Slight Edema Research Articles

Higher ratio of extracellular water to total body water was associated with reduced cognitive function in type 2 diabetes.

Fluid imbalance is associated with various clinical conditions, but the association between elevated extracellular-water to total-body-water (ECW/TBW) ratio, an indicator of fluid balance, and cognitive impairment is unknown. We aimed to investigate relationship between ECW/TBW ratio and cognitive function in type 2 diabetes mellitus. This study was a cross-sectional design, comparing 1233 patients aged 61.4 ± 8.0 years from the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D) cohort. ECW/TBW was measured using bioelectrical impedance method. Cognitive function was assessed with Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multiple linear regression was used to examine association between ECW/TBW and RBANS scores, adjusting for demographics, education, clinical covariates, and apolipoprotein E allele. In unadjusted analyses, there was an inverse dose-dependent association between ECW/TBW and RBANS total score. The associations persisted in fully adjusted model with β = -1.18 (95% confidence interval [CI] -2.19 to -0.17; P = 0.022) for slight edema and -2.33 (-3.99 to -0.67; P = 0.006) for edema. Slight edema and edema were significantly associated with reduced cognitive function in delayed memory and attention. There was significant association between edema but not slight edema, with reduced cognitive function in language. Pulse pressure accounted for 16.8% of association between ECW/TBW and RBANS total score. Our novel finding of an independent association between higher ECW/TBW and poorer cognitive function highlights the potential importance of maintaining body fluid balance in the management of cognitive impairment.

Effects of a Matrine- and Sophoridine-Containing Herbal Compound Medicine (AH-05) on Liver Cancer

Herbal medicine can present an alternative way of treating liver cancer. Here, we explored a matrine- and sophoridine-containing herbal compound medicine (AH-05) extracted from Adenophora capillaris, Sophora flavescens, Astragalus, and other plants. H22 and HepG2 cell models, as well as an H22 xenograft model, were established. Cell proliferation and apoptosis were measured in vitro, and tumor volume and weight were observed in vivo. The activation of AKT/mTOR and nuclear factor-κB (NF-κB) pathways in tumor cells and the polarization of CD4/CD8 T cells in the spleen were tested. To assess safety, hematological toxicity and pathology of the liver, kidney, spleen, and intestine were evaluated. AH-05 inhibited cell viability in a dose- and time-dependent manner. In vivo, tumor volume and weight were reduced, and the activation of NF-κB p50, NF-κB p65, AKT, p-AKT Ser473, and mTOR was suppressed. In addition, AH-05 promoted CD4+ T cell polarization in the spleen. With regard to safety, slight intestinal mucosa edema was observed, but no severe pathological or hematological toxicity was detected. AH-05 exhibited its therapeutic effects against liver cancer by regulating the AKT/mTOR and NF-κB signaling pathways, and the immune environment, by promoting CD4+ T cell polarization in the spleen. Thus, AH-05 represents a potential supplementary herbal compound medicine for liver cancer.

Assessment of patient-specific titanium onlay versus autogenous inlay eminoplasty technique for treatment of recurrent temporomandibular joint dislocation: a randomized clinical trial.

Various procedures have been adopted for eminence augmentation for treatment of recurrent temporomandibular joint dislocation. The aim of this study is to assess maximal incisal opening (MIO) using a custom-made titanium implant versus inlay autogenous augmentation from the patient's chin for more stable condylar movements. Ten patients were treated in this study (20 joints) five patients with bilateral patient-specific titanium onlay implant and five for autogenous inlay grafting technique; each implant in the study group was virtually designed using a specific software and milled from titanium grade V blocks, then fixed with mini screws at the lateral aspect of the zygomatic arch while in the control group, autogenous corticocancellous bone block was harvested from the chin and wedged at the created defect of the eminence to increase its height. The follow-up period ranged from 6 months to 1 year to access the maximal incisal opening (MIO). The mean preoperative maximal incisal opening was 47.8 mm and that of the postoperative was 33.2 mm in the study group and 35.4 mm in the control group, respectively. One patient reported postoperative slight unilateral edema and pain that gradually diminishes after 1 month postoperative. No statistical difference between both groups p value 0.3.

Atypical extraventricular neurocytoma: A case report

Atypical extraventricular neurocytoma (EVN) is a rare condition characterized by diffuse tumor cell hyperplasia, increased neovascularization, increased necrosis, and aggressive characteristics. A case of a 25-year old man who presented with atypical EVN in his left parietal - occipital flaps is reported. Magnetic resonance imaging (MRI) revealed a well-defined globular mass with heterogeneous signals in the left parietal lobe, and mild perilesional edema. After left parietal craniotomy and tumor excision, pathologic examination of the resected tissue revealed that the lesion was localized mainly in the white matter and imbued with tumor cells possessing round hyperchromatic nuclei with perinuclear halos and increased microvascular proliferation. The patient underwent radiotherapy at 21st postoperative day. Over the past 26 months, the patient has been regularly followed up, and so far no neurologic deficits have been observed. The latest MRI showed that the tumor bed was stable with slight peritumoral edema. The results of clinical, histopathological and immunohistochemical examinations indicate that atypical EVN is a rare neoplasm with unique radiographic and pathologic characteristics. It possesses more aggressive properties than typical EVN.

Compare the clinical and postoperative outcomes: laparoscopic versus open surgery

Background: To assess the several postoperative complications and clinical outcomes, a retrospective comparison between laparoscopic or open surgery was performed.Methods: We evaluated patients baseline characteristics clinical characteristics, perioperative, intraoperative, inflammatory stress markers and postoperative outcomes between the two groups by univariate analysis.Results: Total 73 patients’ data were included and divided into two groups. 38 patients in first group (laparoscopic surgery) and 35 patients in second group (open surgery). There were no statistically significance differences between gender, age, weight, body mass index and type of surgery of the patients (p>0.05). There was no significant difference between groups in history of infliximab, history of steroid usage, history of appendectomy and perianal disease (p>0.05). There was no significant difference between groups in total protein, albumin, hemoglobin, skeletal muscle mass and soft lean mass. Operative time, length of incision and blood loss was significantly (p<0.001) different in both groups, respectively. Total number of complications was less in the laparoscopic surgery; however, there was no statistically significant difference. Laparoscopic surgery can shorten the hospital stay by around one day. Patients had better postoperative outcomes after laparoscopic surgery than after open surgery. No significant difference was present in edema grades between groups preoperatively. More patients developed slight edema and edema in open surgery than in laparoscopic surgery on postoperative day (POD-3), but not on POD-5.Conclusions: Laparoscopic surgery has more benefits, safe and high-quality care and better postoperative clinical outcomes for all patients compared to open surgery.

1640 Pulmonary valve in carcinoid disease: be suspicious of functional assessment

Abstract Carcinoid heart disease occurs in 50% of patients with carcinoid syndrome, especially on serotonin-secreting neuroendocrine tumors (NET) [1, 2]. Carcinoid heart disease"s typical findings are carcinoid plaques, composed of smooth muscle, myofibroblasts and endothelium. These plaques, most frequently localized on the right side valvular cusps and leaflets, produce fixation and retraction, causing regurgitation and/or stenosis [3, 4, 5]. Left-sided heart disease is rare (<10%), as serotonin is purified in the pulmonary circulation [3, 6, 7]. We present the case of a 67 year old female patient with previous history of right ovarian NET. She presented with dyspnea (II-III NYHA functional class), and slight edema in lower limbs. She denied symptoms of carcinoid syndrome before or after the ovarian surgery. Examination showed an increased jugular venous pulse. Transthoracic echocardiography (TTE) showed severely dilated right cavities and a rigid, immobile tricuspid valve, with massive tricuspid regurgitation (Panel A, 1). Anatomy of pulmonary valve was not properly visualized but jet area of pulmonary regurgitation was small (Panel A, 2). Left cavities and valves were intact. As TTE was not anatomically conclusive, a cardiac magnetic resonance (CMR) and a cardiac computed tomography (CCT) were performed to assess the carcinoid involvement of pulmonary valve. CMR showed severely dilated right ventricle with mild impairment of systolic function (Panel A, 3). Based on phase contrast imaging, pulmonary regurgitation fraction was 14%, suggestive of a mild grade. However, CCT showed a diffuse thickening of the pulmonary valve, with complete opening during diastole (Panel A, 4, arrowhead). Finally, the patient underwent replacement of tricuspid valve and pulmonary valve for biological prosthesis without complications. Our case is remarkable because it highlights the limitations of the functional assessment of pulmonary regurgitation in the presence of a concomitant massive tricuspid valve regurgitation, since the rapid equalization of pressure between pulmonary artery and right ventricle reduces the expression of pulmonary regurgitation. For these reason, the anatomic assessment of the pulmonary valve is mandatory to stage the involvement of pulmonary valve in carcinoid disease. Abstract 1640 Figure. Panel A

Shuxuening injection, derived from Ginkgo biloba leaf, induced pseudo-allergic reactions through hyperactivation of mTOR

Context Shuxuening injection (SXNI), derived from the leaf of Ginkgo biloba L. (Ginkgoaceae), is widely used to treat cardio-cerebral vascular system related disease due to the efficacy of dilating the blood vessels and improving the function of microcirculation. Nevertheless, SXNI induces immediate hypersensitivity reactions in clinics and the molecular mechanisms are unknown. Objective The present study investigates the molecular mechanism of SXNI mediated hypersensitivity reactions. Materials and methods Naive male ICR mice (n = 10) were administered (i.v.) with negative control combined with Evans blue (EB) (CTL-EB), SXNI (14 or 70 mg/kg) combined with EB (SXNI/1-EB or SXNI/4-EB), vascular leakage was evaluated, ears and lungs were collected for histopathological analysis. In vitro, TSC1 was knockdown in human umbilical vein endothelial cells (HUVECs). HUVECs were incubated with SXNI, and the alterations of endothelial cell permeability were observed. Rapamycin (mTOR inbibitor) was used to investigate SXNI-induced hypersensitivity reactions both in mice and HUVECs. Results SXNI (70 mg/kg) induced vascular leakage in mice. Slight oedema and microvascular dilation in the ears, and broaden of alveolar septal and monocyte infiltration in the lungs were observed in SXNI (70 mg/kg) treated mice. mTOR inhibitor alleviates SXNI mediated vascular endothelial hyperpermeability both in vitro and in vivo. Discussion and conclusions SXNI stimulates pseudo-allergic reactions through hyperactivation of mTOR signalling pathway. Our work provides the new molecular mechanism of drug related pseudo-allergic reactions, and a potential drug to prevent and treat SXNI mediated hypersensitivity reactions.

Generalized swelling (Anasarca)

Anasarca is the medical term referred to an individual who experiences generalized oedema. Anasarca is diverse from slight swelling or oedema that occurs mainly in the feet. Anasarca is very familiar in patients with heart failure and kidney failure. Anasarca happens because there is an underlying problem. A selection of diagnostic methods can be used in a challenge to make a diagnosis of anasarca. Formerly anasarca and the underlying problem is diagnosed, suitable measures will be made to treat the problem. In this section, we can communicate the information regarding anasarca.

U50488H improves organ function after septic shock

Objective To investigate the effect of U50488H on the ultrastructure and organ function in septic shock rats. Methods Forty SD male rats were randomly(random number) divided into 5 groups: sham group, septic shock group, U50488H+septic shock group, nor-BNI+U50488H+septic shock group, and nor-BNI+septic shock group, with 8 rats in each group. Cecal ligation and puncture (CLP) was performed to induce septic shock in the septic shock group. Rats in the U50488H+septic shock group were treated with U50488H injection by intravenous at the shock point, and other procedures were the same as the septic shock group. Rats in the nor-BNI+U50488H+septic shock group were treated with nor-BNI injection by intravenous 3.5 h after abdomen closed, and other procedures were the same as the U50488H+septic shock group. Except for U50488H injection, rats in the nor-BNI+septic shock group received procedures the same as the nor-BNI+U50488H+septic shock group. Albumin, cardiac troponin I (cTnI) and N terminal pro B type natriuretic peptide (NT-proBNP) in serum were measured at abdomen-closed, 3, 6, and 12 h after CLP. The changes of histology and ultramicro structure under electron microscope of lung, heart, liver and kidney of rats were observed at 12 h after CLP. Statistical analysis was performed using SPSS 19.0. Comparison among groups was carried out using ANOVA, and Student’s t-test was used for multiple comparisons as post-hoc. Results At 6 and 12 h of CLP, serum albumin of the septic shock group were significantly lower than those of the sham group (P<0.01), while those in the cTnI and NT-pro BNP groups were higher at 3, 6, and 12 h of CLP (P<0.01). Compared with the septic shock group, serum albumin of the U50488H+septic shock group increased significantly (P<0.01), whereas the serum levels of cTnI and NT-pro BNP decreased remarkably at 3, 6 and 12 h of CLP (P<0.05, P<0.01, respectively). Compared with the sham group, the alveolar wall was severely damaged, the alveolar septum and blood vessel wall were thickened obviously; the myocardial fiber was swollen, necrotic, and the infiltration of central granulocyte was increased significantly; hepatocyte showed edema, vacuolar-like steatosis, fatty degeneration, spotty and focal necrosis; and slight edema and vacuolar degeneration were found in the glomerulus endothelial in the septic shock group. Compared with the septic shock group, the ultrastructural damage of the lung, heart, liver and kidney of the U50488H+ septic shock group was significantly improved. All the above effects of U50488H could be blocked by nor-BNI (a selective κ-opioid receptor antagonist) (P<0.01). Conclusions U50488H can promote the recovery of serum albumin, and protect organ function in septic shock rats. Key words: U50488H; Septic shock; Organ function; Ultrastructure

Mucormycosis Presented with Facial Pain in a Renal Transplant Patient: A Case Report

IntroductionMucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint. CaseA 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oryzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B. ConclusionIt should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain.

Hypovolemic Shock Complicating Nephrotic Syndrome in a Child

The fundamental abnormality in nephrotic syndrome is the structural and electrochemical changes that have been documented to occur in the glomerular basement membrane lead to proteinuria. It is the proteinuria itself which most likely causes hypoalbuminemia and associated complications such as infections, hypercoagulability and hypovolemia. Hypovolemia may cause postural hypotension, acute renal failure, circulatory collaps or sudden death.&#x0D; An eleven-year-old boy was referred to the Child Health Department of Dr. Kariadi Hospital Semarang with a diagnosis of corticosteroid resistant nephrotic syndrome and acute renal failure. Physical examination showed a severely ill boy with general edema, shock, hemoconcentration, hypoalbuminemia, hypercholesterolemia, massive proteinuria and disturbed renal function.&#x0D; The treatment consisted of infusion of dextrose 10% followed by human plasma and furosemide to restore plasma volume and enhance urine production. Two days later he was in better condition, normovolemia, slight edema, good diuresis, but his blood pressure increased, and ophtalmologic examination supported the diagnosis of grade I hypertensive retinopathy. Intravenous clonidine and furosemide were given and were very effective. Kidney biopsy revealed minimal lesion with slight proliferation.

The effects of high-fructose corn syrup consumption on testis physiopathology-The ameliorative role of melatonin.

This study investigated the ameliorative role of melatonin (MLT) and the effects of a long-term intake of high-fructose corn syrup (HFCS) on the male reproductive system. Thirty-six male Sprague Dawley rats were randomly divided into 3 groups as follows: Control, HFCS and HFCS+MLT. Testis and epididymal weights were measured. Malondialdehyde (MDA) levels, superoxide dismutase (SOD) and catalase (CAT) activities, total testosterone levels, testicular histopathological damage scores were evaluated, and immunohistochemical analyses were performed on testicular tissue. Epididymal weights were significantly lower in the HFCS+MLT group than those of the control and HFCS groups. MDA was significantly increased, while SOD and CAT activities were reduced in the HFCS group compared with the control group. Administration of melatonin significantly increased SOD and CAT activities in the HFCS+MLT group. Histopathological evaluation revealed slight hyperaemia and oedema in the stromal tissue of rat testes in the HFCS group. Sperm count and Johnsen's testicular biopsy score (JTBS) were significantly decreased in the HFCS group. Immunohistochemical analysis revealed that HSP, iNOS, MDA, OPN and VEGF values were significantly increased in the HFCS group. However, melatonin ameliorated the immunohistochemical scoring. Our results showed that a long-term intake of HFCS caused testicular damage. Melatonin may be a promising pharmacological agent against testicular toxicity induced by HFCS.

Lentiviral Vector-Mediated Expression of Exoenzyme C3 Transferase Lowers Intraocular Pressure in Monkeys.

Primary open-angle glaucoma (POAG) is considered a lifelong disease characterized by optic nerve deterioration and visual field damage. Although the disease progression can usually be controlled by lowering the intraocular pressure (IOP), therapeutic effects of current approaches do not last long. Gene therapy could be a promising method for persistent treatment of the disease. Our previous study demonstrated that gene transfer of exoenzyme C3 transferase (C3) to the trabecular meshwork (TM) to inhibit Rho GTPase (Rho), the upstream signal molecule of Rho-associated kinase (ROCK), resulted in lowered IOP in normal rodent eyes. In the present study, we show that the lentiviral vector (LV)-mediated C3 expression inactivates RhoA in human TM cells by ADP ribosylation, resulting indisruption of the actin cytoskeleton and altered cell morphology. In addition, intracameral delivery of the C3 vector to monkey eyes leads to persistently lowered IOP without obvious signs of inflammation. This is the first report of using a vector to transduce the TM of an alive non-human primate with a gene that alters cellular machinery and physiology. Our results in non-human primates support that LV-mediated C3 expression in the TM may have therapeutic potential forglaucoma, the leading cause of irreversible blindness in humans.

Pathologic and MRI analysis in acute atypical inflammatory demyelinating lesions.

The diagnosis of atypical inflammatory demyelinating lesions can be difficult. Brain biopsy is often required to exclude neoplasms. Moreover, the relationship between these lesions and multiple sclerosis and NMOSD is not clear. Our objectives were to describe radiological and pathological characteristics of patients with acute inflammatory demyelinating lesions. We retrospectively identified patients with brain biopsy performed for diagnostic uncertainty revealing a demyelinating lesion. A complete clinical, biological, radiological and pathological analysis was performed. Twenty patients (15 with a single lesion) were included. MRI disclosed a wide range of lesions including infiltrative lesions (40%), ring-like lesion (15%) Baló-like lesion (15%) and acute haemorrhagic leukoencephalitis (20%). In spite of a marked heterogeneity, some findings were common: a peripheral B1000 hyperintense rim (70%), a slight oedema with mild mass effect (75%) and an open-rim peripheral enhancement (75%). Histopathology revealed that all cases featured macrophages distributed throughout, extensive demyelination, axonal preservation and absence of haemorrhagic changes. In the majority of cases, macrophages were the predominant inflammatory infiltrate and astrocytes were reactive and dystrophic. Aquaporin-4 staining was systematically preserved. After a mean follow-up of 5years (1-12), 16/20 patients had a diagnosis of monophasic acute atypical inflammatory demyelinating lesion. One patient was diagnosed with MS and 3 with AQP4 negative NMOSD. Although imaging findings in patients with atypical inflammatory demyelinating lesions are heterogeneous, some common features such as peripheral DWI hyperintense rim with open-rim enhancement and absence of oedema argue in favour of a demyelinating lesion and should preclude a brain biopsy. In this context, AQP4 staining is systematically preserved and argues against an AQP4-positive NMOSD. Moreover, long-term follow-up is characterized by low recurrence rate.

SUN-573 Plasmapheresis in Thyroid storm

Background: The indication of plasmapheresis in thyroid storm is currently a category III in the American Society for Apheresis and a recommendation grade IIc. The impact of plasmapheresis on mortality in unstable patients due to thyrotoxicosis is not well studied. Case: A 56-year woman with untreated Graves disease was transferred from a psychiatric institution for atrial fibrillation and acute dyspnea. Her vital signs were a blood pressure of 115/60, a pulse of 190 bpm and a body temperature of 41.3°C. On presentation, she was confused; she had bilateral exophthalmia and slight pedal edema. Her TSH was <0.004 mU/L and a T4 at 37 µg/dl and her T3 at 1.7 µg/dl. In the past, she had a 99mTc scintigraphy that showed diffuse uptake and her TSI was positive, but she refused treatment. An X-Ray showed pneumonia. Upon initial evaluation, her Burch and Wartofsky score was 85, so she was immediately started on propylthiouracil, solucortef, lugol, esmolol which was later changed to propranolol. In the following hours, she developed hypotension and heart failure with pulmonary edema and a rise in hepatic enzymes. Due to her hemodynamic instability and the high mortality rate with thyroid storm, it was decided to proceed to a plasmapheresis. She had two plasmaphereses in the following two days and her T4 lowered from 37 µg/dl to 23 µg/dl after the first plasmapheresis and from 23 µg/dl to 14 µg/dl after the second plasmapheresis. Considering her tachyarrhythmia was difficult to control despite beta-blockers and digoxin, she had an electric cardioversion between the two plasmaphereses and has stayed in sinus rhythm since. After her second plasmapheresis, her level of consciousness and her Burch Wartofsky score improved. She was controlled by medication afterwards and left with methimazole and small dose of propanolol. Conclusion: We believe that plasmapheresis helped manage the patient’s thyroid storm and her hemodynamic instability.

Acute dermal toxicity study of new, used and laboratory aged aircraft engine oils.

There is little data available on toxicity levels of used aircraft engine oils relative to their unused (new) versions. This study was conducted to determine if new engine oils and their used versions have the potential to induce dermal irritation. Twelve male New Zealand White rabbits (Oryctolagus cuniculus, 19 weeks old) were used to determine the acute dermal toxicity potential of four aircraft turbine oils including MIL-PRF-7808 Grades 3 and 4 and MIL-PRF-23699 Grade 5 High Thermal Stability (HTS) and a Grade 5 experimental aircraft engine oil in their unused and used or laboratory stressed states. Five fur-free test sites (6 cm2 each) located lateral to the midline of the back were treated with two undiluted (0.5 ml) new engine oils and their used versions. The fifth site received reverse osmosis deionized (RODI) water as a control. Each treatment was repeated 3 times (3 rabbits/oil type). Each oil was tested under both semi-occluded and occluded conditions. The 4 h exposure was followed by gauze plus wrappings removal, and gentle cleaning of sites prior to scoring for erythema and edema at 0.5-1, 24, 48 and 72 h post exposure based on Draize (1959). E-collars were placed on each animal for at least 72 h to prevent ingestion of the test substance and/or gauze and wrappings and/or disturbance of site recovery. Additional observations were made on days 7, 10 and 14 to determine recovery. Exposure to both used and new oils produced dermal irritation consisting of no more than very slight to well-defined erythema and very slight edema. The calculated Primary Dermal Irritation Index (PDII) indicated that all the oils were slightly irritating (means ranged from 0.42 to 1.08). Although the PDII values for new oils and their used versions were not significantly different from each other, they were all statistically higher (p < 0.05) than those obtained for the control regardless of the type of occlusion binding applied. The used oils under semi-occlusion conditions yielded larger size effects (Cohen's d) relative to their unused versions suggesting an enhancement in irritation when the oil is aging. Grade 4 in the used state yielded the largest size effect which was d = 5.9 versus 2.6 for its unused version. The slight dermal irritation resulting from four hours of exposure to oils raises concerns about the magnitude of impact related to prolonged and/or repeated exposure.

Treatment of basal cell cancer in the periorbital area using a pulsed copper vapour laser

An increase in life expectancy in developed countries is inevitably accompanied by an increase in the number of nonmelanoma skin diseases, which are primarily represented by basal cell cancer (BCC) occurring in elderly and old-age patients. The pathogenesis of such diseases is associated both with impaired proliferation and differentiation of the keratinocytes of the epidermal basal layer, as well as with the transformation of the vasculature in the papillary dermis in the vicinity of BCC. In recent years, such conditions have been increasingly treated using CO2 , neodymium, diode and pulsed-dye lasers. In many cases, these devices allow malignant BCC cells to be successfully eliminated. However, the use of near-infrared lasers in the periorbital area is limited due to a higher risk of damaging the organs of the visual system. Therefore, a search for new laser surgery methods that can be used for treating malignant skin tumours seems to be a prospective research direction.Methods. 3 male and 9 female patients diagnosed with primary BCC were treated using a copper vapour laser (Yakhroma-Med). The age of the patients varied from 34 to 77 years. Laser treatment was carried out in one session under the following irradiation parameters: the wavelength of 511 and 578 nm, the average power of up to 3 W and a series of 15 ns pulses. The pause between the pulses was 60 μs, with the exposure time ranging from 200 to 600 ms. The light spot diameter on the skin surface was 1 mm. The follow-up monitoring duration was 24 months.Results. In all the BCC patients, one session of copper vapour laser treatment allowed malignant cells in the disease area to be completely eliminated without relapses during 2 years after the therapy. The duration of skin healing in the irradiated area was 2 weeks in patients under the age of 40 years, compared to 3–4 weeks in elderly patients. After the treatment, short-term side effects, such as a slight edema, erythema and peeling, were observed.

Magnetic resonance imaging features for primary brain lymphoma

To investigate the magnetic resonance imaging (MRI) features for primary brain lymphoma and improve its diagnosis and differential diagnosis. Methods: The clinical and MRI data from 14 patients with primary brain lymphoma were retrospectively reviewed. Results: Fourteen patients, including 5 males and 9 females, were (55±8) years old. There were 9 patients with single lesion and 5 patients with multiple lesions (2-6 lesions). A total of 26 lesions were identified. All lesions located in supratentorium, such as the cerebral hemisphere, the basal ganglia, and the corpus callosum. Most of them deeply located in the brain. The lesions presented slightly low or equal signal on T1-weighted image (T1WI), slightly high or equal signal on T2-weighted image (T2WI), and slightly high or equal signal on disffusion-weighted imaging (DWI), in which 2 lesions showed central necrosis and 2 lesions included hemorrhage. All of them showed significant enhancement, 3 of them showed annular enhancement, and the rest showed nodular and mass enhancement. The degree of para-tumorous edema for different lesions was different, including 20 lesions with marked edema, 4 with moderate edema, and 2 with slight edema. Conclusion: MRI features for primary brain lymphoma are specific. The tumors mostly locate in supratentorium and deep brain, showing multifocal growth, isointense to grey matter at T1WI and T2WI, marked enhancement, restricted diffusionon DWI, rare necrosis, and obvious space occupying effect.

Short communication: Risk factors for sonographically detectable udder edema in overbagged cows at dairy shows

At dairy cow shows, the appearance of the udder is very important. To show cows at their best, udders are often presented in an overbagged state by extending milking intervals before the show. This practice represents an animal welfare issue because it is associated with behavior changes (e.g., excessive abduction and decreased eating time) and may affect the health of the animal. The aim of the current study was to determine the association between various parameters (e.g., milk yield, days in milk, milking procedures, or administration of nonsteroidal anti-inflammatory drugs, steroids, or diuretics) and the sonographically detectable udder edema score. Data were collected from the show catalogs, by interviewing the exhibitors, by analyzing official veterinary treatment protocols and official milking data, via laboratory analysis of blood samples, and by sonographic examinations of the udders at the show. For sonographically detectable udder edema scoring, 3 scans were taken, 1 on each fore quarter and 1 incorporating both rear quarters at the level of the median suspensory ligament. For grading the scans, a scoring system of 4 grades (score 0 = no edema, 1 = slight edema, 2 = moderate edema, 3 = severe edema) was used. Data from 321 cows of different breeds were collected at 4 highly competitive Swiss dairy shows (shows A-D) between January and September 2017. To determine risk factors for sonographically detectable udder edema, data were analyzed with 2 different logistic regression models. In model 1, the odds ratios were 3.33 (milking intervals of ≥16 h vs. <14 h), 3.84 (show A vs. show C), and 7.39 (dairy breeds vs. dual-purpose breeds). Milking intervals of dairy breeds were significantly higher than those of dual-purpose breeds. In model 2, milking interval was the only significant risk factor with an odds ratio of 9.00 for milking intervals of ≥16 h. Only the milking intervals represented a relevant risk factor in both models; therefore, we concluded that the previously described sonographic udder edema scoring is a useful technique for detecting overbagged udders at dairy shows. Its routine implementation may improve cow welfare at dairy shows.

Technical note: Evaluation of a sonographic overbagging edema scoring system for show cows: Comparison with visual inspection

Overbagged udders are commonly seen at dairy cow shows due to prolonged milking intervals. The aims of this study were to describe the prevalence of udder edema in dairy cows at shows as determined by sonography and to suggest a sonographic scoring system, which was evaluated for reproducibility and repeatability. At 4 highly competitive Swiss dairy cow shows, 319 cows of various breeds were examined. Sonographic scans-1 from each fore quarter and 1 from the rear, representing both hind quarters-were collected by 3 experienced veterinarians at defined positions predisposed to overbagging edema. Sonographic scans were scored with the aid of a newly suggested scoring system (score 0 = no edema, grade 1 = slight edema, grade 2 = moderate edema, grade 3 = severe edema). Further, 139 video sequences from behind while the cows were walking and the same number of photographs of the udder each from the left, right, and behind were selected. The photographs and video sequences were visually scored for different parameters as 0 = not present or 1 = present except for abduction, which was scored on a visual analog scale (0 = no abduction; 100 = maximal imaginable abduction). Visual scores were then compared with the sonographic scoring (Pearson's chi-squared). The prevalence of udder edema scores 1, 2, and 3 was 14.0, 6.5, and 2.3%, respectively. Interobserver reliability for objective sonographic scoring (κ = 0.815) and intraobserver agreement (κ = 0.90 and 0.85 for 2 different observers) was estimated as "almost perfect." Interobserver agreements for visual parameters were κ = 0.40 or less except for teat shape (κ = 0.52). Classification of the videos resulted in better interobserver agreement; when rating hind limb abduction, Spearman correlation coefficient was 0.61, whereas κ = 0.61 for absence of udder movement. Udder movement and teat shape were significantly associated with the edema score. The higher inter- and intraobserver reliability of the sonographic edema scoring compared with the visual scoring system indicates that the newly suggested scoring system might be used in the future to objectively identify udder edema in cows at dairy shows.