Local Necrosis Research Articles

A Liquid Biopsy to Assess Brain Tumor Recurrence: Presence of Circulating Mo-MDSC and CD14+ VNN2+ Myeloid Cells as Biomarkers That Distinguish Brain Metastasis From Radiation Necrosis Following Stereotactic Radiosurgery.

Brain metastases (BM) are the most common type of brain tumor malignancy in the US. They are also the most common indication for stereotactic radiosurgery (SRS). However, the incidence of both local recurrence and radiation necrosis (RN) is increasing as treatments improve. MRI imagery often fails to differentiate BM from RN; thus, patients must often undergo surgical biopsy or resection to obtain a definitive diagnosis. To hypothesize that a marker of immunosuppression might serve as a surrogate marker to differentiate patients with active vs inactive cancer-including RN. We thus purified and quantified Monocytic Myeloid-Derived Suppressor Cells (Mo-MDSC) by flow cytometry in patients proven by biopsy to represent BM or RN. We report the utility of the previously reported HLA-Dr-Vnn2 Index or DVI to discriminate recurrent BM from RN using peripheral blood. The presence of CD14+ HLA-DRneg/low Mo-MDSC is significantly increased in the peripheral blood of patients with brain metastasis recurrence compared to RN (Average 61.5%vs 7%, n=10 and n=12, respectively, P<.0001). In contrast, expression of VNN2 on circulating CD14+ monocytes is decreased in BM patients compared to patients with RN (5.5%vs 26.5%, n=10 and n=12, respectively, P=.0008). In patients with biopsy confirmed recurrence of brain metastasis, the average DVI was 11.65, whereas the average DVI for RN patients was consistently <1 (Avg. of 0.17). These results suggest that DVI could be a useful diagnostic tool to differentiate recurrent BM from RN using a minimally invasive blood sample.

MiR-21-3p alleviates neuronal apoptosis during cerebral ischemiareperfusion injury by targeting SMAD2

Cerebral ischemia is due to the formation of blood clots or embolisms in the brain arteries, which leads to local brain tissue necrosis and neural cell apoptosis. Recent studies have shown that microRNA (miRNA) plays an important regulatory role in the pathological process of ischemic injury. The aim of this study is to investigate the role and the mechanism of miR-21-3p and drosophila mothers against decapentaplegic 2 (SMAD2) in cerebral ischemic reperfusion injured (CIRI) neural cells. The CIRI model was established by oxygen-glucose deprivation and recovery process for N2a cells. The cell viability and the apoptotic was evaluated by MTT assay and the Flow Cytometer, respectively. The expression of miR-21-3p and SMAD2 mRNA was detected by real-time fluorescence quantitative PCR (qRT-PCR), and the expression of SMAD2 and apoptotic-related proteins were detected by Western Blotting. Our results showed that miR-21-3p is down-regulated, and SMAD2 is up-regulated in CIRI. Overexpression of miR- 21-3p inhibits the apoptosis of neural cells in CIRI. miR-21-3p targets SMAD2 and inhibits SMAD2 expression. Overexpression of SMAD2 eliminates the protective effect of over-expression of miR-21-3p on neural cells in CIRI. Token together, this study provides a theoretical basis for the mechanism of ischemic reperfusion injury in neural cells and a new molecular target for ischemic stroke therapy.

RETRACTED: Gui based prediction of heart stroke using artificial intelligence

Abstract Heart strokes are most regularly caused by atherosclerosis or solidifying of the supply routes, and carry the same chance components as heart assaults (myocardial localized necrosis, coronary supply route illness) and peripheral vascular illness. The properties incorporate high blood weight, high cholesterol, diabetes, and smoking. Agreeing to american heart affiliation, one individual passes on every 36 s from the heart illness within the united states. The passing rate of heart stroke is almost 18.1% out of each 3000 patients. It is the fifth driving illness to cause passing. Numerous methods have been broadly utilized in anticipating the event, conclusion, and prognosis of the illness to help the clinicians for the treatment. The most objective is to propose a machine learning-based strategy to anticipate the heart stroke of best precision from comparing administered classification of machine learning calculations. We have moreover computed recipient hopeful bend and range beneath the bends for each classifier. Furthermore, to compare and examine the execution of the different machine learning calculations from the given demonstration with an assessment report, distinguish the perplexity framework, and categorize information. The graphical user interface (gui) is based on the proposed machine learning calculation procedure which can be compared with the finest exactness with precision, review, f1score, roc, affectability, specificity and appears the result successfully.

Progressing Cardiovascular Research

Cardiovascular infection stays the main source of death and handicap on the planet, and its tendency is changing as Americans become more established, fatter, and ethnically more different. Rather than youthful or moderately aged men with ST-section rise myocardial localized necrosis, the ordinary cardiovascular patient currently gives intense coronary disorder or with difficulties identified with ongoing hypertension or ischemic coronary illness, including cardiovascular breakdown, unexpected passing, and atrial fibrillation. Comparably, primary coronary illness is currently overwhelmed by degenerative valve or intrinsic sickness, definitely more normal than rheumatic infection.

Urinary Kidney Injury Molecule-1 as an Early Detection Biomarker for Diagnosis of Acute Kidney Injury in Patients of Snake Bite

Introduction: Acute Kidney Injury (AKI) refers to a sudden impairment of kidney function that results in the retention of nitrogenous waste products. Acute tubular necrosis involves localised necrosis of epithelial lining in renal tubules. A soluble form of human Kidney Injury Molecule-1 (KIM-1) is a type 1 membrane-spanning protein which lends epithelial cells the capacity to perceive and phagocytose dead cells in post ischaemic kidney. Aim: To estimate urinary KIM-1 level in patients with snake bite as a potential biomarker for early detection for AKI. Materials and Methods: This was an analytical case-control study, which was conducted on 100 patients admitted for snake bite at Thanjavur Medical College and hospital, Thanjavur, Tamil Nadu, India, from January 2014 to August 2014. Patients without AKI were regarded as controls and those who developed AKI were considered as cases. Blood and urine samples were collected and analysed for urinary KIM-1 by Enzyme-Linked Immunosorbent Assay (ELISA), method, serum creatinine (by kinetic JAFFE’S method) and serum urea (by Urease- glutamate dehydrogenase method). Student’s t-test was used and p-value &lt;0.05 was regarded significant. Pearson’s correlation coefficient was used to assess correlation between measured parameters. Results: Among 100 patients, 44 were diagnosed as patients having AKI and 56 of them did not develop AKI. No significant difference was found in urinary KIM-1 values between age group of &lt;40 years and age group ≥40 years in cases (p-value=0.39) and in controls (p-value=0.65). A significant elevation of urinary KIM-1 was seen among cases of snake bite who developed AKI. Urinary KIM-1 levels were found to significantly rise within 24 hours of admission (p-value &lt;0.001), whereas, serum creatinine and urea values were not increased until the day 3 of nephrotoxic trauma. The urine KIM-1 and serum creatinine on day 1 had negligible correlation (r-value=0.093, p-value=0.54) and urine KIM-1 and urea on day 1 had low positive correlation (r-value=0.380, p-value=0.011). With progressive damage to the kidneys, a positive correlation was found between urine KIM-1 and serum urea (r-value=0.864), creatinine (r-value=0.882) on third day. Also, levels of urinary KIM-1 significantly increased (p&lt;0.001) with the severity of tubular injury. Conclusion: Urinary KIM-1 is a promising quick predictive marker of AKI in contrast to traditional markers, serum urea and creatinine.

Türkiye’de ampütasyonların endikasyonları, komplikasyonları ve revizyonları

Aim: The objective of this study is to determine the incidence of indications for amputations, major amputation related complications and revision numbers in Level I trauma center; which consists burn care unit, hyperbaric oxygen unit and hand surgery department in Turkey.&#x0D; Materials and Methods: Amputation procedures were retrospectively reviewed and evaluated according to the amputation levels, etiology, and demographic data. Major complications that require surgical intervention, type of surgical intervention for these complications and interval between index surgery and first complication related surgery were recorded. Re-amputations were evaluated according to interval between index and revision surgery, revision indication, and revised level.&#x0D; Results: A total of 558 amputations were performed for 476 patients (367 male, 109 female) in five-year period. The most common indication of amputation was diabetic complications, 250 amputations for 215 diabetic patients (44.8%) were performed. Peripheral arterial disease and trauma were the second and third common indications. The most common indication for upper extremity amputation was trauma. The most common amputation levels were hand amputations in the upper extremity, and below-knee amputation in the lower extremity. Fifty-seven of the surgical procedures were re-amputations and the interval between index surgery and revision amputation was 5.0±15.8 months. The most common indication for revision amputation was diabetic complications. Complications that required surgical intervention were infection in 46 patients, local soft tissue necrosis in 28 patients, and wound dehiscence in 2 patients.&#x0D; Conclusions: This is the first study investigating amputation etiology from high capacity hospital in capital city of Turkey that can demonstrate the whole country. The most common indications in this study were diabetic foot, PAD, and trauma as it is in developed countries. The results of this study can be the first step of multicenter epidemiological studies about amputations.

Allium sativum: Oral mucosal burn

Introduction: Oral medicine practitioner has reported many cases of chemical burn in the oral mucosa. Inappropriate self-treatment with topical application of various therapeutic or non-therapeutic agents often causes chemical burns. Garlic is a century old herb, commonly used in culinary which can cause oral mucosal burns when misused. Case Description: A male patient aged 55 years, reported to the department with a history of tooth pain since one month which had increased in intensity 3 days back. To alleviate the dental pain he had applied crushed raw garlic (Allium sativum) at the site of pain for 60 minutes consecutively for 3 days before visiting the hospital. On intra-oral clinical examination, white pseudo membranous lesion surrounded by erythema was noted on right posterior maxillary and mandibular attach gingiva. At the site of crushed raw garlic application, localized tissue necrosis was observed. The patient was advised to stop self-treatment with raw garlic and was prescribed systemic and topical analgesics to relieve the dental pain. Conclusion: This case report highlights the importance of clinical case history recording. The oral physician should be aware of the herbs like garlic which are commonly used to alleviate pain, which can cause adverse effects like mucosal burn if used inappropriately. Keywords: Chemical burn, garlic, Allium sativum, Oral soft-tissue burns, Mucosal burn.

Root resorption as a result of orthodontic treatment

Apical root resorption is a biological process induced when orthodontic force is exerted on a tooth and local necrosis of the periodontal ligament occurs. Macrophages remove the necrotic tissue. In this way, differentiating osteoclasts can both attach to the now available dental surface and can then provoke root resorption. There is considerable uncertainty among dental practitioners on how to deal with clinically relevant apical root resorption (bigger/equal 2 mm) during or after orthodontic treatment. To increase understanding and to improve the quality of care, the Dutch Association of Orthodontists has developed a clinical practice guideline. Recommendations have been formulated for the diagnosis of apical root resorption, possible risk factors and treatment management in order to respond adequately to this problem in practice.

Drug Crystal-Related Gastrointestinal Complications Involve Crystal-Induced Release of Neutrophil and Monocyte Extracellular Traps.

Ion-exchange resins are commonly used to manage complications of chronic kidney disease, such as hyperphosphatemia, hyperkalemia, and hypercholesterolemia. Occasionally, these drugs can irritate the gastrointestinal lining and cause life-threatening intestinal necrosis. Currently, the pathophysiology of drug crystal-induced intestinal necrosis is not well understood. We hypothesized that crystals of ion-exchange resins like sevelamer, polystyrene sulfonate, and cholestyramine can trigger the formation of neutrophil and monocyte extracellular traps by contributing to intestinal barrier dysfunction. Light and fluorescence microscopy of the colonic resection specimen from a patient with chronic kidney disease revealed severe intestinal necrosis, ulceration, sevelamer crystals, and inflammation upon oral intake of sevelamer, as well as the formation of neutrophil extracellular traps in proximity to small sevelamer crystals. Indeed, drug crystals reduced metabolic activity and induced barrier dysfunction and cell death in human intestinal epithelial cells in vitro. In addition, drug crystals triggered the release of neutrophil and monocyte extracellular traps. Taken together, these data raise the possibility that besides other factors including chronic kidney disease, diabetes mellitus, and hypertension, drug crystals may further amplify a pre-existing barrier dysfunction and necroinflammation in a crescendo of local intestinal necrosis and systemic inflammation/infection, as occasionally observed in patients on ion-exchange resin therapy.

Targeting of cucumber necrosis virus coat protein to the chloroplast stroma attenuates host defense response

Cucumber necrosis virus (CNV) is a (+)ssRNA virus that elicits spreading local and systemic necrosis in Nicotiana benthamiana. We previously showed that the CNV coat protein (CP) arm functions as a chloroplast transit peptide that targets a CP fragment containing the S and P domains to chloroplasts during infection. Here we show that several CP arm mutants that inefficiently target chloroplasts, along with a mutant that lacks the S and P domains, show an early onset of more localized necrosis along with protracted induction of pathogenesis related protein (PR1a). Agroinfiltrated CNV CP is shown to interfere with CNV p33 and Tomato bushy stunt virus p19 induced necrosis. Additionally, we provide evidence that a CP mutant that does not detectably enter the chloroplast stroma induces relatively higher levels of several plant defense-related genes compared to WT CNV. Together, our data suggest that targeting of CNV CP to the chloroplast stroma interferes with chloroplast-mediated plant defense.

SURG-04. SALVAGE RESECTION OF RECURRENT PREVIOUSLY-IRRADIATED BRAIN METASTASES: CLINICAL AND RADIOGRAPHIC OUTCOMES

Abstract BACKGROUND The management of brain metastasis (BrM) recurrence after stereotactic body radiotherapy (SBRT) poses a clinical challenge. The efficacy of salvage resection is undefined, and the role of adjuvant resection cavity reirradiation is unclear given the compounded risk of radiation injury. METHODS Retrospective analysis of previously-irradiated BrM that underwent resection between March 2003 and February 2020 at Memorial Sloan Kettering Cancer Center was performed. Only cases with histopathologic evidence of viable malignancy were included, and specimens were classified by the gross proportion of viable tumor versus treatment effect. Clinical and radiographic parameters were collected. Post-operative recurrence and radiation necrosis were based on RANO-BM criteria and distinguished by histopathologic, radiographic and clinical characteristics. Equivocal cases were adjudicated by a blinded neuroradiologist. RESULTS One-hundred fifty-five resected recurrent BrM following SBRT in 135 patients were evaluated. Seventeen received additional prior whole-brain radiation. Metastases derived from non-small-cell lung (36.8%), melanoma (27.1%), breast (21.3%), renal (3.9%), colorectal (1.9%) and other (9.0%) primary malignancies. Forty-eight (31.0%) had only microscopic malignant disease with extensive necrosis, 44 (28.4%) had mixed or unspecified tumor with treatment effect, and 63 (40.6%) were reported as purely viable tumor by histopathologic report. Thirty-nine (25.2%) post-operative cavities underwent adjuvant reirradiation within 60 days. At 6 and 12 months, local tumor recurrence occurred in 31.6% (95% CI: 24.4%-39.1%) and 40.4% (95% CI: 32.5%-48.2%), respectively, with a proportion of these lesions displaying mixed tumor plus treatment effect. Median overall survival was 13.4 months (95% CI: 10.5-17.7) from salvage resection. CONCLUSIONS Salvage of previously-irradiated BrM remains challenging. This represents the largest known series correlating salvage resection and histopathologically-confirmed viable recurrent BrM with long-term outcomes. Tumor recurrence risk remains high at one year. Further exploration will stratify local progression and radiation necrosis rates by features including extent of resection, degree of viable tumor and adjuvant reirradiation use.

Chevrel technique for ventral incisional hernia. Is it still an effective procedure?

Incisional hernia still represents the most frequent late complication of abdominal surgery. After a direct repair, in literature is reported a recurrence rate ranging from 31 to 49%, meanwhile after a prosthetic repair such values were much lower, with a recurrence rate up to 10%. The sites of prosthetic placement in the abdominal wall are premusculo-aponeurotic (onlay, or Chevrel technique), retromuscular-prefascial and preperitoneal (Rives technique, Stoppa technique), whereas intraperitoneal insertion can be done with open or laparoscopic surgery. The aim of this study was to evaluate the immediate and late postoperative results in patients treated with a Chevrel technique for ventral incisional hernia. A retrospective review was conducted on the medical records of patients undergoing ventral hernia repair between January 2008 and December 2018 at the Emergency Surgery Unit of the Careggi University Hospital in Florence. Between January 2008 and December 2018 at the Emergency Surgery Unit of the Careggi University Hospital in Florence, 461 patients (245 male, 216 female) with a mean age of 61,52 years were submitted to ventral incisional hernia repair with a Chevrel technique. The mean operatory time was 95.29 min (±50.48) and in 72 patients (15.61%) human fibrin glue was vaporized under the mesh using a spray device. Mean postoperative hospital stay was 5 days and all drain tubes were removed after 7.1 days as mean (±4.3). No intraoperative mortality nor postoperative mortality was reported. In our experience the Chevrel technique for ventral incisional hernia show a recurrence rate (3.2%). Parietal complications observed were seroma in 7.1% of patients, hematoma in 4.7%, localized skin necrosis in 5.2%, surgical site infection in 6.7%, data comparable with the results reported in the other studies. Most of the objections to the Chevrel procedure focus on the parietal complications and risk of infection. Chevrel procedure cannot be considered an obsolete intervention, in our series, results were very satisfactory in both immediate and late follow-up; moreover this technique is safe and easy to perform.

Retrospective Multicenter Study of Stereotactic Irradiation for Metastatic Brain Tumors in Japan

Stereotactic Irradiation (STI) has been increasingly utilized in the management for metastatic brain tumor. However, many studies show combined therapy with surgery or whole brain radiation therapy (WBRT). The purpose of this study is to report the multicenter outcome of metastatic brain tumors treated only by STIs in Japan. This was a retrospective multicenter analysis to review a total of 686 patients with 918 lesions which had diameter > 10 mm. STIs were performed among 26 institutions participated in Japanese Radiation Oncology Study Group (JROSG) from January 2013 to December 2015 treated with linear accelerators. Previous WBRT or surgery cases were all excluded. Local control (LC), overall survival (OS), and brain necrosis followed with diagnostic MRI were analyzed by Kaplan-Meier method. Patient characteristics were as follows. Median age was 67 years (range: 26-91). Median follow-up was 12.1 months (range: 0.5-55.5), Median KPS score/ tumor size/ number of lesion were 90/ 17mm/ 2, respectively. Primary sites were lung/ breast/ GI/ others = 527/ 106/ 114/ 171 cases, respectively. Median dose delivered was 31.5 Gy in 3 fractions (range 13.4-55 Gy). Treatment outcome was CR/ PR/ SD/ PR = 151/ 349/ 167/ 145 and death/ survive = 510/ 280, respectively. 1-year LC was 80.5%. Median survival was 15.8 months. 1-year OS was 58.9%. 1-year LC for tumor size of 3-4 cm was 59.2%. There was no difference in LC between single fraction and multiple fractions. Brain necrosis occurred at 6 months/ 1-year = 4.8%/ 10.6%. The incidence was linearly correlated with the time after treatment. Positive outcome of STI for brain metastases without WBRT or surgery was achieved. LC was a little poor with the tumor diameter > 3 cm. Brain necrosis occurred regardless of a tumor size and a delivered dose, and long-term follow-up is mandatory.

Endocrine and Metabolic Manifestations of Snakebite Envenoming.

Snakebite envenoming is a neglected, public health problem in tropical and subtropical regions. Local tissue necrosis, neurotoxic, and hemo-vasculotoxic effects are well-recognized features, whereas the endocrine and metabolic derangements are not as well known. In addition to contributing to morbidity, some of these manifestations can be potentially life-threatening if not recognized early. The most prominent endocrine manifestation is hypopituitarism (HP), which can manifest acutely or remain asymptomatic and present years later. Unexplained recurrent hypoglycemia and refractory hypotension are early clinical clues to suspect corticotroph axis involvement in acute settings. Chronic pituitary failure may present, like Sheehan's syndrome, several years after the bite. The occurrence of acute kidney injury, capillary leak syndrome, and disseminated intravascular coagulation are predictors of HP. Adrenal hemorrhages are documented in autopsy series; however, primary adrenal insufficiency is very rare and confounded by the presence of HP. Hyponatremia, hypokalemia or hyperkalemia, and dysglycemia can occur, but the mechanisms involved are only partially understood. Awareness, a high index of suspicion, correct interpretation of hormonal parameters, and timely treatment of these abnormalities can be lifesaving.

Prevention and Treatment of Pressure Ulcers in Stroke Patients at ICU

Pressure ulcers are local tissue necrosis of the skin tissue and between bone protrusions, patients with stroke have a weakness in one or all limbs that causes patients to undergo treatment with bed rest so that a high risk of pressure ulcers. Treatment and recovery of pressure ulcers with bundle care are given as nursing actions to protect skin integrity. The aims of this study to identify and analyze scientific evidence for the use of bundle care with five key elements. The research method used in the review literature in international articles published in 2015-2019, obtained the results of 5 articles that fit the inclusion criteria. A series of five key bundle care elements should be given from the beginning of the patient being treated.

Effects of osteoblast autophagy on glucocorticoid-induced femoral head necrosis.

Objectives This study aims to explore the mechanism by which osteoblast autophagy participated in glucocorticoid-induced femoral head necrosis (FHN).Materials and methods Thirty male specific-pathogen-free C57 mice (age, one month; weighing 20-25 g) were randomly divided into blank control, dexamethasone and rapamycin-dexamethasone groups (n=10). After six weeks of intervention, right femoral head was obtained to observe morphology and to calculate percentage of empty lacunae. MC3T3-E1 cells were randomly divided into normal, dexamethasone, rapamycin and dexamethasone-rapamycin groups, and cultured for 24 h. Microtubule-associated protein 1 light chain 3 (LC3)-I, LC3-II, mammalian target of rapamycin (mTOR) and Beclin-1 protein expressions were detected by Western blot.Results In rapamycin-dexamethasone group, some bone trabeculae in medullary cavity ruptured and atrophied, and subchondral bone underwent local necrosis. The total apoptosis rates of dexamethasone and rapamycin-dexamethasone groups surpassed that of blank control group, and the former two groups had significantly different rates (p<0.001). LC3-II/LC3-I of dexamethasone group was lower than those of rapamycin and dexamethasone-rapamycin groups (p<0.001), and the ratio of rapamycin group surpassed that of dexamethasone-rapamycin group (p<0.001). Dexamethasone group had higher mTOR protein expression than those of rapamycin and dexamethasone- rapamycin groups (p<0.001), and the expression of rapamycin group was lower than that of dexamethasone-rapamycin group (p<0.001). The Beclin-1 protein expression of dexamethasone group was lower than those of rapamycin and dexamethasone- rapamycin groups (p<0.001), and the expression of rapamycin group exceeded that of dexamethasone-rapamycin group (p<0.05).ConclusionOsteoblast autophagy may play a crucial protective role in dexamethasone-induced FHN. The attenuation of autophagy may be related to the affected expressions of key autophagy regulators mTOR and Beclin-1.

The role of Smad7 in cutaneous wound healing.

Chronic refractory wounds are generally caused by local tissue defects and necrosis, and they are characterized by delayed wound healing as well as high recurrence, which seriously affects life quality. However, effective therapeutics to treat wounds are currently unavailable. Therapy primarily aims to accelerate generation of granulation tissue and decrease recurrence. The pathogenesis of chronic refractory wounds is closely related to multiple complex signaling pathways and a series of cytokines. Among these signaling pathways, TGF-β/Smad7 axis plays a critical role. Specifically, Smad7 is an antagonist of TGF-β that inhibits activation of TGF-β. Moreover, Smad7 promotes wound healing by regulating cytokines and controlling growth, differentiation and apoptosis of cells, which may be exploited to cure the disease. This review aims to reveal the exact functions and mechanisms of Smad7 in regulation of wound healing.

Potential utilization of a lambda carrageenan polysaccharide, derived from a cultivated, clonal strain of the red seaweed Chondrus crispus (Irish moss) against toxic actions of venom of Bothrops jararaca and B. jararacussu snakes

Snakebites are a serious occupational problem affecting rural populations of tropical and sub-tropical, developing countries. Envenomation caused by the snakes Bothrops jararaca and B. jararacussu is characterized by local pain, edema, hemorrhage, tissue necrosis, and death. Despite the fact that antivenom may prevent the death of bite victims, treatment does not prevent tissue necrosis, often leading to amputation or deformity of the victim’s affected limb.Therefore, more efficient therapies need to be investigated. In this work, we tested the ability of a carrageenan galactan polysaccharide, isolated from a clonal strain of the red alga, Chondrus crispus (commonly known as Irish moss) to inhibit toxic, in vitro (coagulation, hemolytic and proteolytic) or in vivo (hemorrhagic, edematogenic, myotoxic and lethal) activities of B. jararaca or B. jararacussu venom. When the polysaccharide was mixed together with the venoms, inhibition of their toxic activities was achieved, but with different potencies. Moreover, inhibition of hemorrhage, edema, lethality, or myotoxicity was observed, even if the polysaccharide was injected before or after the injection of venoms, regardless of the route of administration (i.e., intravenous, subcutaneous, and intraperitoneal). A gel formulation containing the polysaccharide of C. crispus also protected mice from hemorrhage after administration of the venoms. Thus, the lambda carrageenan polysaccharide, as produced by a strain of C. crispus, may aid antivenom to block the toxic activities of B. jararaca and B. jararacussu venom, as well as to aid in the development of a more efficient therapy for envenomation by these venomous snakes.

The clinical effect of static staple in the treatment of lateral metatarsal neck fracture

Objective: To investigate the clinical effect of static staple in the treatment of metatarsal neck fracture. Methods: The clinical data of 34 patients with the 2(nd) to 5(th) metatarsal neck fracture admitted to the Department of Orthopaedic Surgery, Tianjin Fifth Central Hospital from January 2017 to December 2018 were retrospectively analyzed.Seventeen patients were treated with static staple and 17 with retrograde Kirschner wire.In solustaple group, there were 11 males, 6 females, aged 34.6 years (range: 21 to 50 years), 10 cases on the right side, 7 cases on the left side.In retrograde Kirschner wire group, there were 12 males and 5 females, aged 36.2 years (range: 23 to 53 years), 9 on the right and 8 on the left.The fracture healing time was recorded and the postoperative complications were counted.The American Orthopedic Foot and Ankle Society Score (AOFAS) forefoot score, visual analogue scale (VAS), and the active flexion and extension range of metatarsophalangeal joints were measured to compare the clinical efficacy of the two groups.The data were compaired by t test, non-parametric or χ(2) test. Results: All patients were followed up for 14.2 months (range: 12 to 17 months).All the fractures were healed and there was no statistically significant difference between solustaple group and retrograde Kirschner wire group in fracture healing time ((11.2±2.1) week vs.(11.5±3.1) week, t=0.030, P=0.743).There was no statistically significant difference between VAS (1.00 (1.00) vs.1.00 (1.50) M(Q(R)), Z=-0.443, P=0.658) and AOFAS scores(90.9±5.3 vs. 88.6±6.1, t=1.174, P=0.249) at the last follow-up. The difference in active dorsiflexion((35.1±4.3)° vs.(31.2±6.4)°, t=2.055, P=0.048) and flexion range of motion ((34.7±4.5)° vs. (30.2±5.3)°, t=2.681, P=0.011) between the two groups was statistically significant. One case of open fracture in the Solustaple group had local skin necrosis, and three patients had metatarsal pain after weight-bearing walking. Four patients in the retrograde Kirschner wire group developed metatarsalgia after weight-bearing walking, and two patients developed mild dorsal extension contracture and joint pain. Conclusions: The treatment of the 2(nd) to 5(th) metatarsal neck fracture by static staple is minimally invasive and firmly fixed. It can effectively reduce the complications of tendon and joint adhesion, and is beneficial to the fracture healing and joint function recovery.

Co-Administration of Morphine and Naloxone: Histopathological and Biochemical Changes in the Rat Liver

Background: Co-administration of opioid agonists and antagonists at low doses has been reported to significantly enhance and/or prolong the analgesic effects and reduce or prevent tolerance to or dependence on opioids. Objectives: The current study aimed at evaluating the naloxone effect on morphine-induced histopathological and hematologic changes in rats. Materials and Mehods: Thirty mature male Wistar rats were categorized into three groups (n = 10) in a random manner, including the control group receiving normal saline, the morphine-sole group receiving morphine (5 mg/kg/day), and morphine + naloxone group receiving morphine and naloxone (5 and 0.4 mg/kg/day, respectively). After 50 days, the levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), triglyceride (TG), aspartate aminotransferase (AST), cholesterol, and high-density lipoprotein (HDL) were measured in the serum. Moreover, the levels of superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and glutathione peroxidase (GPx) were measured to assess the serum antioxidant capacity. Histopathological changes were investigated via hematoxylin and eosin, Masson’s trichrome, and periodic acid-Schiff staining. Inter-group comparisons were made by GraphPad Prism software using one-way ANOVA and Tukey’s test. Results: The animals in the morphine + naloxone group showed higher AST, ALP, ALT, and CAT levels in comparison with the control and morphine-sole groups (P &lt; 0.05). Our findings revealed no changes in the cholesterol, TG, SOD, and GPx levels among the groups (P &gt; 0.05). However, the morphine-sole group exhibited higher serum levels of HDL compared with the controls (P &lt; 0.05). The morphine-sole group showed fibrosis, local necrosis, immune cell infiltration, and diminished intra-cytoplasmic carbohydrate storage. Conclusions: The findings suggest that apart from unchanged serum markers, morphine can potentially induce hepatotoxicity, and at the same time, naloxone is able to ameliorate morphine-induced histopathological damages.