Edema Index Research Articles

Incidence of irregular astigmatism eligible for contact lens fitting after Descemet membrane endothelial keratoplasty

To evaluate the incidence and causes of anterior corneal surface irregularities after successful Descemet membrane endothelial keratoplasty (DMEK) and the efficacy of contact lens fitting in these cases. Tertiary referral center. Retrospective study of prospectively collected data. Eyes with a subnormal visual outcome or monocular diplopia after successful DMEK were fitted with a contact lens. These cases were evaluated with Pentacam rotating Scheimpflug camera imaging preoperatively and 6 months postoperatively, and outcomes were compared with those in a randomly selected DMEK control group. In a series of 262 surgeries, 23 eyes (21 patients) were fitted with contact lenses; the control group comprised 23 eyes. Indications for contact lens fitting included (1) obvious corneal surface irregularities due to preexisting corneal scarring, (2) surface irregularities associated withlongstanding preoperative stromal edema, and (3) undetectable optical imperfections. The postoperative corrected distance visual acuity (CDVA) with spectacles improved after contact lens correction (P<.001). Preoperative and postoperative irregularity indices were significantly higher in the contact lens group than in the DMEK control group (P<.05). Positive correlations were found between the duration of preoperative stromal edema and postoperative Scheimpflug camera indices (P<.02). After successful DMEK, 23 of 262 eyes (9%) showed subnormal spectacle CDVAand/or monocular diplopia due to corneal scarring, surface irregularities, or undetectable optical imperfections that could be managed by contact lens fitting. Prolonged preoperative corneal edema for more than 12 months may be a risk factor for diffuse irregular astigmatism after DMEK. Dr. Melles is a consultant to DORC International BV/Dutch Ophthalmic USA. No author has a financial or proprietary interest in any material or method mentioned.

Expression of VEGF and collagen XVIII in meningiomas: correlations with histopathological and MRI characteristics

The objective of this study was to assess the possibility of predicting histological characteristics of meningiomas on the basis of preoperative MRI and the correlation of the expression of vascular endothelial growth factor (VEGF) and collagen XVIII with histological parameters already established as predictive of the course of these tumors. Expression of VEGF and collagen XVIII as well as other histological characteristics was examined in meningioma tissues from 20 patients. Preoperative MRI, including dynamic imaging of contrast enhancement, was analyzed. Times to maximum enhancement and maximum intensity increase were noted from dynamic imaging. The relative intensity of the tumor in fluid-attenuated inversion recovery (FLAIR), T2-weighted and contrast enhanced T1-weighted images, as well as volumes of tumor and edema, was calculated. The edema-tumor volume ratio was defined as the edema index (EI). Both VEGF and collagen XVIII were expressed in all meningioma samples. Edema was present in 60 % of cases. The strongest correlation of VEGF expression was to EI. Among histological parameters, microvessel density (MVD) and cellularity correlated moderately with VEGF. Collagen XVIII expression correlated strongly with the maximal intensity increase after contrast agent administration (ρ = 0.71, P = 0.001) as well as with MVD and intensity of the meningioma on FLAIR images. Meningiomas with faster and more intense enhancement in dynamic studies, indicative of good tumor blood supply and permeability of vasculature, are associated with high levels of collagen XVIII and VEGF expression. Occurrence of peritumoral edema in meningiomas is strongly correlated with expression of VEGF.

Oxidative stress and induction of non‐cardiogenic pulmonary edema following cerebral hypoxia in a canine model

Neurogenic pulmonary edema (NPE) is a non‐cardiogenic form of pulmonary edema associated with stroke, traumatic brain injury and seizure. NPE is a public health concern due to high morbidity and mortality, yet the mechanism(s) are unknown.HypothesisCerebral hypoxia, even in the absence of systemic hypoxia, is sufficient to induce pulmonary edema, oxidative stress and compensatory antioxidant mechanisms.MethodsUsing an updated Moss's model, 9 Walker hounds were randomly assigned to cerebral hypoxemia (SaO2 ~55%) with systemic normoxia (SaO2 ~90%) (CH; n=6), or cerebral and systemic normoxia (SaO2 ~90%) (Sham; n=3). Femoral venous (CH) or arterial (Sham) perfusate was delivered from a cardiopulmonary bypass circuit to the brain. Wet to dry lung weight ratios were assessed as an index of pulmonary edema, lipid peroxidation was assessed as an indicator of oxidative stress, and brain and lung compensatory antioxidants were assessed with immunoblotting.ResultsLung wet:dry weight was greater in the CH compared to sham. Lipid peroxidation was greater in CH and was accompanied by increased compensatory antioxidants (hemeoxygenase‐1, NAD(P)H quinone oxidoreductase‐1).ConclusionBrain hypoxemia, despite systemic normoxia, is associated with lipid peroxidation and compensatory antioxidant enzymes, suggesting oxidative stress could contribute to neurogenic pulmonary edema. DARPA N66001‐10‐C‐2134

Comparison of bioimpedance analysis and dual-energy X-ray absorptiometry body composition measurements in peritoneal dialysis patients according to edema

Changes in the difference between bioimpedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) body composition measurements according to edema is an important issue for peritoneal dialysis (PD) patients. We reviewed the medical records of patients to identify all adults who had undergone PD and composition measurements by both BIA and DXA techniques. The aim of this study was to evaluate any change in the difference between BIA and DXA body composition measurements according to edema. We identified 409 patients whose body compositions were measured by both techniques one or more times, for a total of 1,109 pairs of measurements. The measurements were divided into 4 quartiles on the basis of the edema index. Significant correlations and intraclass correlations were noted between the two methods for lean mass (LM), fat mass (FM), and bone mineral content. Simple linear regression analyses using DXA measurements for the prediction of body compositions by BIA showed that non-standardized-βs of total LM decreased as the grade of edema index increased (from 1.008 to 0.949), whereas non-standardized-βs of total FM increased as the grade of edema index increased (from 1.034 to 1.162). Bias for total LM changed from positive to negative, and this negative bias amplified as the grade of edema index escalated (from 0.406 kg to -2.276 kg). A positive bias was observed for total FM in the 1st quartile, and this positive bias increased with an increase in the grade of edema index (from 0.594 kg to 2.863 kg). LM measured by DXA is overestimated in PD patients with edema compared to the measurements by BIA. However, FM and bone mineral content measured by BIA are is overestimated in PD patients, compared to the measurements by DXA, especially in patients with worsening edema. The difference between the two techniques grows more prominent as the grade of edema increases. A combination of two methods will allow clinicians to conduct more accurate body composition assessments for PD patients with edema.

Expression of MMP-2 and MMP-9 in Benign Canine Rostrotentorial Meningiomas Is Not Correlated to the Extent of Peritumoral Edema

Matrix metalloproteinases (MMPs) are proteolytic enzymes involved with extracellular matrix degradation. They have been considered to be important for tumor growth and development of peritumoral edema. This retrospective study investigated the expression of MMP subtypes 9 and 2 in canine intracranial meningiomas and their association with peritumoral edema. Twenty-two cases of histologically confirmed grade I meningiomas based on human World Health Organization classification were enrolled. Tumor volume and peritumoral edema were measured by magnetic resonance imaging volumetry. The intratumoral MMP expression was semiquantitatively assessed by immunoreactivity scores and compared with the imaging data. MMP-9 was expressed in all the samples (22/22), whereas proMMP-2 was expressed in 21 of 22 meningiomas, and a/proMMP-2 was expressed in 9 of 22. The immunoreactivity scores were not statistically linked to the severity of peritumoral edema. None of the evaluated MMP expression parameters were statistically linked to the edema index. Although both edema index and MMP-9 expression were highest in meningiomas of the olfactory and frontal region, only the latter mounted up to statistical significance (P = .002) if compared with parafalx and convexity meningiomas of the parietal lobe. In summary, MMP-2 and MMP-9 expression by tumor cells, evaluated through immunohistochemistry, is not predictive of the formation of peritumoral edema in canine rostrotentorial meningiomas.

Sonographic elastography for assessing changes in masseter muscle elasticity after low-level static contraction

The purpose of this study was to clarify, by use of sonographic elastography, the changes in elasticity of the masseter muscle after low-level continuous contraction by healthy volunteers. The reproducibility of the elasticity index (EI) was verified by using a scoring phantom for elastography. The EI of the masseter muscle was measured for 10 healthy volunteers before, immediately after, and 10 min after static contraction at 20 % of the maximum force for 10 min. The masseter muscle thicknesses were also measured at these times as a surrogate index of muscle edema. The reproducibility of the EI measurements was sufficient for clinical use. The elasticity expressed by the EI increased after low-level contraction compared with that before contraction and changed similarly to the thickness along the time course of the experiment. Low-level static contraction increased the elasticity and thickness of the masseter muscle. A potential relationship may exist between elasticity and edematous change in the masseter muscle.

Correlation of influencing factors with the extent of peritumoral brain glioma edema

To explore the correlation of various influencing factors with the extent of peritumoral brain glioma edema. A total of 69 glioma cases were confirmed by pathology after operation. And stepwise multiple linear regression analysis was performed on gender, age, Karnofsky performance scale (KPS) score, onset to treatment time, tumor size, location, shape and WHO pathological grade. All of them had peritumoral edema. The relevant factors included pathology grading, onset to treatment time, KPS score and age. The data were entered into the regression equation of edema index. The partial regression coefficients were 0.853, 0.456, -0.352 and 0.291 respectively (P < 0.01). Peritumoral brain edema in glioma patients are correlated with WHO pathologic grading, onset to treatment time, KPS score and age. But it has no correlation with patient gender, tumor location, tumor size and shape.

Biological and Demographic Profile of Meningiomas in a Cohort of Egyptian Patients: Impact on Tumor Recurrence

Objective. This work was designed to study the biological and demographic characteristics of meningiomas and their impact on tumor recurrence in Egyptian patients. Material and Methods. A cohort of 265 Egyptian patients with meningioma was studied. Immunohistochemistry for VEGF, Ki67, PR, CD20, and CD3 was performed. Statistical analysis was used to detect independent predictors of recurrence. Results. Adults represented 98.9% of cases, with female preponderance (M : F ratio = 1 : 2.4). Histologically, 78.10% of cases were grade I, 19.20% were grade II, and 2.60% were grade III. Transitional variant was the most common (43.40%). VEGF expression (38.50% of cases) correlated positively with perifocal edema, tumor size, and proliferative index (PI). PR expression (64.5% of cases) correlated inversely with the PI (mean 3.75). Lymphocytic aggregates were detected in 7.20% of cases, with a mean CD20 : CD3 ratio of 1 : 10.1. In a multivariate analysis, only tumor size, PR expression and necrosis predicted recurrence independently. Using ROC curve, size was the best predictor of tumor recurrence with a cut-off point of >6 cm and an excellent negative predictive value (97.6%). Conclusions. Meningiomas in our region showed some distinctive clinicopathological and demographic criteria. Tumor size was found to be the best recurrence predictor factor of meningioma.

Effects of Yiqi-Humo recipe on mucosa repair after EMR and ESD

Objective To observe the influences of Yiqi-Humo recipe,A traditional Chinese prescription,on mucosa repair after endoscopic mucosal resction (EMR) and (or) endoscopic submucoal dissection (ESD).Methods 32 patients,who received EMR or ESD,were randomly recurited into a control group with 14 patients (omeprazole) and a experiment group with 18 patients (Yiqi-Humo recipe + omeprazole).Patients of both groups received treatment for a period of 4 weeks.Follow-up endoscopy was performed at 1 and 4 weeks after EMR or ESD,the index of symptom and mucosa signs were evaluated before and after the operation.Results At the 4 weeks after the procedure,the index of pain,pantothenic acid,anorexia,burning sensation in the experiment group [(0± 0.00)、(0± 0.00)、(2 ± 0.11)、(1 ± 0.06)] were lower than those in the control group [(12±0.86)、(6±0.43)、(15 ± 1.07)、(14± 1.00),P＜0.01].The index of hyperemia and edema of the experiment group [(3 ± 0.17)、(3 ± 0.17)] were less than those of the control group [(16± 1.14)、(15 ± 1.07),P＜ 0.01].Conclusion The prescription of Yiqi-Humo recipe promoted mucosa repair significantly after EMR or ESD. Key words: Prescription of Yiqi-Humo recipe ; EMR ; ESD ; Symptom ; Mucosa repair ;

Shikonin attenuates lipopolysaccharide-induced acute lung injury in mice

BackgroundShikonin, a natural naphthoquinone pigment extracted from the root of Lithospermum erythrorhizon, has shown a variety of pharmacologic properties including anti-inflammatory effect. In the present study, we analyzed the role of shikonin in acute lung injury induced by lipopolysaccharide (LPS) in mice. Materials and methodsSixty male BALB/C mice were randomly allocated into six groups (n = 10, each): control group, shikonin group (50 mg/kg), LPS group, and three different doses (12.5, 25, and 50 mg/kg) for shikonin-treated groups. Shikonin or vehicle was given with an intragastric administration 1 h before an intratracheal instillation of LPS (5 mg/kg). The severity of pulmonary injury was evaluated 6 h after LPS challenge. ResultsShikonin pretreatment significantly attenuated LPS-induced pulmonary histopathologic changes, alveolar hemorrhage, and neutrophil infiltration. The lung wet-to-dry weight ratios, as the index of pulmonary edema, were markedly decreased by shikonin pretreatment. Moreover, shikonin decreased the productions of the proinflammatory cytokines including tumor necrosis factor alpha and interleukin 1β and the concentration of total proteins in the bronchoalveolar lavage fluid. Shikonin pretreatment also reduced the concentrations of myeloperoxidase and nitric oxide in lung tissues. In addition, shikonin pretreatment significantly suppressed LPS-induced activation of cyclooxygenase 2 and inducible nitric oxide synthase and the nuclear factor κB DNA-binding activity in lung tissues. ConclusionsThis study indicates that shikonin may have a protective effect against LPS-induced acute lung injury, and the potential mechanism of this action may attribute partly to the inhibition of inducible nitric oxide synthase and cyclooxygenase 2 expression by downregulating nuclear factor κB activation.

Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema

Various degrees of peritumoral brain edema (PTBE) are observed in patients with intracranial meningiomas. Factors affecting the occurrence of PTBE in intracranial meningioma were investigated. PTBE was investigated retrospectively for 110 patients with primary intracranial meningiomas. Predictive factors related to PTBE were analyzed, for example patient age, sex, magnetic resonance imaging features (contrast enhancement, tumor shape, tumor location, tumor volume), angiographical features (tumor stain, pial-cortical arterial supply, venous obstruction), and histopathological features (histological subtypes, mindbomb homolog 1 labeling index (MIB1-LI)). Histological subtypes were classified into World Health Organization (WHO) grade I common type (meningothelial, transitional, fibrous), grade I uncommon type, and grade II and III types. The extent of PTBE was assessed by calculation of the edema index (EI). PTBE was present in 53 cases (48%). Male sex, heterogeneous enhancement, superficial location, tumor volume (≥10cm(3)), remarkable tumor stain, pial supply, venous obstruction, malignant pathology, and MIB1-LI ≥4% were correlated with PTBE in univariate analysis. Pial supply and remarkable tumor stain were correlated with PTBE in multivariate analysis. WHO grade I uncommon type had obviously higher EI than WHO grade I common type, and WHO grade II and III types (P<0.001). Seven cases with prominently high EI (EI ≥10) were all WHO grade I uncommon type, including angiomatous, microcystic, secretory, and lymphoplasmacyte-rich meningioma. Prominently extensive PTBE might indicate the presence of WHO grade I uncommon type meningioma.

Protective Effect of Magnolol on Lipopolysaccharide-Induced Acute Lung Injury in Mice

Magnolol, a tradition Chinese herb, displays an array of activities including antifungal, antibacterial, and antioxidant effects. To investigate the protective effect of magnolol on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice. ALI was induced in mice by intratracheal instillation of LPS (1mg/kg). The mice received intratracheal instillation of magnolol (5μg/kg) 30min before LPS administration. Pulmonary histological changes were evaluated by hematoxylin-eosin stain and lung wet/dry weight ratios were observed. Concentrations of tumor necrosis factor (TNF)-α and interleukin (IL)-1β, and myeloperoxidase (MPO) activity were measured by enzyme-linked immunosorbent assay. Expression of cyclooxygenase (COX)-2 in lung tissues was determined by Western blot analysis. Magnolol pretreatment significantly attenuated the severity of lung injury and inhibited the production of TNF-α and IL-1β in mice with ALI. After LPS administration, the lung wet/dry weight ratios, as an index of lung edema, and MPO activity were also markedly reduced by magnolol pretreatment. The expression of COX-2 was significantly suppressed by magnolol pretreatment. Magnolol potently protected against LPS-induced ALI and the protective effects of magnolol may attribute partly to the suppression of COX-2 expression.

475 Does All Myocardial Edema as Observed in Cardiovascular Magnetic Resonance Represent Myocardial Salvage?

In patients with acute myocardial infarction (AMI) the myocardial salvage index (MSI) quantified by Cardiovascular Magnetic Resonance (CMR) is defined as the proportion of myocardial edema without infarction, derived from Late Gadolinium Enhancement (LGE), within the myocardial area at risk (MAR), as defined by the area of edema. While after a coronary occlusion time of more than 8 hours, relevant myocardial salvage is highly unlikely, previous data, however, showed evidence for myocardial edema surrounding the infarcted tissue even more than 6 hours after onset of symptoms. We therefore speculated that peri-infarct edema in the setting of very late reperfused MI is a consistent finding and thus not be related to salvage. In 6 tertiary hospitals, 74 patients who underwent PCI between 8 to 24 hours after presentation with AMI were included in the study. The time to reperfusion (TTR) was correlated with the infarct size (IS), extent of myocardial edema and MSI. T2-weighted and LGE images were used to characterize the extent of myocardial edema, infarction and the apparent myocardial salvage index. A stratified analysis was conducted considering subjects divided in four quartiles of TTR. The mean TTR was 696±231 minutes. The edematous area was consistently larger than the infarct (mean difference 10± 8.4%) and the apparent myocardial salvage index was 31±20%. There was a strong correlation between the area of infarction and the extent of myocardial edema (r=0.84, p<0.0001). TTR did not show significant correlation with the infarct area (p=0.21), the extent of myocardial edema (p=0.084), microvascular obstruction (p=0.78) and salvage index (p=0.93) on the entire population and between the 4 groups. In patients with more than 8 hours ischemia time, we consistently demonstrated myocardial edema surrounding the infarcted tissue. Its extent did not vary significantly between quartiles of different times to reperfusion. These data therefore indicate that, in late reperfused AMI, peri-infarct edema may not be related to myocardial salvage, but may represent peri-infarct injury secondary to reperfusion. These findings have significant implications for the quantification of myocardial salvage by CMR in patients with late refused AMI.

비만의 한방치료 효과 및 집단 간 효과차이에 관한 연구

Objectives : The purpose of this study were to evaluate the effects of oriental medical therapy on obesity and different effects according to Body Mass Index(BMI), menopause, obesity treatment experience, age, treatment period in patients. Methods : 46 patients were treated from November 2011 to April 2012 in Oriental Obesity Center, Dong-eui Medical Center. They were measured change of body compositions by bioelectrical impedance analysis every 2~3 weeks and 27 patients out of 46 were checked body compositions every 2 weeks. 46 and 27 patients were divided into two or three groups according to BMI, menopause, obesity treatment experience, age, treatment period. We compared before and after treatment body compositions. Results : Body compositions, except edema index were significantly reduced. Abdominal Visceral Fat(AVF) was significantly reduced in Obese group. Body Weight(BW), BMI, Body Fat(BF), Body Fat Percetage(BFP), Abdominal Visceral Fat Level(AVFL), Abdominal Visceral Fat(AVF), Abdominal Subcutaneous Fat(ASF) were significantly reduced in non-menopause group(43 female patients). But in 26 female patients out of 27, there were no significantly differences between groups in menopause. There were no significantly differences between groups in obesity treatment experience. But in 27 patients, BMI and AVF were significantly reduced in non-experience group and AVFL was significantly reduced in experience group. BW, BMI, BF, BFP, VAF, ASF were significantly reduced in younger age group. But in 27 patients, BW and Muscle were significantly reduced in younger age group. BMI, BF, BFP, Edema, AFVL, Abdominal Visceral Fat Area(AVFA), AVF, ASF were significantly reduced in longer treatment period group. Conclusion : The BF, BMI, BF, BFP, Muscle, AVFL, AVFA, AVF, ASF were almost decreased significantly. It resulted that the effects of oriental medical therapy in obesity was positive. And it was meaningful study to know about different effects between groups.

Predictive value of brain edema in preoperative computerized tomography scanning on the recurrence of meningioma

IntroductionMeningioma is a common benign intracranial tumor. The most common histological subtypes are the transitional and mesothelial subtypes. It can be cured by adequate excision, which is mostly measured by the Simpson grading system. Meningioma can have a peritumoral edema seen in the preoperative computerized tomography as well as in magnetic resonance imaging. It is caused by the release of vasogenic factors that causes leak of fluid from the blood vessels into the brain parenchyma. Recurrence of meningioma has been linked to the presence of preoperative peritumoral brain edema. AimThe aim of this study is to predict the possibility of meningioma recurrence based on the extent of brain edema in the preoperative computerized scanning of the brain. MethodsTwenty five patients with supratentorial meningioma were retrospectively studied for the relationship between preoperative peritumoral brain edema as measured by the brain edema index and the recurrence of meningioma. ResultsThe age of the patients ranged from 26 to 69years. Males and females had almost equal percentages. Most of the cases recurred within a period from 3years to less than 6years; while the least recurrence occurred within one year of the surgery. Most of the cases of recurrent meningioma had high brain edema index. The higher the brain edema index, the less average years required for recurrence. The higher the preoperative brain edema index, the higher the possibility of postoperative complications. Tumors at a maximum diameter of three to less than six cm represented the majority of cases. Peritumoral brain edema was present in all cases in sphenoid ridge and parasagittal site. ConclusionPreoperative brain edema as measured by brain edema index on the preoperative brain computerized tomography scan had an important impact on the postoperative complication rate as well as on the incidence of tumor recurrence.

Netzhautdickenmessung mit dem Heidelberg Retina Tomograph bei Patienten mit Makulaödem und bei Gesunden

This study was carried out to test the reliability of a defined cut-off value for retinal thickness with estimation of the sensitivity, specificity and formation of an edema index in comparison to retinal thickness. This was a single center prospective clinical non-blinded study of 100 eyes, including 22 eyes with central vein or branch vein occlusions, 20 eyes with diabetic macular edema, 6 eyes with postoperative macular edema, 2 eyes with uveitis and 50 healthy eyes. Detection of macular edema was carried out by third generation optical coherence tomography. Using the latest version of the Heidelberg retina tomograph (HRT 3) series of five images were produced and evaluated. The 9-zone circle of the HRT was used as the analysis contour. The reliability of measuring retinal thickness with the HRT in the subjects showed an intraclass correlation between 0.248 and 0.740 and patients with macular edema showed values between 0.515 and 0.949. The reliability of the edema index with the HRT in the subjects showed an intraclass correlation between 0.461 and 0.826 and patients with macular edema showed values between 0.383 and 0.826. The calculated cut-off values were between 285µm and 360µm. The corresponding sensitivity values were between 74.7% and 95.9% with a corresponding specificity of 74.7-90.2%. There was also a highly significant correlation between the edema index and retinal thickness (p < 0.001). The retina module of the latest generation HRT is capable of reproducible measurement of the retinal thickness in micrometers. The defined cut-off values correspond to expectations and can be used in this form in the clinical practice.

Comparison of bioimpedance analysis and dual-energy x-ray absorptiometry in peritoneal diaysis patients according to edema

The change in difference between bioimpedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA) according to edema is an important issue for peritoneal dialysis (PD) patients. We reviewed all adults who received PD. Patients had undergone two body composition measurements. 1108 cases were measured simultaneously by BIA and DEXA. Measurements were divided into four quartiles based on edema index. There were significant correlations and intraclass correlations between the two methods for lean mass (LM), fat mass (FM) and bone mineral content. On a simple linear regression analysis, non-standardized-βs of total LM decreased as the grade of edema index increased (from 1.008 to 0.949). Those of total FM were increased as the grade of edema index increased (from 1.034 to 1.162). Bias for total LM changed to negative and negative bias increased as the grade of edema index increased (from 0.406 kg to –2.276 kg). There was a positive bias for total FM in first quartile and increased as the grade of edema index increased (from 0.594 kg to 2.863 kg). In conclusion, the present study demonstrates that BIA can measure normal hydrated LM in CAPD patients with edema. However, FM is overestimated in PD patients with edema. The difference between the two measurements increases as the grade of edema increases.

Edema index established by a segmental multifrequency bioelectrical impedance analysis provides prognostic value in acute heart failure

A segmental multifrequency bioelectrical impedance analysis (SMBIA) is a noninvasive and reproducible modality for estimating the fluid state. The aim of this study was to test whether the SMBIA-derived edema index provides prognostic value in patients hospitalized due to acute heart failure (AHF). To estimate the 6-month prognostic value of the predischarge edema index in patients hospitalized due to AHF, 112 patients were consecutively enrolled. Both predischarge edema index and B-type natriuretic peptide (BNP) were measured. Outcome follow-up focused on heart failure-related and all-cause re-hospitalizations and all events. On the basis of a cutoff value of edema index of 0.390, patients were separated into two groups: edema index more than 0.390 (n = 44) and edema index of 0.390 or less (n = 68). Compared with patients with edema index 0.390 or less, those with edema index of more than 0.390 were older, had lower blood albumin and hemoglobin levels, and had higher predischarge BNP levels, functional class, incidence of diabetes mellitus, valvular cause, and diuretic use. Although edema indexes were correlated with BNP levels (r = 0.47, P < 0.0001), a mismatch was noted in 33 (29%) patients. Univariate and multivariate analysis showed that an edema index of more than 0.390 predicted a higher incidence of heart failure-related re-hospitalization [odds ratio (OR) = 4.14, confidence interval (CI) = 1.05-15.28, P = 0.04] and all events (OR = 3.97, CI = 1.4-11.25, P = 0.01). The edema index provided a prognostic value superior to that of BNP. Reducing the edema index in high-risk patients resulted in fewer heart failure-related re-hospitalizations (OR = 0.81, CI = 0.77-0.84, P < 0.001) and all events (OR = 0.8, CI = 0.76-0.85, P < 0.001). Edema index provides 6-month prognostic values in patients hospitalized due to AHF. Reducing the edema index in high-risk patients results in better outcomes.

Scanning laser edema index: A reliable tool to correlate with diabetic retinopathy and systemic risk factors?

To correlate Heidelberg Retina Tomograph (HRT) derived macular edema (DME) index with severity of diabetic retinopathy and systemic factors.A total of 300 diabetic patients were recruited for the study for each of them a value for the macular edema index was obtained using the HRT II. Patients' age, gender, duration and type of diabetes mellitus, latest HbA1c result and presence or absence of co-morbid factors (hypertension, ischemic heart disease, nephropathy) were recorded together with the stage of diabetic retinopathy. These were correlated with DME.Out of 300 patients, HRT defined macula edema was seen in 68 patients (22.6%). There is a wider and higher range (95% percentile) of macula edema index in the severe non proliferative diabetic retinopathy (NPDR) group. Independent samples t test showed significant difference between the severe NPDR group and no DR group (p<0.001), mild NPDR group (p<0.05) and moderate NPDR group (p<0.05). A higher macula edema index was also found to have a low degree of correlation with more advanced stages of retinopathy (r=0.310; p<0.001). Also nephropathy showed a strong and significant correlation with DME. Hypertension had moderately significant correlation with DME. This study found no correlation between ischemic heart disease and DME.HRT derived scanning laser edema index is a reliable objective tool to evaluate diabetic retinopathy and systemic risk factors.

Role of VEGF and matrix metalloproteinase‐9 in peritumoral brain edema associated with supratentorial benign meningiomas

Accumulating evidence indicates that VEGF and matrix metalloproteinase-9 (MMP-9) play a central role in the development of peritumoral brain edema (PTBE) associated with human brain tumors. However, the roles of these proteins, particularly of MMP-9, in PTBE associated with benign meningiomas have not been elucidated. We investigated the association between clinical features and biological factors, such as VEGF and MMP-9, and the incidence of PTBE and edema index (EI) in 60 patients with benign meningiomas. In this study, supratentorial lesions were examined for evaluating the extent of PTBE in the surrounding normal brain tissue. VEGF and MMP-9 expression was immunohistochemically examined. Multivariate analysis revealed that the presence of pial blood supply (odds ratio [OR] 12.250; P = 0.0096) and VEGF (OR 7.683; P = 0.0155), but not MMP-9 (OR 1.178; P = 0.8113), expression are significant factors that independently predict the incidence of PTBE and influence EI. VEGF (P = 0.0397) and MMP-9 (P = 0.0057) expression correlates with the presence of pial blood supply. Moreover, tumors with high VEGF and MMP-9 expression had higher EIs than those with high expression of either (P = 0.030). Our findings suggest that MMP-9 expression was positively related to VEGF expression and pial blood supply and promoted the occurrence of PTBE by inducing the disruption of the arachnoid membrane and formation of pial blood supply.