Edema In Group Research Articles

Cerebrospinal fluid markers of neuroinflammation and coagulation in severe cerebral edema and chronic hydrocephalus after subarachnoid hemorrhage: a prospective study

BackgroundEarly severe cerebral edema and chronic hydrocephalus are the primary cause of poor prognosis in patients with subarachnoid hemorrhage (SAH). This study investigated the role of cerebrospinal fluid (CSF) inflammatory cytokines and coagulation factors in the development of severe cerebral edema and chronic hydrocephalus in patients with SAH.MethodsPatients with SAH enrolled in this study were categorized into mild and severe cerebral edema groups based on the Subarachnoid Hemorrhage Early Brain Edema Score at admission. During long-term follow-up, patients were further classified into hydrocephalus and non-hydrocephalus groups. CSF samples were collected within 48 h post-SAH, and levels of inflammatory cytokines and coagulation factors were measured. Univariate and multivariate logistic regression analyses were performed to identify independent factors associated with severe cerebral edema and chronic hydrocephalus. The correlation between inflammatory cytokines and coagulation factors was further investigated and validated in a mouse model of SAH.ResultsSeventy-two patients were enrolled in the study. Factors from the extrinsic coagulation pathway and inflammatory cytokines were associated with both severe cerebral edema and chronic hydrocephalus. Coagulation products thrombin-antithrombin complexes (TAT) and fibrin, as well as inflammatory cytokines IL-1β, IL-2, IL-5, IL-7, and IL-4, were independently associated with severe cerebral edema. Additionally, Factor VII, fibrin, IL-2, IL-5, IL-12, TNF-α, and CCL-4 were independently associated with chronic hydrocephalus. A positive correlation between extrinsic coagulation factors and inflammatory cytokines was observed. In the SAH mouse model, tissue plasminogen activator was shown to alleviate neuroinflammation and cerebral edema, potentially by restoring glymphatic-meningeal lymphatic function.ConclusionsElevated levels of inflammatory cytokines and extrinsic coagulation pathway factors in the CSF are associated with the development of early severe cerebral edema and chronic hydrocephalus following SAH. These factors are interrelated and may contribute to post-SAH glymphatic-meningeal lymphatic dysfunction.

Optical coherence tomography angiography for microaneurysms in anti-vascular endothelial growth factor treated diabetic macular edema

BackgroundWe aimed to evaluate microaneurysms (MAs) after treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy to understand causes of chronic edema and anti-VEGF resistance.MethodsPatients with non-proliferative diabetic retinopathy, with or without macular edema were recruited. Optical coherence tomography angiography (OCTA) MAs-related parameters were observed, including the maximum diameter of overall dimensions, material presence, and flow signal within the lumen. OCTA parameters also included central macular thickness (CMT), foveal avascular zone, superficial and deep capillary plexuses, and non-flow area measurements on the superficial retinal slab.ResultsOverall, 48 eyes from 43 patients were evaluated. CMT differed significantly between the diabetic macular edema (DME ) and non-DME (NDME) groups at 1st, 2nd, 3rd, and 6th months of follow-up (P < 0.001; <0.001; 0.003; <0.001, respectively). A total of 55 and 59 MAs were observed in the DME (mean = 99.40 ± 3.18 μm) and NDME (mean maximum diameter = 74.70 ± 2.86 μm) groups at baseline, respectively (significant between-group difference: P < 0.001). Blood flow signal was measurable for 46 (83.6%) and 34 (59.3%) eyes in the DME and NDME groups, respectively (significant between-group difference: P < 0.001).ConclusionsCompared to the NDME group, the DME group had larger MAs and a higher blood-flow signal ratio. Following anti-VEGF therapy, changes in the diameter of MAs were observed before changes in CMT thickness.Graphical

P223 BENEFICIAL EFFECT OF ACEI/ARB, BETABLOCKER AND MINERALOCORTICOID RECEPTOR ANTAGONIST IN PATIENTS WITH RECURRENT FLASH PULMONARY EDEMA INITIATED ON HEMODIALYSIS FOR END STAGE RENAL FAILURE

Background and Objectives: Recurrent flash pulmonary edema is a rare manifestation of ESRF commencing hemodialysis, necessitating more frequent dialysis. Recurrent flash pulmonary edema is seen in renal artery stenosis and rarely in chronic kidney disease. Objective of the study is look for any possible contributory factors for recurrent flash pulmonary edema in patients with ESRF initiated on hemodialysis; and the potential role of ACEI/ARB, β blockers and MRA in controlling episodes of flash pulmonary edema. Methods: All patients initiated on hemodialysis from January 2020 to December 2023 were studied in detail; including ECHO cardiography and renal ultrasound doppler. Patient were divided in to 2 groups based on absence or presence of recurrent flash pulmonary edema (Group A and Group B).Group B further divided in to Group C and D. Group C were treated with ACEI/ARB, β blocker and MRA in addition to nitroglycerine infusion and hemodialysis. Group D were given usual anti hypertensives nitroglycerine infusion and hemodialysis as per requirement. Group C and D were followed up for 2 months and evaluated for the final out come. Results: 238 patients were initiated on hemodialysis during the period of 3 years. 18 patients (7.56%) presented with recurrent flash pulmonary edema (Group B) and 220 patients (92.44%) comprised Group A. Patients in Group B had more severe LVH, left ventricular diastolic dysfunction (LVDD) PAH and accelerated hypertension. None of the patients had renal artery stenosis. At the end of 2 months patients in Group C (9 patients) were free from recurrent flash pulmonary edema compared to Group D (9 patients) Conclusions: Recurrent flash pulmonary edema is a rare manifestation of ESRF. Renal artery stenosis was not seen in our patients. LVH, LVDD due to uremic cardiomyopathy and accelerated hypertension due to RAAS activation may be the contributory factors. Treatment with ACEI/ARB, β blockers and MRA may help in controlling episodes of flash pulmonary edema.

Can optic disc vessel density help in cases of residual disc elevation after shunt surgery in cases of idiopathic intracranial hypertension?

AimTo detect if we can use the reduction in the optic disc vessel density as an indicator to the reduction in intracranial tension in patients with residual optic disc elevation after shunt surgery as fundus examination in those cases is not conclusive.Patients and method21 patients with papilledema due to idiopathic intracranial hypertension underwent shunt surgery. Full neurological and ophthalmological assessments were done. The optic disc vessel density was measured before and 3 months after surgery. Patients were then divided according to the resolution of papilledema into 2 groups: 1) Residual disc elevation group. 2) Completely resolved disc edema group. CSF pressure was measured via lumber puncture preoperative for all patients and 3 months post-operative only for patients with residual disc edema. A comparison between both groups was done.ResultsThere was a highly statistically significant difference between the two groups as regard the papilledema grade (the residual disc elevation group had a higher grade of papilledema) with P-value=0.000. As regard the difference in the preoperative optic disc vessel density between the two groups, there were statistically significant differences (optic disc vessel density was more in the residual disc elevation group). As regard the postoperative optic disc vessel density, there were non-significant differences between the two groups in whole image, inside disc and peripapillary vessel density (either in macro or microvasculature).ConclusionThe optic disc vessel density decreased with normal postoperative CSF opening pressure in cases with residual disc elevation postoperatively. Thus, in cases of residual optic disc swelling after shunt surgery, we can detect the reduction of intracranial pressure by the reduction in the optic disc vessel density which is a safe non-invasive technique. That may help in cases of residual disc elevation.

Multiparametric prenatal imaging characterization of fetal brain edema in Chiari II malformation might help to select candidates for fetal surgery

ObjectiveTo identify brain edema in fetuses with Chiari II malformation using a multiparametric approach including structural T2-weighted, diffusion tensor imaging (DTI) metrics, and MRI-based radiomics.MethodsA single-center retrospective review of MRI scans obtained in fetuses with Chiari II was performed. Brain edema cases were radiologically identified using the following MR criteria: brain parenchymal T2 prolongation, blurring of lamination, and effacement of external CSF spaces. Fractional anisotropy (FA) values were calculated from regions of interest (ROI), including hemispheric parenchyma, internal capsule, and corticospinal tract, and compared group-wise. After 1:1 age matching and manual single-slice 2D segmentation of the fetal brain parenchyma using ITK-Snap, radiomics features were extracted using pyradiomics. Areas under the curve (AUCs) of the features regarding discriminating subgroups were calculated.ResultsNinety-one fetuses with Chiari II underwent a total of 101 MRI scans at a median gestational age of 24.4 weeks and were included. Fifty scans were visually classified as Chiari II with brain edema group and showed significantly reduced external CSF spaces compared to the nonedema group (9.8 vs. 18.3 mm, p < 0.001). FA values of all used ROIs were elevated in the edema group (p < 0.001 for all ROIs). The 10 most important radiomics features showed an AUC of 0.81 (95%CI: 0.71, 0.91) for discriminating between Chiari II fetuses with and without edema.ConclusionsBrain edema in fetuses with Chiari II is common and radiologically detectable on T2-weighted fetal MRI sequences, and DTI-based FA values and radiomics features provide further evidence of microstructure differences between subgroups with and without edema.Clinical relevance statementA more severe phenotype of fetuses with Chiari II malformation is characterized by prenatal brain edema and more postnatal clinical morbidity and disability. Fetal brain edema is a promising prenatal MR imaging biomarker candidate for optimizing the risk-benefit evaluation of selection for fetal surgery.Key PointsBrain edema of fetuses prenatally diagnosed with Chiari II malformation is a common, so far unknown, association.DTI metrics and radiomics confirm microstructural differences between the brains of Chiari II fetuses with and without edema.Fetal brain edema may explain worse motor outcomes in this Chiari II subgroup, who may substantially benefit from fetal surgery.Graphical

One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13

ABSTRACT Purpose To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. Methods In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. Results 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (p = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (p = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (p = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (p > .05). The groups had no significant difference in mean CMT at month 12 (p = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (p = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (p = 0,014 and p = 0,017). Conclusions In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, better anatomical improvement was achieved in Group 4 than in the other DME groups.

Effects of therapeutic hypercapnia on the expression and function of γδT cells in transplanted lungs in rats.

To investigate the effect of therapeutic hypercapnia on the expression and function of gamma delta T (γδ T) cells during ischemia-reperfusion injury (IRI) after lung transplantation. We randomly divided male Wistar rats into three groups (n = 6 in each group), the control group (group N), the IRI group (group I), and the therapeutic hypercapnia group (group H). We then assessed pulmonary edema, neutrophil infiltration, wet-to-dry (W/D) weight ratio, and microscopic histopathology and separately measured the levels of γδT cell surface antigen (TCR) and Interleukin-17 (IL-17) using flow cytometry and enzyme-linked immunosorbent assays (ELISAs). The infiltration of neutrophils and the expression of TCR and IL-17 were significantly increased in the I group compared to the control, and the biopsy edema in group I was more severe. Arterial partial pressure of oxygen (PaO2) was decreased after reperfusion in group I compared with the control group. W/D weight ratio, neutrophil infiltration, and the expression of TCR and IL-17 decreased drastically in the H group compared to the I group. Our findings suggest that γδ T lymphocytes were directly involved in lung injury. In addition, therapeutic hypercapnia effectively reduced the expression of γδ T cells and IL-17, and this has the potential to become a treatment strategy for IRI and an intervention to improve lung function.

Comparison of the Effectiveness of Kencur Warm Water Soaking with Salt Warm Water Against Leg Edema of Third Trimester Pregnant Women in the Working Area of Rawang Health Center, Indonesia

Leg edema is a common complaint in third trimester pregnant women. It is believed that soaking in kencur warm water and salt warm water can help overcome this. Comparing the effectiveness of soaking in warm kencur water with warm salt water on leg edema in third trimester pregnant women. Quasi-experimental research with a pretest-posttest design with the control group. A total of 60 third trimester pregnant women were divided into two groups: the kencur warm water immersion group (n=30) and the salt warm water immersion group (n=30). The intervention was carried out for 15 minutes, twice a day for 3 days. Leg edema was measured using a measuring tape before and after the intervention. There was a significant reduction in leg edema in both groups after intervention (p&lt;0.05). The reduction in leg edema in the kencur warm water immersion group was greater than in the salt warm water immersion group (p&lt;0.05). Kencur warm water soaks are more effective than salt warm water soaks in reducing leg edema in third-trimester pregnant women.

The effect of alfalfa supplementation during the peripartum period on udder oedema and fertility in dairy sheep

AbstractIn recent years, there has been a trend towards hyperoestrogenic feeding methods in field conditions, particularly in dairy small ruminants. This study aimed to investigate the effect of alfalfa supplemented ration in the prepartum period on the occurrence of udder oedema in dairy ewes and its impact on fertility problems (dystocia, vaginal prolapse, uterine prolapse, retained placenta) and diseases (mastitis, udder dermatitis) occurring in the postpartum period. In addition, it aimed to follow up the data on maternal rejection behaviours and litter viability, which are believed to affect the future productivity and fertility of the herd. The ewes were divided into two groups: the oedema group (n = 20) and the control group (n = 23). For trial purposes in the oedema group, primiparous animals were provided with alfalfa supplementation. The control group consisted of ewes fed the same ration but without alfalfa supplementation. Ingredient analysis of the rations was performed in the groups. In biochemical analyses, the oedema group demonstrated significantly higher levels of serum urea (p &lt; .05), Ca (p &lt; .000) and Ca/P ratio (p &lt; .01) compared to the control group. Clinical mastitis (0–7 days, p = .051) and (8–30 days, p = .149) were reported at a higher rate in the oedema group compared to the control group. Udder dermatitis cases were more common in the oedema group (p = .005). The mother's rejection of the lamb was higher in the oedema group. Dystocia was determined to be 30% in the oedema group (p = .023). In conclusion, applying hyperoestrogenic feeding strategies during the periparturient period firstly exacerbates physiological udder oedema in ewes, thus predisposing them to various herd fertility problems. This feeding strategy, frequently encountered in field conditions, seriously harms the physiological fertility process.

Characteristics of macular edema associated with retinal vein occlusion showing poor anatomic response to three loading anti-vascular endothelial growth factor injections: an optical coherence tomography analysis

PurposeTo analyze the clinical features of refractory cystoid macular edema related to retinal vein occlusion associated with the response to three consecutive loading doses of anti–vascular endothelial growth factor.MethodsA retrospective chart review was performed on retinal vein occlusion patients treated by three anti–vascular endothelial growth factor injections. They were divided into a group according to resolution of macular edema in optical coherence tomography (Group 1) and with persistent macular edema (Group 2). We analyzed qualitative and quantitative morphologic features of optical coherence tomography.ResultsWe enrolled a total of 120 eyes from 120 patients (Group 1: n = 54, Group 2: n = 66). The baseline choroidal thickness differed significantly between groups 1 and 2 (290.70 ± 19.58 μm and 311.06 ± 17.87 μm P < 0.001). The presence of Hyperreflective foci (16.70% vs. 36.40% P < 0.001), Disorganization of the retinal inner layers (14.80% vs. 87.90%) and external limiting membrane disruption (16.60% vs. 39.3% P < 0.001) differed significantly. Logistic regression analysis showed that the initial central macular thickness (B = 0.012; P = 0.006), baseline choroidal thickness (B = 0.232; P = 0.016) and presence of hyperreflective foci (B = 1.050; P = 0.019), disorganization of the retinal inner layers (B = 1.132; P = 0.001) and external limiting membrane disruption (B = 1.575; P = 0.012) significantly affected the anti–vascular endothelial growth factor treatment response.ConclusionA thicker sub-fovea choroid and the presence of hyperreflective foci, disruption of the external limiting membrane and disorganization of the retinal inner layers associated with a poorer response to three loading anti–vascular endothelial growth factor injections in macular edema associated retinal vein occlusion.

Comparison of keratoplasty outcomes at the scar versus edema stages of keratoconus.

To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed. The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision. In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.

Scheimpflug Tomography as a Predictor of Corneal Edema After Phacoemulsification in Fuchs Endothelial Corneal Dystrophy.

To determine if Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict the occurrence of corneal edema following uneventful phacoemulsification surgery in Fuchs endothelial corneal dystrophy (FECD). Observational prospective case-control study. Fifty FECD eyes (50 patients) with visually significant cataract: 25 with subclinical corneal edema (SCE) versus 25 without SCE. Preoperatively, FECD was clinically assessed, and only patients devoid of clinical corneal edema were enrolled. Utilizing the Mayo Clinic classification for subclinical corneal edema (SCE), eligible FECD eyes were stratified based on Scheimpflug imaging pachymetry map and posterior elevation map characteristics, including loss of regular isopachs, displacement of the cornea's thinnest point, and the presence of posterior surface depression, into two groups: Group A representing FECD with SCE, and Group B: FECD without SCE. One week postoperatively, clinical and tomographic evaluation was performed. Regression analysis was conducted to evaluate predictors of corneal edema after uneventful phacoemulsification surgery in both groups. All patients were successfully imaged before and 1 week after surgery. Visual acuity was significantly improved in both groups (P < 0.001). No postoperative clinical edema was observed in Group B, while 23 (92%) had mild edema and 2 (8%) had moderate edema in Group A. Both groups showed a significant increase in postoperative central corneal thickness (CCT) and thinnest corneal thickness (TCT) (both P < 0.001). Compared to Group B, Group A showed a significant central flattening of the anterior corneal surface (P = 0.007 and P = 0.04 for K1 and K2 respectively), and a significant increase in the postoperative posterior surface depression. Multivariate analysis showed that 94% of postoperative corneal edema could be predicted by the presence of preoperative posterior surface depression (P = 0.04, ARR = 5.8 (1.89-35.7)). Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict corneal edema after uneventful phacoemulsification surgery in FECD with subclinical corneal edema.

К вопросу о резистентности диабетического макулярного отека

Purpose. To evaluate the morphofunctional features of diabetic macular edema (DME) and propose a classification of the degree of its resistance. Material and methods. The study included 448 patients (448 eyes) with newly diagnosed DME. A complete ophthalmological examination was performed, including spectral optical coherence tomography of the macular area. All patients were divided into 3 study groups depending on the anti-VEGF drug used: Brolucizumab (138), Ranibizumab (142) and Aflibercept (168). All patients (110) resistant to loading doses of an anti-VEGF drug were switched to intravitreal administration of a dexamethasone-containing implant. The observation period was 6 months. Results. According to the results of our study, the overall percentage of resistance to anti-VEGF therapy in patients with DME was 24.6%. At the same time, in group 1 it was observed in 20.2% of patients, in group 2 in 28.1% and in group 3 in 25.0%. It was found that when switching to intravitreal administration of a dexamethasone-containing biodegradable implant, there was an increase in visual acuity in the studied groups, respectively, from 0.25 to 0.67, from 0.04 to 0.3 and from 0.38 to 0.6 against the background of a decrease in retinal edema. Conclusion. The use of a dexamethasone-containing biodegradable implant after 6 months improved the architectonics of the retinal layers, increased visual acuity and reduced retinal edema in group 1 in 92.9% of patients, in group 2 in 87.5% and in group 3 in 90.5%. The developed clinical classification of the degree of DME resistance, depending on the morphofunctional features of the patient's retina, contributes to making the optimal decision regarding the choice of the most effective initial intravitreal pharmacotherapy for this disease. Key words: diabetic macular edema, anti- VEGF drugs, classification of DME resistance to intravitreal pharmacotherapy, dexamethasone implant

Study of anti-inflammatory and antinociceptive properties of new derivatives of condensed 3-aminothieno[2,3-b]pyridines and 1,4-dihydropyridines

Background. α-сyanothioacetamide derivatives are promising targets for the search for effective and safe antinociceptive agents with antipyretic and antiexudative activity. The aim. To conduct in vivo experimental study of anti-inflammatory and analgesic effects of new thienopyridines and 1,4-dihydropyridines derivatives. Materials and methods. The synthesized cyanothioacetamide derivatives were subjected to virtual bioscreening using Swiss Target Prediction online service. 140 laboratory rats were randomly distributed into intact and control (dextran edema) groups, reference groups (acetylsalicylic acid and nimesulide) and ten experimental groups for the investigated derivatives of thieno[2,3-b]pyridine and 1,4-dihydropyridine. The anti-inflammatory activity of the compounds at a dose of 5 mg/kg was evaluated by modeling acute dextran edema of rat paw. Determination of analgesic activity was carried out in the hotplate analgesic assay on 130 rats in comparison with sodium metamizole. Results. 1,4-dihydropyridines AZ331 and AZ420, as well as thienopyridine derivative AZ023 were determined to have strong anti-inflammatory activity (2.5 times more effective than nimesulide and 2.2 times more effective than acetylsalicylic acid). Compounds AZ023, AZ331 and AZ383 showed pronounced analgesic activity. The time of stay on the heated plate for rats of experimental groups that were fed with AZ331 and AZ383 for prophylactic purpose was respectively 9.56 and 9.93 times more than the same index in the reference group. The animals receiving AZ023 were characterized by an increase in the latent reaction time up to 241.2 seconds, which is 14.53 times higher than that in the rats received sodium metamizole. Conclusion. New thienopyridine and 1,4-dihydropyridine derivatives with high antiinflammatory and analgesic activity were synthesized and studied; they were recognized as promising targets for further preclinical studies.

Does local injection of long acting corticosteroid improve postoperative outcome of hypospadias repair? A randomized controlled trial

PurposeTo assess the safety and efficacy of local corticosteroid injection during hypospadias repair.MethodsBetween May 2021 and March 2023 children less than 10 years who were admitted for hypospadias repair were divided by random allocation into two groups. We injected local corticosteroid 2 ml proximal to coronal sulcus in group A while in group B we didn’t. All types of hypospadias were included in the study. We excluded patients older than 10 years and those with pre-existing complicated hypospadias (multiple fistulae and multiple surgeries), or bleeding diatheses. Pre-operative, intraoperative and postoperative variables were compared between the two groups.ResultsA total of 120 patients (60 in each group) were enrolled in the study. The mean ages and preoperative variables were not significantly different. The site of hypospadias and the type of surgery were comparable in both groups. (Table) There were no significant differences between both groups regarding average blood loss and operative time in each type of surgical repair. There was a significant higher incidence of intraoperative and postoperative penile oedema in group B (P-value < 0.001) while the incidence of skin discolouration was higher in group A. Postoperative complications, described as Clavian classification, were significantly higher in group B. The incidences of superficial skin infection, meatal stenosis, urethral fistula, and recurrence with the need for redo repair were significantly higher in group B (P-value: 0.002, 0.018, 0.032, and 0.001, respectively).ConclusionLocal corticosteroid injection during hypospadias repair minimize the penile oedema and decrease the incidence of postoperative functional and cosmetic complications.

Automated, fast, robust brain extraction on contrast-enhanced T1-weighted MRI in presence of brain tumors: an optimized model based on multi-center datasets

ObjectivesExisting brain extraction models should be further optimized to provide more information for oncological analysis. We aimed to develop an nnU-Net–based deep learning model for automated brain extraction on contrast-enhanced T1-weighted (T1CE) images in presence of brain tumors.MethodsThis is a multi-center, retrospective study involving 920 patients. A total of 720 cases with four types of intracranial tumors from private institutions were collected and set as the training group and the internal test group. Mann–Whitney U test (U test) was used to investigate if the model performance was associated with pathological types and tumor characteristics. Then, the generalization of model was independently tested on public datasets consisting of 100 glioma and 100 vestibular schwannoma cases.ResultsIn the internal test, the model achieved promising performance with median Dice similarity coefficient (DSC) of 0.989 (interquartile range (IQR), 0.988–0.991), and Hausdorff distance (HD) of 6.403 mm (IQR, 5.099–8.426 mm). U test suggested a slightly descending performance in meningioma and vestibular schwannoma group. The results of U test also suggested that there was a significant difference in peritumoral edema group, with median DSC of 0.990 (IQR, 0.989–0.991, p = 0.002), and median HD of 5.916 mm (IQR, 5.000–8.000 mm, p = 0.049). In the external test, our model also showed to be robust performance, with median DSC of 0.991 (IQR, 0.983–0.998) and HD of 8.972 mm (IQR, 6.164–13.710 mm).ConclusionsFor automated processing of MRI neuroimaging data presence of brain tumors, the proposed model can perform brain extraction including important superficial structures for oncological analysis.Clinical relevance statementThe proposed model serves as a radiological tool for image preprocessing in tumor cases, focusing on superficial brain structures, which could streamline the workflow and enhance the efficiency of subsequent radiological assessments.Key Points• The nnU-Net–based model is capable of segmenting significant superficial structures in brain extraction.• The proposed model showed feasible performance, regardless of pathological types or tumor characteristics.• The model showed generalization in the public datasets.

Should isolated superolateral Hoffa's fat pad edema identified by MRI be reported or ignored in adolescent patients?

Background and objectiveThe presence of superolateral Hoffa's fat pad (SHFP) edema is associated with several morphometric measurements related to patellar alignment and trochlear morphology. Our aim is to evaluate management implications in adolescent patients with isolated superolateral Hoffa's fat pad edema on MRI. Materials and methodsRetrospective review of 117 adolescents with knee MRI (mean 14.8 years old) with isolated superolateral Hoffa's fat pad edema. Patients with edema were separated into two groups based on the number of MRI axial slices involved with edema: group 1 (G1) of 27 patients with 1 slice vs group 2 (G2) of 90 patients with 2 or more slices. A comparison control group was used (45 patients who had normal MRI knees). Data points included % referral for physical therapy (PT) or surgery, Hoffa's fat pad edema, tibial tubercle-trochlear groove (TT-TG) distance and lateral trochlear inclination (LTI) angle. Fisher's exact and independent t-tests, ANOVA and regression models were used for statistical analysis. ResultsThere is statistically significant difference between Hoffa's fat pad edema patients and control regarding PT referral with G1: 70%, G2: 76%, and control: 53% (p = 0.03). There is statistically significant difference between these groups regarding TT-TG measurements with higher values in edema groups; G1: 11.9 mm±4.1, G2 13 mm ±4.1, and control 8.7 mm±3.6, (p = 0.001). There was a statistically significant association between edema and increased TT-TG distance (p = 0.001) but not LTI angle (p = 0.2). ConclusionMRI identification of isolated superolateral Hoffa's fat pad edema is positively associated with TT-TG distance and its presence is associated with higher referral rates to physical therapy for patella maltracking.

Short-term effect of macular edema on the peripapillary retinal nerve fiber layer in patients with wet age-related macular degeneration and diabetic macular edema: A comparative study

BackgroundThe combined presence of glaucoma and age-related macular degeneration (ARMD), or glaucoma and diabetes mellitus (DM), occur fairly frequently, especially in elderly patients. This study was intended to compare the effect of resolving macular edema due to DM and wet ARMD on peripapillary retinal nerve fiber layer (RNFL) thickness. MethodsThis cross-sectional study included 76 patients with macular edema secondary to DM (n = 40, 52.6%) or wet ARMD (n = 36, 47.4%). The control group was comprised of 34 age and sex-matched healthy subjects. All study participants underwent evaluation of central macular thickness (CMT) and the peripapillary RNFL using spectral domain-optical coherence tomography (SD-OCT). Data from eyes that received an anti-VEGF injection were obtained one month after the procedure and were compared with pre-injection data. ResultsThe average initial thickness of the global peripapillary RNFL was 98.9 ± 16.7 (61–163) µm in the macular edema group and 92.0 ± 16.0 (84–115) µm in the control group (p = 0.045). The post-injection global peripapillary RNFL thickness was 97.3 ± 19.0 (61–163) µm in the macular edema group and 92.2 ± 18.0 (81–126) µm in the control group (p = 0.187). In the DM group, the changes in global RNFL thickness, as well as central and temporal quadrant thicknesses, were found to correlate significantly with the change in CMT (r = 0.356, p = 0.024; r = 0.545, p < 0.001, respectively). ConclusionsMacular edema in wet ARMD appeared not to affect RNFL thickness. Differences in the etiology of macular edema can have varied effects on peripapillary RNFL. It is recommended that peripapillary RNFL thickness be evaluated cautiously in DM patients receiving intravitreal anti-VEGF therapy.

Results of monitoring diabetic retinopathy in patients after simultaneous pancreas and kidney transplantation

BACKGROUND: Very few studies have focused on the state of the fundus and visual functions before and after simultaneous transplantation of the pancreas and kidney. In addition, the results and conclusions of authors on this topic are contradictory. AIMS: To evaluate the ophthalmological status of patients with diabetic retinopathy before and after kidney and pancreas transplantation. MATERIALS AND METHODS: The patients were divided into three groups: group 1 included patients on the transplant waiting list receiving hemodialysis, group 2 were kidney transplant recipients, and group 3 included patients who had undergone simultaneous pancreas and kidney transplantation. The ophthalmological status of patients was assessed through standard ophthalmic diagnostic methods and measurements of photosensitivity, central retinal thickness, choroid thickness, density perfusion of the superficial and deep retinal capillary plexus, choriocapillary layer, and deep choroidal layer in the foveal and parafoveal zones of the macular region. RESULTS: The study involved 76 patients (152 eyes) (group 1, n=30 patients undergoing dialysis; group 2, n=24 kidney transplant recipients; group 3, n=22 kidney and pancreaticoduodenal post-transplant recipients). Signs of the active phase of the proliferative stage of diabetic retinopathy (group 1, 54.1%; group 2, 53.3%; and group 3, 25.9%, p 0.05) and diabetic macular edema (group 1, 26.4%; group 2, 31.8%; and group 3, 12.8%, p 0.05) were more common in groups 1 and 2 than in group 3. Moreover, group 3 needed laser therapy (group 1, 45.3%; group 2, 43.2%; and group 3, 20.5%, p 0.05) and antiangiogenic therapy to a lesser extent (group 1, 18.9%; group 2, 25.0%; and group 3, 5.1%, p 0.05) than patients undergoing dialysis and kidney recipients. The eyes of patients after simultaneous pancreas and kidney transplantation were characterized by the smallest retinal thickness, highest retinal and choroidal perfusion, and highest visual acuity and photosensitivity (p 0.05). CONCLUSIONS: A surgical method for restoring euglycemia through transplantation of physiologically active pancreatic tissue favorably affects the morphological and histological state of the retina and retinal and choroidal hemoperfusion and reduces the frequency of the active phase of proliferative diabetic retinopathy and diabetic macular edema.

Kronik Alt Ekstremite Ödemi Olan Hastalarda Sakroiliyak Eklem Disfonksiyonu Varlığı ve Postür Analizi

Abstract&#x0D; Background and Aim: Chronic lower extremity edema has been associated with postural impairment, sacroiliac joint dysfunction (SIJD), and abnormal gait. Lymphedema and lipedema are important chronic lower extremity causes. This study aimed to detect the presence of SIJD and postural disorders in patients with lower extremity edema and the relationship between them.&#x0D; Methods: This is a comparative, prospective cohort study. Fifty-three patients with lower extremity edema and 53 healthy subjects were included in the study. Pain provocation tests were used to determine SIJD. Postural analysis was conducted with PostureScreen® Mobile 11.2 (PostureCo, Inc., Trinity, FL) software. The life quality of participants was determined by the Lymphedema Quality of Life (LYMQOL) scale. The functional status of the patients was determined by the Oswestry Disability Index and Lower Extremity Functional Scale.&#x0D; Results: SIJD (18.9%) was more common in the edema group. There was a positive correlation between volume differences, percentages, and the development of SIJD. We found deviations in the head, shoulder, and hip angulations in the edema group. Q angle and lateral shoulder angulation were significantly higher in patients with SIJD in the edema group. In the edema group, LYMQOL-leg total score was higher in patients with SIJD.&#x0D; Conclusion: Chronic lower extremity edema was found to be associated with postural deviations and SIJD. Besides edema control, postural disorders and SIJD should also be considered in these patients.