodontal and endodontic pathology may critically affect bone formation and maturation, leading to delayed and compromised extraction socket healing.

Comparison of the pain-relieving effects of transcutaneous electrical nerve stimulation applied at the same dermatome levels as the site of pain in the wrist joint.

[Purpose] The purpose of this study was to develop a proposal for an effective interventional option for therapeutic stimulation sites by comparing the pain-relieving effect of transcutaneous electrical nerve stimulation (TENS) applied to the same dermatome level of the contralateral sites of the dorsal wrist joint with the pain or the neck, or both sites simultaneously. [Subjects and Methods] A control was first established by triggering pain in the left dorsal wrist joints of adult females by using heat stimulation. Three interventions were then performed, comprising the TENS to the contralateral wrist joint (CW) and to the neck (N) at the same dermatome level as the site of pain, and the TENS to both CW and N simultaneously (CWN). Levels of pain and cerebral blood flow were also measured. [Results] The pain levels of three interventions were found to be significantly decreased compared with the control; however, no significant differences in the levels of pain were seen between any combinations of three interventions. Furthermore, no significant differences were seen between any interventions in terms of cerebral blood flow. [Conclusion] The results suggest that in order for TENS to be effective, it is necessary to make effective use of the dermatome.

Bleeding on probing around dental implants: a retrospective study of associated factors.

To (i) identify factors associated with the probability of a peri-implant site to be positive to bleeding on probing (BoP+) and (ii) compare BoP+ probability around dental implants and contra-lateral teeth. In 112 patients, data related to 1725 peri-implant sites and 1020 contra-lateral dental sites were retrospectively obtained. To analyse the association between patient-, implant- and site-related factors and BoP+ probability, a logistic, three-level model was built with BoP as the binary outcome variable (+/-). BoP+ probability for a peri-implant site with probing depth (PD) of 4mm was 27%, and the odds ratio increased by 1.6 for each 1-mm increment in PD (p<0.001). Also, BoP+ probability was higher in females compared to males (OR=1.61; p=0.048), and lower at posterior compared to anterior dental implants (OR=0.55; p<0.01). No significant difference in BoP+ probability was observed between peri-implant and contra-lateral dental sites when controlling for the difference in PD. The probability of a peri-implant site to bleed upon probing is (i) associated with PD, implant position and gender, and (ii) similar to that observed at contra-lateral dental sites when controlling for the effect of PD.

Thermal symmetry of healthy feet: a precursor to a thermal study of diabetic feet prior to skin breakdown

Early identification of areas of inflammation may aid prevention of diabetic foot ulcers. A new bespoke thermal camera system has been developed to thermally image feet at risk. Hotspots (areas at least 2.2 °C hotter than the contralateral site) may indicate areas of inflammation prior to any apparent visual signs. This article describes the thermal pattern and symmetry of 103 healthy pairs of feet. 68% of participants were thermally symmetric at the 33 foot sites measured. 32% of participants had at least one hotspot, but hotspots overall only accounted for 5% of the measurements made. Refinements to the definition of hotspots are proposed when considering feet at risk of ulceration.

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

ObjectiveTo determine the prevalence and correlation of various risk factors [radiation dose, periodontal status, alcohol and smoking] to the development of osteoradionecrosis (ORN). Patients and methodsThe records of 1023 patients treated with IMRT for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) between 2004 and 2013 were retrospectively reviewed to identify patients who developed ORN. Fisher exact tests were used to analyze patient characteristics between ORN patients with OCC and OPC. Paired Wilcoxon tests were used to compare the dose volumes to the ORN and contralateral non-ORN sites. To evaluate an association between ORN and risk factors, a case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by gender, tumor site and size. General estimation equations models were used to compare the risk factors in ORN cases and matched controls. Results44 (4.3%) patients developed ORN during a median follow-up time of 52.5months. In 82% of patients, ORN occurred spontaneously. Patients with OPC are prone to develop ORN earlier compared to patients with OCC (P=0.03). OPC patients received a higher Dmax compared to OCC patients (P=0.01). In the matched case-control analysis the significant risk factors on univariate analysis were poor periodontal status, history of alcohol use and radiation dose (P=0.03, 0.002 and 0.009, respectively) and on multivariate analysis were alcohol use and radiation dose (P=0.004 and 0.026, respectively). ConclusionIn our study, higher radiation dose, poor periodontal status and alcohol use are significantly related to the risk of developing ORN.

Periodontal Conditions of Sites Treated With Gingival Augmentation Surgery Compared With Untreated Contralateral Homologous Sites: An 18- to 35-Year Long-Term Study.

The aim of this split-mouth study is to compare long-term (18 to 35 years) periodontal conditions of sites treated with gingival augmentation procedures (GAPs) and untreated homologous contralateral sites. Forty-seven patients with 64 sites (test group), with lack of attached gingiva associated with recessions, were treated with marginal or submarginal free gingival grafts. Sixty-four contralateral homologous sites (control group), with or without gingival recession (GR) and with attached gingiva, were left untreated. Patients were recalled every 4 to 6 months during follow-up period. GR depth, keratinized tissue (KT) width, and probing depth were measured at baseline (T0), 1 year after surgery (T1), during follow-up (10 to 27 years, T2), and at the end of the follow-up period (18 to 35 years, T3). Multilevel and regression analyses were conducted. At the end of T3, 83% of the 64 treated sites showed recession reduction (RecRed), whereas 48% of the 64 untreated sites experienced increase in recession. Treated sites ended with gingival margin (GM) 1.7 mm (P = 0.01) more coronal and KT 3.3 mm (P <0.001) wider than untreated sites. In grafted sites, KT at T3 remained stable compared with T1 value (4.1 mm, P <0.001). Sites treated with GAPs resulted in coronal displacement of GM with RecRed up to complete root coverage, whereas contralateral untreated sites showed a tendency to increase in existing recession or develop new recession during the 18- to 35-year follow-up.

Dexamethasone inhibits endotoxin‐induced coagulopathy in human lungs

Essentials Glucocorticoids are associated with an increased risk of thrombosis.Healthy volunteers received dexamethasone or placebo in an endotoxin lung instillation model.Dexamethasone suppressed thrombin generation in bronchoalveolar lavage.Glucocorticoids inhibit endotoxin induced pulmonary coagulopathy. SummaryBackgroundActivation of local and systemic coagulation is a common finding in patients with pneumonia. There is evidence that glucocorticoids have procoagulant activity in the circulation, particularly in the context of inflammation. The effects of glucocorticoids on local pulmonary coagulation have not yet been investigated.ObjectiveTo use a human model of lung inflammation based on the local instillation of endotoxin in order to investigate whether glucocorticoids alter pulmonary coagulation.MethodsTwenty‐four healthy volunteers were randomized to receive either dexamethasone or placebo in a double‐blind trial. Endotoxin was instilled via bronchoscope into right or left lung segments, followed by saline into the contralateral site. Six hours later, a bilateral bronchoalveolar lavage (BAL) was performed and coagulation parameters were measured.ResultsEndotoxin induced activation of coagulation in the bronchoalveolar compartment: the level of prothrombin fragment 1 + 2 (F1 + 2) was increased three‐fold (248 pmol L−1, 95% confidence interval [CI] 43–454 versus 743 pmol L−1, 95% CI 437–1050) and the level of thrombin–antithrombin complex (TATc) was increased by ~ 50% (31 μg L−1, 95% CI 18–45 versus 49 μg L−1, 95% CI 36–61) as compared with saline‐challenged segments. Dexamethasone reduced F1 + 2 (284 pmol L−1, 95% CI 34–534) and TATc (9 μg L−1, 95% CI 0.7–17) levels almost to those measured in BAL fluid from the saline‐instilled segments in the placebo group. Dexamethasone even profoundly reduced F1 + 2 levels (80%) in saline‐instilled lung segments (50 pmol L−1, 95% CI 12–87). In contrast, dexamethasone had no effect on systemic F1 + 2 levels.ConclusionsDexamethasone inhibits endotoxin‐induced coagulopathy in lungs. This trial is the first to provide insights into the effects of glucocorticoids on pulmonary coagulation in response to endotoxin.

Site and incidence of birth canal lacerations from instrumental delivery with mediolateral episiotomy

ObjectiveInstrument-assisted vaginal delivery is a significant risk factor for birth canal lacerations. Although many obstetricians recently are recommending restrictive rather than a routine episiotomy, reports have shown restrictive episiotomy to be associated with more extensive anterior birth canal trauma compared with routine episiotomy. Materials and MethodsWe retrospectively reviewed 110 cases of forceps and vacuum deliveries and investigated the site of birth canal lacerations. Birth canal lacerations were divided into four sites according to direction—anterior, ipsilateral, contralateral, and posterior. ResultsThe frequency of lacerations were, from most to least, posterior (34%), lateral (21.7%), and anterior (1.9%). Moreover, among the lateral lacerations, they were more frequent in the contralateral side of episiotomy than the ipsilateral side (18.9% vs. 4.7%, p < 0.01). ConclusionOur results indicate that caution is also needed concerning not only the anterior site, but also the contralateral site of an episiotomy to prevent laceration in an instrument-assisted vaginal delivery.

Preservation of extraction socket in immediate implant placement: a clinical study.

The objective of this study was to compare different approaches temporary restoration in an immediate implant placement. To determine the respective influence of each parameter, two treatment groups were formed; a strict and standardized study protocol was applied to minimize the influence of bias and confounding factors. The Pink Esthetic Score (PES) - the esthetic out-come of soft tissue appearance was evaluated. Sixteen patients with a single failing tooth in the maxilla and a natural contralateral site were randomly distributed into two groups. Treatment variations affected the provisional restorative in detail, group 1 with immediate implant placement and immediate temporary restoration with the simulation of the first three mm of the root and the seal of the socket, group 2 with immediate implant placement and immediate temporary restoration without the seal of the socket. All patients received the final prosthetic restoration 10-12 weeks after implant placement. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES. The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 1), 6.62 (SD 3.24, group 2). The differences between groups 1 and 2 and were statistically significant (P=0.015 and P=0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity. Immediate implant placement and restoration appear to be a suitable alternative to early implant placement if an experienced surgeon is entrusted with the implantation procedure.

Lower limb ischemia caused by resuscitative balloon occlusion of aorta.

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure to manage severe hemorrhagic shock from torso injury but can cause severe ischemia of the lower extremities. However, lower extremity ischemia occurring as a complication of REBOA has been rarely reported. We describe the severe lower extremity ischemia caused by REBOA with a 12-Fr sheath in a small-built patient.Case representationThe patient was a 16-year-old male who developed severe hemorrhagic shock due to abdominal blunt trauma. Following REBOA with a 12-Fr sheath on the right femoral artery, an emergency laparotomy and angiography to control the hemorrhage were performed. Twenty-eight hours after admission, suspecting lower extremity ischemia and compartment syndrome, we removed the sheath with a manual maneuver and performed fasciotomy. The limb ischemia was thus partially resolved. However, amputation was necessary because of ischemic necrosis on day 32. Our patient was physically small, and the diameter of his femoral artery on the contralateral site of sheath placement was also small. Therefore, disproportion of the sheath and femoral artery sizes may have caused the ischemic complication.ConclusionOur experience highlights the importance of appropriate size selection for the sheath in line with the target vessel. We also recommend postoperative monitoring of limb perfusion in such cases with the use of near-infrared spectroscopy to facilitate the early detection of ischemia.

Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases.

Background: The aim of this study was the evaluation of the clinical success and complication rates associated with autologous bone grafts harvested from the mandibular ramus for alveolar ridge augmentation and the identification of possible risk factors for graft failure. Methods: In a consecutive retrospective study 86 patients could be included. In these patients a total of 104 bone grafts from the mandibular ramus were harvested for alveolar ridge augmentation. Medical history, age of patient, smoking status, periodontal status and complications were recorded. The need for bone grafting was defined by the impossibility of installing dental implants of adequate length or diameter to fulfill prosthetic requirements, or for aesthetic reasons. The surgical outcome was evaluated concerning complications at the donor or at the recipient site, risk factors associated with the complications and graft survival. All patients were treated using a two-stage technique. In the first operation bone blocks harvested from the retromolar region were placed as lateral or vertical onlay grafts using augmentation templates and were fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After a healing period of 3–5 months computed tomography scans were performed followed by virtual implant planning and the implants were inserted using guided dental implantation. Results: 97 of the 104 onlay bone grafts were successful. In only 7 patients a graft failure occurred after a postsurgical complication. No long-term nerve damage occurred. Postoperative nerve disturbances were reported by 11 patients and had temporary character only. After the healing period between 4 to 5 months, 155 implants were placed (39 in the maxilla, 116 in the mandible). A final rehabilitation with dental implants was possible in 82 of the 86 patients. Except the 7 graft failures, all recorded complications were minor complications which could be easily treated successfully without any long-term problems. Complications at the donor site were recorded in 3 patients and 17 patients experienced complications at the recipient site. Three of 7 patients with graft failure, were secondarily augmented with a new retromolar graft, harvested from the contra-lateral site and dental implants could be successfully inserted later. No association between complications and smoking habit, age of patient, jaw area, and dental situation (tooth gap or free dental arch) could be detected. Conclusions: Retromolar bone grafts are an effective and safe method for the reconstruction of small- to medium-sized alveolar defects of the maxilla and mandible prior to dental implantation and show a low graft failure rate.

EP 19. Quantitative EMG analysis of nerve regeneration after reconstruction of the facial nerve by hypoglossal-facial nerve jump anastomosis

Introduction Although electromyography (EMG) provides accurate information of the reinnervation of muscles, there are almost no quantitative data, that would describe this process in the facial muscles after a reconstruction of the facial nerve. Using the example of reinnervation surgery of the facial nerve quantitative data are presented here for the first time. Materials and methods Needle-EMG data of 11 patients with a hypoglossal-facial nerve jump anastomosis (HFJA) were retrospectively evaluated. The main object of the quantitative measurements were 3 EMG-parameters of the motor unit action potentials (MUAP): amplitude, duration, polyphasia. Contralateral healthy sites of the faces of six patients were evaluated on the same principles as at the patients for the purpose of control. These data were correlated with the Stennert-index of the patients, that was simultaneously assessed with the needle EMG-evaluation. Results A total of 1025 action potentials of 308 motor units were measured. The amplitudes of the MUAPs showed a steady increase of the amplitudes and in the extension of the duration of the amplitudes over 2 years in the course of regeneration after HFJA. The duration rose clearly earlier than the height of the amplitude. There was a significant correlation between height of the amplitudes and the Stennert index. An improvement in the Stennert index by one point corresponded to an increase in the height of an amplitude to 112.793 microvolts ( p = 0.001). A subanalysis of the Stennert index during mimic movements and the Stennert index at rest showed, that Stennert index at rest correlated stronger ( r = 139,8; p = 0.002) with the increase of the amplitude than Stennert index during movements ( r = 57,0; p = 0.323). Conclusions The increase in the height of the amplitude appears to be the most powerful indicator of an improvement of the clinical condition. In order to assess the progress of a facial nerve reinnervation, both the increase in the amplitude, but also the duration can be used. The reinnervation can last clinically and electrophysiologically up to two years after surgery. This is important for the planning of a further rehabilitation as well as for a patient education.

The skin microbiome in allergen-induced canine atopic dermatitis.

Studies focusing on next-generation sequencing of the bacterial 16S rRNA gene have allowed detailed surveys of skin bacterial populations (microbiota) of the skin. This study evaluated temporal changes in the skin microbiota in a canine model of atopic dermatitis. Eight atopic dogs previously sensitized with house dust mites (HDM). The dogs were topically challenged on the right groin with HDM allergens. Swabs were collected from the challenged and the contralateral nonchallenged sites prior to provocation (pre-challenge; baseline sample) and on days 1, 7, 14, 21 and 28 after allergen challenge. The 16S rRNA gene was amplified, sequenced and analysed. Staphylococcus spp. and Staphylococcus pseudintermedius were quantified with quantitative PCR (RT-qPCR). Skin lesions developed in all dogs on the challenged sites. Differences in bacterial groups were observed on the challenged site over time. Relatively lower abundances of Fusobacteriaceae on Day 7, and, based on LEfSe, increased abundances of Corynebacteriaceae on Day 1, and Staphylococcaceae on days 7, 14 and 21, were observed on the challenged site, compared to the contralateral site. Results of RT-qPCR correlated with those of next-generation sequencing, with significantly increased numbers of Staphylococcus spp. and S. pseudintermedius on Day 21, and days 7 and 21 on the challenged site compared to the contralateral site, respectively. This study demonstrates that an allergen challenge in sensitized dogs leads to bacterial dysbiosis with increased abundance of S. pseudintermedius at the site of lesion induction.

Effectiveness of minocycline in acute white matter injury after intracerebral hemorrhage.

OBJECTIVE Intracerebral hemorrhage (ICH) is a fatal disease with high morbidity and mortality, which may be followed by white matter injury (WMI) due to the local oxidizing reaction induced by iron (Fe). In this study, the authors examined the effect of the tetracycline antibiotic minocycline on Fe-induced WMI and c-Jun N-terminal kinase (JNK) activation in rats. METHODS Thirty-six male Sprague-Dawley rats underwent an intracaudate injection of saline, Fe, or Fe + minocycline. Another 36 rats had an intracaudate injection of autologous blood and were treated with minocycline or vehicle (saline). Biomarkers of both WMI and JNK activation were examined. RESULTS In the Fe-injection group, minocycline suppressed WMI labeled by β-amyloid precursor protein (β-APP) and degraded myelin basic protein (dMBP)/MBP ratio. Protein levels of phosphorylated-JNK were increased after Fe injection, and could be suppressed by minocycline treatment. In the autologous blood-injection group, β-APP and dMBP/MBP levels increased in the ipsilateral site compared with the contralateral site, which could be suppressed by 7 days of minocycline intervention. CONCLUSIONS Iron plays a critical role in WMI after ICH, which can be suppressed by minocycline through reducing the damage induced by Fe.

Microvascular Response in Patients with Complex Regional Pain Syndrome as Measured by Laser Doppler Imaging.

ObjectivesOur aim was to investigate the hypothesis that microvascular dysfunction occurs in patients with CRPS. Specifically, whether there were functional differences in either deeper cutaneous blood vessels or more superficial nutritive vessels between the affected and unaffected limb in patients with CRPS, and between CRPS patients and healthy control subjects.MethodsTwenty‐two patients with CRPS (five male; mean age 45 years; eight upper limb involvement, 14 lower limb) and 23 healthy control subjects (one male; 43 years) were recruited. Microvascular flow at affected and unaffected contralateral sites was measured, following local heating, using laser Doppler imaging (red/green wavelengths). Corresponding sites were imaged in healthy controls. Maximum flux level and area under the curve (first 20 scans, AUC20) were measured.ResultsVasodilator responses to heat were similar in affected and unaffected limbs, and in healthy controls. For example, median (IQR) “red” AUC20 in CRPS was 138.6 (120.0–152.9)% change from baseline in affected limb and 135.0 (120.7–166.8)% in unaffected limb, and (in healthy controls) 133.1 (117.2–145.9)% and 139.1% (126.0–162.1) in limb 1 and 2.ConclusionsWe found no impairment of vasodilation in cutaneous microvessels in CRPS. The vasomotor changes in CRPS may relate to larger vessel dysfunction.

Biomechanical properties of infantile hemangiomas: clinical stage and effect of age.

Infantile hemangiomas (IHs) are benign vascular neoplasms with rapid capillary proliferation shortly after birth and slow involution with diminishing capillary proliferative activity, fibrosis, and fatty replacement over 7-10 years. Hemangiomas and contralateral control sites in 88 subjects were measured using a suction device, 6-mm probe and 200 mbar negative pressure. Mechanical properties were assessed vs. controls and effects of body site, depth, clinical stage, histology diagnosis, and time. Biological elasticity, overall elasticity, net elasticity, total recovery, and elastic recovery were lower for IH vs. controls (P < 0.001). IH total deformation, elastic deformation, viscoelastic creep, and residual deformation were higher than controls (P < 0.001). Involuting IHs had lower viscoelasticity than proliferating and stable lesions (P < 0.001) and lower viscoelastic creep than stable IHs (P = 0.04). IH viscoelasticity was higher at 2.3 than 12.9, 23.7, and 61.0 months and at 4.9 and 8.1 than 61.0 months. IH elastic recovery varied by body site with larger differences vs. control for abdomen and leg. Elastic recovery differences from control were smaller at younger vs. older ages. Measurement of biomechanical properties may be useful to characterize IH progression and treatment response in clinical settings.