Visible Edema Research Articles

Eucalyptus robusta leaves methanolic extract suppresses inflammatory mediators by specifically targeting TLR4/TLR9, MPO, COX2, iNOS and inflammatory cytokines in experimentally-induced endometritis in rats

Ethnopharmacological relevanceBacterial endometritis is one of the major causes of reproductive disorders including infertility in farm animals. Antibiotics are generally used for treatment of such disorders but now a days residues of antibiotics are of great public health concern, therefore, phytoremediation is being considered as an alternative to use of antibiotics. Aim of the studyPresent study was undertaken to investigate the efficacy of Eucalyptus robusta leaves methanolic extract against endometritis along with the possible mechanism of action especially targeting inflammatory biomarkers. Materials and methodsBacterial endometritis was produced using clinical isolates of E. coli and Staphyloccocus aureus from bovines (cows and buffaloes) endometritis cases. After seven days of inoculation of the mixed bacterial culture, endometritis was confirmed based on the presence of visible pus and edema, thinning of endometrial lining and presence of large number of polymorphonuclear cells and bacterial load in uterine flushing. Female Wistar rats were divided in to five groups namely control, sham-operated, endometritis, endometritis plus Eucalyptus leaves extract and endometritis plus cefixime. Serum specific inflammatory biomarkers (interleukin-1β, interleukin-10, tumor necrosis factor-α, intercellular adhesion molecule-1, serum amyloid A) and myleoperoxidase, toll like receptors-4 and -9, inducible nitric oxide synthase, nitric oxide, cyclooxygenase 1 and 2 were estimated in uterine tissues using ELISA kits. ResultsInterleukin-10, serum amyloid A, myleoperoxidase, toll like receptors-4 and-9, cyclooxygenase-2, inducible nitric oxide synthase and nitric oxide were significantly increased while non significant increase in interleukin-1β, cycloxygenase-1 and intercellular adhesion molecule-1 were observed but level of tumor necrosis factor-α was found decreased in rats of endometritis group. Histopathological lesions in uterus showed efficient induction of endometritis by presence of inflammatory cells which are lessened effectively after treatment with Eucalyptus leaves extract. Eucalyptus robusta leaves extract produced curative and protective effect against endometritis and results were comparable to or even better than cefixime. ConclusionsEucalyptus robusta leaves extract possess promising antibacterial activity and efficacy against experimental endometritis and, therefore, holds promising potential for development of effective formulation for treatment of endometritis in animals.

Alcohol Consumption, High-Density Lipoprotein Cholesterol, Antithrombin III, and Body Mass Index Are Associated with Great Saphenous Vein Reflux in the Thigh

Venous valvular reflux is the main cause of chronic venous dysfunction. However, the etiology of valvular reflux is not completely understood. We conducted this study to investigate new risk factors for venous reflux of the great saphenous vein (GSV) in the thigh. We studied 139 consecutive patients (278 legs) who underwent Doppler ultrasonography at our hospital between March 2015 and February 2016 for leg discomfort with visible varicosities, edema, skin changes, or venous ulcer in the legs. Continuous variables included age, body mass index (BMI), hematological and blood chemistry parameters, smoking (pack-years), and alcohol consumption (days). Nominal variables included sex, comorbidities, smoking status, alcohol drinking status, and specific antibodies. The relationship of GSV reflux with pregnancy and number of children was investigated in 184 legs of 92 patients among 96 female patients. On logistic regression analysis, independent factors determining GSV reflux were BMI (B=0.126, P=0.012), high-density lipoprotein (HDL) cholesterol level (B=0.029, P=0.025), duration of alcohol consumption (B=1.237E-4, P=0.016), and antithrombin III level (B=-0.036, P=0.011). In this study, the factors determining GSV reflux were higher HDL cholesterol level, longer duration of alcohol consumption, lower antithrombin III level, and higher BMI.

Preliminary study of the effects of furosemide on blood pressure during late-onset pre-eclampsia in patients with highcardiac output.

To examine the effect of furosemide on hypertension and edema in patients with pre-eclampsia experiencing high cardiac output. The present cohort study enrolled patients with pre-eclampsia who were admitted to the pregnancy pathology unit of the Department of Obstetrics and Gynecology, University of Pécs, Hungary, between January 1 and December 31, 2015. Eligible patients had singleton pregnancies with no fetal anomalies, high blood volume, visible edema, and a hematocrit concentration below 37L/L. Blood pressure was measured and impedance cardiography was used to determine cardiac output for all patients before they received a 40-mg dose of furosemide; after 60minutes blood pressure and cardiac output were measured again. The study enrolled 14 patients. Lower cardiac output (P=0.002), systolic blood pressure (P=0.002), and diastolic blood pressure (P=0.002) were recorded after furosemide administration, with patient heart rates remaining stable. The heart-rate stability suggests that the change of cardiac output was due to a decrease in blood volume. These data suggest that diuretics could be useful in the management of late-onset pre-eclampsia, indicating that an increase in water retention could play a role in the development of late-onset pre-eclampsia.

Enoxaparin ameliorates post-traumatic brain injury edema and neurologic recovery, reducing cerebral leukocyte endothelial interactions and vessel permeability in vivo.

Traumatic brain injury (TBI) confers a high risk of venous thrombosis, but early prevention with heparinoids is often withheld, fearing cerebral hematoma expansion. Yet, studies have shown heparinoids not only to be safe but also to limit brain edema and contusion size after TBI. Human TBI data also suggest faster radiologic and clinical neurologic recovery with earlier heparinoid administration. We hypothesized that enoxaparin (ENX) after TBI blunts in vivo leukocyte (LEU) mobilization to injured brain and cerebral edema, while improving neurologic recovery without increasing the size of the cerebral hemorrhagic contusion. CD1 male mice underwent either TBI by controlled cortical impact (CCI, 1-mm depth, 6 m/s) or sham craniotomy. ENX (1 mg/kg) or vehicle (VEH, 0.9% saline, 1 mL/kg) was administered at 2, 8, 14, 23, and 32 hours after TBI. At 48 hours, intravital microscopy was used to visualize live LEUs interacting with endothelium and microvascular leakage of fluorescein isothiocyanate-albumin. Neurologic function (Neurological Severity Score, NSS), activated clotting time, hemorrhagic contusion size, as well as brain and lung wet-to-dry ratios were evaluated post mortem. Analysis of variance with Bonferroni correction was used for statistical comparisons between groups. Compared with VEH, ENX significantly reduced in vivo LEU rolling on endothelium (72.7 ± 28.3 LEU/100 μm/min vs. 30.6 ± 18.3 LEU/100 μm/min, p = 0.02) and cerebrovascular albumin leakage (34.5% ± 8.1% vs. 23.8% ± 5.5%, p = 0.047). CCI significantly increased ipsilateral cerebral hemisphere edema, but ENX treatment reduced post-CCI edema to near control levels (81.5% ± 1.5% vs. 77.6% ± 0.6%, p < 0.01). Compared with VEH, ENX reduced body weight loss at 24 hours (8.7% ± 1.2% vs. 5.8% ± 1.1%, p < 0.01) and improved NSS at 24 hours (14.5 ± 0.5 vs. 16.2 ± 0.4, p < 0.01) and 48 hours (15.1 ± 0.4 vs. 16.7 ± 0.5, p < 0.01) after injury. There were no significant differences in activated clotting time, hemorrhagic contusion size, and lung water content between the groups. ENX reduces LEU recruitment to injured brain, diminishing visible microvascular permeability and edema. ENX may also accelerate neurologic recovery without increasing cerebral contusion size. Further study in humans is necessary to determine safety, appropriate dosage, and timing of ENX administration early after TBI.

Corneal High-Order Aberrations and Backscatter in Fuchs' Endothelial Corneal Dystrophy.

Suboptimal visual acuity after endothelial keratoplasty has been attributed to increased anterior corneal high-order aberrations (HOAs). In this study, we determined anterior and posterior corneal HOAs over a range of severity of Fuchs' endothelial corneal dystrophy (FECD). Cross-sectional study. A total of 108 eyes (62 subjects) with a range of severity of FECD and 71 normal eyes (38 subjects). All corneas were examined by using slit-lamp biomicroscopy to determine the severity of FECD versus normality. Fuchs' endothelial corneal dystrophy corneas were categorized as mild, moderate, or advanced according to the area and confluence of guttae and the presence of clinically visible edema. Normal corneas were devoid of any guttae. Wavefront errors from the anterior and posterior corneal surfaces were derived from Scheimpflug images and expressed as Zernike polynomials through the sixth order over a 6-mm diameter optical zone. Backscatter from the anterior 120 μm and posterior 60 μm of the cornea also was measured from Scheimpflug images and was standardized to a fixed scatter source. Variables were compared between FECD and control eyes by using generalized estimating equation models to adjust for age and correlation between fellow eyes. High-order aberrations, expressed as root mean square of wavefront errors, and backscatter of the anterior and posterior cornea. Total anterior corneal HOAs were increased in moderate (0.61±0.27 μm, mean ± standard deviation; P = 0.01) and advanced (0.66±0.28 μm; P = 0.01) FECD compared with controls (0.47±0.16 μm). Total posterior corneal HOAs were increased in mild (0.22±0.09 μm; P = 0.017), moderate (0.22±0.08 μm; P < 0.001), and advanced (0.23±0.09 μm; P < 0.001) FECD compared with controls (0.16±0.03 μm). Anterior and posterior corneal backscatter were higher for all severities of FECD compared with controls (P ≤ 0.02, anterior; P ≤ 0.001, posterior). Anterior and posterior corneal HOAs and backscatter are higher than normal even in early stages of FECD. The early onset of HOAs in FECD might contribute to the persistence of HOAs and incomplete visual rehabilitation after endothelial keratoplasty.

A potent and selective calcitonin gene-related peptide (CGRP) receptor antagonist, MK-8825, inhibits responses to nociceptive trigeminal activation: Role of CGRP in orofacial pain

Temporomandibular disorders (TMDs) are orofacial pains within the trigeminal distribution, which involve the masticatory musculature, the temporomandibular joint or both. Their pathophysiology remains unclear, as inflammatory mediators are thought to be involved, and clinically TMD presents pain and sometimes limitation of function, but often appears without gross indications of local inflammation, such as visible edema, redness and increase in temperature. Calcitonin gene-related peptide (CGRP) has been implicated in other pain disorders with trigeminal distribution, such as migraine, of which TMD shares a significant co-morbidity. CGRP causes activation and sensitization of trigeminal primary afferent neurons, independent of any inflammatory mechanisms, and thus may also be involved in TMD. Here we used a small molecule, selective CGRP receptor antagonist, MK-8825, to dissect the role of CGRP in inducing spontaneous nociceptive facial grooming behaviors, neuronal activation in the trigeminal nucleus, and systemic release of pro-inflammatory cytokines, in a mouse model of acute orofacial masseteric muscle pain that we have developed, as a surrogate of acute TMD. We show that CFA masseteric injection causes significant spontaneous orofacial pain behaviors, neuronal activation in the trigeminal nucleus, and release of interleukin-6 (IL-6). In mice pre-treated with MK-8825 there is a significant reduction in these spontaneous orofacial pain behaviors. Also, at 2 and 24h after CFA injection the level of Fos immunoreactivity in the trigeminal nucleus, used as a marker of neuronal activation, was much lower on both ipsilateral and contralateral sides after pre-treatment with MK-8825. There was no effect of MK-8825 on the release of IL-6. These data suggest that CGRP may be involved in TMD pathophysiology, but not via inflammatory mechanisms, at least in the acute stage. Furthermore, CGRP receptor antagonists may have therapeutic efficacy in the treatment of TMD, as they do with migraine.

The Potential of Color Doppler Ultrasound Efficiency in Monitoring Diabetic Nonulcerated Neuroarthropathic (Charcot) Foot

A 30 year-old female having type 1 diabetes for 23 years, noticed progressively, for four months, inflammatory mild painful signs on her right foot. During the interview she recalled a post-traumatic fracture of her ipsilateral 5th toe. We documented an acute nonulcerated neuroarthropathic foot (Eichenholtz I, Brodski 1) but no occlusive arterial disease. The patient agreed offloading the foot only for three months (removable total contact cast). Before offloading, physical signs revealed midfoot are inflammatory swelling, ectatic veins and no plantar arches, still keeping after, a higher temperature without visible edema (Figure 1).

The use of bio-electrical impedance analysis (BIA) to guide fluid management, resuscitation and deresuscitation in critically ill patients: a bench-to-bedside review.

The impact of a positive fluid balance on morbidity and mortality has been well established. However, little is known about how to monitor fluid status and fluid overload. This narrative review summarises the recent literature and discusses the different parameters related to bio-electrical impedance analysis (BIA) and how they might be used to guide fluid management in critically ill patients. Definitions are listed for the different parameters that can be obtained with BIA; these include among others total body water (TBW), intracellular water (ICW), extracellular water (ECW), ECW/ICW ratio and volume excess (VE). BIA allows calculation of body composition and volumes by means of a current going through the body considered as a cylinder. Reproducible measurements can be obtained with tetrapolar electrodes with two current and two detection electrodes placed on hands and feet. Modern devices also apply multiple frequencies, further improving the accuracy and reproducibility of the results. Some pitfalls and conditions are discussed that need to be taken into account for correct BIA interpretation. Although BIA is a simple, noninvasive, rapid, portable, reproducible, and convenient method of measuring body composition and fluid distribution with fewer physical demands than other techniques, it is still unclear whether it is sufficiently accurate for clinical use in critically ill patients. However, the potential clinical applications are numerous. An overview regarding the use of BIA parameters in critically ill patients is given, based on the available literature. BIA seems a promising tool if performed correctly. It is non-invasive and relatively inexpensive and can be performed at bedside, and it does not expose to ionising radiation. Modern devices have very limited between-observer variations, but BIA parameters are population-specific and one must be aware of clinical situations that may interfere with the measurement such as visible oedema, nutritional status, or fluid and salt administration. BIA can help guide fluid management, resuscitation and de-resuscitation. The latter is especially important in patients not progressing spontaneously from the Ebb to the Flow phase of shock. More research is needed in critically ill patients before widespread use of BIA can be suggested in this patient population.

Improving The Prognostic Value Of FDG-PET For NSCLC Patients Treated With SABR Using Advanced Computational Modeling

suppression weighted (T2FS) sequences. The cohort had a median followup period of 33 months (range: 9-70) during which 19 patients developed lung metastases. Forty-one different textures (e.g., homogeneity, coarseness, large zone emphasis, etc.) were extracted from the tumor region (excluding surrounding edema) of the separate (FDG-PET, T1 and T2FS) and fused (FDG-PET/T1 and FDG-PET/T2FS) PET/MR scans. Fusion of the scans was implemented using the wavelet transform. The construction of prediction models from the combination of different textural features was then performed using logistic regression with feature set reduction, forward feature selection, and correction for small sample size effect. The performance of the resulting models for lung metastases prediction was evaluated using the area under the receiver operating characteristic curve (AUC) on bootstrap resampling in order to maximize their generalizability to out-of-sample STS population. Results: Overall, textures extracted from fused scans outperformed those from separate scans for the prediction of lung metastases by 10%. The best performance was found using a multivariable model with the following 3 texture parameters extracted from fused scans: small zone emphasis, zonesize variance and high gray-level zone emphasis. The average prediction performance of this model using 1000 bootstrapping testing sets yielded an AUC of 0.978 0.001, with a sensitivity and specificity of 0.909 0.006 and 0.899 0.004, respectively. Finally, the uncertainty of the texture model due to contouring variations was analyzed to be 15% using two different contours: one including the visible edema in the vicinity of the tumors, and one excluding it. Conclusions: Our results demonstrate that textural features extracted from fused FDG-PET/MR scans can be used to assess lung metastasis risk at diagnosis of STS. Accurate risk assessment could improve patient outcomes by allowing better treatment adaptation. For future work, we intend to generalize the methodology developed in this study to other cancer types and clinical endpoints. Author Disclosure: M. Vallieres: None. C.R. Freeman: None. S. Skamene: None. I. El Naqa: None.

Extracellular hydration, cardiovascular risk, and the interstitium: a three-dimensional view

Volume expansion is a major contributor to poor cardiovascular outcomes in kidney disease. The relationship of extracellular volume (ECV) overload to cardiovascular changes in chronic kidney disease (CKD) remains speculative. Recent studies are challenging traditional concepts and providing new insight into mechanisms and the relationship of ECV to cardiovascular health. A dynamic role of the extracellular interstitium in inducing cardiovascular risk is emerging in CKD.

Body composition of chronic renal patients: anthropometry and bioimpedance vector analysis

to compare the body composition of patients undergoing hemodialysis with that of healthy individuals using different methods. cross-sectional study assessing male individuals using anthropometric markers, electrical bioimpedance and vector analysis. the healthy individuals presented larger triceps skinfold and arm circumference (p<0.001). The bioimpedance variables also presented significant higher values in this group. Significant difference was found in the confidence interval of the vector analysis performed for both the patients and healthy individuals (p<0.0001). The tolerance intervals showed that 55.20% of the patients were dehydrated, 10.30% presented visible edema, and 34.50% were within normal levels of hydration. Bioimpedance and vector analysis revealed that 52% of the patients presented decreased cell mass while 14.00% presented increased cell mass. the differences in the body composition of patients and healthy individuals were revealed through bioimpedance and vector analysis but not through their measures of arm circumference and arm muscle area.

Conditional ablation of LYVE-1+ cells unveils defensive roles of lymphatic vessels in intestine and lymph nodes

AbstractTo unveil the organotypic role and vulnerability of lymphatic vessels, we generated a lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1)-Cre/iDTR double-transgenic mouse and ablated LYVE-1–expressing lymphatic vessels in adult mice in a diphtheria toxin (DT)–inducible manner based on selective expression of LYVE-1 in most lymphatic vessels. Strikingly, lymphatic vessels in the small intestine and lymph nodes were rapidly ablated, but lymphatic vessels in the other organs were relatively intact at 24 hours after DT administration. Unexpectedly, LYVE-1-Cre/iDTR mice died of sepsis without visible edema at 24 and 60 hours after DT administration. The cause of death appeared to be related to acute failure of immune surveillance systems in the small intestine and draining lymph nodes. Of note, acute loss of lymphatic lacteals in intestinal villi appeared to trigger distortion of blood capillaries and the whole architecture of the villi, whereas acute loss of lymphatic vessels in lymph nodes caused dysfunction of lymph drainage and abnormal distribution of dendritic cells and macrophages. Thus, intact lymphatic vessels are required for structural and functional maintenance of surrounding tissues in an organotypic manner, at least in the intestine and lymph nodes.

Effectiveness of a Sodium Restricted Diet on Reducing Weight Gain and Edema Formation in Adult Patients with Chronic Heart Failure: A Systematic Review Protocol

Review question/objective What is the effectiveness of a sodium restricted diet on reducing weight gain and edema formation in adult patients with chronic heart failure? Types of participants The review will consider studies that include all patients 18 years of age and older, females and males, all types and classes of heart failure, in patients that are not hospitalized but are receiving treatment for heart failure via pharmacologic interventions and non-pharmacologic interventions. Types of interventions The review will consider studies that evaluate the effectiveness of various sodium restricted diets, low sodium versus high sodium. The average low-sodium diet is defined as a daily intake of two grams of sodium. 17 Types of outcomes Types of outcomes that will be evaluated will be amount of weight gain in pounds/kilograms associated with various sodium restricted diets and the visible edema noted by physical examination based on patient self-report or clinician exam. Furthermore urinary sodium excretion data will be utilized when available to further quantify the efficacy of the low sodium diet, in terms of physiological utilization of sodium ingested.

An RCT on the effects of topical CGP on surgical wound appearance and residual scarring in bilateral total-knee arthroplasty patients

To test the hypothesis that topically applied calcium glycerophosphate (CGP) would improve the appearance of the wound following bilateral knee replacement. Healthy patients, aged 45-75 years, scheduled for bilateral total-knee replacement surgery were recruited into the study. One knee was randomly assigned to the treatment group, while the contralateral knee was designated the control (standard care). Subjects were instructed to apply a preparation of 10% CGP in an aqueous lotion to the treated knee once daily for 42 days, starting at the third postoperative day. Functional sealing and cosmetic appearance of the incision were evaluated by two surgeons by direct examination of the patient and then by two experienced assessors from photographs. The investigators qualitatively scored the intensity and extent of erythema along the incision and over the entire knee, the appearance of visible oedema along the incision and over the knee, and the overall clinical impression of wound healing. All four assessors were blinded to the subjects' allocation and the latter two assessors to the initial investigators' assessments. Subjects were also followed up for an additional 46 weeks, giving a total study duration of 12 months. Twenty patients completed the study. Statistical analysis showed that both the area and intensity of erythema along the incision were significantly reduced in the treated vs untreated knee over the entire study period. The analysis further showed that treatment significantly reduced oedema, both along the incision and across the entire knee. The differences were most marked at the seventh postoperative day and diminished with time. No adverse effects were observed for any patient, in either treated or untreated knees. These data demonstrate that postoperative application of 10% CGP could improve the appearance of the wound following total knee arthroplasty.

Inhibitory Effects of Neo Muscat Grape Vine Extracts on Melanin Biosynthesis

Neo Muscat grape vine extracts significantly inhibited melanin production in melanocyte stimulating hormone-stimulated B16 cells. They also exhibited tyrosinase inhibitory activity and reduced the levels of intra-cellular tyrosinase. Moreover, when the extracts were treated with UV B-induced hyper-pigmented brown guinea pig skin, depigmenting activity was observed, but with no visible edema. These results indicate that the vine extracts of Neo Muscat grapes might prove useful as a skin depigmenting agent.

Clinical Presentation and Patterns of Venous Reflux in Thai Patients with Chronic Venous Insufficiency (CVI)

Objective To study the extent of chronic venous insufficiency (CVI) in Thai patients by assessing venous clinical severity scores (VCSSs), venous disability scores (VDSs) and prevalence of lower limb venous reflux in a cohort of patients attending a vascular surgery clinic. Design Prospective comparative cohort study. Material All patients presenting with CVI (Clinical, Etiology, Anatomy and Pathophysiology (CEAP) C4–6) in our vascular surgery clinic between October 2006 and December 2008 were enrolled and compared with the same number of control patients. Method A standardised interview was conducted to document each patient’s history of venous disease, VCSS and VDS. Duplex ultrasonography of selected superficial and deep veins was performed. Results There were 41 patients, mean age 58 years and a mean body mass index (BMI) of 26.7. Of 58 limbs, 35%, 19% and 47% were of CEAP clinical stages C4, C5 and C6, respectively. Previous deep vein thrombosis (DVT) was reported by 7% and major leg trauma by 9% of patients. The mean VCSS was 9.7 and mean VDS was 1.0. VDS 2 or 3 were found in 10% of patients. The VCSS 2 and 3 for pain, oedema and inflammation were found in 22%, 26% and 0% of C6 legs. The prevalence of combined superficial and deep vein reflux was 71%. The prevalence of isolated superficial and deep vein reflux were 8% and 17%, respectively. One patient had iliac vein occlusion. Compared with the control group, risk factors that were found to be significant were physical findings of varicose veins, history of leg trauma, standing posture and BMI. Conclusions Thai patients with CVI were relatively young. Visible varicose veins, pain, oedema and inflammation were uncommon and most patients could maintain their usual activities despite advanced venous disease. An association with obesity was not common. Despite a low prevalence of a history of previous DVT, the prevalence of deep vein reflux was high and commonly combined with superficial venous reflux.

Systemic PPARγ Ligation Inhibits Allergic Immune Response in the Skin

We have shown previously that specific ligands of the peroxisome proliferator-activated receptor-gamma (PPARgamma) inhibit the systemic allergic immune response. The objective of this study was to investigate the impact of PPARgamma-ligand treatment on the local allergic immune response. We established a murine model exhibiting clinical and histological features of AD-like skin lesions with high reproducibility. In this model, the PPARgamma ligand was applied in an either preventive or therapeutic manner via systemic and local routes. The affected skin areas were assessed by standardized skin score, histological analyses, and immunohistochemical examinations. Our data show that systemic application of PPARgamma ligand by a preventive protocol led to significantly reduced onset of eczematous skin lesions. This was confirmed by histology, showing decreased skin thickness accompanied by significantly reduced infiltrations of CD4+ and CD8+ lymphocytes but also mast cells. Additionally, early allergen-specific IgE and IgG1 responses were reduced (day 21/35), whereas IgG2a levels remained unchanged. In conclusion, our results demonstrate that PPARgamma-ligand treatment inhibits not only systemic allergic immune response, but also local allergen-mediated dermatitis. Our findings point to therapeutic strategies, including a PPARgamma-ligand-based treatment.

Effects of Acute Global Venous Obstruction and Unfractionated Heparin on Muscle Cytokine Synthesis

Phlegmasia cerulea dolens is a devastating complication of massive deep venous thrombosis, which is clinically characterized by massive lower extremity tissue edema and subsequent arterial insufficiency. These experiments evaluated the local tissue effects of acute global venous obstruction combined with partial arterial ischemia. Experiments were performed to assess the effects of heparin on the cytokine response to simultaneous venous and partial arterial obstruction. Murine hind limbs were subjected to conditions of unilateral venous occlusion and partial tourniquet limb ischemia, which was confirmed by laser Doppler imaging (LDI). Mice underwent either hind limb venous obstruction with intravenous unfractionated heparin (200IU/kg) or intravenous saline 5min before venous occlusion. Sham-treated mice were subjected to anesthesia alone without venous occlusion. After 3hr, the mice were killed and tissue was harvested for measurement of edema (wet to dry weight ratio, W/D), muscle viability, indices of local thrombosis (thrombin-antithrombin complex [TAT]), and cytokine analysis for growth-related oncogene-1 (GRO-1) and interleukin-6 (IL-6, protein via enzyme-linked immunoassay and mRNA via reverse transcriptase polymerase chain reaction). Bleeding time and volume were documented in saline- and heparin-treated mice to confirm systemic anticoagulation. Administration of intravenous heparin resulted in a marked increase in bleeding time and volume. LDI confirmed venous obstruction and ongoing arterial inflow. Venous obstruction resulted in severe visible edema that correlated with a significantly higher W/D ratio but was not associated with a significant decrease in muscle viability. GRO-1 and IL-6 protein and mRNA levels were significantly elevated in the venous occlusion group compared to sham. Heparin therapy significantly decreased TAT3 levels but did not alter the profile of GRO-1 or IL-6 protein levels seen with venous occlusion. Venous occlusion with partial ischemia induces a unique and potent local cytokine expression. Heparin therapy did not ameliorate the cytokine response. These data indicate that heparin therapy does not modulate the cytokine response to venous obstruction.

Evolution of central corneal thickness in children with congenital glaucoma requiring glaucoma surgery

The purpose of the study was to investigate the evolution of central corneal thickness (CCT) in correlation to the intraocular pressure (IOP) in children with congenital glaucoma before and after glaucoma surgery. Nine eyes of five children (age 2 weeks to 6 months, mean 23 weeks) underwent trabeculotomy for congenital glaucoma. Corneal ultrasound pachymetry (PacScan 3000 AP, Technomed, Germany), tonometry using the Perkins tonometer, and slit-lamp examination (additionally to a clinical routine examination with retinoscopy, funduscopy, measurement of axial length and corneal diameter) were performed before and for at least 12 months after glaucoma surgery. In all children, corneal pachymetry and slit-lamp biomicroscopy--and whenever possible applanation tonometry--were performed without sedation or general anesthesia. If measurement of the IOP was not possible otherwise (in four of the five children), sedation with midazolam orally was used to measure the IOP at 2 weeks, 6 weeks, and 3 months after trabeculotomy, then every 3 months. Six of nine eyes had biomicroscopically clear corneas without visible corneal edema before trabeculotomy. In three eyes, a corneal edema was visible in at least one quadrant of the cornea. Regarding all eyes together, mean CCT was 651 +/- 138 microm before trabeculotomy; this decreased to 592 +/- 119 microm within 2 weeks after trabeculotomy. At 6 weeks and 3 months there was a further regression to 569.4 +/- 16 microm. Mean IOP was 18.6 +/- 7.5 mmHg before and decreased to 14.8 +/- 5.8 mmHg after glaucoma surgery. Regarding IOP data obtained under general anaesthesia, decrease of CCT was significantly correlated with decrease in IOP. There was no significant difference in the correlation between eyes with and without visible corneal edema. Corneal ultrasound pachymetry appears to be a valuable additional measure in the follow-up of infants and small children requiring glaucoma surgery.

Preparation method of an ideal model of multiple organ injury of rat with severe acute pancreatitis

To establish an ideal model of multiple organ injury of rats with severe acute pancreatitis (SAP). SAP models were induced by retrograde injection of 0.1 mL/100 g 3.5% sodium taurocholate into the biliopancreatic duct of Sprague-Dawley rats. The plasma and samples of multiple organ tissues of rats were collected at 3, 6 and 12 h after modeling. The ascites volume, ascites/body weight ratio, and contents of amylase, endotoxin, endothelin-1 (ET-1), nitrogen monoxidum (NO), phospholipase A(2) (PLA(2)), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) in plasma were determined. The histological changes of multiple organs were observed under light microscope. The ascites volume, ascites/body weight ratio, and contents of various inflammatory mediators in blood were higher in the model group than in the sham operation group at all time points [2.38 (1.10), 2.58 (0.70), 2.54 (0.71) vs 0.20 (0.04), 0.30 (0.30), 0.22 (0.10) at 3, 6 and 12 h in ascites/body weight ratio; 1582 (284), 1769 (362), 1618 (302) (U/L) vs 5303 (1373), 6276 (1029), 7538 (2934) (U/L) at 3, 6 and 12 h in Amylase; 0.016 (0.005), 0.016 (0.010), 0.014 (0.015) (EU/mL) vs 0.053 (0.029), 0.059 (0.037), 0.060 (0.022) (EU/mL) at 3, 6 and 12 h in Endotoxin; 3.900 (3.200), 4.000 (1.700), 5.300 (3.000) (ng/L) vs 41.438 (37.721), 92.151 (23.119), 65.016 (26.806) (ng/L) at 3, 6 and 12 h in TNF-alpha, all P < 0.01]. Visible congestion, edema and lamellar necrosis and massive leukocytic infiltration were found in the pancreas of rats of model group. There were also pathological changes of lung, liver, kidney, spleen, ileum, lymphonode, thymus, myocardium and brain. This rat model features reliability, convenience and a high achievement ratio. Complicated with multiple organ injury, it is an ideal animal model of SAP.