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A utilização da pressão subatmosférica através de curativo à vácuo em pacientes com abdome aberto é usada cada vez mais para o fechamento abdominal temporário. O curativo à vácuo pode ser utilizado como uma “ponte” entre o surgimento da lesão inicial e a cirurgia de fechamento definitivo da ferida, naqueles casos em que o fechamento fascial primário não é possível. O objetivo deste trabalho é apresentar uma proposta prática para o fechamento abdominal temporário utilizando curativo à vácuo (técnica de Barker modificada), como alternativas as demais técnicas. O mecanismo de ação envolve o controle do exsudato, redução do edema intersticial perilesional, aumento do fluxo sanguíneo, estímulo à formação de tecido de granulação e contração da ferida. O curativo apresentou baixos custos, fácil aplicação e utilizando materiais disponíveis com frequência na maioria dos hospitais públicos. De acordo com a literatura, a técnica de Barker modificada apresenta bons resultados e índices de complicações semelhantes aos kits de TPN comerciais.

In the second phase of shock therapy, we regularly find fluid overload with edema in our patients, which not only involves the skin and interstitial tissue but can also impair kidney, liver and pulmonary function. Revision of the Starling principle and new insights into physiology of the endothelial glycocalyx have important implications for fluid therapy in intensive care medicine. Determination of fluid overload and an appropriate therapy with either diuretics or ultrafiltration are the focus of "late goal-directed fluid removal" management.

The work estimates histological changes in the myocardial structure of old, hypertensive rats after the introduction of cryopreserved cord-blood nucleated cells (CBNCs). The goal of the work was to estimate the structural organization of myocardial tissues and blood vessels on the third, seventh, and 30th days after the intraperitoneal administration of cryopreserved CBNCs to rats with stress-induced arterial hypertension. The experiments were carried out on 28- to 30-month-old, white, outbred, male rats. It was established that the introduction of cryopreserved CBNCs to old animals with stress-induced arterial hypertension led to a significant improvement in the structure of myocardial tissues and blood vessels. The number and area of cardiomyocyte nuclei increased already on the third day, and these changes were accompanied by a pronounced neoangiogenesis. The density of fibroblasts in the interstitial connective tissue and around the blood vessels increased by the 30th day after the introduction of cryopreserved CBNCs. There was a decrease in perivascular and interstitial edema, and there were no traits of focal ischemia and cardiosclerosis in the tissues.

Burned patients may need prolonged admissions in the Intensive Care Service, both for initial care and for the pre and postoperative treatment of the multiple surgeries they require. The initial resuscitation of critically burned patients requires adequate monitoring to calculate the fluid therapy necessary to replenish the losses and ensure tissue perfusion, but without excesses that increase interstitial edema. In addition, monitoring can evaluate the systemic inflammatory response that can lead to shock and organic dysfunctions. After this initial phase we will find a critical patient who requires multiple reinterventions in non-optimal situations, so he will need special care over a long period of time. In addition, the SMI offers specific postoperative care for reconstructive surgery and the transplantation of composite tissues (upper limb and face) in which its success depends on a rigorous control through adequate monitoring and treatment.

The aim of this study was to sonographically detect pulmonary edema, which is a major problem in pregnant women with preeclampsia, in the interstitial phase. We evaluated 41 preeclampsia patients and 21 control subjects prospectively. In the preeclampsia group, 26 patients had severe features, whereas the other 15 patients had none. To detect early fluid loading in lungs, sonographic B lines were counted from the intercostal space by using ultrasonography, and left ventricular loading findings were examined for corporation by using transthoracic echocardiography both before and after birth. In severe preeclampsia, the number of B lines before and after birth is statistically significant compared with the other groups. In addition, the total number of B lines calculated at 24 hours after delivery was significantly lower than that calculated before delivery (P < 0.018). In terms of prenatal E values, a statistically significant difference was found between all groups (P < 0.001). A strong positive and statistically significant relationship was found between B lines and prenatal E/e' (r = 0.768; P < 0.001). The overall accuracy rate of the prenatal E/e' and E value for estimation of the B line number classification is 0.791 (95% confidence interval, 0.674-0.908; P < 0.001) and 0.829 (95% confidence interval, 0.722-0.936; P < 0.001), respectively. Pulmonary edema is a serious complication in patients with severe preeclampsia and may be detected interstitially in some patients, even if it does not occur clinically.

У пацієнтів з гострою абдомінальною патологією середнього і високого хірургічного ризику загальна частота післяопераційних легеневих ускладнень становить 10,5%, з них 80,9% всіх випадків пов'язаноз пневмонією. У пацієнтів середнього хірургічного ризику режим інфузійної терапії впливає на частоту виникнення післяопераційних легеневих ускладнень як: ліберальний режим супроводжується розвитком інтерстиціального набряку, збільшенням позасудинної рідини в легенях помірного ступеня і частотою розвитку легеневих ускладнень у 16%, рестриктивний режим зберігає об'єм інтерстиції в межах норми весь післяопераційний період і знижує ризики легеневих ускладнень до 6%. У пацієнтів високого хірургічного ризику згострою абдомінальною патологією післяопераційний період ускладнюється розвитком легеневих ускладнень у 10% випадків через збільшення інтерстиціального обсягу і легеневої позасудинної рідини легкого ступеня у першу добу при цілеспрямованому режимі інфузійної терапії, обмеження розвитку інтерстиціального набряку весь післяопераційний період при рестриктивному режимі інфузійної терапії. In patients with acute abdominal pathology of middle and high surgical risk the overall incidence of postoperative pulmonary complications is 10.5%, of which 80.9% of all cases are associated with pneumonia. Moderate surgical risk patients had a different infusion therapy's affects to the development of postoperative pulmonary complications;a liberal regime is accompanied by the development of interstitial edema, increased extravascular fluid in the lungs and incidence of pulmonary complications in 16%, restrictive mode preserves the volume of the interstices within the boundaries of the rules during postoperative period and reduces the risks of pulmonary complications to 6%. High surgical risk patients with acute abdominal pathology,postoperative period is complicated by development of pulmonary complications in 10% of cases due to increased interstitial volume and pulmonary extravascular fluid mild in the first day when targeted mode of infusion therapy limitsthe development of interstitial edema during all the postoperative period in the restrictive mode of infusion therapy.

Standard-of-care multiparameter magnetic resonance imaging (MRI) scans of the brain were used to objectively subdivide glioblastoma multiforme (GBM) tumors into regions that correspond to variations in blood flow, interstitial edema, and cellular density. We hypothesized that the distribution of these distinct tumor ecological “habitats” at the time of presentation will impact the course of the disease. We retrospectively analyzed initial MRI scans in 2 groups of patients diagnosed with GBM, a long-term survival group comprising subjects who survived &gt, 36 month postdiagnosis, and a short-term survival group comprising subjects who survived ≤19 month postdiagnosis. The single-institution discovery cohort contained 22 subjects in each group, while the multi-institution validation cohort contained 15 subjects per group. MRI voxel intensities were calibrated, and tumor voxels clustered on contrast-enhanced T1-weighted and fluid-attenuated inversion-recovery (FLAIR) images into 6 distinct “habitats” based on low- to medium- to high-contrast enhancement and low–high signal on FLAIR scans. Habitat 6 (high signal on calibrated contrast-enhanced T1-weighted and FLAIR sequences) comprised a significantly higher volume fraction of tumors in the long-term survival group (discovery cohort, 35% ± 6.5%, validation cohort, 34% ± 4.8%) compared with tumors in the short-term survival group (discovery cohort, 17% ± 4.5%, p &lt, 0.03, validation cohort, 16 ± 4.0%, p &lt, 0.007). Of the 6 distinct MRI-defined habitats, the fractional tumor volume of habitat 6 at diagnosis was significantly predictive of long- or short-term survival. We discuss a possible mechanistic basis for this association and implications for habitat-driven adaptive therapy of GBM.

Multiple studies have demonstrated that substantial regional variations in the genetic properties of cells are commonly observed within a clinical tumor. This heterogeneity is a fundamental barrier to curative therapy and is typically thought to be “somatic evolution” caused by accumulation of random mutations. However, classic Darwinian dynamics in evolution by natural selection are governed by variations in environmental selection forces that promote different adaptive strategies. This link between ecology and evolution allows radiologic imaging to repeatedly and noninvasively demonstrate spatial and temporal variations in key environmental properties, such as blood flow, interstitial edema, and cellular density, affecting response and resistance during local or systemic cancer therapy.

Titanium dioxide nanoparticles (TiO2 NPs) have novel application and are used in many household application, nanomedicine, agriculture, industries and pharmaceutical products. These applications may be accompanied with potential risk in human health and the ecosystems. The current study was carried out to find out the acute damage that might be induced by TiO2 NPs in the heart and testis. Three groups of Wistar albino rats (Rattus norvegicus) were subjected to a single dose TiO2 NPs (126, 252, 378 mg/kg bw). Cardiac and testicular biopsies from each animal under study were handled for histological and histochemical examination. Rats exposed to TiO2 NPs demonstrated the following cardiac alterations: myofibres wavy appearance, myofibre disarray, partial cross striation, cardiomyocytes hydropic degeneration together with vacuolation and nuclear alterations. Moreover, acute exposure to TiO2 NPs induced the following testicular alterations: spermatocytes degeneration, spermatids sloughing and interstitial edema. The presented cardiac and testicular alterations were dose dependent. From the findings of the present study, it might be concluded that TiO2 nanomaterials are capable of inducing acute cardiac and testicular damage that is dose dependent and could adversely affect the function of the vital organs.

Shenfu injection (SFI) is a well-known Chinese herbal medicine widely used in the treatment of septic shock in China.The aims of this study are to investigate the protective effects of SFI on sepsis-induced myocardial injury in mice and to identify the underlying mechanism of action.Seventy-two male C57/B6J mice (5-6 weeks old) were randomly divided into five groups: control (NC), sham sepsis (sham), sepsis (Lipopolysaccharide- LPS), sepsis treated with a low dose SFI, and sepsis treated with a high dose SFI. Sepsis was induced in mice by intraperitoneal injection of LPS. Myocardial tissue samples were collected from different groups at 6 h, 12 h, and 24 h post-LPS injection. Myocardial injury was examined using hematoxylin-eosin (HE) and TUNEL staining. Western-blot analysis was performed to determine the protein expression of B-cell lymphoma 2 (Bcl-2), BH3 interacting-domain death agonist (Bid), truncated-Bid (t-Bid) and caspase-9 in all the groups. Moreover, the structural changes in the mitochondria of cardiomyocytes were also observed by transmission electron microscopy.HE staining revealed structural damage, local necrosis, interstitial edema, inflammatory cell infiltration and vacuolar changes in the myocardial tissue in the sepsis (LPS) group; almost intact myocardial tissue was observed in the high dose SFI group with improvements in interstitial edema and inflammatory cell infiltration. We observed that LPS-induced cardiomyocyte apoptosis was significantly improved with high dose SFI as compared with sepsis (LPS) group (P ˂ 0.05). LPS was found to decrease the protein expression of Bcl-2 and increase the level of Bid, t-Bid and caspase-9. Treatment with SFI significantly increased the Bcl-2 protein expression (P ˂ 0.05) and decreased the protein expression of Bid, t-Bid and caspase-9 as compared with LPS group (P ˂ 0.05). Markedly swollen myocardial mitochondria with partial vacuolation were observed in LPS treated mice while SFI treatment was found to significantly improve the LPS-induced morphological damage of the mitochondria.In conclusion, we demonstrate that SFI protects against sepsis-induced myocardial injury in mice through the suppression of myocardial apoptosis. It upregulates the protein expression of Bcl-2 and downregulates the protein expression of Bid, t-Bid and caspase-9, and alleviates sepsis-induced mitochondrial damage.

Background.According to the recommendations of the European Society of Cardiology, ultrasound examination of the lung can be used to assess congestive changes, however, this method has so far a low recommendation class IIb and a level of evidence C, which can be regarded as a consequence of its insufficient knowledge.The aim of the research.To study ultrasound characteristics of the lung tissue in patients with intermediate left ventricular function after resolving of acute decompensation of heart failure.Materials and methods. The ultrasound profile of the lung tissue was studied in 71 patients after resolution of acute heart failure decompensation under intermediate left ventricular function. The average age of patients studied was 65.2 ± 3.6 years. 64.3% of them were males ,25.7%-females. Using the ultrasonic method, B-lines were studied, the distance between them being 3 mm and 7 mm in a semi-quantitative manner, according to the method of E. Picano in 2016. The results were statistically processedResults.In persons after the acute decompensation of the heart failure residual congestion persisted with interstitial component dominated in both lungs. Appearance of interstitial lung edema to be considered as prognostic factor of re-hospitalizations rate increasing.Conclusion.Interstitial congestion in the pulmonary parenchyma considered as a factor in the deterioration of the clinical course of heart failure sign of its acute decompensation. In this connection, it is interesting to identify interstitial pulmonary edema at the early stage to prevent real clinical presentation of acute decompensation of the heart failure.

We induce a model of experimental chronic suppurative pneumonia (e-CSP) by prolonged mechanical irritation of the bronchi by the method of Batyreva Z. B., and Shamirzaev N. X in white rats. The purpose and objectives are to study the morphology and cellular response of lung tissue and the walls of the diaphragmatic muscles in e-CSP. During the examination on 30th and 45th days from the beginning of the experiment with the background of purulent inflammation of the lungs we determined mild manifestations of inflammatory changes on the sections of the tissue. There were cellular shifts in the bronchial mucosa, lung tissue and diaphragm with lymphoid reaction and morphological changes in the tissues. These anifestations were characterized by capillary and arterial fullness, focal lymphocytic-macrophage infiltration between the alveolar septa, moderate daily edema, dystrophic and compensatory changes in the lung tissue and walls of the diaphragm. Morphological changes in rats were haracterized by focal infiltration of lymphoid elements, moderate interstitial edema with impaired blood circulation in the pulmonary tissue and the muscular part of the diaphragm wall. On drug-prints in the bronchi and, especially in the lungs, there was a "revival" of both blood and tissue protective cells at the site of inflammation. The main feature of cytological changes in the long-standing form of chronic purulent process in the lungs is a lymphoid reaction with the appearance of young plasma cells, occurring against the background of reduced activity of macrophages, indicating a decrease in the protective capabilities of the body in e-CSP. The revealed morphological and cytological changes occurring in the pulmonary and diaphragm tissues testified to simultaneous inclusion of the pulmonary tissue and diaphragm in the inflammatory process, which must be taken into account in practical health care.

Heart transplantation (HTX) in mice is used to characterize gene-deficient mice and to test new treatment strategies. The purpose was to establish noninvasive magnetic resonance imaging techniques in mice to monitor pathophysiological changes of the allograft during rejection.Magnetic resonance imaging was performed at baseline and days 1 and 6 after isogenic (n = 10, C57BL/6) and allogenic (n = 12, C57BL/6 to BALB/c) heterotopic HTX on a 7 T small animal scanner. Respiratory- and electrocardiogram-gated multislice multi-echo spin echo sequences were acquired, and parameter maps of T2 relaxation time were generated. T2 times in septal, anterior, lateral, and posterior myocardial segments as well as global T2 times were calculated and compared between groups. At day 7 animals were sacrificed and graft pathology was assessed by semiquantitative regional analysis and correlated with magnetic resonance imaging results.Myocardial T2 relaxation time was significantly increased in allogenic (33.4 ± 0.1 ms) and isogenic cardiac grafts (31.8 ± 1.8 ms) on day 1 after HTX compared with healthy donor hearts at baseline (23.1 ± 0.3 ms, P0.001). Until day 6 after HTX, myocardial T2 further increased markedly in allografts but not in isografts (43.4 ± 1.9 vs 31.2 ± 1.1 ms, P0.001). Mean segmental T2 values as well as mean global T2 values in allogenic compared with isogenic cardiac grafts on day 6 were significantly higher (P0.01). Histologically, isogenic grafts were almost normal besides small focal leukocyte infiltrates and signs of interstitial edema, most likely due to ischemia reperfusion injury (histological sum score, 0.9 ± 0.4). In allogenic HTX, histology revealed severe inflammation and tissue edema representing allograft rejection with increased histological scores (5.3 ± 0.7, P0.001). Higher histological scores of rejection were significantly associated with increased T2 times on a segmental and a global level.We could show that T2 mapping is a suitable noninvasive imaging method to monitor global and regional HTX pathologies in experimental heart transplantation in mice. Progressive prolongation of T2 time was significantly associated with pathological signs of rejection.

The article is an overview of publications 2015-2017 on the problems of the infusion therapy of burn shock. Restoration of central and peripheral hemodynamics in the acute period of burn injury is an extremely difficult problem due to the fact that the fluid is especially poorly retained in the bloodstream because of the "capillary leakage" syndrome. A large amount of infusion is dangerous for the development of interstitial edema of tissues and multiple organ failure, therefore the main part of the research is devoted to the development of new methods for optimal infusion therapy of burn shock. At this time, the best results in the treatment of patients during burn shock stage are achieved by the application of early goal directed individualized therapy. This strategy provides for a differentiat ed choice of a combination of colloids and crystalloids for the constant monitoring of hemodynamics using instrumental methods. Further increase in the effectiveness of burn resustication researchers are ass ociated with the use of computerized monitoring systems for infusion therapy, as well as with the improvement of solutions used for transfusion.

Negative-pressure pulmonary edema (NPPE) is acute-onset bilateral pulmonary interstitial edema. This condition can be caused by significant negative intrathoracic pressure generated by large inspiratory effort against acute upper airway obstruction. Postoperative NPPE is rare but potentially life-threatening if not recognized and treated promptly. This article describes a patient who developed postoperative NPPE following a laparoscopic appendectomy.

Background We occasionally noticed that native collateral blood flow showed a recessive trend in the early stages of acute myocardial infarction in rats, which greatly interferes with the accurate assessment of native collateral circulation levels. Here, we sought to recognize the coronary collateral circulation system in depth, especially the microcirculation part, on this basis. Methods and Results In this study, we detected native collateral flow with positron emission tomography perfusion imaging in rats and found that the native flow is relatively abundant when it is initially recruited. However, this flow is extremely unstable in the early stage of acute myocardial infarction and quickly fails. We used tracers to mark the collateral in an ischemic area and a massive preformed collateral network was labeled. The ultrastructures of these collateral microvessels are flawed, which contributes to extensive leakage and consequent interstitial edema in the ischemic region. Conclusions An unrecognized short‐lived native coronary collateral microcirculation reserve is widely distributed in rat hearts. Recession of collateral blood flow transported by coronary collateral microcirculation reserve contributes to instability of native collateral blood flow in the early stage of acute myocardial infarction. The immature structure determines that these microvessels are short‐lived and provide conditions for the development of early interstitial edema in acute myocardial infarction.

Fine reticular opacities are reliable evidence of interstitial lung disease that requires consideration of a variety of acute and chronic diseases. Acute interstitial disease is most often the result of interstitial edema or pneumonia. Both may spread through the bronchovascular and septal interstitium. Involvement of the interlobular septa in the periphery of the lung are described as Kerley B lines. Kerley B lines are a common finding in patients with interstitial edema, but when they are more chronic they are a clue to suspect lymphangitic spread of a tumor. The collagen vascular and idiopathic interstitial lung diseases cause interstitial scarring that is more disorganized and does not spare the normal interstitial septa. Fine reticular opacities may be evidence of an early stage of these diseases.