Soft Tissue Edema Research Articles

Effect of targeted responsibility system nursing combined with psychological intervention on compliance and complications of patients with autologous nasal septum and ear cartilage transplantation.

The purpose was to explore the effect of targeted responsibility system nursing combined with psychological intervention on compliance and complications of patients with autologous nasal septum cartilage and ear cartilage transplantation filling. A retrospective analysis of the clinical data of 80 patients who underwent rhinoplasty with autologous septal cartilage and ear cartilage graft filling was conducted. Patients before the implementation of the "targeted accountable care combined with psychological intervention" program from January 2020 to December 2020 were set up as the control group (N.=40), and patients after the implementation of the program from January 2021 to December 2021 were set up as the study group (N.=40). The Hamilton Anxiety Scale (HAMA), Lund-Kennedy Endoscopy Score, Hamilton Depression Scale (HAMD), treatment compliance, and complications were compared between the two groups. At two weeks postoperatively, HAMA and HAMD were lower in the study group than in the control group (t=9.087, 9.265, P<0.05), and bilateral Lund-Kennedy scores were lower in the study group than in the control group (t=8.761, 10.267, P<0.05). The study group had a higher compliance excellence rate (75.00% vs. 52.50%) than the control group (χ2=4.021, P<0.05) and a lower complication rate (7.50% vs. 27.50%) than the control group (χ2=4.242, P<0.05). Targeted accountable care combined with psychological intervention can alleviate negative emotions in patients with nasal septum cartilage and ear cartilage graft filling, reduce the risk of postoperative soft tissue edema and other complications, and improve patient compliance with treatment.

Prospective Evaluation of Magnetic Resonance Imaging Features of Magnesium-Based Alloy Screw Resorption in Pediatric Fractures.

The resorption of magnesium-based alloy bioabsorbable screws results in the release of hydrogen gas, which can mimic infection and enter the growth plate. The screw itself and the released gas may also affect image quality. The evaluation of magnetic resonance imaging (MRI) findings during the most active phase of screw resorption is the objective, with particular focus on the growth plate and to assess for the presence of metal-induced artifacts. In total, 30 prospectively acquired MRIs from 17 pediatric patients with fractures treated with magnesium screws were assessed for the presence and distribution of intraosseous, extraosseous, and intra-articular gas; gas within the growth plate; osteolysis along the screw; joint effusion; bone marrow edema; periosteal reaction; soft tissue edema; and metal-induced artifacts. Gas locules were found in the bone and soft tissues in 100% of the examinations, intra-articular in 40%, and in 37% of unfused growth plates. Osteolysis and the periosteal reaction were present in 87%, bone marrow edema in 100%, soft tissue edema in 100%, and joint effusion in 50% of examinations. Pile-up artifacts were present in 100%, and geometric distortion in 0% of examinations. Fat suppression was not significantly impaired in any examination. Gas and edema in the bone and soft tissues are normal findings during the resorption of magnesium screws and should not be misinterpreted as infection. Gas can also be detected within growth plates. MRI examinations can be performed without metal artifact reduction sequences. Standard fat suppression techniques are not significantly affected.

Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease

ObjectivesAcute gastrointestinal graft-versus-host disease (GI-aGVHD) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT). Diagnosis relies on clinical, endoscopic, and pathological investigations. Our purpose is to assess the value of magnetic resonance imaging (MRI) in the diagnosis, staging, and prediction of GI-aGVHD-related mortality.MethodsTwenty-one hematological patients who underwent MRI for clinical suspicion of acute GI-GVHD were retrospectively selected. Three independent radiologists, blinded to the clinical findings, reanalyzed MRI images. The GI tract was evaluated from stomach to rectum by analyzing fifteen MRI signs suggestive of intestinal and peritoneal inflammation. All selected patients underwent colonoscopy with biopsies. Disease severity was determined on the basis of clinical criteria, identifying 4 stages of increasing severity. Disease-related mortality was also assessed.ResultsThe diagnosis of GI-aGVHD was histologically confirmed with biopsy in 13 patients (61.9%). Using 6 major signs (diagnostic score), MRI showed 84.6% sensitivity and 100% specificity in identifying GI-aGVHD (AUC = 0.962; 95% confidence interval 0.891–1). The proximal, middle, and distal ileum were the segments most frequently affected by the disease (84.6%). Using all 15 signs of inflammation (severity score), MRI showed 100% sensitivity and 90% specificity for 1-month related mortality. No correlation with the clinical score was found.ConclusionMRI has proved to be an effective tool for diagnosing and scoring GI-aGVHD, with a high prognostic value. If larger studies will confirm these results, MRI could partly replace endoscopy, thus becoming the primary diagnostic tool for GI-aGVHD, being more complete, less invasive, and more easily repeatable.Key Points• We have developed a new promising MRI diagnostic score for GI-aGVHD with a sensitivity of 84.6% and specificity of 100%; results are to be confirmed by larger multicentric studies.• This MRI diagnostic score is based on the six MRI signs most frequently associated with GI-aGVHD: small-bowel inflammatory involvement, bowel wall stratification on T2-w images, wall stratification on post-contrast T1-w images, ascites, and edema of retroperitoneal fat and declivous soft tissues.• A broader MRI severity score based on 15 MRI signs showed no correlation with clinical staging but high prognostic value (100% sensitivity, 90% specificity for 1-month related mortality); these results also need to be confirmed by larger studies.

The Effect of Steroid and Mannitol Combination Treatment on Postoperative Rehabilitation of Multiple Metacarpal Bone Fractures.

Background and Objectives: The expedient resolution of postoperative soft tissue edema is particularly important in hand surgery. Prolonged edema and pain become an obstacle to postoperative rehabilitation, delay return to daily life, and in severe cases, lead to a permanent decrease in range of motion. Based on the common physiology between postoperative hand swelling and complex regional pain syndrome (CRPS), we sought to determine if postoperative mannitol and steroid administration to multiple metacarpal bone fracture patients effectively reduces hand swelling and pain and is beneficial for hand rehabilitation. Materials and Methods: From March 2015 to February 2019, 21 patients who received closed pinning for multiple metacarpal fractures were included in a retrospective cohort study. The control group (n = 11) underwent a routine recovery, while the treatment group (n = 10) received dexamethasone and mannitol injections for five days postoperatively. Serial changes in the degree of pain and fingertip-to-palm distance (FPD) were measured in both groups. The duration from surgery to the initiation of rehabilitation and time to full grip was also compared. Results: Compared to the control, the treatment group showed a faster alleviation of pain scores from the postoperative fifth day (2.91 versus 1.80, p = 0.013), and faster recovery of FPD from postoperative two weeks (3.27 versus 1.90, p = 0.002). Time to physical therapy initiation (6.73 versus 3.80 days, p = 0.002) and full grip achievement (42.46 versus 32.70 days, p = 0.002) were also faster in the treatment group. Conclusions: The steroid-mannitol combination treatment for multiple metacarpal bone fracture patients in the acute postoperative phase promoted the reduction of hand edema and pain, leading to the earlier initiation of physical therapy, rapid improvement in joint motion, and faster achievement of full grip.

VARIOUS METHODS OF EARLY REHABILITATION OF ATHLETES WITH ANKLE JOINT INJURIES

Among the emerging sports injuries, injuries of the upper and lower extremities deserve special attention. Most of the injuries of the lower extremities are injuries of the ankle joint. The main pathogenic link in the occurrence of an ankle joint injury is the level of impact of the traumatic moment. Further, the processes of damage to the soft tissue component, the ligamentous -muscular apparatus and bone-articular structures begin. Then it manifests itself mainly in the development of soft tissue edema in the area of the injury, followed by the launch and development of pathogenic changes. Blood and lymphatic vessels are damaged, which are the main trigger for the formation of edema. All these processes are associated with the occurrence of subsequent compression of the surrounding tissues, an increase in edema and the development of a severe pain syndrome. The search for literature sources made it possible to determine the existing problem and assess the relevance of the ongoing scientific research. The study is aimed at developing and searching for new modern methods, therapy regimens. The aim of the work is to improve the quality of therapy for ankle joint injuries in athletes and to achieve early recovery of lost functions with a return to full-fledged sports activity

MRI or ultrasound-which imaging technique do we need?

Diagnostic imaging of epicondylitis is primarily performed using widely available, radiation-free ultrasound. The dynamic examination allows arapid point-of-care assessment. Typical imaging findings of epicondylitis include intratendinous hypoechogenic foci at the humeral origin, ossification at the enthesis, intratendinous calcifications, or (partial) rupture. In particular, Doppler sonography increases sensitivity by assessing possible neovascularization within the tendon. When sonographic findings are unclear or extensive, or when ultrasound machines or the required expertise in elbow examinations are not available, magnetic resonance imaging is indicated. Here, the use of proton density-weighted sequences is appropriate for assessing bone marrow and soft tissue edema and tendon tears, while ossifications are best delineated in T1weighted sequences. Projection radiography and computed tomography can be helpful for larger ossifications, although they are not part of the standard imaging protocol.

Investigation into the genetics of fetal congenital lymphatic anomalies.

Congenital lymphatic anomalies (LAs) arise due to defects in lymphatic development and often present in utero as pleural effusion, chylothorax, nuchal and soft tissue edema, ascites, or hydrops. Many LAs are caused by single nucleotide variants, which are not detected on routine prenatal testing. Demographic data were compared between two subcohorts, those with clinically significant fetal edema (CSFE) and isolated fetal edema. A targeted variant analysis of LA genes was performed using American College of Medical Genetics criteria on whole exome sequencing (WES) data generated for 71 fetal edema cases who remained undiagnosed after standard workup. CSFE cases had poor outcomes, including preterm delivery, demise, and maternal preeclampsia. Pathogenic and likely pathogenic variants were identified in 7% (5/71) of cases, including variants in RASopathy genes, RASA1, SOS1, PTPN11, and a novel PIEZO1 variant. Variants of uncertain significance (VOUS) were identified in 45% (32/71) of cases. In CSFEs, VOUS were found in CELSR1, EPHB4, TIE1, PIEZO1, ITGA9, RASopathy genes, SOS1, SOS2, and RAF1. WES identified pathogenic and likely pathogenic variants and VOUS in LA genes in 51% of fetal edema cases, supporting WES and expanded hydrops panels in cases of idiopathic fetal hydrops and fluid collections.

Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis.

Psoriatic arthritis (PsA) can mimic rheumatoid arthritis (RA) at an early stage, especially when psoriasis is lacking. In the absence of specific radiological and immunological markers, the differential diagnosis between these two diseases can be challenging. We aimed to determine whether hands ultrasonography (US) may be useful in the differential diagnosis between PsA and RA. We conducted a cross-sectional study including patients with PsA and RA. All wrists and small joints of the hands were examined using gray-scale and Power Doppler US. The evaluated US lesions were: synovitis, tenosynovitis of extensor carpi ulnaris, extensor communis and flexor tendons, enthesitis of extensor tendons at distal interphalangeal joints, peritendon inflammation of extensor tendons, and soft tissue edema. Six hundred joints in 20 PsA patients and 900 joints in 30 RA patients were assessed. Extensor enthesitis was significantly more observed in PsA compared with RA (39.4 vs 26.3%, P=.006) with a significant higher frequency of enthesophytes and calcifications (P=.022 and P=.002, respectively). Peritendon inflammation of extensor digitorum tendons was observed in 13% of metacarpophalangeal joints in PsA patients versus 3% in RA patients with a significant difference (P < .001). Soft tissue edema was exclusively observed in PsA (1.5 vs 0%, P=.033). Power Doppler synovitis was significantly more frequent in RA (9.2 vs 5%, P=.002). Extensor carpi ulnaris tenosynovitis was significantly more frequent in RA (18.3 vs 2.5%, P=.017). Extrasynovial US findings may be helpful to distinguish PsA from RA especially in patients with immunonegative polyarthritis and no evidence of psoriasis.

Primary Bone Lymphoma: A Review of the Literature with Emphasis on Histopathology and Histogenesis.

Primary bone lymphoma (PBL) is a rare neoplasm of malignant lymphoid cells presenting with one or more bone lesions without nodal or other extranodal involvement. It accounts for approximately 1% of all lymphomas and 7% of malignant primary bone tumors. Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) represents the predominant histological type and constitutes over 80% of all cases. PBL may occur at all ages with a typical diagnosis age of 45-60 years and a slight male predominance. Local bone pain, soft tissue edema, palpable mass and pathological fracture are the most common clinical features. Diagnosis of the disease, which is frequently delayed due to its non-specific clinical presentation, is based on the combination of clinical examination and imaging studies and confirmed by combined histopathological and immunohistochemical examination. PBL can develop in any part of the skeleton, although it occurs most commonly in the femur, humerus, tibia, spine and pelvis. The imaging appearance of PBL is highly variable and unspecific. In terms of the cell-of-origin, most cases of primary bone DLBCL (PB-DLBCL), NOS belong to the germinal center B-cell-like subtype and specifically originate from germinal center centrocytes. PB-DLBCL, NOS has been considered a distinct clinical entity based on its particular prognosis, histogenesis, gene expression and mutational profile and miRNA signature. PBL carries a favorable prognosis, especially when treated with combined chemoradiotherapy.

Inflammatory arthritis in systemic sclerosis is associated with elevated C-reactive protein and requires musculoskeletal ultrasound for reliable detection.

About 25% of patients with systemic sclerosis (SSc) have elevated C-reactive protein (CRP) levels. Specific causes of CRP elevation are unknown so far. We aimed to investigate whether inflammatory arthritis is associated with CRP elevation. Furthermore, we evaluated the sensitivity and specificity of clinical examination compared to musculoskeletal ultrasound (MSUS) for detection of arthritis. Sixty-five patients with SSc (51 females) were enrolled and allocated into a CRP-positive (CRP+, n = 20; CRP elevated for at least two years prior to enrollment) and a CRP-negative (CRP-; n = 45) cohort. All patients were examined clinically (modified Rodnan Skin Score, mRSS; swollen/tender joint count 66/68), received a comprehensive MSUS of their hands and feet, as well as laboratory testing (antibody status; CRP). Statistical analyses were performed using non-parametrical tests without adjustments. Patient with a disease duration <3 years had higher CRP levels (p = 0.042). Anti-centromere antibodies dominated in CRP- patients (p = 0.013), and anti-Scl70 antibodies in CRP + patients (p = 0.041). Joint effusion and B-mode synovitis prevailed in male (p < 0.00001; p < 0.0001) and CRP + (p = 0.001; p < 0.00001) patients. Power Doppler (PD)-synovitis predominated in patients with diffuse SSc (p = 0.0052). Joint effusion and B-/PD-synovitis were mostly confined to wrists, MTPs and talo-navicular joints. Compared to MSUS, sensitivity of clinical examination was as low as 14.6%; specificity was 87.7%. Sensitivity was reduced by the presence of soft tissue edema or a mRSS > 10. Arthritis is more frequent in CRP + compared to CRP- SSc patients. Compared to MSUS sensitivity of clinical examination is low for the detection of arthritis; this is likely due to skin fibrosis and soft tissue edema. Therefore, regular monitoring via MSUS should be considered as routine assessment in SSc patients.

Radiological Overview of Tubercular Arthritis of Wrist Joint: A Case Report

Musculoskeletal Tuberculosis (TB) worldwide with wrist involvement is very rare. Maximum cases of tuberculous arthritis arise in patients born in and migrated from endemic regions, particularly in patients who are co-infected with Human Immunodeficiency Virus (HIV). Authors present a rare case of tuberculous arthritis of the wrist joint in a 64-year-old male having pain, swelling, and decreased range of motion in the left wrist for six months. X-ray and Computed Tomography (CT) showed erosion of carpal bones, reduced joint space, and soft tissue oedema and abscess. On Ultrasonography (USG) joint effusion and soft tissue oedema, were seen around the wrist joint, and on Magnetic Resonance Imaging (MRI) along with this marrow oedema were also noted. Aspirated fluid culture from abscess suggested Mycobacterium positive culture and Ziehl–Neelsen (Z-N) staining showed acid-fast bacilli. Antitubercular therapy was the mainstay of treatment. A high level of suspicion should be kept for TB in every infection of the wrist joint.

Компьютерная томография и ультразвуковое исследование в диагностики некротизирующего фасциита

The purpose — to demonstrate the capabilities of computed tomography and ultrasound in the diagnosis and treatment planning of a patient with a rare case of necrotizing fasciitis. Material and methods. A clinical observation of a 57-year-old patient K. with complaints of pain in the area of the right foot, reddening of the skin on the right foot is presented. T — 37.2 ºC. To determine the nature of the revealed changes, the patient was referred to the Department of Radiation and Functional Diagnostic Methods for soft tissue ultrasound and computed tomography (CT) of the vessels of the lower extremities to assess the lesion and plan surgical treatment. Results. After an ultrasound of the soft tissues of the right leg posterior surface, around the gastrocnemius muscle, an inhomogeneous liquid rim (an echo picture of fasciitis), soft tissue edema was visualized. CT of the lower extremities vessels showed a decrease in blood flow in the lower leg arteries, infiltration and a moderate amount of gas in the soft tissues of n/3 of the lower leg and foot. Discussion. Necrotizing fasciitis (fasciitis necrotisans) is a representative of a large group of surgical infections of soft tissues, the morphological basis of which is progressive necrosis of the superficial fascia (fascia superficialis) and subcutaneous adipose tissue, and the clinical course is particularly severe and is accompanied by high mortality. NF is an emergency surgical situation. Early and accurate diagnosis is critical to provide the necessary aggressive treatment. Conclusion. This clinical observation demonstrates the importance of conducting a study using computed tomography and ultrasound in patients with necrotizing fasciitis for the earliest possible diagnosis and immediate surgical treatment, supported by effective antibiotic therapy.

Ultrasound protocol in odontogenic infections: a new proposal.

Point-of-care-ultrasound can be applied to preview a difficult airway, detect the presence of fluid collection, and soft-tissue edema, and guide the drainage location, although is rarely used. The purpose of this study is to validate a protocol for the assessment of these clinical features on patients with severe odontogenic infections. This was a single-group prospective cohort study (n=20) including patients with the diagnosis of deep-neck propagation of odontogenic infection. A transcervical linear high-frequency probe transducer (13-6 MHz) was used to scan the structures of the upper airway and the infectious collections. The drainage was guided by ultrasound and the patients were daily evaluated, according to the protocol. The data were extracted and the airway volume, midline deviation, and other important data such as length of hospital stay, dysphagia, voice alteration, raised floor of the mouth, dyspnea, and neck swelling were registered. The ultrasound examination was correlated with multiple clinical findings, such as dyslalia (p=0,069), dysphagia (p=0,028), dyspnea (p=0,001), among others. This protocol has an advantage as it can be used at bedside evaluation, allowing the assessment of severe and unstable patients, and predicting the increase of the hospitalization time (p=0,019). This protocol is reliable for the assessment of the upper airway, even in an emergency, predicting not only the severity of the clinical features but aids in the determination of the length of the hospitalization time.

Adverse effects of articaine versus lidocaine in pediatric dentistry: a meta-analysis.

Over the last few years, numerous reports have lauded the efficacy of articaine hydrochloride as a local anesthetic (LA) in dental procedures. Numerous studies have shown that articaine outperforms lidocaine in various aspects of dental treatment, leading to its widespread adoption in both adults and children. Despite the publications of comparative studies, there remains a dearth of systematic reviews examining the adverse effects of articaine versus lidocaine in randomized controlled trials. The aim was to assess the available research on the adverse effects of articaine and lidocaine in pediatric dentistry. A comprehensive search was conducted on Cochrane Library, Pubmed, Chinese Biomedical Literature Database (CBM), Embase, Web of Science and China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCT) that compared articaine with lidocaine in pediatric dentistry were included. Methodological quality assessment and risk of bias were determined for each of the included studies. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the strength of evidence for every research. A total of 333 studies were identified through electronic searches. After conducting primary and secondary assessments, eight studies were included for the final qualitative analysis. We found no difference in the probability of adverse reactions between articaine and lidocaine after treatment in pediatric patients (risk ratio (RR) = 1.08, 95% confidence interval (CI) (0.54-2.15), p = 0.83). However, a high heterogeneity was reported among the outcomes in the investigated studies (I2 = 57%), and the strength of the evidence was classified as "moderate" based on the GRADE approach. Besides, we found no significant difference in the probability of postoperative pain, postoperative soft tissue injury and edema between articaine and lidocaine in pediatric patients following treatment. There was moderate quality evidence suggesting no difference in the occurrence of adverse events between articaine and lidocaine when used for pediatric dental procedures.

Imaging of Knee Joint Pathologies: A Comparative Study of Ultrasound and Magnetic Resonance Imaging

Background: Magnetic resonance imaging (MRI) has been accepted as the best non-invasive imaging modality for the evaluation of knee joint pathology but the advantages of ultrasound (US) over magnetic resonance imaging (MRI) are that the ultrasound is readily available, cheap and offers real-time imaging. Aim: To assess the accuracy of ultrasound in diagnosing knee joint pathologies using MRI as a reference. Materials And Methods: 50 patients were evaluated prospectively over a period of 1.5 years by USG followed by MRI of the affected knee. Accuracy of USG was calculated with MRI as reference. Results: In our study, the majority of patients were in age group 21-30 years. Perfect agreement was noted between ultrasound and MRI for detecting Baker’s cyst. Near perfect agreement was noted between ultrasound and MRI for detecting joint effusion, soft tissue edema and osteophytes. Substantial agreement was noted between ultrasound and MRI for Collateral ligaments tear and Meniscal injuries. Moderate agreement was noted between ultrasound and MRI for PCL tear. Fair agreement was noted between ultrasound and MRI for ACL tear. Conclusion: Knee USG has high accuracy in diagnosing pathologies like knee joint effusion, synovitis, popliteal/baker’s cysts, soft tissue edema/cellulitis, arthritic changes, collateral ligament and meniscal tears. Keywords: Knee joint pathologies, Ultrasound, MRI, Ligaments

Improvement of fibroid-associated symptoms and quality of life after US-guided high-intensity focused ultrasound (HIFU) of uterine fibroids

Uterine fibroids are the most common benign uterine tumors and can cause various severe symptoms as abnormal menstrual bleeding or pelvic pain. Therefore, the primary objective in the treatment of uterine fibroids is a sufficient symptom relief. Ultrasound (US)-guided High-intensity focused ultrasound (HIFU) is an effective non-invasive treatment strategy for ablation of uterine fibroids that can achieve a significant tumor volume reduction. The aim of the study is to evaluate if US-guided HIFU treatment can reduce fibroid-associated symptoms leading to an improvement of health-related quality of life. Fifty-five women with symptomatic uterine fibroids underwent US-guided HIFU ablation. Clinical evaluation was performed on the basis of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) at baseline, 6 weeks, 3, 6, 9 and 12 months after HIFU. Imaging follow-up included contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI. A significant reduction of the Symptom Severity Scale (SSS) was observed between 6 weeks and 12 months after HIFU (49.9 ± 19.4 at baseline vs. 42.2 ± 20.1 at 6 weeks and 23.6 ± 12.7 at 12 months after treatment, p < 0.001) correlating with a significant improvement (p < 0.001) of Health-related Quality of Life (HRQL) (52.5 ± 22.7 at baseline vs. 59.8 ± 22 at 6 weeks and 77.9 ± 17.3 at 12 months after treatment). Significant postinterventional improvement was observed in every subscale of HRQL. In the majority of patients, only minor, short-lasting and self-limiting side effects were observed, e.g. soft tissue edema of the anterior lower abdominal wall in the acoustic pathway or transient moderate lower abdominal pain as during menstruation. One patient with a very large fibroid experienced strong short-lasting pain after the procedure; two patients experienced post-procedurally a transient sciatic nerve irritation. US-guided HIFU of uterine fibroids reduces disease-related symptoms and improves health-related quality of life.

Application of bioinformatical analysis to identify candidate genes associated with hereditary angioedema

Primary immunodeficiencies (PID) are a heterogeneous group of hereditary diseases that lead to impaired immune defense. Often, the diagnosis cannot be made without identifying mutations that lead to the development of the disease. For many PIDs, there is no clear understanding of the etiology, pathogenesis, and genes involved. There is an obvious need to identify candidate genes potentially capable of leading to the development of PIDs.Hereditary angioedema (HAE) is a rare genetically determined disease, accompanied by recurrent edema of soft tissues and submucosal membranes, posing a threat to the life of patients. Diagnosis is based on the clinical presentation, family history, laboratory values of C1-esterase inhibitor, complement component 4, complement component 1q, antibodies to C1 and genetic testing for a number of mutations in the genes SERPING1, F12, PLG, ANGPT1, KNG1, MYOF, HS3ST6. However, pathogenesis may involve other genes in which the negative effect of mutations has not yet been studied. HAE is a non-monogenic disease that may involve an extensive network of genes. It seems important to determine the groups of the most probable candidate genes presumably involved in the development of pathology.Aim – to identify, using bioinformatics analysis, candidate genes for the development/pathogenesis of HAE and to reveal their biological context.The analysis was based on a group of genes, mutations in which are significantly associated with HAE: SERPING1, F12, PLG, ANGPT1, KNG1, MYOF, HS3ST6. To analised genetic and protein–protein networks and identify the biological context of the selected candidate genes, a number of web resources were used: HumanNetv3, GeneMania, FUMA GWAS in the GENE2FUNC mode.One hundred potential candidate genes in which mutations can be associated with HAE have been identified. The biological context of the identified genes was determined. The data of the biological context, genetic and protein-protein interactions made it possible to exclude a number of genes from the list of the most likely participants in pathogenesis and divide the remaining ones into groups with a greater or lesser potential for involvement. The group of the most likely HAO candidate genes includes PLAT, HRG, SERPINA1, SERPINF2, MASP2, GRB14, C1QBP, DOK2, KLKB1, F11, TEK, KLK10, KRT1, APOH, CPB2, F2.The results obtained can provide significant assistance in the study of the HAE molecular mechanism, as well as in the diagnosis and prognosis of the disease course. The identified candidate genes have the potential to serve as diagnostic biomarkers for patients with unexplained angioedema.The use of bioinformatic methods makes it possible to determine the list of candidate genes that are presumably involved in the disease pathogenesis or aggravate its course, and to obtain up-to-date information about the biological context of the identified genes. Understanding the genetic underpinnings and pathophysiology of PID may help define new diagnostic and therapeutic targets.

Accuracy of point‑of‑care ultrasonography in the diagnosis of necrotizing fasciitis: A case report

Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.

Neuromuscular Toxicity and Dose-Volume Relationships Following SBRT for Bone Oligometastases: Post-Hoc Analysis of Two Ongoing Clinical Trials

<h3>Purpose/Objective(s)</h3> Growing evidence suggests that stereotactic body radiotherapy (SBRT) is effective for oligometastatic disease. Currently, there is limited data to define dose-volume relationships between muscle and adipose tissues and neuromuscular toxicities. In this post hoc analysis, we evaluated these associations in patients enrolled in two phase II clinical trials (NCT03575611, NCT03599765) where bone oligometastases were ablated with SBRT. <h3>Materials/Methods</h3> We reviewed three-fraction SBRT treatment plans for bone oligometastases where total dose ranged from 24-36 Gy. We contoured muscle and adjacent soft tissue receiving at least 10Gy based on anatomical function (e.g., hip flexors) and defined the largest-volume group as the most-affected functional muscle group (MFMG). Muscle and adipose tissues within MFMGs (MFMG-m and MFMG-a respectively) were further delineated by semi-automated contouring scripts using previously validated CT Hounsfield unit ranges for muscle (-29 to +150 HU) and adipose (-190 to -30 HU). Associations between neuromuscular adverse events (AE) (graded by Common Terminology Criteria for Adverse Events version 5) with dose to 2cc-30cc of contoured volumes (D2cc-D30cc) and clinical variables (BMI, ECOG, etc.) were assessed using two-sided Mann-Whitney U tests. Results were considered significant at P<0.0071 with Bonferroni correction. <h3>Results</h3> We evaluated 43 treatment plans for 37 patients with target lesions in the pelvic girdle (n=18), rib (n=15), femur (n=4), lumbar vertebra (n=2), scapula (n=2), and sternum (n=2). Three patients (8.1%) experienced grade 3 hip pain, 1 patient (2.7%) had grade 2 hip pain, and 2 patients (5.4%) had grade 1 hip or rib pain. There were no grade 4 or 5 AEs. Median time to AE was 2.3 months (range: 1.2–4.5 months). Patients with AEs had significantly higher MFMG D25cc (median = 28.4 vs 18.6Gy; p=0.004), MFMG-m D25cc (median = 27.7 vs 17.3Gy; p=0.006), and MFMG-a D5cc (median = 30.2 vs 18.9Gy; p=0.006) compared to pain-free patients. We identified a dose/volume threshold at MFMG D25cc > 25 Gy, where 5/11 (45.5%) treatment plans above and 1/32 (3.1%) below this threshold led to AEs, corresponding to an odds ratio of 25.8. There was no relationship between AEs and BMI, ECOG score, or demographics. No local tumor recurrences occurred with median follow-up of 15.5 months (range: 3.1–35.4 months). Two patients with grade 3 AEs after SBRT to pelvic girdle lesions had 3- and 5-month follow-up MRIs which identified soft tissue edema consistent with our findings. <h3>Conclusion</h3> Preliminary results from two prospective trials suggests that SBRT for bone oligometastases can be conducted safely with excellent tumor control and minimal toxicity. We propose that MFMG D25cc be limited to 25 Gy to avoid symptomatic neuromuscular toxicity. Future studies are needed for dose criteria verification.

MRI of Lymphedema.

Lymphedema is a devastating disease that has no cure. Management of lymphedema has evolved rapidly over the past two decades with the advent of surgeries that can ameliorate symptoms. MRI has played an increasingly important role in the diagnosis and evaluation of lymphedema, as it provides high spatial resolution of the distribution and severity of soft tissue edema, characterizes diseased lymphatic channels, and assesses secondary effects such as fat hypertrophy. Many different MR techniques have been developed for the evaluation of lymphedema, and the modality can be tailored to suit the needs of a lymphatic clinic. In this review article we provide an overview of lymphedema, current management options, and the current role of MRI in lymphedema diagnosis and management. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 5.