Occurrence Of Edema Research Articles

A Rare Occurrence of Premature Birth and Recurrent Acute Pulmonary Oedema in the Mother due to Cushing’s Syndrome: A Case Report

Presentation of Cushing’s syndrome during pregnancy is extremely rare. We report a 21-year-old female with Cushing’s syndrome diagnosed at 23 weeks of gestation and had recurrent acute pulmonary oedema during the antepartum and postpartum period. She delivered prematurely via emergency caesarean section at 28 weeks of gestation. This case highlights the rare occurrence of recurrent acute pulmonary oedema during pregnancy and consequential premature birth in a patient with adrenal Cushing’s. She was diagnosed with adrenal Cushing’s during the postpartum period based on unsuppressed serum cortisol after overnight and low-dose dexamethasone suppression test with a suppressed ACTH. CT scan of the adrenal glands revealed a right adrenal cortical adenoma. The risk of complications in infants and mothers who suffer from Cushing’s syndrome needs to be handled carefully. The diagnosis of Cushing’s syndrome in pregnant women often overlaps and is difficult to establish in early pregnancy.

Long-term prophylaxis therapy in patients with hereditary angioedema in Russia: resolution of the expert Council

Hereditary angioedema is a rare (orphan) disease associated with the development of angioedema of various localization caused by the action of bradykinin. The main symptoms of the disease are peripheral angioedema, abdominal attacks (accompanied by severe pain syndrome), edema of the upper respiratory tract, which may lead to asphyxia and death of the patient. Peripheral edema disrupts social and professional activity, the occurrence of facial edema complicates social adaptation, the unpredictability and potential threat to life of edema in the larynx, as well as the lack of effect from standard (systemic glucocorticoid and antihistamines) therapy regimens lead to a low quality of life of patients, a large number of days of disability, hospitalizations, in some cases, premature death of patients.
 According to international studies, on-demand therapy does not reduce the burden of the disease, and therefore international guidelines emphasize the importance of timely and individualized selection of long-term prevention for patients with hereditary angioedema. Taking into account the appearance of a new drug for long-term prevention in Russia, an Expert Council was held to assess the burden of the disease in Russian patients, determine the proportion of patients who need long-term prevention, criteria for choosing a medication for prophylaxis and the place of Lanadelumab in it.

P-24 FREQUENCY AND SEVERITY OF LIVER INVOLVEMENT IN PREGNANT WOMEN ADMITTED TO AN INTENSIVE CARE UNIT WITH HYPERTENSIVE DISORDERS OF PREGNANCY

The hypertensive disorders of pregnancy(HDP) are major causes of maternal and perinatal morbidity-mortality worldwide. To evaluate the frequency and severity of liver involvement in pregnant women with HDP, assessing its outcomes. A total of 210 parturients were retrospectively evaluated. The frequency of any type of liver involvement was investigated, and its occurrence correlated with maternal-fetal mortality and prematurity. The most common symptoms were abdominal pain (100; 47.6%) and headache (83; 39.5%). Most patients had gestational hypertension defined as severe (n = 184), including 6 (2.9%) women progressing to eclampsia. Changes in liver enzymes and HELLP syndrome were observed in 124 (59%) and 19 (9%) patients, respectively. Subcapsular hemorrhage and spontaneous hepatic rupture were identified in one woman who died. No patient had definitive diagnosis for acute fatty liver of pregnancy, neither acute liver failure. 62% of deliveries occurred before 37 weeks. Fetal mortality was observed in 6 (2.9%) cases. It was associated with gestational age (29.3±5.7 vs.34.01 ±4, p = 0.006), the occurrence of pulmonary edema (16.7% vs. 0.5%, p= 0.005) and renal insufficiency (33% vs. 5%, p= 0.04). Multiparity (68%vs, 30%, p=0.0001), previous history of hypertension (22.4 %vs 12.3 %, p=0.05), uric acid concentration (6.7±1.6 vs 5.9±1.5, p= 0.005) and renal dysfunction (7.5% vs. 1.4 % vs. p=0.05) were associated with prematurity. There was no significant correlation between prematurity or maternal-fetal mortality and liver involvement. HDP form a spectrum of disease. Early recognition and multidisciplinar support are essential in order to ensure better outcomes.

Herpetic endotheliitis following an uncomplicated cataract surgery

Introduction: Herpetic endotheliitis after cataract surgery is a rare complication, and it is more likely linked with previous ocular herpetic infection. Case Report: In the current case, the patient of this study is a 66-year-old woman without a personal history of herpes simplex keratitis (HSK) who underwent an uneventful phacoemulsification in her left eye. For the next two weeks, corneal endotheliitis appeared in the same eye, and then the initial diagnosis of HSK was made clinically. The patient was treated with systemic and topical antiviral therapy associated with an intensive topical corticosteroid. In four weeks, a complete resolution of the corneal edema was noticed and the visual acuity was improved (6/9). Conclusion: The occurrence of corneal edema after cataract surgery could reveal a herpetic endotheliitis, although early diagnosis and early treatment with strict monitoring are the keys to successful control of this affection.

48-Hour versus 7-day antibiotic prophylaxis in the prevention of surgical site infection after simple dental extractions: A randomised clinical trial with amoxicillin

ObjectiveThe aim of this study was to evaluate the efficacy of 48-h antibiotic prophylaxis in the prevention of surgical site infections during simple dental extractions by conducting a clinical trial controlled by 7-day antibiotic therapy. Our hypothesis was that there was no difference between these two protocols in the prevention of surgical site infection. Methodology: This was a 6-month randomised multicentre clinical trial conducted in three health facilities in the city of Yaoundé. The study included any patient aged 18 years or older who was scheduled for a simple dental extraction. The calculated sample size was 142 patients randomly divided into 2 groups. Group I consisted of patients who took 1 g of amoxicillin 1 h before surgery and then 1 g every 12 h for 48 h. Group 2 took amoxicillin only postoperatively at a rate of 1 g every 12 h for 7 days. The control was done at day and day 7. The primary endpoint was the occurrence of surgical site infection and the secondary endpoints were the occurrence of dry socket, oedema and pain. ResultsNo statistically significant difference was found at the 5% level between the two protocols regarding the occurrence of pain, postoperative oedema and surgical site infection with respective p-values of 0.834; 0.414; 0.175. In addition, a statistically significant difference was found for dry socket disease (p-value = 0.0149) showing a reduced risk in the 48-h group. ConclusionIt was found that there was no difference between these two protocols except for dry socket disease where the 48 h antibiotic prophylaxis protocol seems to be more effective. Furthermore, the question of the necessity of antibiotic prophylaxis for simple extractions remains, as only a randomised placebo-controlled clinical trial could provide answers.

S100A9-containing serum exosomes of burn injury patients promote permeability of pulmonary microvascular endothelial cells

Microvascular hyperpermeability is a leading mechanism responsible for occurrence of edema in remote organs and tissues in patients with burn injury. Accumulated evidence has shown that exosomes can be transported into target cells, where they are capable of regulating biological functions and physiology. Of exosomal proteins contributing to enhanced inflammation and vascular permeability, S100 calcium binding protein A9 (S100A9) has received increasing attention. Here we hypothesized that S100A9-containing serum exosomes of patients with burn injury contribute to pathogenesis of hyperpermeability of microvascular structure in lung by transferring signaling molecules into it and activating downstream signaling pathways, ultimately leading to disruption of the tight junctions (TJs) and endothelial barrier. A use of enzyme-linked immunosorbent assay revealed that total serum concentrations of S100A9 were significantly augmented in burn injury patients in comparison to normal controls. With use of human pulmonary microvascular endothelial cells (HPMECs) as an in vitro model, we found that patients' serum exosomes were effectively internalized by HPMECs. We further found that serum exosomes of stage II/II burn patients inhibited zonula occludens (ZO-1) and occludin protein levels, which are essential for TJs integrity and endothelial barrier function, but activated p38 MAPK signaling pathway in HPMECs. As expected, such exosomes-mediated effects on HPMECs were reversed by a simultaneous treatment of anti-S100A9 neutralizing antibody. Finally, we found that a recombinant human S100A9 treatment led to inhibition of expression of occludin and ZO-1 but an activation of p38 signaling in HPMECs, and that such effects were reversed when p38 activity was repressed, implying that S100A9 may stimulate p38 activity to inhibit ZO-1 and occludin in HPMECs. Collectively, these data suggest that S100A9-containing serum exosomes may play a critical role in contributing to pulmonary microvascular hyperpermeability, thus supporting that blocking exosomes' access to HPMECs could hold a promise strategy for treatment of lung edema resulting from burn injuries.

Post-operative analgesia following TPLO surgery: A comparison between cimicoxib and tramadol

ObjectiveTo compare the analgesic effects of oral administration of cimicoxib and tramadol over a 30 day period following Tibial Plateau Leveling Osteotomy and partial menisectomy in dogs. DesignRandomized, double blinded, prospective clinical trial. Animals42 adult client-owned dogs with unilateral cranial cruciate ligament disease and partial meniscal tears. MethodsDogs were allocated into 2 treatment groups (cimicoxib or tramadol). Weight bearing while standing, thigh circumference, flexion and extension range of motions, wound classification, adverse effects, Visual Analogue Scale (VAS), Glasgow Composite Measure Pain Scale (CMPS-SF) and Helsinki Chronic Pain Index (HCPI) questionnaire and limb function by means of pressure platform gait analysis were recorded before surgery and at several time points after surgery for 30 days. Outcome measures were compared at each time point among groups. ResultsA significant improvement in two objective measures of gait of the cimicoxib group: the vertical impulse on day 1 and day 20 and the peak vertical force on day 20 were significantly improved when compared to the tramadol group. However, no difference was seen for the VI or PVF of dogs on the other days compared. In addiction there was no difference in the weight bearing while standing, thigh circumference, wound classification, adverse effects, VAS, CMPS-SF and HCPI. We did not observe a difference in the number of adverse effects measured in this study with the exception of hock edaema. Conclusions and clinical relevanceA significant difference was not found in long-term postoperative analgesia provided by cimicoxib or tramadol in dogs undergoing TPLO when subjective parameters (with the exception of knee joint range of motion) were evaluated, but use of the force plate analysis revealed a significant difference between groups at T20 for both PVF and VI. The use of cimicoxib improved the limb function and ROM and reduced the occurrence of hock edema, in the first 20 days after surgery, without any additional side effects, compared to tramadol. Thus, the use of cimicoxib should be preferred to tramadol alone in clinical cases similar to the ones included in this study.

Endoscopy-assisted pars plana lensectomy for brunescent cataracts in eyes with microcornea with microphthalmos

ABSTRACT Purpose Conventional cataract surgeries can be a challenge in eyes with microcorneas due to difficult manipulation in a crowded anterior chamber (AC) and can lead to a high occurrence of corneal edema and an increased rate of complications. Similarly, in cases of dense brunescent cataracts even a lensectomy through posterior approach may prove to be difficult because of inadequate visualization. An endoscopyassisted pars plana lensectomy can help in obviating these difficulties. This study aims to describe the surgical technique of endoscopy-assisted pars plana lensectomy in eyes with brunescent cataract, microcornea, and microphthalmos. Methods Retrospective review of two cases where endoscopy-assisted pars plana vitrectomy and lensectomy was performed for patients with dense cataract and microcornea and microphthalmos. Result Complete clearance of the cataract was achieved without having to resort to a sclerocorneal incision. Postoperatively the cornea was clear and there was no postoperative corneal edema. Conclusion Endoscopy-assisted pars plana lensectomy can help in overcoming the challenges of conventional anterior and posterior approaches of cataract extraction in cases of microcornea with reduced intraoperative and postoperative complications.

Epiretinal membrane vitrectomy: outcomes with or without cataract surgery and a novel prognostic factor for cystoid macular edema.

To assess the outcomes of vitrectomy with or without cataract surgery for the treatment of idiopathic ERM in phakic eyes and evaluate predictors of functional and anatomical outcomes. Retrospective cohort of consecutive phakic ERM eyes distributed in three groups: a) combined (phacovitrectomy) group, b) PPV-only group, and c) consecutive group (PPV followed by cataract surgery). Main outcomes were final visual acuity (VA) and cystoid macular edema (CME) occurrence. Potential predictors of VA or CME included clinical variables and SD-OCT parameters. A total of 108 eyes were included in this study. There were no differences in the final VA between consecutive and combined groups (0.22 vs 0.10 logMAR, p= 0.851). Twelve eyes from the combined group (23%) and one eye from the PPV-only group presented CME (p= 0.001). There were no differences between postoperative CME occurrence in combined versus consecutive group (12 vs 7, p= 0.38). The presence of cotton-ball sign predicted the development of CME [OR 2.86 (95%CI 1.01-8.18), p= 0.049] while separated ERM-ILM complex was found to be protective [OR 0.25 (95%CI 0.08-0.77), p= 0.015]. Functional and anatomical results of PPV with ERM and ILM peeling combined with cataract surgery was equivalent to the consecutive procedure, with both strategies being effective. Separated ERM-ILM complex has prognostic value in these patients, as its presence at baseline was found to be protective for postoperative CME.

Role of Vitamin D and uric acid levels in serum to identify the risk of developing macular edema - A case-control study

Background: Diabetes mellitus is more prevalent in India and also an emerging epidemic across the world. Uncontrolled diabetes mellitus is associated with chronic microvascular complications including diabetic retinopathy. In patients with diabetic retinopathy, macular edema is one of the common causes of vision loss. Vitamin D has inhibitory role against inflammation and angiogenesis and uric acid are found to be associated with microvascular damage. Aim and Objective: Our study was aimed to check the Vitamin D and uric acid levels in serum and its association with patients with macular edema and compare them with age-matched controls. Materials and Methods: It is an observational case–control study. The study group consists of a total of 100 subjects. Among them, there were 50 patients in Group1 and 50 controls (selective age matched) in Group 2 enrolled into the study. Group 1 cases have diagnosed cases of macular edema including both males and females. After taking informed consent, detailed history taken and thorough ophthalmological examination was done, patients in Group 1 underwent optical coherence tomography scan to assess macular edema to detect central retinal thickness. Later, they were advised for Vitamin D and uric acid levels in serum in an advanced biochemistry laboratory. Data were expressed in mean ± SD and Student’s t-test was applied to compare groups. P ≤ 0.05 was considered statistically significant. Results: Uric acid levels were raised and Vitamin D levels were reduced in serum of patients with macular edema when compared to the age-matched controls and were statistically significant (P < 0.001). Conclusion: Decreased Vitamin D levels and increased uric acid levels can be a risk factor for occurrence of macular edema in adults. Hence, serum Vitamin D levels and uric acid levels to be investigated for all patients with macular edema. It remains to be determined whether normalizing the serum Vitamin D and serum uric acid levels could improve visual acuity and prevent the occurrence of macular edema in the other eye.

Molecular mechanisms of developmental toxicities of azoxystrobin and pyraclostrobin toward zebrafish (Danio rerio) embryos: Visualization of abnormal development using two transgenic lines.

Azoxystrobin (AZ) and pyraclostrobin (PY) are strobilurin fungicides that inhibit fungal mitochondrial respiration. In this study, a representative model, zebrafish (Danio rerio), was used as a test species for acute and developmental toxicity. Survival and malformation rates were observed only PY-treated embryos, with an LC50 value of 77.75ppb accompanied by a dramatic decrease in hatching rate, while AZ did not show great mortality. Morphological changes were observed in PY-treated embryos with the occurrence of pericadial edema at 25ppb. A delay in growth was observed after treatment with pyraclostrobin at 50ppb. Use of genetically engineered Tg(cmlc:EGFP) allowed fluorescence observation during heart development. PY interfered with normal heart development via upregulation of the nppa gene responsible for the expression of natriuretic peptides. Heart function was dramatically reduced as indicated by reduced heart rates. Increased expression of the nppa gene was also seen in AZ-treated embryos. The expression level of cyp24a1 was also up-regulated, while ugt1a1 and sult1st6 were down-regulated after treatment of zebrafish embryos with AZ or PY. Overall, strobilurin fungicides might inhibit normal heart formation and function within the range of concentrations tested.

Effect of Phacoemulsification on Outcomes after Vitrectomy with Membrane Peeling regarding New Intraretinal Cystoid Changes and Transient Macular Edema

Purpose: The aim of the present study was to analyze the effect of phacoemulsification on outcomes among patients undergoing vitrectomy with membrane peeling for idiopathic epiretinal membranes, with respect to new postoperative intraretinal cystoid changes and early transient macular edema. Procedures: This retrospective analysis included patients from 6 prospective studies, examining outcomes of 23G pars plana vitrectomy with membrane peeling due to idiopathic epiretinal membranes. Phacovitrectomy with membrane peeling was performed only in the case of coexisting vision affecting cataract. Optical coherence tomography was performed prior to surgery, in the first week, and 3 months after surgery. Results: In total, 183 patients were included. The occurrence of new postoperative intraretinal cystoid changes and early transient macular edema showed a trend toward being higher among patients undergoing phacovitrectomy with membrane peeling, compared to vitrectomy with membrane peeling alone, but it did not reach statistical significance (p = 0.5 and p = 0.186). The final best corrected distance visual acuity (BCVA) 3 months after surgery was significantly lower among patients with new postoperative intraretinal cystoid changes compared to patients without (with a median difference of 1 line between groups; p = 0.016). Conclusions: New postoperative intraretinal cystoid changes and early transient macular edema are more frequent among patients undergoing phacovitrectomy with membrane peeling compared to patients with vitrectomy with membrane peeling alone.

Metabolic Activation and Covalent Protein Binding of Berberrubine: Insight into the Underlying Mechanism Related to Its Hepatotoxicity.

IntroductionBerberrubine (BRB), an isoquinoline alkaloid, is a major constituent of medicinal plants Coptis chinensis Franch or Phellodendron chinense Schneid. BRB exhibits various pharmacological activities, whereas exposure to BRB may cause toxicity in experimental animals.MethodsIn this study, we thoroughly investigated the liver injury induced by BRB in mice and rats. To explore the underlying mechanism, a study of the metabolic activation of BRB was conducted. Furthermore, covalent modifications of cysteine residues of proteins were observed in liver homogenate samples of animals after exposure to BRB, by application of an exhaustive proteolytic digestion method.ResultsIt was demonstrated that BRB-induced hepatotoxicities in a time- and dose-dependent manner, based on the biochemical parameters ALT and AST. H&E stained histopathological examination showed the occurrence of obvious edema in liver of mice after intraperitoneal (i.p.) administration of BRB at a single dose of 100 mg/kg. Slight hepatotoxicity was also observed in rats given the same doses of BRB after six weeks of gavage. As a result, four GSH adducts derived from reactive metabolites of BRB were detected in microsomal incubations with BRB fortified with GSH as a trapping agent. Moreover, four cys-based adducts derived from reaction of electrophilic metabolites of BBR with proteins were found in livers.ConclusionThese results suggested that the formation of protein adducts originating from metabolic activation of BRB could be a crucial factor of the mechanism of BRB-induced toxicities.

Sudden death in epilepsy: There is room for intracranial pressure.

IntroductionSudden unexpected death in patients with epilepsy (SUDEP) remains a poorly understood entity, and it is unclear whether the same pathomechanisms underlie all sudden deaths occurring in patients with epilepsy. One aspect not included in current models of SUDEP is the role of increased intracranial pressure (ICP) which can be observed immediately upon seizure activity in neurosurgical practice.MethodsWe conducted a systematic review of the occurrence of edema in patients with epilepsy reported to have died of sudden death who underwent brain autopsy or postmortem brain imaging and discuss how increased ICP may contribute to clinical features of SUDEP.Results19 eligible studies comprising a total of 623 patients were identified. Edema—mostly mild or moderate—was reported in 17% of cases and 74% of studies. 1% (n = 6) of the overall cases were clearly identified as having Dravet syndrome or an SCN1A mutation. In these patients, edema was found in 4 (67%) of cases.ConclusionEdema is regularly found in patients with epilepsy classified to have died from SUDEP. We argue that seizures preceding SUDEP may in certain cases elicit acute edema which may represent an additional contributing factor in the cascade of events leading to sudden death of patients with epilepsy. Furthermore, we hypothesize that mild edema may especially progress to severe edema in patients with sodium channel mutations which may represent an important mechanism to investigate in the context of understanding the significantly elevated risk of SUDEP in patients with SCN1A mutations.

Comparison of n butyl 2 cyanoacrylate and silk sutures for the minor surgical procedure: a clinical study

Background and Aim:The purpose of this study is to compare the clinical responses of intraoral mucosal incisions closed with n-butyl-2- cyanoacrylates with incisions closed with silk sutures. Materials and Methods: In thirty patients requiring minor oral surgical procedures bilateral mucosal incisions were placed. One side was closed with n-butyl cyanoacrylate and other with silk suture. Postoperatively patients were recalled on 1st, 7th, 14th, and 21st day and evaluated for pain, edema, wound dehiscence, and scar. Results were evaluated using the chi-square test. Results: The results showed that there was no statistically significant difference between suture and cyanoacrylate for occurrences of pain, edema, and wound dehiscence, and scar formation. However, the averages time taken for suturing was considerable more than the time taken for cyanoacrylate application. Conclusion: This study suggests that the efficacy of cyanoacrylate and suture in intraoral wound closure is similar for postoperatively finding like pain, edema, wound dehiscence, and scar formation. However, cyanoacrylate has certain advantages like ease of application, less time consuming, and is well accepted by patients.

Myocardial Fluid Balance and Pathophysiology of Myocardial Edema in Coronary Artery Bypass Grafting.

Myocardial edema is one of the most common complications of coronary artery bypass grafting (CABG) that is linearly related to many coronary artery diseases. Myocardial edema can cause several consequences including systolic dysfunction, diastolic dysfunction, arrhythmia, and cardiac tissue fibrosis that can increase mortality in CABG. Understanding myocardial fluid balance and tissue and systemic fluid regulation is crucial in order to ultimately link how coronary artery bypass grafting can cause myocardial edema in such a setting. The identification of susceptible patients by using imaging modalities is still challenging. Future studies about the technique of imaging modalities, examination protocols, prevention, and treatment of myocardial edema should be carried out, in order to limit myocardial edema occurrence and prevent complications.

Diagnostic Value of Magnetic Resonance Imaging in Fibrodysplasia Ossificans Progressiva.

ABSTRACTUsing [18F] Sodium Fuoride (NaF) Positron Emission Tomography (PET) it is not only possible to identify the ossifying potency of a flare‐up, but also to identify an asymptomatic chronic stage of fibrodysplasia ossificans progressiva (FOP). The purpose of this study was to investigate the diagnostic role of a more widely available imaging modality, Magnetic Resonance Imaging (MRI), which is of special interest for studies in pediatric FOP patients. MRI and [18F]NaF PET/CT images at time of inclusion and subsequent follow‐up CT scans of 4 patients were analyzed retrospectively. Presence, location, and intensity of edema identified by MRI were compared with activity on [18F]NaF PET. Occurrence or progression of heterotopic ossification (HO) was examined on the follow‐up CT images. Thirteen different lesions in various muscle groups were identified: five lesions with only edema, five lesions with both edema and increased [18F]NaF uptake, one lesion with only increased [18F]NaF uptake, and two lesions with neither edema nor uptake of [18F]NaF. Mild edema, found in three lesions, was present at asymptomatic sites, which did not show increased [18F] NaF uptake or progression of HO on consecutive CT images. Moderate edema was found in three symptomatic lesions, with increased [18F]NaF on PET and progression of HO on CT. Severe edema was identified in four lesions. Interestingly, two of these lesions did not develop HO during follow‐up; one of these two even gave obvious symptoms of a flare‐up. MRI can identify whether symptoms are the result of an acute flare‐up by the presence of moderate to severe edema. The occurrence of severe edema on MRI was not always related to an ossifying lesion. The additional diagnostic value of MRI requires further investigation, but MRI does not seem to fully replace the diagnostic characteristics of [18F]NaF PET/CT in FOP. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

The attack localizations in C1 inhibitor deficient hereditary angioedema patients

Background Hereditary angioedema (HAE) is a rare autosomal dominant inherited disease characterized by recurrent angioedema episodes and classified as HAE with C1-inhibitor (C1INH) deficiency (HAE-C1INH) and HAE with normal C1-inhibitor (HAE-nlC1INH). It may involve the face, larynx, upper airways, trunk, gastrointestinal system, genital area, and extremities. The angioedema attacks are disabling, and laryngeal edema can lead to asphyxiation and death if it is not treated successfully. We aim to investigate the association between the attack localizations and complement parameters of HAE C1INH patients.Methods Patients with HAE-C1INH from Ege University Faculty of Medicine were included. Patients with HAE-nl-C1INH were excluded from the study. Data on the clinical records were obtained retrospectively. Sociodemographic data, age at disease onset, annual attack frequencies, attack localizations, and complement parameters were recorded.Results One-hundred patients were in the study group. Fifty four percent of them were female. The majority of patients were HAE-C1INH type I (87%). The mean age at disease onset was 12.01 ±7.04 years. Plasma C4 levels were normal in eight patients (8.16%). The most frequently involved localizations were extremities (91%), gastrointestinal system (89%), and genital area (85%). Having a facial attack and erythema marginatum were both found to be correlated with the occurrence of laryngeal edema. Laryngeal edema was seen in 83.8% of the patients with erythema marginatum (P=0.010), and 75.9% of the patients with facial attacks (P&amp;lt;0.001).Conclusion The correlation between erythema marginatum and laryngeal edema was not reported in previous studies. Due to the unpredictable and fatal nature of the laryngeal attacks, all HAE patients and physicians should be alert of the occurrence and emergency treatment of laryngeal edema. We recommend that C4 alone should not be used to exclude the diagnosis of HAE-C1INH. The laboratory work-up should also include C1 inhibitor levels and C1INH function analysis.

Embryotoxicity of atrazine and its degradation products to early life stages of zebrafish (Danio rerio)

Triazine herbicide atrazine is considered to be moderately toxic to various aquatic animals. The aim of our study was to evaluate the acute embryotoxicity of atrazine and its two degradation products, desisopropylatrazine and desethylatrazine, and their mixture to the early life stages of zebrafish (Danio rerio) by means of a modified method of the Fish Embryo Acute Toxicity (FET) Test – OECD guideline 236. Toxic effects were studied by the evaluation of lethal endpoints and development of disorders. Furthermore, sublethal endpoints such as hatching rate, formation of somites, development of eyes, spontaneous movement, heartbeat, blood circulation, pigmentation and occurrence of edema at 24, 48, 72 and 96 h post fertilization were assessed. Newly fertilized eggs were exposed to various concentrations of atrazine, desisopropylatrazine and desethylatrazine, and their combination 0.3, 30, 100, 300, 1000, 3,000 and 10,000 μg/l, which represent environmentally relevant levels of these pollutants in surface waters and multiples of these concentrations to find out if the toxic effect depends on dose. Single substances and their combination were not associated with a negative effect on mortality. Rare malformations were observed during these embryonal toxicity tests. Only pericardial edema was recorded during the monitored observation. A significant increase in the occurrence of pericardial edema between the control 0% and the experimental group 17.6 %) was found only in the group exposed to the highest concentration of a triazine herbicide combination (10,000 μg/l) at 72 and 96 h post fertilization. Obtained results indicate that especially higher not environmentally relevant concentrations of atrazine, its metabolites or their combination present a potencial risk of embryotoxicity for zebrafish.

Apelin/APJ system: an emerging therapeutic target for respiratory diseases.

Apelin is an endogenous ligand of G protein-coupled receptor APJ. It is extensively expressed in many tissues such as heart, liver, and kidney, especially in lung tissue. A growing body of evidence suggests that apelin/APJ system is closely related to the development of respiratory diseases. Therefore, in this review, we focus on the role of apelin/APJ system in respiratory diseases, including pulmonary arterial hypertension (PAH), pulmonary embolism (PE), acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), obstructive sleep apnoea syndrome (OSAS), non-small cell lung cancer (NSCLC), pulmonary edema, asthma, and chronic obstructive pulmonary diseases. In detail, apelin/APJ system attenuates PAH by activating AMPK-KLF2-eNOS-NO signaling and miR424/503-FGF axis. Also, apelin protects against ALI/ARDS by reducing mitochondrial ROS-triggered oxidative damage, mitochondria apoptosis, and inflammatory responses induced by the activation of NF-κB and NLRP3 inflammasome. Apelin/APJ system also prevents the occurrence of pulmonary edema via activating AKT-NOS3-NO pathway. Moreover, apelin/APJ system accelerates NSCLC cells' proliferation and migration via triggering ERK1/2-cyclin D1 and PAK1-cofilin signaling, respectively. Additionally, apelin/APJ system may act as a predictor in the development of OSAS and PE. Considering the pleiotropic actions of apelin/APJ system, targeting apelin/APJ system may be a potent therapeutic avenue for respiratory diseases.