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Cell May 2020Swelling of the brain or spinal cord (CNS edema) affects millions of people every year. All potential pharmacological interventions have failed in clinical trials,...
Swelling of the brain or spinal cord (CNS edema) affects millions of people every year. All potential pharmacological interventions have failed in clinical trials, meaning that symptom management is the only treatment option. The water channel protein aquaporin-4 (AQP4) is expressed in astrocytes and mediates water flux across the blood-brain and blood-spinal cord barriers. Here we show that AQP4 cell-surface abundance increases in response to hypoxia-induced cell swelling in a calmodulin-dependent manner. Calmodulin directly binds the AQP4 carboxyl terminus, causing a specific conformational change and driving AQP4 cell-surface localization. Inhibition of calmodulin in a rat spinal cord injury model with the licensed drug trifluoperazine inhibited AQP4 localization to the blood-spinal cord barrier, ablated CNS edema, and led to accelerated functional recovery compared with untreated animals. We propose that targeting the mechanism of calmodulin-mediated cell-surface localization of AQP4 is a viable strategy for development of CNS edema therapies.
Topics: Animals; Aquaporin 4; Astrocytes; Brain; Brain Edema; Calmodulin; Central Nervous System; Edema; Male; Rats; Rats, Sprague-Dawley; Spinal Cord; Spinal Cord Injuries; Trifluoperazine
PubMed: 32413299
DOI: 10.1016/j.cell.2020.03.037 -
ESC Heart Failure Oct 2020The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema... (Review)
Review
The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema elimination in patients with chronic venous disease and lymphedema, but it is not routinely considered in subjects with CHF-related swelling. In the study, an overview of the current knowledge related to the benefits and risk of using MC in the supportive treatment of leg oedema in CHF patients is presented. The available studies dedicated the comprehensive management of leg swelling using MC in CHF patients published in the English language literature till December 2019 were evaluated in term of the treatment efficacy and safety. In studies performed on CHF populations, manual lymphatic drainage, MC stocking, multilayer bandaged, as well as intermittent pneumatic compression or electric calf stimulations were used. The current evidence is based on non-randomized studies, small study cohorts, as well as very heterogenous populations. The use of the intermittent pneumatic compression in CHF patients significantly increases the right auricular pressure and mean pulmonary artery pressures as well as decreases systemic vascular resistance in most patients without the clinical worsening. The transient and rapid increase in the human atrial natriuretic peptide, after an application of the MC stocking in New York Heart Association (NYHA) class II patients was observed without clinical exacerbation. An application of the multilayer bandages in NYHA classes III and IV patients lead a significant increase in the right arterial pressure and lead to transient deterioration of the right and the left ventricular functions. In the manual lymphatic drainage study, aside from expected leg circumference reduction, no clinical worsening was observed. In a pilot study performed in a small cohort of CHF patients, electrical calf stimulation use resulted in a reduction in the lean mass of the legs without cardiac function worsening. The use of local leg compression can be considered stable CHF patients without decompensated heart function for both CHF-related oedema treatment and for treatment of the concomitant diseases leading to leg swelling occurrence. The use of MC in more severe classes of CHF (NYHA III and IV) should be the subject of future clinical studies to select the safest and most efficient compression method as well as to select the patients who benefit most from this kind of treatment.
Topics: Edema; Heart Failure; Humans; Leg; Pilot Projects; Pressure
PubMed: 32710511
DOI: 10.1002/ehf2.12848 -
Lymphatic Research and Biology Apr 2019Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the...
Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the number of people with chronic edema (CO) in local health services. Data collection occurred through questionnaire-based interviews and clinical assessment with provided LIMPRINT tools. Four different types of services across three states in Australia participated. A total of 222 adults participated with an age range from 22 to 102 years, and 60% were female. Site 1 included three residential care facilities (54% of participants had swelling), site 2 was community-delivered aged care services (24% of participants had swelling), site 3 was a hospital setting (facility-based prevalence study; 28% of participants had swelling), and site 4 was a wound treatment center (specific patient population; 100% of participants had swelling). Of those with CO or secondary lymphedema, 93% were not related to cancer, the lower limbs were affected in 51% of cases, and 18% of participants with swelling reported one or more episodes of cellulitis in the previous year. Wounds were identified in 47% ( = 105) of all participants with more than half of those with wounds coming from the dedicated wound clinic. Leg/foot ulcer was the most common type of wound (65%, = 68). Distances between services, lack of specialized services, and various state funding models contribute to inequities in CO treatment. Understanding the high number of noncancer-related CO presentations will assist health services to provide timely effective care and improve referral pathways.
Topics: Adult; Aged; Aged, 80 and over; Australia; Cellulitis; Chronic Disease; Community Health Centers; Diagnosis, Differential; Edema; Female; Healthcare Disparities; Humans; Leg Ulcer; Lymphatic System; Lymphedema; Male; Middle Aged; Prevalence; Residential Facilities; Risk Factors; Surveys and Questionnaires; Wounds and Injuries
PubMed: 30995183
DOI: 10.1089/lrb.2018.0087 -
Cells Jun 2023Edema formation following traumatic spinal cord injury (SCI) exacerbates secondary injury, and the severity of edema correlates with worse neurological outcome in human... (Review)
Review
Edema formation following traumatic spinal cord injury (SCI) exacerbates secondary injury, and the severity of edema correlates with worse neurological outcome in human patients. To date, there are no effective treatments to directly resolve edema within the spinal cord. The aquaporin-4 (AQP4) water channel is found on plasma membranes of astrocytic endfeet in direct contact with blood vessels, the glia limitans in contact with the cerebrospinal fluid, and ependyma around the central canal. Local expression at these tissue-fluid interfaces allows AQP4 channels to play an important role in the bidirectional regulation of water homeostasis under normal conditions and following trauma. In this review, we consider the available evidence regarding the potential role of AQP4 in edema after SCI. Although more work remains to be carried out, the overall evidence indicates a critical role for AQP4 channels in edema formation and resolution following SCI and the therapeutic potential of AQP4 modulation in edema resolution and functional recovery. Further work to elucidate the expression and subcellular localization of AQP4 during specific phases after SCI will inform the therapeutic modulation of AQP4 for the optimization of histological and neurological outcomes.
Topics: Humans; Spinal Cord Injuries; Aquaporin 4; Neuroglia; Edema
PubMed: 37443735
DOI: 10.3390/cells12131701 -
Circulation. Cardiovascular Imaging Mar 2020Background Cardiovascular magnetic resonance can demonstrate myocardial processes in Fabry disease (FD), such as low native T1 (sphingolipid storage) and late gadolinium...
Background Cardiovascular magnetic resonance can demonstrate myocardial processes in Fabry disease (FD), such as low native T1 (sphingolipid storage) and late gadolinium enhancement (LGE, scar). Recently, high T2 (edema) has been observed in the basal inferolateral wall along with troponin elevation. We hypothesized that edema and myocyte injury would be chronically associated and have electrical, mechanical, and disease associations in FD. Methods A prospective international multicenter study was conducted on 186 consecutive FD patients (45.2±1.1 years, 58% females). Additionally, 28 patients with hypertrophic cardiomyopathy, 30 with chronic myocardial infarction and 59 healthy volunteers were included. All study participants underwent comprehensive cardiovascular magnetic resonance with T1 and T2 mapping, cines, and LGE imaging. Results LGE in the basal inferolateral wall in FD had T2 elevation (FD 58.2±5.0 ms versus hypertrophic cardiomyopathy 55.6±4.3 ms, chronic myocardial infarction 53.7±3.4 ms and healthy volunteers 48.9±2.5 ms, <0.001), but when LGE was present there was also global T2 elevation (53.1±2.9 versus 50.6±2.2 ms, <0.001). Thirty-eight percent of FD patients had high troponin. The strongest predictor of increased troponin was high basal inferolateral wall T2 (odds ratio, 18.2 [95% CI, 3.7-90.9], <0.0001). Both T2 and troponin elevations were chronic over 1 year. High basal inferolateral wall T2 was associated with baseline global longitudinal strain impairment (=0.005) and electrocardiographic abnormalities (long PR, complete bundle branch block, left ventricular hypertrophy voltage criteria, long QTc, and T-wave inversion, all <0.05) and predicted clinical worsening after 1 year (Fabry stabilization index >20%, =0.034). Conclusions LGE in Fabry has chronic local T2 elevation that is strongly associated with chronic troponin elevation. In addition, there is slight global T2 elevation. Both are associated with ECG and mechanical changes and clinical worsening over 1 year.
Topics: Adult; Edema; Fabry Disease; Female; Follow-Up Studies; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Myocardium; Prospective Studies; Severity of Illness Index; Ventricular Function, Left; Ventricular Remodeling
PubMed: 32114828
DOI: 10.1161/CIRCIMAGING.119.010171 -
Acta Medica Portuguesa Apr 2022A 61-year old male was referred to the Ophthalmology department because of decreased bilateral visual acuity. The patient had metastatic pancreatic adenocarcinoma and...
A 61-year old male was referred to the Ophthalmology department because of decreased bilateral visual acuity. The patient had metastatic pancreatic adenocarcinoma and was being treated with gemcitabine+nab-paclitaxel. On examination, the patient presented best corrected visual acuities of 4/20 and 2/20 in the right and left eye, respectively. The optical coherence tomography revealed bilateral severe macular edema. Macular edema was considered secondary to nab-paclitaxel and the drug was discontinued. Three months after drug discontinuation, the patient presented best corrected visual acuities of 20/20 and 16/20 in the right and left eye, respectively, and normal fundoscopy. Macular edema is a very rare side effect of taxanes, and the etiopathology is still unknown. Edema is usually reversible upon discontinuation of the offending agent. Clinicians should be aware of this adverse effect of taxanes, and a high index of clinical suspicion is essential for diagnosis.
Topics: Adenocarcinoma; Albumins; Antineoplastic Agents, Phytogenic; Edema; Humans; Male; Middle Aged; Paclitaxel; Pancreatic Neoplasms
PubMed: 34287143
DOI: 10.20344/amp.13421 -
La Clinica Terapeutica May 2021The definition of neuromuscular taping (NMT) has yet to be clearly analysed as a possible treatment for diabetic foot. Case studies, theoretical analysis and results of... (Review)
Review
OBJECTIVE
The definition of neuromuscular taping (NMT) has yet to be clearly analysed as a possible treatment for diabetic foot. Case studies, theoretical analysis and results of existing research may lead to varying perceptions on the definition of NMT and its possible effects on diabetic foot. This article aims to analyse the definition of the NMT concept and furthermore as a basis for future research development on diabetic foot.
METHODS
The procedure for reference source search include the principal data bases using "neuromuscular taping" and "diabetic foot" keywords for the period of 2010-2019. The concept analysis uses an 8-step approach with the Walker and Avant's method.
CONCLUSIONS
NMT is a decompression application of an elastic tape on the skin on the diabetic foot that has the effect of reducing the inflammatory response, improving vascularity and neuromusculoskel-etal function. It aims to improve neuromusculoskeletal and lymphatic system functioning due to the presence of wrinkles, indicating dila-tion, with local effects on the sensorimotor and proprioceptive senses in conditions of care, rehabilitation and injury.
RESULTS
Analysis of the NMT concept on diabetic foot obtained attributes of elastic tape, skin, pain, edema, injury, sensorimotor, circulation, drainage, relaxation, local, proprioceptive, motion func-tion, strength, contraction, stabilisation, reflex, rehabilitation, care, musculoskeletal, nerve, muscles, tendons, fascia, joints, lymphatic, longitudinal, wrinkles. There were four groups of attributes, namely inflammatory response, vascularity, neuromusculoskeletal function and musculoskeletal system. NMT application benefits for diabetic foot can be attributed to improving walking function, leg position, decreasing pain response, improving body function index, improving leg muscle strength and motor function, increasing range of movement (ROM), maintaining stability of leg joint function, preventing injury, increas-ing strength and improving position of ankle joints, reducing stiffness, reducing edema and helping wound healing processes.
Topics: Athletic Tape; Diabetes Mellitus; Diabetic Foot; Edema; Humans; Muscle, Skeletal; Walking
PubMed: 33956043
DOI: 10.7417/CT.2021.2320 -
Ear, Nose, & Throat Journal Feb 2021Open rhinoplasty has been performed for over 50 years. Rhinoplasty procedures have a risk of complications and it is important to follow each step diligently in order to...
BACKGROUND
Open rhinoplasty has been performed for over 50 years. Rhinoplasty procedures have a risk of complications and it is important to follow each step diligently in order to avoid complications. Periorbital edema is the most common complication of septorhinoplasty. As far as we are aware, there are no studies in the available literature examining the impact of the septorhinoplasty on intraocular pressure and the retina.
OBJECTIVES
The aim of this study was to evaluate the effects of septorhinoplasty-related periorbital edema on intraocular pressure and the retina by means of objective tests.
METHODS
Ten patients with phase 4 periorbital edema (5 males and 5 females) who underwent open rhinoplasty with bilateral lateral osteotomies were enrolled in the study. All the patients were examined by an eye specialist for visual acuity, intraocular pressure, retinal nerve fiber layer, and ganglion cell complex pathologies with optical coherence tomography preoperatively and postoperatively on the seventh day.
RESULTS
Preoperative and postoperative best-corrected visual acuity; intraocular pressure; average, superior, and inferior retinal nerve fiber layer thickness; and total, superior, and inferior ganglion cell complex thickness in both eyes for all patients were within normal limits. There was no statistical difference between preoperative and postoperative values ( > .05).
CONCLUSION
We concluded that periorbital edema after septorhinoplasty causes no significant complications affecting intraocular pressure and visual acuity. We believe that when osteotomies and local anesthetic injections are undertaken correctly, periorbital complications do not affect vision.
Topics: Adult; Edema; Female; Humans; Intraocular Pressure; Male; Nasal Septum; Orbital Diseases; Osteotomy; Postoperative Complications; Retina; Rhinoplasty; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity
PubMed: 31547702
DOI: 10.1177/0145561319875734 -
Journal of Neurosurgery Dec 2018OBJECTIVETumor and edema volume changes of brain metastases after stereotactic radiosurgery (SRS) and ipilimumab are not well described, and there is concern regarding...
OBJECTIVETumor and edema volume changes of brain metastases after stereotactic radiosurgery (SRS) and ipilimumab are not well described, and there is concern regarding the safety of combination treatment. The authors evaluated tumor, edema, and adverse radiation-induced changes after SRS with and without ipilimumab and identified associated risk factors.METHODSThis single-institution retrospective study included 72 patients with melanoma brain metastases treated consecutively with upfront SRS from 2006 to 2015. Concurrent ipilimumab was defined as ipilimumab treatment within 4 weeks of SRS. At baseline and during each follow-up, tumor and edema were measured in 3 orthogonal planes. The (length × width × height/2) formula was used to estimate tumor and edema volumes and was validated in the present study for estimation of edema volume. Tumor and edema volume changes from baseline were compared using the Kruskal-Wallis test. Local failure, lesion hemorrhage, and treatment-related imaging changes (TRICs) were analyzed with the Cox proportional hazards model.RESULTSOf 310 analyzed lesions, 91 were not treated with ipilimumab, 59 were treated with concurrent ipilimumab, and 160 were treated with nonconcurrent ipilimumab. Of 106 randomly selected lesions with measurable peritumoral edema, the mean edema volume by manual contouring was 7.45 cm3 and the mean volume by (length × width × height)/2 formula estimation was 7.79 cm3 with R2 = 0.99 and slope of 1.08 on line of best fit. At 6 months after SRS, the ipilimumab groups had greater tumor (p = 0.001) and edema (p = 0.005) volume reduction than the control group. The concurrent ipilimumab group had the highest rate of lesion response and lowest rate of lesion progression (p = 0.002). Within the concurrent ipilimumab group, SRS dose ≥ 20 Gy was associated with significantly greater median tumor volume reduction at 3 months (p = 0.01) and 6 months (p = 0.02). The concurrent ipilimumab group also had the highest rate of lesion hemorrhage (p = 0.01). Any ipilimumab was associated with higher incidence of symptomatic TRICs (p = 0.005). The overall incidence of pathologically confirmed radiation necrosis (RN) was 2%. In multivariate analysis, tumor and edema response at 3 months were the strongest predictors of local failure (HR 0.131 and HR 0.125) and lesion hemorrhage (HR 0.225 and HR 0.262). Tumor and edema response at 1.5 months were the strongest predictors of TRICs (HR 0.144 and HR 0.297).CONCLUSIONSThe addition of ipilimumab improved tumor and edema volume reduction but was associated with a higher incidence of lesion hemorrhage and symptomatic TRICs. There may be a radiation dose-response relationship between SRS and ipilimumab when administered concurrently. Early tumor and edema response were excellent predictors of subsequent local failure, lesion hemorrhage, and TRICs. The incidence of pathologically proven RN was low, supporting the relative safety of ipilimumab in radiosurgery treatment.
Topics: Aged; Antineoplastic Agents, Immunological; Brain Neoplasms; Combined Modality Therapy; Disease Progression; Edema; Female; Humans; Ipilimumab; Male; Melanoma; Middle Aged; Radiosurgery; Retrospective Studies; Treatment Outcome; Tumor Burden
PubMed: 29303446
DOI: 10.3171/2017.7.JNS171286 -
Arthritis Research & Therapy Sep 2012Magnetic resonance imaging bone marrow edema is an imaging feature that has been described in many conditions, including osteomyelitis, overuse syndromes, avascular... (Review)
Review
Magnetic resonance imaging bone marrow edema is an imaging feature that has been described in many conditions, including osteomyelitis, overuse syndromes, avascular necrosis, trauma, and inflammatory arthritides. In rheumatoid arthritis (RA), bone edema has special significance as it has been shown to be a common and widespread lesion that is often apparent at the hands and wrists but has also been described elsewhere, including the feet. It may occur in early or late disease and has been shown in several large cohort studies to have major negative implications for prognosis. It is the strongest predictor of erosive progression yet to be identified and characteristically occurs in those patients with the most aggressive and potentially disabling disease. In patients with undifferentiated arthritis, bone edema also predicts progression to criteria-positive RA, both independently and to a greater extent when combined with anti-cyclic citrullinated peptide status or rheumatoid factor positivity. Its histological correlate in the late stages of RA has been shown to be osteitis, in which the bone marrow beneath the joint is invaded by an inflammatory and vascular lymphoplasmacytic infiltrate. This lies adjacent to trabecular bone, where increased numbers of osteoclasts have been observed within resorption lacunae, suggesting a mechanistic link between inflammation and erosive bone damage. This could lead to erosion both of the overlying cortex, leading to classic radiographic rheumatoid erosions, and of local trabecular bone, possibly contributing to periarticular osteopenia and cyst formation. In addition to synovitis, osteitis is now regarded as a major rheumatoid lesion that is responsive to therapeutic intervention.
Topics: Arthritis, Rheumatoid; Bone Marrow Diseases; Diagnostic Imaging; Disease Progression; Edema; Humans; Magnetic Resonance Imaging; Osteitis; Radiography; Ultrasonography
PubMed: 23043770
DOI: 10.1186/ar4035