Significant Edema Research Articles

A CLINICAL CASE OF SUCCESSFUL SURGICAL TREATMENT OF A LATE-PRESENTING PATIENT WITH TRAUMATIC FLAP DISLOCATION AFTER FEMTOLASIK

FemtoLASIK is a frequently performed refractive surgery, one of the complications of which is flap dislocation. Most often, this condition is accompanied by decreased vision, pain, lacrimation, which makes patients immediately visit ophthalmologist. This article describes a case of a patient who came to the clinic only on the fourth day after the flap displacement due to blunt eye trauma. By this time, the patient’s corneal flap had significant edema, was folded and displaced with exposure of the stromal bed, which was epithelialized over 2/3 of the area. The surgical treatment of this patient with restoration of anatomical structures, as well as visual functions exceeding the maximum-corrected at the preoperative stage is presented. The treatment provided a stable result for 15 months after the performed reposition.

Abstract 4123391: CardioMEMS and Mavacamten: A Synergistic Approach in Managing Hypertrophic Obstructive Cardiomyopathy with HFpEF Phenotype

Introduction: Mavacamten is a cardiac myosin inhibitor that has been approved for obstructive hypertrophic cardiomyopathy (oHCM). The CardioMEMS PA (pulmonary artery) sensor allows remote pulmonary artery diastolic (PAD) pressure monitoring to adjust diuresis in heart failure with preserved ejection fraction (HFpEF). We present the case of a patient with oHCM and HFpEF where data extrapolated from CardioMEMS provided valuable insight to the hemodynamic impact of cardiac myosin inhibitors. Case: A 66-year-old female with hypertension, obesity and oHCM presented with worsening dyspnea and was evaluated for septal myectomy. However, surgery was deferred because of decompensated HFpEF, as evidenced by significant leg edema on exam, and severely elevated left and right-side filling pressure, with restrictive physiology on right heart catheterization. A CardioMEMS PA sensor was implanted to guide decongestion, however, escalation of diuresis was limited due to severe left ventricular outflow tract (LVOT) obstruction. PAD remained elevated at 20-30 mmHg. Due to the refractory LVOT obstruction and despite the use of maximally tolerated beta blockers, Mavacamten was initiated and escalated according to protocol. LVOT obstruction resolved on follow up echocardiogram. Without any adjustment in her diuretic regimen, her PAD decreased to 15-20 mmHg. On follow-up visit, the patient reported improvement in dyspnea and reduction in lower extremity edema. Discussion: Managing oHCM is challenging, particularly when complicated by HFpEF. Mavacamten has shown promise in reducing LVOT gradients and improving symptoms in oHCM. However, managing fluid status in these patients can be difficult due to the risk of exacerbating LVOT obstruction while optimizing filling pressures. Our case provides direct evidence that treating LVOT obstruction with a cardiac myosin inhibitor leads to improvement in decompensated heart failure, as evidenced by the reduction in PAD. Conclusion: Addressing LVOT obstruction is key to decongesting and managing heart failure in oHCM patients. In our case, the use of CardioMEMS PA sensor system allowed a novel perspective of assessing hemodynamic impact of cardiac myosin inhibitors.

Primary Congenital Glaucoma presenting with Acute Corneal Hydrops: a challenging approach to amblyopia prevention

Introduction: Acute hydrops is a rare initial manifestation of Primary Congenital Glaucoma (PCG). It can result in significant corneal opacity, posing an additional risk for amblyopia development in PCG patients. We report a case of a newborn with PCG presenting with acute corneal hydrops and significant corneal scarring, discussing the management and challenges of amblyopia prevention. Case Presentation: A 3-day-old female newborn was referred to our department due to bilateral corneal clouding. Anterior segment examination revealed bilateral corneal edema, with severe corneal prolapse in the right eye consistent with acute hydrops. The anterior chamber structures of the right eye were indiscernible due to significant corneal edema. The left eye presented a deep, quiet anterior chamber with no dysgenesis of anterior segment structures. Intraocular pressure (IOP) measurements were >40 mmHg in both eyes. Corneal diameters were 10 mm OD and 12 mm OS. Fundoscopic posterior segment assessment was not possible due to unclear media. B-scan ultrasonography revealed no significant changes. The patient underwent urgent bilateral trabeculotomy. Postoperatively, intense mechanical stretching induced by severely increased IOP was visible, with the right cornea exhibiting a central opacity managed with topical corticosteroids and showing improvement. Right corneal opacity spared the superior cornea, and atropine drops combined with left eye occlusion were employed to mitigate right eye deprivation amblyopia. Eighteen months later, the patient can fixate and follow objects with the right eye. Left eye corneal transparency was restored, and bilateral IOP control was achieved. Conclusion: Despite prompt surgical treatment, acute hydrops presents a postoperative management challenge and may result in irreversible corneal scarring. Timely management of corneal opacities is crucial to prevent amblyopia. A multidisciplinary approach is essential for the best visual outcome.

Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study.

Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women. 51 pregnant women (second trimester) were randomly recruited into either a study group CG with compression ccl1 or a control group NCG, both with physical activity (PA) recommendation. The assessment concerned venous system condition, limb size, and compression comfort. Edema was diagnosed as ≥10% measurement increase. Venous reflux (8/22 CG, 1/16 NCG) and an onset of CVD (6/22 CG, 1/16 NCG) were diagnosed in the first measurement. After postpartum, a significant reduction of the great saphenous vein (GSV) diameter in the proximal part of the left lower limb in CG (P=0.014) and expansion of the small saphenous vein (SSV) in the proximal part of the left lower limb in NCG (P=0.028) were observed. An analysis of the limb sizes in the second measurement revealed a significant increase of all circumferences and volumes in the NCG, and of lower leg volumes in the CG. Edema was diagnosed in five women in the NCG in the second measurement. Consequently, compression was recommended for the new group (NCG+C), and a significant edema reduction (P=0.026) occurred in the third measurement. Compression ccl1 reduces the risk of edema, venous insufficiency, and improves women's quality of life during pregnancy and postpartum.

A case of anaphylactic reaction to oxytocin in a parturient undergoing emergency caesarean section

Anaphylaxis to oxytocin is a rare but critical complication that can arise during labor and delivery [1], necessitating rapid recognition and management. We describe the case of a 20-year-old term primigravida with gestational hypertension who underwent an emergency lower segment caesarean section (LSCS) due to fetal distress. After successful spinal anesthesia with 0.5% bupivacaine, an infusion of 10 U oxytocin was initiated immediately following the delivery of the infant. Shortly thereafter, the patient developed acute respiratory distress, hypotension, and swelling of the lips and tongue, which progressed to bradycardia and a drop in oxygen saturation. Emergency intubation was performed due to significant airway edema, and resuscitation included intravenous adrenaline, atropine, hydrocortisone, pheniramine, and deriphylline. The surgical procedure concluded uneventfully, and the patient was transferred to the ICU for mechanical ventilation. She was extubated the following day and discharged five days later without complications. This case underscores the rare occurrence of anaphylaxis due to oxytocin administration. It highlights the need for vigilance and preparedness for allergic reactions in obstetric settings, as well as the importance of having alternative uterotonics available.

Posterior short ciliary arteries ischemia following embolization of anterior ethmoid artery to treat dural arteriovenous fistulas: a case report

BackgroundThe Onyx™ Liquid Embolic System is a non-adhesive liquid embolic agent, which has been proved by the US FDA for embolization of lesions in the peripheral and neurovasculature since 2005. We reported a case of ischemic optic neuropathy after using Onyx-18 to embolize the anterior ethmoid arteries that feeding dural arteriovenous fistulas (DAVF).Case presentationA 57-year-old Asian male presented with anterior cranial fossa DAVF underwent embolotherapy by delivering Onyx-18 through a microcatheter into the anterior ethmoid arteries under angiography guidance. The interventional procedure was successful and no clear evidence was found pointing to untargeted occlusive embolus. But after the surgery the patient experienced delayed painless vision loss in the right eye (RE). The fundoscopy showed unilateral papilledema with pale optic disc in RE, accompanied by significant edema and thickening in the retinal nerve fiber layer (RNFL) of macula. The fundus fluorescence angiography showed that most of the optic disc in RE had postponed or absent fluorescence filling. Visual evoked potential (VEP) confirmed that the amplitude of the P100 component was decreased in RE without significant prolongation of the latency. The patient was diagnosed with anterior ischemic optic neuropathy, but immediate pulse steroid therapy failed to rescue his vision.ConclusionPreoperative evaluation of the patient’s hemodynamic status and fundus examination are essential for assessing the risk of ischemic ocular complications, and the non-adhesive liquid embolic agent Onyx-18 should be used cautiously during endovascular embolization of intracranial artery.

Histopathological changes in the human tissues in various types of poisoning: A cross-sectional autopsy study

BackgroundPoisoning is a critical health issue caused by exposure to harmful substances, leading to a range of biological effects from mild irritation to severe organ damage and death. Acute poisoning is particularly prevalent in developing countries reliant on agriculture, where agricultural poisons such as organophosphates, carbamates, pyrethroids, and aluminum/zinc phosphide are common. This study aims to analyze the histopathological changes in various organs in autopsy of poisoning cases to understand the extent and nature of organ damage. MethodsAutopsies were performed on cases with an established or suspected history of poison ingestion. Tissue samples from the stomach, intestine, liver, spleen, kidneys, brain, and lungs were examined for histopathological changes. ResultsOut of 52 cases analyzed, aluminum phosphide was the predominant poison, accounting for 76.92 % of cases. Histopathological findings in poisoning cases included significant pulmonary edema (55.77 %), intra-alveolar hemorrhage (48.08 %), liver ballooning degeneration (48.08 %), acute tubular necrosis (51.92 %) in kidney, and universal brain and spleen congestion (100 %). Stomach findings showed partial loss of rugosity (80.77 %), congestion (51.92 %), necrosis of the mucosa (30.77 %), congestion (71.15 %), denudation of the epithelium (48.08 %), and mucosal inflammation (48.08 %) as predominant findings. Aluminum phosphide caused severe histopathological changes across all examined organs. ConclusionThe study highlights the critical role of histopathological examination in diagnosing and understanding organ damage in poisoning cases. Forensic pathologists can use these histopathological patterns as reference points to differentiate poisoning from other causes of death, aiding in accurate diagnosis and targeted treatment.

6702 Management And Complications Of Metastatic Adrenocortical Carcinoma Presenting With Severe Cushing Syndrome

Abstract Disclosure: S. Rodrigues: None. A.K. Sumal: None. Background: Metastatic adrenocortical carcinoma (ACC) presenting with Cushing syndrome (CS) is a complicated, aggressive disease that commonly requires multiple adrenal steroidogenesis inhibitors and chemotherapy to achieve hormonal and tumor control. Clinical Case: A 66-year-old man with a history of prostate cancer and hypertension presented with right flank and back pain, worsening type 2 diabetes, profound proximal muscle weakness, and 3+ lower extremity edema to his thighs. CT and PET-CT revealed a 10.9 cm right adrenal mass with pericaval lymphadenopathy and metastatic disease at the L2 vertebral body. Laboratory testing demonstrated evidence of hypercortisolism with elevated 24-hour urinary cortisol excretion (449 mcg/24h; n<45 mcg/24h), and abnormal 1 mg dexamethasone suppression test (cortisol 15 mcg/dL; n< 1.8 mcg/dL) with suppressed ACTH (<6 pg/mL; n=7-63 pg/mL). Surgical resection of the primary tumor was aborted intraoperatively given the discovery of new peritoneal metastases, which were confirmed by biopsy to be metastatic ACC. He was started on mitotane and osilodrostat to manage his severe CS. He was also started on dexamethasone, both to prevent adrenal insufficiency and to avoid influencing serum cortisol measurements used to assess disease control. However, given his significant peripheral edema and weakness, he was functionally unable to receive chemotherapy. Despite rapid uptitration of mitotane and osilodrostat over three weeks, his CS remained uncontrolled, and he was ultimately hospitalized for lower extremity paralysis and septic shock due to pyelonephritis. Repeat imaging revealed severe spinal canal stenosis from an L2 pathologic fracture, as well as worsening hepatic, osseous, peritoneal, and retroperitoneal metastases. After recovery from his septic shock, he was started on chemotherapy with carboplatin and etoposide while hospitalized, but his mitotane was intermittently held due to elevated transaminases. His hospital course was complicated by hypotension requiring pressor support, atrial fibrillation, hemoperitoneum, worsening anasarca, and acute kidney injury requiring continuous renal replacement therapy. Given his worsening condition that precluded him from further chemotherapy or palliative radiation, he elected to pursue comfort care measures and expired shortly thereafter. Conclusion: This case highlights the therapeutic challenges of metastatic ACC presenting with life-threatening CS. Simultaneous use of multiple adrenal steroidogenesis inhibitors is often required for control of hypercortisolism, and chemotherapy is equally necessary to manage tumor burden. However, as in this case, disease-related complications can limit treatment management and result in rapid deterioration. Thus, early diagnosis and prompt treatment of metastatic ACC presenting with CS is critical to prevent morbidity and mortality. Presentation: 6/3/2024

Catechin reduces liver inflammation by regulating Kupffer cell activation in rats

The liver is a defense against infections due to its strategic location between the gastrointestinal and systemic circulations. In dogs and cats, infectious hepatitis encompasses a range of contagious diseases affecting the liver either directly or as part of a broader systemic infection, including bacterial, mycobacterial, viral, fungal, protozoal, parasitic, and rickettsial diseases. Catechins possess well-recognized natural antioxidant properties. This study investigated their therapeutic potential for applications in hepatology, evaluating whether catechins reduce hepatic inflammation in rats repeatedly exposed to carbon tetrachloride (CCl4). Sprague-Dawley rats were given catechin 50 (C50) or 100 (C100) mg/kg body weight orally daily for 3 days. This treatment was given with or without concurrent intraperitoneal injections of CCl4. Phosphate-buffered saline served as the vehicle control, while silymarin administered at 100 mg/kg was used as the positive control.Gross examination revealed significant enlargement, edema, and darker tissue in CCl4-induced livers treated with vehicle. Additionally, spotty discoloration was observed on the surface. Kupffer cell activation suppressed the expression of inflammatory mediators, including inducible nitric oxide synthase (iNOS), in groups co-treated with catechin and CCl4; this effect was reversed when catalase replaced catechin in CCl4-injured rats. Catechin alleviates hepatic inflammation in rats repeatedly exposed to CCl4; it also modulates the activation of Kupffer cells and monocytes. These results should lead to new treatments for liver inflammation in veterinary practice.

Managing RS3PE: Diagnostic approach, initial steroid response, and long-term management with DMARDs

Background. RS3PE, or Remitting Seronegative Symmetrical Synovitis with Pitting Edema, is a unique and relatively rare form of inflammatory arthritis that predominantly affects older adults. It is distinguished by its hallmark features: symmetrical swelling of the joints, significant pitting edema in the extremities, and a negative serological profile for common markers associated with rheumatoid arthritis, such as rheumatoid factor (RA factor) and anti-citrullinated protein antibodies (anti-CCP). This condition is often characterized by a remitting course, meaning that symptoms may improve or resolve over time, particularly with appropriate treatment. The condition usually affects older adults and can sometimes be associated with other underlying health issues, such as malignancies or infections. The “remitting” aspect of RS3PE refers to the fact that the symptoms often improve or resolve over time, particularly with appropriate treatment, which usually involves corticosteroids or other anti-inflammatory medications. Case report. This case study details the clinical presentation, diagnosis, and management of a 56-year-old female patient with known hypertension who presented with bilateral dorsal hand swelling, pain, and early morning stiffness over a 15-day period. The patient’s initial examination revealed bilateral pitting edema and active arthritis in the proximal interphalangeal joints, with significant warmth and tenderness. Laboratory tests showed elevated ESR and CRP, normocytic normochromic anemia, and negative rheumatoid factor and anti-CCP antibodies. Imaging studies, including X-ray, ultrasound, and mammogram, showed no erosive changes or malignancy, while a Pap smear and serum CA-125 levels were within normal limits. The clinical picture, combined with the exclusion of other conditions, supported the diagnosis of RS3PE. Treatment commenced with intravenous low-dose dexamethasone, which led to significant symptomatic improvement. This was followed by a transition to oral prednisolone, and the patient initially showed complete resolution of symptoms. However, recurrence of symptoms occurred upon discharge, prompting the introduction of steroid-sparing agents: methotrexate and hydroxychloroquine, alongside continued oral steroid treatment. Over a two-month follow-up period, the patient experienced no signs of relapse. This case fits the clinical and investigative criteria for RS3PE. The patient showed symptomatic improvement after treatment with low-dose steroids.

Effect of Acoustically Responsive Droplet-based Low-intensity Histotripsy on Canine Prostate

ObjectiveLow-intensity histotripsy (LIH) is a novel and safe technique for tissue ablation. This study aimed to explore the effects of LIH on canine prostate tissue and identify the degree of acute injury to the gland. MethodsWe constructed and evaluated two types of acoustically responsive droplet (ARD) emulsions using either perfluoropentane (PFP) with a lipid shell or perfluoromethyl-cyclopentane (PFMCP) with lauromacrogol (L) injection. Twenty beagles were assigned to four experimental groups: ultrasound (US) + PFP (n = 6), US + PFMCP-L (n = 6), PFMCP-L (n = 5) and PFP (n = 3). The ARDs were injected transcutaneously and transabdominally into normal canine prostates under US-guided imaging. Subsequently, focused therapeutic US was employed to induce acoustic droplet vaporization and bubble cloud cavitation. The mechanical damage to canine prostate tissue was evaluated using gross and histological examination. ResultsGross specimens showed that the injured area was dark brown. Hematoxylin and eosin-stained tissue sections of the damage zone showed significant cavity formation and interstitial edema. The total tissue damage scores in the US + PFP group were compared to those of the other three experimental groups. No statistically significant differences were observed in the extent of tissue damage and total scores among the US + PFMCP-L, PFMCP-L and PFP groups. ConclusionWe achieved significant mechanical tissue damage in the canine prostate using PFP ARD-based LIH that proved to be superior to that using PFMCP ARDs with LIH.

Meta-analysis of cardiac magnetic resonance in prognosticating left ventricular function in peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) may result in a number of detrimental adverse cardiovascular events, notably persistent left ventricular ejection fraction (LVEF) reduction or even mortality. Imaging parameters on cardiac magnetic resonance (CMR) and their prognostic implications have rarely been perused in PPCM. We aimed to describe CMR's prognostic value in predicting poor left ventricular (LV) function recovery using late gadolinium enhancement (LGE) and T2-weighted or T2 mapping. PubMed, Europe PMC, and ScienceDirect were screened for studies on late gadolinium enhancement (LGE) and myocardial oedema using CMR and PPCM. The outcome of interest was poor LV function recovery, with a follow-up period of at least 6months. Comparisons between groups with the presence of LGE, myocardial oedema, and recovered against non-recovered patients were pooled. A random-effects model was employed to calculate the effect size. All pooled results were expressed as risk ratios (RRs) and 95% confidence intervals (CI). The area under the curve (AUC) was generated to test overall prognostic accuracy. Six cohort studies with 162 patients were included. The mean age of participants in this study was 30.6years, and the majority of patients were diagnosed with PPCM after delivery. LGE was associated with a higher risk of poor LV function recovery, particularly when conducted at a later stage of disease (≥2.8months) [RR=2.83 (95% CI=1.25-6.40); P=0.001]. On the contrary, CMR conducted early (<2.8months) exhibited a greater predictive value for myocardial oedema perceived by T2 mapping [RR=3.44 (95% CI=1.04-11.34); P=0.043]. Diagnostic-test accuracy meta-analysis revealed that LGE had a sensitivity of 73% (95% CI, 56-85%), specificity of 79% (95% CI, 45-95%), and AUC of 0.78 (95% CI, 0.75-0.82) in predicting poor LV recovery when performed in the later phase, whereas significant myocardial oedema in those with non-recovered LV function had a sensitivity of 12% (95% CI, 2-52%), specificity of 68% (95% CI, 39-88%), and AUC of 0.40 (95% CI, 0.36-0.44) while undertaken in the latter phase. Our findings support the notion that inflammation plays a significant role in PPCM and that alterations to tissue composition occur in a time-dependent manner. Contrast-enhanced CMR can be utilized as an adjunct examination in post-partum PPCM patients to stratify the risk of poor LV function recovery while conducted at a suitable point in time.

Impact of Negative Pressure Wound Therapy on Perfusion Dynamics in Free Latissimus Dorsi Muscle Flaps.

Background: Free muscle flaps can develop significant postoperative edema and wound exudation, thereby increasing interstitial pressure and potentially compromising microcirculation. While concerns exist regarding negative pressure wound therapy (NPWT) to compress free flaps and hinder monitoring, recent studies have indicated a reduction in edema and an increase in blood flow. Objective: To compare microcirculation in free latissimus dorsi muscle (LDM) flaps dressed with and without NPWT. Methods: This retrospective cohort study analyzed prospectively collected data of patients who received free LDM flap reconstruction. Patients were separated into two groups according to management with or without NPWT. Microcirculation was evaluated continuously for up to 72 h utilizing laser doppler flowmetry and tissue spectrometry. Results: In total, n = 61 patients (26 females, 35 males) with an average age of 56.90 (17.4) years were included. NPWT was applied in 12 patients, while a regular cotton dressing was used in 49 patients. Overall, no significant differences in the number of minor and major complications were observed between groups. Both groups showed an increase in microvascular flow over the investigated time period. The flow showed higher absolute values in the NPWT group, reaching statistical significance at 12 h post-anastomosis, p = 0.038. There was a tendency for lower rHb values in the NPWT group, without reaching statistical significance. Conclusions: The presented study confirms the increase in microvascular flow after NPWT application. Whilst ensuring continuous free flap monitoring utilizing laser doppler flowmetry and spectrometry, the data further support the safety of NPWT application without risking vascular compromise due to external compression.

Descemet Membrane Endothelial Keratoplasty for Late Corneal Edema Secondary to Obstetrical Forceps–Related Tears

Purpose: The purpose of our paper is to describe the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with a history of known obstetrical forceps–related tears who developed clinically significant corneal edema in their eighth decade of life. Methods: Case series. Results: Two patients with a known history of obstetrical forceps–related tears presented with corneal edema and vertical tears of Descemet membrane consistent with birth trauma. DMEK was performed for both cases. Case 1 underwent pseudophakic DMEK, and Case 2 underwent combined phacoemulsification and DMEK (triple-DMEK). DMEK grafts were fully attached in both cases at postoperative 1-day and 1-week appointments, as confirmed on slit-lamp examination and anterior segment optical coherence tomography. There was marked improvement in best-corrected visual acuity and corneal edema in both patients. Conclusions: We demonstrate that DMEK can afford excellent results in patients with a history of obstetrical forceps injury, who experience corneal edema later in life. In addition, we show that the triple-DMEK can be done successfully in this entity.

A Novel Deep Learning Approach for the Automatic Diagnosis of Acute Appendicitis.

Background: Acute appendicitis (AA) is a major cause of acute abdominal pain requiring surgical intervention. Approximately 20% of AA cases are diagnosed neither early nor accurately, leading to an increased risk of appendiceal perforation and postoperative sequelae. AA can be identified with good accuracy using computed tomography (CT). However, some studies have found that a false-negative AA diagnosis made using CT can cause surgical therapy to be delayed. Deep learning experiments are aimed at minimizing false-negative diagnoses. However, the success rates reported in these studies are far from 100%. In addition, the methods used to divide patients into groups do not adequately reflect situations in which accurate radiological diagnosis is difficult. Therefore, in this study, we propose a novel deep-learning approach for the automatic diagnosis of AA using CT based on establishing a new strategy for classification according to the difficulties encountered in radiological diagnosis. Methods: A total of 266 patients with a pathological diagnosis of AA who underwent appendectomy were divided into two groups based on CT images and radiology reports. A deep learning analysis was performed on the CT images and clinical and laboratory parameters that contributed to the diagnosis of both the patient and age- and sex-adjusted control groups. Results: The deep learning diagnosis success rate was 96% for the group with advanced radiological findings and 83.3% for the group with radiologically suspicious findings that could be considered normal. Conclusions: Using deep learning, successful results can be achieved in cases in which the appendix diameter has not increased significantly and there is no significant edema effect.

Docosahexaenoic acid eliminates endoplasmic reticulum stress and inflammatory pathways in diabetic rat keratopathy

Diabetic keratopathy, characterized by corneal structural changes, is a common complication of diabetes mellitus (DM). Docosahexaenoic acid (DHA), an omega-3 fatty acid, has shown potential therapeutic benefits in various diabetic complications. This study aimed to investigate the protective effect of DHA on corneal tissue in streptozotocin (STZ)-induced type 2 DM in rats. Forty male Sprague–Dawley rats were randomly assigned to four groups (n = 10 per group): Control, DHA, DM, and DM + DHA. The DHA group received DHA by oral gavage at a dose of 100 mg/kg daily for 10 days. In the DM group, diabetes was induced by a single intraperitoneal injection of STZ at 50 mg/kg. Confirmation of diabetes induction was based on monitoring fasting blood glucose levels on the third day post-injection. The DM + DHA group underwent the same diabetes induction protocol with STZ and received DHA at 100 mg/kg daily via oral gavage for 10 consecutive days. Corneal tissue samples were collected at the end of the study period for histopathological, immunohistochemical, qRT-PCR, and ELISA analyses. Histopathological analysis showed significant edema, angiogenesis, and degeneration in the DM group compared to the control (p < 0.001). DHA treatment significantly mitigated these changes, approaching control levels (p < 0.01). Immunohistochemistry showed increased VEGFR2 and iNOS expression in the DM group, which was significantly reduced in the DM + DHA group (p < 0.01). qRT-PCR results indicated a significant decrease in Bcl-2 expression (p < 0.001) and an increase in ATF-6, IRE1, NF-κB, TNF-α, IL-1β, NLRP3, Bax, and Caspase-3 expressions in the DM group (p < 0.001). ELISA analyses revealed significantly elevated levels of inflammatory markers NF-κB, TNF-α, IL-1β, and IL-6 in the DM group compared to the control (p < 0.001). DHA treatment significantly upregulated Bcl-2 and downregulated apoptotic and inflammatory markers (p < 0.01). DHA demonstrated significant protective effects against STZ-induced corneal damage in diabetic rats by modulating apoptotic and inflammatory pathways. These findings suggest that DHA may be a promising therapeutic agent for preventing diabetic keratopathy.

Cerebral involvement in sitosterolemia

BackgroundSitosterolemia, an autosomal recessive condition, is characterized by impaired metabolism of plant sterols. Clinical symptoms include skin xanthoma, premature atherosclerotic disease, arthritis, and unexplained hematological abnormalities. However, there is a dearth of studies on sitosterolemia-related brain damage.MethodsThis study focused on the family of two sitosterolemia patients who presented with severe hypercholesterolemia and xanthoma. Radiological examinations, biopsies, whole-exome sequencing (WES), and plant sterol tests were conducted.ResultsThe index patient, a 66-year-old female, initially exhibited weakness in both lower limbs and later developed urinary and fecal incontinence. Neuroimaging showed that the falx of the brain had irregular fusiform thickening. Significant tissue edema was observed around the lesions in the bilateral frontal-parietal lobes. Pathological analysis of the biopsied brain lesion revealed extensive cholesterol crystal deposition and lymphocyte infiltration in the matrix. The index patient who experienced cerebral impairment and her sister both carried two compound heterozygous variants in ATP binding cassette transporter G5 (ABCG5). These included the nonsense variants NM_022436: c.751 C > T (p.Q251X) in exon 6 and NM_022436: c.1336 C > T (p.R446X) in exon 10. A notable increase in plant sterol levels was observed in the younger sister of the index patient.ConclusionThis study highlights a previously unreported neurological aspect of sitosterolemia. Imaging and pathology findings suggest that cholesterol crystals may be deposited in connective tissues such as the cerebral falx and pia mater through blood circulation.

A Predictive Model for Graft Failure in Femtosecond Laser-Assisted Penetrating Keratoplasty Among Chinese Patients: A 2-Year Study.

Graft failure is a major challenge in femtosecond laser-assisted penetrating keratoplasty (Fs-PKP). This study focuses on the development and validation of a clinical predictive model aimed at identifying the risk of graft failure in individuals undergoing Fs-PKP in China, offering a tailored approach to improve surgical outcomes. This retrospective cohort study at Nanjing First Hospital involved 238 patients and followed the TRIPOD statement. The cohort was divided into a training set (n = 166) and a validation set (n = 72) in a 7:3 ratio. It analyzed 23 predictor variables related to recipient, donor, and surgical factors, defining graft failure as "visually significant and irreversible corneal stromal edema, haze, or scarring." A comprehensive nomogram was created using univariate and multivariate Cox regression analyses and assessed by concordance index (C-index), time-dependent receiver operating characteristics (ROC) curve, calibration plots, and decision curve analysis (DCA). Five critical risk factors were identified: recipients' history of systemic autoimmune disorders, ocular trauma, prior penetrating keratoplasty (PKP) history, donors' diabetes history, and the endothelial cell density of the donor cornea. The nomogram showed a C-index of 0.72 (95% CI 0.65-0.79) in the training group and 0.66 (95% CI 0.55-0.76) in the validation group, indicating robust predictive accuracy. Time-dependent ROC curves, calibration plots, and DCA consistently validated the model's reliability, predictive power, and clinical utility across both training and validation cohorts. Our study developed and validated a model incorporating five key factors, enhancing preoperative prediction and management for Chinese patients with Fs-PKP graft failure.

Convexity Meningioma, Parasagittal Meningioma, Falx Meningioma

During surgery for meningioma, basic surgical techniques and strategies required for the removal of the tumor are common, particularly for tumors located superficially, such as convexity, parasagittal, and falx meningiomas. Four basic surgical techniques, including detachment; devascularization; debulking; and dissection should be combined and repeated in appropriate sequence, tailored to the specific conditions of each tumor. This eventually enables the total circumferential dissection of the tumor from the surrounding tissues. It is essential to retract the tumor towards the space created at the tumor center through internal debulking, rather than retracting the normal brain, to avoid damage to the surrounding brain tissue. During surgery for parasagittal meningioma with venous sinus occlusion, it is crucial to preserve the cortical veins that have developed as collateral pathways to prevent venous complications. During surgery for falx meningioma, the selection of a surgical approach including a contralateral approach based on factors such as the development of bridging veins and significant peritumoral brain edema is required. In this article, detailed surgical procedures for convexity meningioma, parasagittal meningioma, and falx meningioma were described focusing on the application of fundamental surgical techniques tailored to each tumor type.

Muscle diffusion tensor imaging in facioscapulohumeral muscular dystrophy.

Muscle diffusion tensor imaging has not yet been explored in facioscapulohumeral muscular dystrophy (FSHD). We assessed diffusivity parameters in FSHD subjects compared with healthy controls (HCs), with regard to their ability to precede any fat replacement or edema. Fat fraction (FF), water T2 (wT2), mean, radial, axial diffusivity (MD, RD, AD), and fractional anisotropy (FA) of thigh muscles were calculated in 10 FSHD subjects and 15 HCs. All parameters were compared between FSHD and controls, also exploring their gradient along the main axis of the muscle. Diffusivity parameters were tested in a subgroup analysis as predictors of disease involvement in muscle compartments with different degrees of FF and wT2 and were also correlated with clinical severity scores. We found that MD, RD, and AD were significantly lower in FSHD subjects than in controls, whereas we failed to find a difference for FA. In contrast, we found a significant positive correlation between FF and FA and a negative correlation between MD, RD, and AD and FF. No correlation was found with wT2. In our subgroup analysis we found that muscle compartments with no significant fat replacement or edema (FF < 10% and wT2 < 41 ms) showed a reduced AD and FA compared with controls. Less involved compartments showed different diffusivity parameters than more involved compartments. Our exploratory study was able to demonstrate diffusivity parameter abnormalities even in muscles with no significant fat replacement or edema. Larger cohorts are needed to confirm these preliminary findings.