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JHEP Reports : Innovation in Hepatology Oct 2021Hepatic encephalopathy (HE) is a neurological complication of hepatic dysfunction and portosystemic shunting. It is highly prevalent in patients with cirrhosis and is... (Review)
Review
Hepatic encephalopathy (HE) is a neurological complication of hepatic dysfunction and portosystemic shunting. It is highly prevalent in patients with cirrhosis and is associated with poor outcomes. New insights into the role of peripheral origins in HE have led to the development of innovative treatment strategies like faecal microbiota transplantation. However, this broadening of view has not been applied fully to perturbations in the central nervous system. The old paradigm that HE is the clinical manifestation of ammonia-induced astrocyte dysfunction and its secondary neuronal consequences requires updating. In this review, we will use the holistic concept of the neurogliovascular unit to describe central nervous system disturbances in HE, an approach that has proven instrumental in other neurological disorders. We will describe HE as a global dysfunction of the neurogliovascular unit, where blood flow and nutrient supply to the brain, as well as the function of the blood-brain barrier, are impaired. This leads to an accumulation of neurotoxic substances, chief among them ammonia and inflammatory mediators, causing dysfunction of astrocytes and microglia. Finally, glymphatic dysfunction impairs the clearance of these neurotoxins, further aggravating their effect on the brain. Taking a broader view of central nervous system alterations in liver disease could serve as the basis for further research into the specific brain pathophysiology of HE, as well as the development of therapeutic strategies specifically aimed at counteracting the often irreversible central nervous system damage seen in these patients.
PubMed: 34611619
DOI: 10.1016/j.jhepr.2021.100352 -
Clinical Research in Cardiology :... Apr 2020Diuretic resistance is a common issue in patients with acute decompensation of advanced chronic heart failure (ACHF). The aim of this trial was to compare boluses and... (Comparative Study)
Comparative Study Randomized Controlled Trial
Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure-bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial.
BACKGROUND
Diuretic resistance is a common issue in patients with acute decompensation of advanced chronic heart failure (ACHF). The aim of this trial was to compare boluses and continuous infusion of furosemide in a selected population of patients with ACHF and high risk for diuretic resistance.
METHODS
In this single-centre, double-blind, double-dummy, randomized trial, we enrolled 80 patients admitted for acute decompensation of ACHF (NYHA IV, EF ≤ 30%) with criteria of high risk for diuretic resistance (SBP ≤ 110 mmHg, wet score ≥ 12/18, and sodium ≤ 135 mMol/L). Patients were assigned in a 1:1 ratio to receive furosemide by bolus every 12 h or by continuous infusion. Diuretic treatment and dummy treatment were prepared by a nurse unassigned to patients' care. The study treatment was continued for up to 72 h. Coprimary endpoints were total urinary output and freedom from congestion at 72 h.
RESULTS
80 patients were enrolled with 40 patients in each treatment arm. Mean daily furosemide was 216 mg in continuous-infusion arm and 195 mg in the bolus intermittent arm. Freedom from congestion (defined as jugular venous pressure of < 8 cm, with no orthopnea and with trace peripheral edema or no edema) occurred more in the continuous infusion than in the bolus arm (48% vs. 25%, p = 0.04), while total urinary output after 72 h was 8612 ± 2984 ml in the bolus arm and 10,020 ± 3032 ml in the continuous arm (p = 0.04). Treatment failure occurred less in the continuous-infusion group (15% vs. 38%, p = 0.02), while there was no significant difference between groups in the incidence of worsening of renal function.
CONCLUSION
Among patients with acute decompensation of ACHF and high risk of diuretic resistance, continuous infusion of intravenous furosemide was associated with better decongestion.
DRAIN TRIAL
ClinicalTrials.gov number NCT03592836.
Topics: Aged; Central Venous Pressure; Chronic Disease; Double-Blind Method; Drug Administration Schedule; Drug Resistance; Edema; Female; Furosemide; Heart Failure; Humans; Infusions, Intravenous; Injections, Intravenous; Italy; Male; Middle Aged; Sodium Potassium Chloride Symporter Inhibitors; Time Factors; Treatment Outcome
PubMed: 31256261
DOI: 10.1007/s00392-019-01521-y -
Journal Der Deutschen Dermatologischen... Sep 2023Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to...
Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.
Topics: Humans; Dermatology; Treatment Outcome; Veins; Edema; Lymphatic Diseases; Varicose Ulcer; Compression Bandages; Stockings, Compression
PubMed: 37565365
DOI: 10.1111/ddg.15161 -
Journal of Veterinary Internal Medicine 2023The prevalence and clinical characteristics of different etiologies of peripheral edema in dogs are unknown.
BACKGROUND
The prevalence and clinical characteristics of different etiologies of peripheral edema in dogs are unknown.
HYPOTHESIS/OBJECTIVES
To determine the prevalence of different etiologies of peripheral edema, describe clinical characteristics that vary among etiologies, and report survival times.
ANIMALS
Five hundred twenty-seven dogs with peripheral edema.
METHODS
Retrospective medical record review. Differences in clinical variables among etiology groups were assessed by Kruskal-Wallis testing with post hoc pairwise Dunn's testing and Chi-square testing with Monte Carlo simulation.
RESULTS
The most common etiologies of peripheral edema in dogs were vasculitis (n = 193, 37%), lymphatic/venous obstruction (LVO; 114, 22%), and hypoalbuminemia (94, 18%). Right-sided congestive heart failure (R-CHF) was uncommon (25, 5%). Edema was localized in 377 (72%) dogs and generalized in 142 (27%) dogs, and hypoalbuminemia was more likely to cause generalized edema compared to LVO or vasculitis (P < .0001). Concurrent abdominal effusion (155, 29%) was more common than pleural (77, 15%) or pericardial (12, 2%) effusion. Abdominal and pleural effusion occurred more commonly in dogs with hypoalbuminemia or R-CHF compared to LVO or vasculitis (P < .0001).
CONCLUSIONS AND CLINICAL IMPORTANCE
Distribution of edema, concurrent cavitary effusions, and clinicopathological data can help predict the underlying etiology of peripheral edema in dogs.
Topics: Dogs; Animals; Hypoalbuminemia; Retrospective Studies; Edema; Pleural Effusion; Heart Failure; Vasculitis; Dog Diseases
PubMed: 37452610
DOI: 10.1111/jvim.16815 -
International Journal of Retina and... 2019Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy. It can result in significant visual loss from complications... (Review)
Review
BACKGROUND
Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy. It can result in significant visual loss from complications like macula edema, retinal and iris neovascularization, and vitreous hemorrhage. Recently, ultra-widefield imaging (UWF) has been developed for posterior pole visualization and has shown to be useful in the evaluation and treatment of RVO.
MAIN TEXT
Ultra-widefield imaging (UWF) imaging allows for visualization of the retina up to an angle of 200°. This is especially important in detecting peripheral retinal pathologies, especially in retinal conditions such as RVO, where the disease process affects the peripheral as well as central retina. In particular, retinal non-perfusion in RVO is a risk factor for neovascularization. Various techniques, such as ischemic index and stereographic projection, have been described to assess areas of ischemia on UWF images. Retinal non-perfusion has an impact on disease complications, such as macular edema, and retinal and iris neovascularization. Retinal non-perfusion also has implications on disease response, including visual acuity, reduction in retinal edema and treatment burden.
CONCLUSION
Ultra-widefield imaging (UWF) imaging plays an important role in the assessment and management of RVO, especially in measuring retinal non-perfusion in the peripheries.
PubMed: 31890282
DOI: 10.1186/s40942-019-0163-1 -
PloS One 2021Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its...
Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its association with demographics, comorbidities, activity, or mobility. This study used data from the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults (age 51+/ N = 19,988 for 2016), to evaluate time trends and correlates of peripheral edema using weighted descriptive statistics and logistic regressions, respectively. Peripheral edema was assessed with the question "Have you had… // Persistent swelling in your feet or ankles?" The weighted prevalence of edema among older U.S. adults was 19% to 20% between 2000 and 2016. Peripheral edema was associated with older age, female sex, non-white race, low wealth, obesity, diabetes, hypertension, pain, low activity levels, and mobility limitations (odds ratios ranging from 1.2-5.6; p-values ≤0.001). This study provides the first estimates of national prevalence and correlates of peripheral edema among older Americans. Peripheral edema is common and strongly associated with comorbidities, pain, low activity levels, and mobility limitations, and disproportionately affects poorer and minority groups. Peripheral edema should be a focus of future research in order to develop novel and cost-effective interventions.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Edema; Ethnicity; Female; Follow-Up Studies; Humans; Longitudinal Studies; Lower Extremity; Male; Middle Aged; Mobility Limitation; Prognosis; Surveys and Questionnaires; United States
PubMed: 34914717
DOI: 10.1371/journal.pone.0260742 -
Investigative Radiology Jan 2023Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an... (Review)
Review
Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the diagnosis and characterization of disease processes. Emerging CBCT technologies improved spatial resolution for osseous microstructures in the quantitative analysis of osteoarthritis-related subchondral bone changes, trauma, and fracture healing. Dual-energy CT-based material decomposition visualizes and quantifies monosodium urate crystals in gout, bone marrow edema in traumatic and nontraumatic fractures, and neoplastic disease. Recently, DE techniques have been applied to CBCT, contributing to increased image quality in contrast-enhanced arthrography, bone densitometry, and bone marrow imaging. This review describes 4-dimensional CT, CBCT, and DECT advances, current logistical limitations, and prospects for each technique.
Topics: Humans; Tomography, X-Ray Computed; Bone Marrow Diseases; Cone-Beam Computed Tomography; Magnetic Resonance Imaging; Edema; Gout
PubMed: 35976763
DOI: 10.1097/RLI.0000000000000908 -
Radiographics : a Review Publication of... 2021Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The... (Review)
Review
Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. RSNA, 2021.
Topics: Adnexal Diseases; Female; Humans; Magnetic Resonance Imaging; Ovarian Cysts; Ovarian Torsion; Torsion Abnormality
PubMed: 33577417
DOI: 10.1148/rg.2021200118 -
Indian Journal of Ophthalmology Jun 2023To determine the correlation between serum inflammatory and metabolic biomarkers of patients with diabetic retinopathy (DR) and diabetic macular edema (DME).
PURPOSE
To determine the correlation between serum inflammatory and metabolic biomarkers of patients with diabetic retinopathy (DR) and diabetic macular edema (DME).
METHODS
Serum samples were obtained from 100 diabetic patients. Patients were divided into three groups: group 1 (patients with no DR, n = 27), group 2 (DR with DME, n = 34), and group 3 (DR without DME, n = 39). Serum concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured by quantitative turbidimetric immunoassay and sandwich chemiluminescence immunoassay, respectively. Metabolic parameters such as glycated hemoglobin (HbA1c), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), serum creatinine, and blood urea were determined by automated analyzer om-360 after standardization.
RESULTS
The levels of IL-6 and CRP differed significantly in patients with DR and without DR (P < 0.001 and P = 0.045, respectively). We also found a positive correlation between IL-6 and CRP with the severity of DR. When DR patients with DME were compared to patients without DME, only IL-6 was observed to be significantly elevated (P < 0.001). None of the metabolic markers correlated significantly with DR and DME.
CONCLUSION
Significantly raised levels of serum inflammatory biomarkers can be used to elucidate the significant role of inflammation in the pathogenesis of DR. Therefore, circulating biomarkers can serve as diagnostic and therapeutic predictors for monitoring the onset and progression of DR and DME.
Topics: Humans; Macular Edema; Diabetic Retinopathy; Interleukin-6; Glycated Hemoglobin; C-Reactive Protein; Biomarkers; Diabetes Mellitus, Type 2
PubMed: 37322673
DOI: 10.4103/IJO.IJO_345_23 -
International Journal of Molecular... Jan 2021Increased vascular permeability is a hallmark of several cardiovascular anomalies, including ischaemia/reperfusion injury and inflammation. During both... (Review)
Review
Increased vascular permeability is a hallmark of several cardiovascular anomalies, including ischaemia/reperfusion injury and inflammation. During both ischaemia/reperfusion and inflammation, massive amounts of various nucleotides, particularly adenosine 5'-triphosphate (ATP) and adenosine, are released that can induce a plethora of signalling pathways via activation of several purinergic receptors and may affect endothelial barrier properties. The nature of the effects on endothelial barrier function may depend on the prevalence and type of purinergic receptors activated in a particular tissue. In this review, we discuss the influence of the activation of various purinergic receptors and downstream signalling pathways on vascular permeability during pathological conditions.
Topics: Adenosine; Animals; Biomarkers; Blood-Air Barrier; Blood-Brain Barrier; Capillary Permeability; Endothelium; Humans; Purines; Receptors, Purinergic; Receptors, Purinergic P2; Signal Transduction
PubMed: 33530557
DOI: 10.3390/ijms22031207