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Background: The numbers of minimally invasive cosmetic procedures performed in the United States have steadily increased each year. Concurrently, the rates of filler complications have also increased. Delayed filler reactions and granulomas have recently been attributed to biofilm infections., Objective: The biology and pathogenesis of biofilms, and their diagnosis, treatment, and prevention will be discussed., Methods: The relevant and recent literature on delayed filler reactions and biofilms was reviewed., Results: Increasing evidence implicates biofilm infections in the pathogenesis of delayed filler reactions. Therapeutic and preventative measures can be taken to minimize the occurrence of these potentially devastating consequences of dermal fillers., Conclusion: Awareness of biofilm infections is key in the assessment of filler reactions in order to ensure timely and accurate diagnosis and treatment.

Context 3,4-Oxo-isopropylidene-shikimic acid (ISA) is an analog of shikimic acid (SA). SA is extracted from the dry fruit of Illicium verum Hook. f. (Magnoliaceae), which has been used for treating stomachaches, skin inflammation and rheumatic pain. Objective To investigate the anti-inflammatory, analgesic and antioxidant activities of ISA. Materials and methods Analgesic and anti-inflammatory activities of ISA were evaluated using writhing, hot plate, xylene-induced ear oedema, carrageenan-induced paw oedema and cotton pellets-induced granuloma test, meanwhile the prostaglandin E2 (PGE2) and malondialdehyde (MDA) levels were assessed in the oedema paw tissue. ISA (60, 120 and 240 mg/kg in mice model and 50, 120 and 200 mg/kg in rat model) was administered orally, 30 min before induction of inflammation/pain. Additionally, ISA was administered for 12 d in rats from the day of cotton pellet implantation. The active oxygen species scavenging potencies of ISA (10(-3)-10(-5) M) were evaluated by the electron spin resonance spin-trapping technique. Results ISA caused a reduction of inflammation induced by xylene (18.1-31.4%), carrageenan (7.8-51.0%) and cotton pellets (11.4-24.0%). Furthermore, ISA decreased the production of PGE2 and MDA in the rat paw tissue by 1.0-15.6% and 6.3-27.6%, respectively. ISA also reduced pain induced by acetic acid (15.6-48.9%) and hot plate (10.5-28.5%). Finally, ISA exhibited moderate antioxidant activity by scavenging the superoxide radical and hydroxyl radical with IC50 values of 0.214 and 0.450 μg/mL, respectively. Discussion and conclusion Our findings confirmed the anti-inflammatory, analgesic and antioxidant activities of ISA.

This column highlights some of the potential complications that have been associated with cosmetic procedures. Tips for how dermatology residents may prevent, identify, and manage complications from cosmetic procedures for optimal patient outcomes is provided. In part 1 of this series, soft-tissue augmentation and botulinum toxin injections are discussed. Part 2 will focus on chemical peels and laser therapy.

Background: Since dermal fillers were introduced in 1981, millions of patients have undergone wrinkle treatment with dermal fillers. Except for autologous fat, all fillers can act as potential foreign bodies, which have the potential ability to induce an immune reaction. Persisting material may induce activation of the immune system and finally granuloma formation. Frequency, histology, and clinical presentation of such foreign body reactions may vary depending on the filler used., Case Report: This case describes a patient who received innumerable filler injections over the last two decades presenting with massive facial granulomas.

Background: Reducing granulomatous reaction for stent implantation is important for the treatment of tracheobronchomalacia because formation of granuloma leads to refractory complication causing further respiratory distress. The purpose of this study was to clarify granulomatous reaction of newly innovated coated stents compared to non-coated metal stents., Methods: Materials and animal experiments were performed using the newly invented metallic stent (laser-cut stainless steel with a coating of polyurethane). In the materials experiment, the correlation between the holding force and deformity was tested by a compressor. In the animal examination, coated stents were orally implanted into the trachea in five rabbits, while non-coated stents were implanted in another five rabbits. After 3 weeks' observation, the inner diameter was measured by 3-D computed tomography, and the number of granulation tissues was counted by bronchofiberscope. Histological investigation followed in both groups., Results: In the materials experiment, new stents demonstrated a holding force similar to stainless steel stents. In the animal experiment, no difference was found in the inner diameter of the coated and non-coated stent groups (5.70 ± 0.17 vs 5.60 ± 0.27, P = 0.07). However, the number of granulation tissues was higher in non-coated stents than in coated stents (1.60 ± 0.55 vs 0.40 ± 0.55, P < 0.01). Histological investigation showed direct attachment of metal to the tracheal wall around the non-coated stents where epithelial structure was destroyed, while tracheal epithelia were preserved in the group of coated stents., Conclusions: The new polyurethane-coated metallic stent maintains enough holding force, and reduces histobiological reaction to foreign bodies in this experiment., (© 2014 Japan Pediatric Society.)

Background: The silicone granuloma was first described in the literature in 1964. During the course of clinical practice, the plastic surgeon will encounter a silicone granuloma in a breast augmentation or reconstruction patient. This review addresses the clinical significance associated with silicone granulomas. Clinical implications and indications for intervention are discussed, and a reasonable management algorithm is proposed., Methods: A review of the literature relating to silicone granulomas and their clinical implications was performed., Results: Although case series have been reported, there is no consensus regarding the treatment of silicone granulomas., Conclusions: This important clinical entity warrants investigative attention to better understand its clinical implications and prevention. An algorithm for treatment is proposed.

Echinacea purpurea L. is a medicinal plant originally from North America. It has become a commonly used herbal medicine worldwide because it contains various biologically active compounds. This study was designed to investigate the anti-inflammatory effects of essential oils from E. purpurea in both mice and rats. The extract was obtained from flower of E. purpurea by steam distillation. The anti-inflammatory potential was evaluated in vivo by using different animal models such as xylene-induced mouse ear edema, egg-white-induced rat paw edema, and cotton-induced granuloma tissue proliferating inflammation in mice. The serial dosages were used in vivo: the low dosage, the medium dosage and the high dosage. The low, medium and high dosages of extracts produced inhibitions of 39.24%, 47.22% and 44.79% respectively in the ear edema induced by xylene when compare with the control group. Only the high dosage group showed statistically significant inhibition (48.51%) of paw edema formation induced three hours by egg white compared with the control group (P<0.01). Moreover, the granulation formation was also significantly reduced the most by 28.52% in the high dose groups compared with the control group (P <0.05). The pro-inflammatory cytokines such as IL-2, IL-6 and TNF-α in the blood were reduced in the treated groups. The essential oils from extracts of E. purpurea have anti-inflammatory effects.

Context: Byrsonima crassifolia is a tropical tree, commonly known as nance and distributed widely in Mexico and Central and South America. Since pre- Hispanic times, the seeds of the fruits have been used in folklore medicine as an anti-inflammatory; however, currently no researchers have examined its potential pharmacological properties in scientific studies., Objective: This study investigated the anti-inflammatory activity of extracts obtained with the solvents n-hexane, chloroform, and methanol from seeds of B crassifolia., Design: The research team induced edemas in Wistar rats with 12-O-tetradecanoylphorbol (TPA), formaldehyde, carrageenan, and histamine to study the anti-inflammatory activity of the three organic extracts of seeds from B crassifolia. The team also used the cotton-pellet granuloma method to induce edemas in Wistar rats and study the inhibitory effect of the three extracts from B crassifolia. Finally, the team examined the participation of the nitric oxide (NO) system in the anti-inflammatory activity of the hexane extract of nance seeds (NS), diclorofenac, and L-NAME as well as the effects of L-arginine and D-arginine on the antiinflammatory actions of the compounds., Setting: This research was conducted in the Laboratory of Research of Natural Products, School of Chemical Engineering, National Polytechnic Institute (IPNESIQIE) and Department of Biotechnology and Bioengineering, Cinvestav-IPN, Av. IPN 2508, Col. San Pedro Zacatenco, Mexico D.F., CP 07360, Mexico., Outcome Measures: The research team measured the edema that the solvents caused, either in the ears of rats for tetradecanoylphorbol or in the paws for formaldehyde, carrageenan, and histamine. To study the antiproliferative effects of the extracts after implantation of the cotton-pellet granuloma, the team determined the wet and dry weights of the pellets, after drying at 70°C for 1 hour in the second case. To study the participation of the NO system in the anti-inflammatory activity of the hexane extract of NS, diclofenac, and L-NAME, the research team measured paw edema., Results: Among the extracts tested, NS showed the most significant anti-inflammatory activity. That extract decreased the paw edema that carrageenan, formaldehyde, histamine, and cotton pellet-induced, either by oral or topical administration at doses of 200 mg/kg, with 31%, 66%, 83%, and 58.2% inhibition respectively. In addition, NS inhibited the ear edema that TPA induced by 62%. Methanol and chloroform extracts produced a small effect, so the team does not present the results in this article. L-arginine, a precursor of NO, significantly inhibited the anti-inflammatory effects of NS and L-NAME, an anti-inflammatory drug, on mouse paw edema, but D-arginine did not. In contrast, neither D-arginine nor L-arginine inhibited the anti-inflammatory effects that diclofenac produced. These results indicate that the anti-inflammatory effect of NS on mouse paw edema occurs via the inhibition of NO production, as does the anti-inflammatory effect of L-NAME but not the anti-inflammatory effect of diclofenac. The anti-inflammatory activity of NS was comparable to standard anti-inflammatory drugs such as indomethacin, dexamethasone, and sodium diclofenac., Conclusions: The hexane extract from seeds of B crassifolia exhibited significant anti-inflammatory activity in both acute and chronic inflammatory models with a partial contribution of inhibitory actions on some cellular inflammatory responses. The anti-inflammatory mechanism of NS may be related to the other isoform (iNOS).

Ethnopharmacological Relevance: Phyllanthus simplex (Family: Euphorbiacae) is widely used in traditional medicines for treatment of various diseases including inflammation., Materials and Methods: Petroleum ether extract (PSPE) and ethanol extract (PSEE) of the whole plant of Phyllanthus simplex were characterized for their total phenolics, tannins and flavonoids content. These extracts were standardized by HPTLC using phyllanthin and gallic acid respectively as markers. Antioxidant activity of extracts was evaluated by the DPPH, hydroxyl and superoxide radicals scavenging assay. The total antioxidant capacity of extracts was determined. Anti-inflammatory activity was evaluated by their effect on nitric oxide (NO) production in isolated rat peritoneal macrophages; carragennan-induced paw edema and formation of cotton pellet-induced granuloma in rats., Results: Abundance of phenolics was found in PSEE. Phyllanthin and gallic acid content in PSPE and PSEE were found to be 14.5 and 0.65% (w/w) respectively. PSEE showed concentration dependent significant scavenging of DPPH, hydroxyl and superoxide radicals with IC(50) values 102.219, 171.485 and 24.73 μg/ml respectively. PSEE significantly inhibited NO production in isolated rat peritoneum macrophages. Moreover, it also exhibited significant inhibition of carragennan-induced paw edema (58.48 ± 0.028%, p < 0.001, at 6h, 200 mg/kg oral dose) and cotton pellet-induced granuloma formation (45.671 ± 0.712%, p < 0.001, at 200mg/kg oral dose). Anti-inflammatory activity of PSEE was found to be comparable to diclofenac sodium., Conclusions: Significant antioxidant and anti-inflammatory activities were found in PSEE which may be attributed to its high phenolic content., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Ethnopharmacological Relevance: Byrsonima intermedia A. Juss. is popularly known as "murici pequeno" and is native to the Brazilian Cerrado. This species has been used as an antimicrobial, anti-hemorrhagic, anti-diarrheal and anti-inflammatory. Nevertheless, scientific information regarding Byrsonima intermedia is limited; there are no reports related to its possible anti inflammatory and antinociceptive effects. This study employed in vivo inflammatory and nociceptive models to evaluate the scientific basis for the traditional use of Byrsonima intermedia., Materials and Methods: Carrageenan-induced paw edema, peritonitis and fibrovascular tissue growth induced by s.c. cotton pellet implantation tests were used to investigate the anti-inflammatory activity of Byrsonima intermedia aqueous extract (BiAE) in rats. Mechanical nociceptive paw, formalin and hot plate tests were used to evaluate the antinociceptive activity in mice. High-performance liquid chromatography (HPLC), phytochemistry screening and determination of total phenolics and flavonoids were used to determine the chemical profile of the BiAE., Results: BiAE at test doses of 30-300 mg/kg p.o. clearly demonstrated anti-inflammatory effects by reduced carrageenan-induced paw edema, by inhibited leukocyte recruitment into the peritoneal cavity and, in the model of chronic inflammation, by using the cotton pellet-induced fibrovascular tissue growth in rats. The extracts at test doses of 30-300 mg/kg p.o. clearly demonstrated antinociceptive activity in all tests. Administration of the opioid receptor antagonist naloxone completely inhibited the antinociceptive effect induced by BiAE (100 mg/kg)., Conclusion: BiAE markedly exhibits anti-inflammatory action in rats and antinociceptive activity in mice. Thus, it may be useful in the treatment of inflammatory hyperalgesic disorders, which supports previous claims of its traditional use., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Ethnopharmacological Relevance: Sipunculus nudus has long been employed as traditional Chinese medicine in folk remedies for the treatment of carbuncles, tuberculosis and nocturia, regulating the functions of stomach and spleen, as well as for the restoration to health in debilities caused by various pathogens and aging. Decoction of Sipunculus nudus has traditionally been used to remedy sternalgia in folk medicine., Aim of the Study: This study aimed to assess the anti-inflammatory and anti-nociceptive activity of the water extract from Sipunculus nudus., Materials and Methods: The water extract from the body wall of Sipunculus nudus was obtained with the yield of 14.1%. The anti-inflammatory effect in six animal models and anti-nociceptive effect in two animal models of the water extract were evaluated by oral for the study., Results: Pretreatment with the extract (at the dose of 50, 100 and 200 mg/kg) produced significant dose-dependent anti-inflammatory and anti-nociceptive effects. At 200 mg/kg dose, the inhibition ratio of the extract on carrageenan-induced rat hind paw oedema, dextran-induced rat paw oedema, cotton pellet granuloma in rats, carrageenan-induced peritonitis and acetic acid-induced vascular permeability were 59.2%, 51.0%, 53.1%, 42.5%, 50.8%, better than that of indomethacin (5 mg/kg) 49.5%, 50%, 44.4%, 37.6%, 46.8%, respectively. The inhibition ratio of the extract (200 mg/kg dose) on xylene-induced mouse ear oedema was 61.5%, lower than 63.7% for indomethacin (5 mg/kg). At 200mg/kg, the extract decreased number of writhing 52.3% in acetic acid-induced writhing model and increased the response latency 25.24% in hot plate test., Conclusions: The water extract from the body wall of Sipunculus nudus possesses excellent anti-inflammatory activity as well as peripheral and central analgesic properties., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

The present study investigates the protective effects of curcumin on experimentally induced inflammation, hepatotoxicity, and cardiotoxicity using various animal models with biochemical parameters like serum marker enzymes and antioxidants in target tissues. In addition, liver and cardiac histoarchitecture changes were also studied. Curcumin treatment inhibited carrageenin and albumin induced edema, cotton pellet granuloma formation. The increased relative weight of liver and heart in CCl(4) induced liver injury and isoproterenol induced cardiac necrosis were also reduced by curcumin treatment. Elevated serum marker enzymes, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) increased lipid peroxidation, decreased gluthione (GSH), glutathione peroxidase (GPx) and superoxide dismutase (SOD) in edematous, granulomatus, liver and heart tissues during inflammation, liver injury and cardiac necrosis, respectively. Curcumin treatment reversed all these above mentioned biochemical changes significantly in all animal models studied. Even histoarchitecture alterations observed in liver injury and cardiac necrosis observed were partially reversed (improved) by curcumin treatments. In in vitro experiments too curcumin inhibited iron catalyzed lipid peroxidation in liver homogenates, scavenged nitric oxide spontaneously generated from nitroprusside and inhibited heat induced hemolysis of rat erythrocytes. The present in vitro and in vivo experimental findings suggest the protective effect of curcumin on experimentally induced inflammation, hepatotoxicity, and cardiotoxicity in rats., (Copyright © 2010 Elsevier GmbH. All rights reserved.)

Trans-radial cardiac catheterization has lower rates of arterial access site complications. Hydrophilic-coated sheaths designed specifically for trans-radial procedures have resulted in numerous reports of a foreign body reaction to retained material. Although this is a self-limited condition that should be managed expectantly, it is often confused with an infected pseudoaneurysm, resulting in unnecessary surgery. We searched the FDA MAUDE (Manufacturer and User Facility Device Experience) database to determine which brands of sheath have been associated with this complication. In addition, we performed a literature search for all reported cases of this complication. Only one brand of sheath has been associated with this condition. As trans-radial procedures become more common in the US, knowledge of such complications, which appear to be specific to the Cook radial hydrophilic-coated sheaths, is imperative for all radial interventionalists to prevent unnecessary surgical procedures. © 2010 Wiley-Liss, Inc.

Background: A constantly increasing number of gel fillers for aesthetic and reconstructive purposes have been introduced during the last 20 years. Most of the new ones are modified versions of the original collagen and hyaluronic acid gels. They have been reconstructed, often by adding cross-bindings to the polymer in order to obtain a more dense molecular structure, which will prolong degradation and filling effect of the gel. Other gel fillers contain particles of organic (poly-lactic acid) or inorganic (calcium hydroxylapatite) material, which have been used in human tissue for other purposes (degradable suture material and bone cement, respectively). The permanent fillers (silicone oil and polyacrylamide gel) have been used for many years, silicone mainly in the US and polyacrylamide gel in most countries outside the US and Canada., Objective: Complications occur, and they appear to be more frequent with particulated fillers, polyacrylamide gel and silicone oil. However, these complications differ in nature and depend on the filler type used., Methods and Materials: This overview presents the different gel filler types, how they interact with host tissue, and what can go wrong. The results and conclusion are based on experimental and clinical observations coupled with a search of the literature., Results and Conclusion: Complications following homogenous hydrogels are caused by infection with bacteria, which have been inserted into the gel during injection. If not treated with relevant antibiotics (but instead steroids or large doses of NSAIDs) the bacteria form a biofilm, which gives rise to a low-grade chronic infection that is resistant to antibiotics. Complications following particulated gels and silicone oil are not known, but bacteria in a biofilm and/or endotoxins released by these is a possibility which deserves further investigations, primarily by using the fluorescence in situ hybridization (FISH) technique.

Background: Effective laparoscopic ventral herniorrhaphy mandates the use of an intraperitoneal mesh. Visceral adhesions and shrinkage of prosthetics may complicate repairs. The aim of this study was to compare adhesion formation, mesh shrinkage and tissue ingrowth after intra-abdominal placement of a novel two-component monofilament mesh structure made of polypropylene (PP) and polyvinylidenfluoride (PVDF) with current alternatives., Materials and Methods: Forty Sprague-Dawley rats were used in this study. Mesh samples were fixed as intra-abdominal only mesh at the right lateral abdominal wall. The study groups were: PVDF+PP (polypropylene parietally and polyvinylidenfluoride viscerally), PP+Col (polypropylene with a collagenoxidized film), ePTFE (smooth surface viscerally and a textured surface parietally), and PP (a pure polypropylene mesh serving as control). The meshes were explanted after 30 days. Adhesions were scored as a percentage of explanted biomaterials' affected surface area; prosthetic shrinkage was calculated. Foreign-body reaction to mesh materials was measured by investigating the amount of inflammatory infiltrate and fibrotic tissue formation., Results: In terms of adhesion score, the pure PP mesh showed the highest values followed by the ePTFE, PVDF+PP, and PP+Col meshes. Quantitative assessment of adhesion area revealed a significantly higher value of the pure PP mesh sample (62.0 +/- 22.1%) compared with the PP+Col (26.8 +/- 12.1%) and the PVDF+PP mesh (34.6 +/- 8.2%). Percentage of shrinkage showed a significantly higher value of the ePTFE mesh (52.4 +/- 13.9%) compared with all other mesh modifications (PP+Col 19.8 +/- 13.9%, PVDF+PP 19.9 +/- 7.0%, and PP 26.8 +/- 9.5%). Inflammatory infiltrate was significantly reduced in the PVDF+PP mesh group compared with all other mesh samples., Conclusion: The use of the novel two-component monofilament mesh structure made of polypropylene and polyvinylidenfluoride was found to be favorable regarding adhesion formation and mesh shrinkage compared to conventional mesh materials used for intra-abdominal placement.

A recurring problem during prosthetic rehabilitation following reconstruction by means of a vascularized fibula flap, after ablation of tumors affecting the facial skeleton, is the hyperplastic granulomatous reactive tissue that forms around the prosthetic abutments of the implant. The features of this phenomenon seem to be directly related to the characteristics of the peri-implant tissue and to the material from which the prosthetic abutments are manufactured. Two main ways of avoiding this are proposed. 1) Skin grafts around implants seem to inhibit the overgrowth of granulomatous tissue. 2) Acrylic provisionals should be avoided and substituted with complete metal-ceramic restoration.

The 50% ethanolic extract of Fumaria indica was investigated for its anti-inflammatory and antinociceptive potential in animal models. Oral administration of F. indica dry extract (100, 200 and 400 mg kg-1) exhibited dose dependent and significant anti-inflammatory activity in acute (carrageenean and histamine induced hind paw oedema, p < 0.05) and chronic cotton pellet granuloma models of inflammation, p < 0.01). The extract (400 mg kg-1) exhibited maximum anti-inflammatory effects of 42.2 and 42.1% after 3 h with carrageenean and histamine, respectively. The same dose of extract showed 38.9% reduction in granuloma mass in a chronic condition. A significant anti-nociceptive activity was evidenced in mice; 6.6-67.7% (p < 0.01) protection in mechanical, 33.9-125.1% (p < 0.05) protection in thermal induced pain and 22.2-73.9% (p < 0.05) protection in acetic acid-induced writhing.

Background: Late capsular contraction around breast implants is one of the most difficult complications to prevent or resolve. The authors studied the mechanisms that control the fibrotic process in an animal model. Using angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonist, the authors previously described a significant reduction in fibrosis in different experimental models., Methods: Four groups of six rats each had a mini breast implant, 12 with a smooth surface and 12 with a textured surface. In two groups, the angiotensin-converting enzyme inhibitor enalapril was administered in drinking water, ad libitum, to determine its effect on both implant types. Two control groups were given plain drinking water. Three months postoperatively, all of the rats were killed and the capsule sections were cut and stained with hematoxylin and eosin and Masson's trichrome. Immunolabeling of collagen III and transforming growth factor (TGF)-beta1 was performed using monoclonal antibodies., Results: Significant differences were found between smooth and textured implants, with a uniformly low inflammatory response found on textured implants. For both surfaces, the enalapril-treated group had a significant reduction of the inflammatory process that was especially marked in the textured implants. Immunostaining for collagen III and TGF-beta1 showed a consistent reduction in both fibrous tissue and cytokine mediator., Conclusions: Enalapril lowers the expression of fibrotic mediators, TGF-beta1, inflammatory markers, anti-ED1, anti-collagen III monoclonals, and the periprosthetic fibrosis process. The reduction of TGF-beta1 indicates that the probable main cytokine mediator of the fibrotic cascade is attenuated. This hypothesis may provide the basis for a safe and cheap therapeutic strategy with which to modify the capsular contracture that sometimes affects women with mammary implants.

This study evaluated a new herbal preparation, HemoHIM, for its antiinflammatory activity against carrageenan-induced edema, the formation of granulation tissues by cotton pellet and experimental colitis by 2,4,6-trinitrobenzene sulfonic acid (TNBS). The HemoHIM was prepared by adding its ethanol-insoluble polysaccharide fraction to the total water extract of Angelica Radix, Cnidii Rhizoma and Paeonia Radix. The preparation (4 mg of solids/mL of drinking water, p.o., 50-100 mg/kg of body weight, i.p.) produced a dose-related inhibition of carrageenan-induced paw edema and cotton pellet-induced granuloma in rats. In addition, HemoHIM also reduced the degree of TNBS-induced colitis and improved the gross and histological changes such as thickening, dilatation, ulceration, and infiltration by polymorphonuclear leukocytes and multiple erosive lesions. These results demonstrate that the HemoHIM has a potent antiinflammatory effect., (Copyright 2007 John Wiley & Sons, Ltd.)

Luteolin, a flavonoid abundant in plants worldwide, demonstrates a spectrum of biological activities. This study is aimed at evaluating its inhibiting effects on inflammatory responses in vivo. We investigated the anti-inflammatory activity of luteolin in acute and chronic models in mice. We found that oral administration of luteolin (10 and 50 mg/kg) efficiently suppressed paw edema when induced by injecting carrageenan, and a similar tendency was also observed in the cotton pellet granuloma test. In the air pouch test, luteolin markedly reduced the number of infiltrated leukocytes and the elevated level of 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) in the exudate. The results derived from the whole blood assay for cyclooxygenase (COX) and from the reverse transcription-polymerase chain reaction (RT-PCR) assay indicate that luteolin may be a potent selective inhibitor of cyclooxygenase-2 (COX-2) and that the inhibition is attributable to its down-regulation of the mRNA expression of COX-2 in inflammatory responses.

In this study the effects of compound B1, bis(3-aryl-3-oxo-propyl)methylamine hydrochloride, and an anti-inflammatory drug, indomethacin, were tested by carrageenan-induced paw edema and cotton pellet granuloma tests, for effects on acute and chronic phases of inflammation, respectively. Their effects on vascular permeability were also determined by hyaluronidase-induced capillary permeability test. Anti-inflammatory activity of B1 was compared with indomethacin. B1 decreased the carrageenan-induced paw edema by 49%, 35%, and 47% at 50, 100, and 200 mg kg(-1) doses, respectively, while this decrease was 82% by indomethacin at 20 mg kg(-1) dose. Antiproliferative effects in cotton pellet test of B1 at 50 mg kg(-1) and indomethacin at 20 mg kg(-1) doses were 44% and 43%, respectively. Indomethacin but not B1 inhibited the hyaluronidase-induced increase in capillary permeability. Our results suggest that B1 inhibits both acute and chronic phases of inflammation probably by an effect not mediated by prevention of increased capillary permeability. Especially, its anti-inflammatory activity against chronic phase of inflammation was comparable with that of indomethacin. Further detailed studies are needed to clarify the mechanism(s) of action responsible for the anti-inflammatory activity of B1.

All fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of and accept these risks. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., too superficial an implantation of a long-lasting filler substance). Such adverse events can be treated with intradermal 5-fluorouracil, steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunologic phenomena such as late-onset allergy and nonallergic foreign body granuloma. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions shall remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granuloma in the subcutaneous fat.

Pluchea sagittalis whole plant dichloromethane extract showed inhibitory activity in several inflammatory models: rat hind paw-edema, mice ear edema, and air-pouch rat granuloma. The extract inhibited the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in stimulated human neutrophils. It also showed inhibitory effect on heat shock protein 72 (hsp72) synthesis in stimulated neutrophils, while it had opposite effects on unstimulated cells. The triterpene taraxasteryl acetate was obtained from the dichloromethane extract by bioassay directed isolation, being active against induced ROS and RNS production in human neutrophils. In mice ear edema (induced by phorbol-12-mirystate-13-acetate, croton oil and arachidonic acid), taraxasteryl acetate showed a topical anti-inflammatory activity similar to the extract, but at 1/20 of the dose. The same ratio was observed for the inhibition of hsp72 production in stimulated human neutrophils. In unstimulated monocytes and neutrophils, taraxasteryl acetate showed a higher stimulating activity of hsp72 production than the extract, involving different mechanisms in each cell type. To our knowledge, taraxasteryl acetate is the first natural product for which a dual effect on the hsp response is reported.

The hydroalcoholic extract (HAE) of Ageratum conyzoides leaves was studied for its antiinflammatory effect on subacute (cotton pellet-induced granuloma) and chronic (formaldehyde-induced arthritis) models of inflammation in rats. The absence or presence of toxicity by prolonged use of HAE was also evaluated through biochemical and hematological analysis of rats blood samples using daily oral doses of 250 or 500 mg/kg body wt., during 90 days. The results showed that the group of rats treated with HAE (250 mg/kg body wt.; p.o.) had a 38.7% (p < 0.05) reduction in cotton-pellet granuloma. The development of chronically induced paw edema was also reduced significantly (p < 0.05) by the plant extract. The toxicity study did not show any treatment-related abnormalities in biochemical and hematological parameters. The biochemical analysis from blood samples drawn from group of rats treated orally with 500 mg/kg body wt. did, however, present 30.2% (p < 0.05) reduction of SGPT activity as compared to the corresponding control group. These results confirm the antiinflammatory properties of A. conyzoides, with no apparent hepatotoxicity.

The anti-inflammatory activity of Ionidium suffruticosam (Violaceae) methanol extract was evaluated on carrageenin, histamine and serotonin-induced rat hind paw oedema acute models. The extract at doses of 200 and 400 mg/kg has been found to possess significant anti-inflammatory activity on the tested experimental models. The extract at the dose level of 400 mg/kg exhibited maximum anti-inflammatory activity in all the animal models. In a chronic test, the extract (400 mg/kg) showed 42.78% reduction in granuloma weight. The effect produced by the extract was comparable to that of phenylbutazone, a proto type of a non-steroidal anti-inflammatory agent.

Methanolic extracts from the heart wood, stem bark, and stem wood of Ventilago harmandiana Pierre (Family Rhamnaceae) were assessed for anti-inflammatory effects using both acute and chronic inflammatory models. Analgesic and antipyretic activities of the extracts were also evaluated. It was found that all extracts possessed strong inhibitory effects on the acute phase of inflammation as seen in ethyl phenylpropiolate (EPP)- and arachidonic acid (AA)-induced ear edema as well as in carrageenin-induced paw edema in rats. The extracts elicited only weak inhibitory activity on cotton pellet-induced granuloma formation, a subchronic inflammatory model. In the analgesic test, all extracts exerted pronounced inhibitory activity in acetic acid-induced writhing response but showed only weak effects in the tail-flick test. The extracts also showed excellent antipyretic activity on yeast-induced hyperthermia in rats.

The natural resin collected from the trunk wood of Protium heptaphyllum is used in folk medicine to treat inflammatory conditions and to hasten wound repair. In the search of new potential anti-inflammatory agents with gastroprotective property, the present study evaluated its effects in experimental models of gastric ulcer and inflammation. In mice, the resin (200 and 400 mg/kg) significantly attenuated the gastric damage induced by ethanol or acidified ethanol (HCl/ethanol), in a manner similar to N-acetyl-L-cysteine (NAC), a replenisher of sulfhydryls. Unlike NAC the resin failed to restore the ethanol-induced depletion of non-protein sulfhydryl content, indicating a different mechanism of gastroprotection. However, in 4-h pylorus-ligated rats, the resin significantly reduced the total acidity without much change in gastric secretory volume. In rats, at similar doses the resin did not modify the hind-paw edema induced by carrageenan, but effectively reduced the formation of cotton pellet-induced granuloma, suggesting its inhibitory effect on collagen formation but not on acute edema. Furthermore, the vascular permeability increase induced by acetic acid was significantly reduced in mice that received 400 mg/kg resin. The resin demonstrated no overt toxicity in mice up to an oral dose of 5 g/kg. Phytochemical analysis revealed the presence of alpha- and beta-amyrins as principal triterpenoid constituents of resin, which were previously described to have anti-ulcer property. These findings indicate the potential gastroprotective and anti-inflammatory property of P. heptaphyllum resin and further support its popular use in gastrointestinal disorders.

The sesquiterpene lactone fraction of Saussurea lappa roots was evaluated for its effect on the transudative, exudative and proliferative phases of inflammation using the cotton pellet granuloma assay in rats. The fraction (25-100 mg/kg, p.o.) showed significant dose-dependent inhibition of the increase in wet weight of the cotton pellet at 3 h (transudative phase), leakage of dye from the bloodstream around granuloma at 24 h (exudative phase) and increase in dry weight of the cotton pellet on day 6 (proliferative phase). It significantly lowered the elevated biochemical parameters such as alkaline phosphatase, acid phosphatase, gamma-glutamyltranspeptidase and significantly elevated the lowered albumin concentration in serum. The studies suggest that the antiinflammatory activity of the sesquiterpene lactone fraction of S. lappa may, in part, be due to stabilization of lysosomal membranes and an antiproliferative effect., (Copyright 2003 John Wiley & Sons, Ltd.)

The anti-inflammatory potential of methanol extract of Pavetta indica Linn. leaves (Family: Rubiaceae) was evaluated against several models of inflammation such as carragenin, histamine and dextran induced pedal inflammation in rats. The extract showed 48.41%, 41.10% and 24.22% inhibition respectively; when compared to that of control animals. The effect was comparable with that of the standard drug indomethacin, a standard non-steroidal anti-inflammatory drug. Simultaneous subplantar administration of the extract and carrageenin in a mixture helps in differentiating true anti-inflammatory action from an apparent anti-inflammatory effect due to counter-irritant activity. The methanol extract also effectively and significantly reduced cotton pellet induced granuloma. The percentage of inhibition was 62.78 at the dose 500 mg/kg, thereby suggesting its activity in the proliferative phase of the inflammatory process., (Copyright 2003 John Wiley & Sons, Ltd.)

The essential oil of Lippia multiflora Moldenke (Verbenaceae) produced by conventional hydrodistillation was analyzed and studied for its analgesic, antipyretic and anti-inflammatory activities in rats and mice. At the doses used (2, 4 and 8 ml/kg o.s.) the essential oil of L. multiflora showed significant and dose-dependent analgesic effect on acetic acid-induced writhing in mice. Only the dose of 8 ml/kg of essential oil, antagonized hyperexia induced by brewer's yeast. No effect on granuloma formation was observed.

An aqeuous extract of Lobaria pulmonaria (L.) Hoffm., from which a tea is prepared and consumed as treatment for various diseases in northeastern Turkey, was tested for its anti-inflammatory and antiulcerogenic effects in rats. The carrageenan-induced paw edema, cotton pellet granuloma and indomethacin-induced gastric damage models were used to determine these effects. The extract exhibited moderate anti-inflammatory and strong antiulcerogenic activities.

Latex allergy has received considerable attention during the past decade. The occurrence of latex allergy in health care workers is higher than in the general population. Latex gloves are the most frequent form of exposure that health care workers have to natural rubber latex; therefore, the relationship between gloves and latex allergies, has been well studied. Scientific evidence supports the link between glove powder and the occurrence of latex allergies, as well as the development of postoperative complications in surgical patients. This article describes how a multihospital system, which is the seventh largest not-for-profit health care corporation in the nation and includes 35 ORs, successfully eliminated powdered gloves from the environment.

For maximum motility of the prosthesis, the hydroxyapatite orbital implant should be drilled and coupled to the prosthesis via a motility peg. However, problems of peg extrusion have been reported to occur in 25-30% of cases. In this animal study, serial histopathological changes within the drill hole after hydroxyapatite implantation were observed and the effect of mitomycin-C (MMC) was evaluated as a new method of hole maintenance. A hole was drilled into each hydroxyapatite implant 20 weeks after enucleation and different concentrations of MMC solution were applied. The morphological changes of the holes were evaluated with proliferating cell nuclear antigen. In the control group (non-MMC-treated), all the motility pegs were extruded showing occluded holes. In the groups treated with 0.5 and 1.0 mg/ ml MMC, all the motility pegs were maintained in position with the holes at ample depth and width. However, toxicity, such as conjunctival ulcer and implant exposure around the hole, was observed in the 1.0 mg/ml MMC group. A 0.5 mg/ml MMC application for 5 min to the drill hole effectively reduced the risk of peg extrusion in this albino rabbit model., (Copyright 2001 S. Karger AG, Basel)

A methanol extract of the dried leaves of Chasmanthera dependens was investigated for anti-inflammatory and analgesic activities. The extract (100--400 mg/kg, p.o.) produced dose-related inhibition of carrageenan-induced paw oedema and cotton pellet-induced granuloma in rats. Furthermore, an inhibition in the leakage of Evan's blue induced by acetic acid was observed in mice. At same doses, analgesic effect was also observed on writhing response induced by acetic acid as well as on the early and late phase of formalin-induced paw licking in mice.

The defatted methanolic extract of Entada abyssinica was evaluated for anti-inflammatory activity in acute and chronic models of inflammation. The extract (50--200 mg/kg, p.o.) exhibited dose-dependent and significant inhibition of both the carrageenan-induced rat paw oedema and granuloma tissue formation in rats. The extract (50--200 mg/kg, p.o.) was also found to inhibit the acetic acid-induced vascular permeability in a dose-dependent fashion in mice. This study demonstrated the anti-inflammatory activity of Entada abyssinica.

The 10% ethanol extract of the aerial parts of Calligonum comosum (50--400 mg/kg, i.p.) significantly reduced the increase in hind paw oedema induced by carrageenan in rats. Following sub-acute oral administration of the extract (50 and 100 mg/kg, daily for 14 days), a significant anti-inflammatory activity in the cotton pellet model was observed. Pre-treatment with the extract (100, 200 and 400 mg/kg) produced a significant and dose-dependent inhibition to the acute gastric ulcers induced by phenylbutazone, indomethacin, 0.2 N NaOH and 80% ethanol.

The ethanolic extract of the bark of Syzygium cumini was investigated for its anti-inflammatory activity in animal models. The extract did not show any sign of toxicity up to a dose of 10.125 g/kg, p.o. in mice. Significant anti-inflammatory activity was observed in carrageenin (acute), kaolin-carrageenin (subacute), formaldehyde (subacute)-induced paw oedema and cotton pellet granuloma (chronic) tests in rats. The extract did not induce any gastric lesion in both acute and chronic ulcerogenic tests in rats. Thus, the present study demonstrated that S. cumini bark extract has a potent anti-inflammatory action against different phases of inflammation without any side effect on gastric mucosa.

(+)-Usnic acid, isolated from the lichen Roccella montagnei, showed a dose-dependent anti-inflammatory activity when tested on rats, employing acute and chronic models.

The antiinflammatory activities of 30 flavonoids isolated from several plants of the Compositae family were investigated using carrageenan-induced mouse paw edema and cotton pellet-induced rat granuloma. Compounds were administered with a unique dose of 75 mg/kg i.p. in the acute test with carrageenan and 25 mg/kg/day in the chronic granuloma test. Flavonoids inhibit the development of the induced granuloma, mostly when a catechol or guaiacol-like B ring is contained in the compound structure, jaceosidin being the most active flavonoid screened. Flavonoids significantly inhibited the maximum edema response in the acute test. We conclude that several of the isolated flavonoids tested here showed antiinflammatory effects, depending on the experimental model used.

Objective: To investigate the effect of anti-fecundity and anti-embryonation immunity on liver granuloma formation in mice immunized with soluble immature egg antigen (SIEA) of schistosoma japonicum., Method: BALB/c mice were immunized with the crude SIEA or 26,000-28,000 molecular antigen derived from SIEA and compared the size in schistosoma japonicum egg granulomas in the liver after challenge infection both the immunized mice and unimmunized controls., Results: The number and size of egg granuloma were significantly decreased in mice immunized with SIEA and SIEA 26-28,000, by 29.26% and 49.64%, respectively. The inhibitive effects on granuloma formation and spleen weights in the group immunized with SIEA 26-28,000 were stronger than those in the group immunized with the crude SIEA. However, mean granuloma size and spleen weights in the group immunized with SEA or SIEA-1 fraction were not different from unimmunized control., Conclusion: SIEA and SIEA 26-28,000 antigenic molecule play an important role in inhibition on liver granuloma formation through their anti-embryonation and anti-fecundity immunity effects.

Powdered and powder-free gloves were compared during ophthalmic surgery. It was found that powder may reappear on well-rinsed gloves by the end of intraocular surgery and be implanted inadvertently into the eye or in the stromal interface during laser in situ keratomileusis. Powder-free gloves, therefore, make surgery significantly safer.

Recent studies have demonstrated a crucial role for TNF during inflammatory granuloma formation. In addition, TNF has been shown to up-regulate adhesion molecules that participate in cellular recruitment and lymphocyte activation. In the present study, we have examined the mechanism of TNF activation during Schistosoma mansoni egg granuloma formation and its relationship to the expression of ICAM-1. Our initial studies showed that high affinity human soluble TNFR coupled to the Fc portion of an Ig (sTNFR:Fc construct) could effectively diminish granuloma formation and lymphocyte activation in vivo. We have also assessed the increased expression of ICAM-1, its contribution to granuloma development, and its relationship with TNF during lesion formation. Increased steady state ICAM-1 mRNA expression was observed in primary egg granulomas when compared with normal lung and foreign body (Sephadex bead) granulomas, which suggests a role for ICAM-1 in Ag-induced lesion formation. Subsequent studies have demonstrated that sTNFR:Fc treatment down-regulated granuloma formation and ICAM-1 expression, thus suggesting one mechanism of TNF involvement in granuloma formation was through the induction of ICAM-1. Anti-ICAM-1 decreased the soluble egg Ag-specific T cell proliferation in vitro. In addition, passive immunization of mice with anti-ICAM-1 mAb during primary granuloma formation resulted in an attenuation of lesion development as compared with lesion development in a control Ab-treated group. The proliferative response to soluble egg Ag was also significantly reduced in ex vivo experiments that used spleen cells from the anti-ICAM-1 treated mice. These data demonstrate that both TNF and ICAM-1 participate in lymphocyte activation and granuloma formation and suggest that one mechanism of TNF in granuloma development is through TNF-induced ICAM-1 expression.