The Effects of Moxibustion on PD-1/PD-L1-Related Molecular Expression and Inflammatory Cytokine Levels in RA Rats

Objective. Rheumatoid arthritis (RA) is an autoimmune disease that starts with inflammation of the synovium. The pain and joint dysfunction caused by RA urgently need an effective treatment to alleviate the inflammatory reaction and delay the progression of the disease. The pathological damage of RA is proposed to associate with the dysfunction of the programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) pathway. Moxibustion, as a main complementary therapy of traditional Chinese medicine (TCM), has been proved effective to reduce chronic inflammatory reaction on RA, but whether the anti-inflammatory effects are mediated by PD-1/PD-L1 pathway is still unclear. Therefore, moxibustion was conducted in the rats with RA to investigate its effect on PD-1/PD-L1. Methods. The rats' right hind paws were injected with Freundʼs complete adjuvant (FCA) to establish the model of RA. Seven days after the injection of FCA, moxibustion therapy was performed on the acupoints of Shenshu (BL23) and Zusanli (ST36) once a day for three weeks. Then, ELISA and immunohistochemical methods were used to analyze the influence of moxibustion on the expression of PD-1/PD-L1. If the moxibustion had an effect on the expression of PD-1/PD-L1-related molecules, we would knock down PD-1 with adenovirus vector. After moxibustion therapy, ELISA and histological analysis were performed to observe the anti-inflammatory effect of moxibustion. Results. The results demonstrated that moxibustion had an effect on the expression of PD-1-related molecules. The results of ELISA manifested that moxibustion decreased the level of IFN-γ and increased the level of IL-4 and IL-10. HE staining revealed that moxibustion alleviated the proliferation of synovial tissue. However, the anti-inflammatory effect and pathological improvement were weakened when PD-1 was blocked. Conclusions. The results indicate that moxibustion affected the expression of PD-1/PD-L1-related molecules and can effectively treat RA damage. The anti-inflammatory effect of moxibustion was weakened when PD-1 was knocked down.

Hemorrhagic ascites endometriosis could be a cause: a case report

Background Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus, where it induces a chronic inflammatory reaction that may result in scar tissue. Endometriosis with massive ascites causing abdominal distension and other symptoms simulating malignancy has been described in the literature. Case presentation A case of a 27-year-old woman who presented to the Ascites Study Group Tropical Medicine department Ain Shams University in collaboration with the Egyption Club of Ascites (ECA) with increased central abdominal contour, shifting dullness, and hemorrhagic transudate hypocellular ascites with no malignant cells and bilateral ovarian cysts. A long stepwise approach was conducted to the patient, and after exclusion of other causes of hemorrhagic ascites, the patient was prepared for laparoscopy. The diagnosis of endometriosis was made. The patient was discharged on goserelin acetate subcutaneous injection every 28 days with good response, and she regularly follows up with our study group on scheduled visits monthly according to her clinical status. Conclusions Endometriosis could be a possible cause of massive hemorrhagic obscured ascites. The unexplained infertility should increase the probability of the endometriosis.

Should All Endometriotic Cysts Be Removed?

Endometriosis is a chronic condition that affects 5-10% of women of reproductive age. It is characterized by the presence of endometrial tissue outside the uterus, which induces a chronic inflammatory reaction and formation of scar tissue and adhesions, resulting in the deformation of the female pelvis anatomy. Twenty-five to fifty percent of women with infertility suffer from endometriosis, while 30-50% of infertile women are diagnosed with the disease. Endometrioma is a benign cyst of the ovary that contains ectopic endometrial tissue and is a common cause of endometriosis. There are some gray areas regarding clinical decisions and endometriotic cysts. The chapter aims to present current evidence regarding optimal management of endometriotic cysts.

Pulmonary emphysema and atherosclerosis: association or syndrome?

Background Atherosclerosis is an inflammatory reaction of the vessel wall. Emphysema may induce systemic inflammation, part of which may be the development or progression of atherosclerosis. So, the relationship between emphysema and atherosclerosis, whether both are due to the same causative agent and pathogenesis or emphysema led to atherosclerosis, is still not clearly understood. So, the aim of this work is to study the relationship between carotid atherosclerosis versus pulmonary emphysema extent and airflow obstruction. Results Cigarette smoking index was higher in patients than controls. According to FEV1%, patients were classified into: GOLD 1 (mild): FEV1 ≥ 80% predicted, GOLD 2 (moderate): 50% ≤ FEV1 < 80% predicted, GOLD 3 (severe):30% ≤ FEV1 < 50% predicted, and GOLD 4 (very severe): FEV1 < 30% predicted. There was a significant difference between the studied groups as regard to ABG parameters. Emphysema score showed a positive correlation with thrombus size, plaque size, and stenosis percent. Approximately 2/3 of patients had atherosclerotic changes and the other 1/3 had increased IMT. GOLD staging, also, correlated with thrombus size and stenosis percent. So, there was a strong positive correlation between both emphysema score and GOLD staging and carotid atherosclerosis. Conclusion The relationship between emphysema and atherosclerosis is suggested to be the chronic inflammatory reaction (against the same risk factor) based on the positive correlation between carotid atherosclerosis versus emphysema score and GOLD staging. The inherence of emphysema and atherosclerosis may be considered a syndrome. If so, targeting the same pathogenic mechanism will be valuable for their control.

Endometriosis: Unveiling the contemporary issues in diagnosis and treatment

Endometriosis is characterized by the presence of ectopic endometrial-like tissue in extra-uterine sites which may induce chronic inflammatory reaction, scar tissue, and adhesions that may distort the pelvic anatomy. The true prevalence of the disease is not known. The disease usually affects women of the reproductive age group and is most typically diagnosed in women aged between 25-30years. Some of the factors which increase the risk of disease include early menarche, shorter menstrual cycles and nulliparity. The symptoms are often non-specific making diagnosis difficult with resultant delay in initiation of appropriate therapy. However, chronic cyclical or non-cyclical pelvic pain with or without menstrual abnormality is common. This review describes the various management options in endometriosis with emphasis on the effective medical and surgical interventions which are useful in the developing world.

The Role of Oxidative Stress and Membrane Transport Systems during Endometriosis: A Fresh Look at a Busy Corner

Endometriosis is a condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to a chronic inflammatory reaction. It is one of the most widespread gynecological diseases with a 10–15% prevalence in the general female population, rising up to 30–45% in patients with infertility. Although it was first described in 1860, its etiology and pathogenesis are still unclear. It is now accepted that inflammation plays a central role in the development and progression of endometriosis. In particular, it is marked by an inflammatory process associated with the overproduction of an array of inflammatory mediators such as prostaglandins, metalloproteinases, cytokines, and chemokines. In addition, the growth and adhesion of endometrial cells in the peritoneal cavity due to reactive oxygen species (ROS) and free radicals lead to disease onset, its ensuing symptoms—among which pain and infertility. The aim of our review is to evaluate the role of oxidative stress and ROS in the pathogenesis of endometriosis and the efficacy of antioxidant therapy in the treatment and mitigation of its symptoms.

Medical treatment of endometriosis: an update

Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy. Endometriosis is primarily found in young women, but its occurrence is not related to ethnic or social group distinctions. Patients with endometriosis mainly complain of pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female population; in women with pain, infertility, or both, the frequency is 35-50%. This is an evidence based narrative review conducted by searching Medline up to (2017) and other online articles from Pubmed, Google scholar by using terms like Endometriosis, management, evidence based, updated treatment, pharmacoceutical hormon treatment and non-hormonal treatment. Articles were selected based on their currency and relevance to the discussion. Numerous cofactors can play a role in the progression and maintenance of endometriosis, which is thus a complex multifactorial disease. Hormonal therapy represents the treatment of choice in patients with endometriosis; with this in mind, we could consider CAM a supplementary option to be added to hormonal treatment, or as a valuable opportunity for those women in whom medical therapy is contraindicated.

Diagnostic and treatment of endometriosis - recommendations for clinical practice

Endometriosis is characterized by endometrial tissue found outside of the uterus (primarily in the pelvic cavity), causing chronic inflammatory reaction, infertility, and pain. The impact of endometriosis on different aspects of women?s life is important, including family and social life, work, and reproduction. The usual way of examining endometriosis is history taking, recognition of typical symptoms, clinical examination, and the use of imaging techniques, but the diagnosis is made by histopathology findings, usually after laparoscopy. The aim is to represent current recommendations and guidelines referring to endometriosis diagnostics and therapy, proposed by two major societies dealing with reproductive medicine: European Society for Human Reproduction and Embryology (ESHRE) and American Society of Reproductive Medicine (ASRM). The recommendations refer primarily to the therapeutic modalities in infertility and pain problems caused by endometriosis, and represent the basis of appropriate strategy for overcoming numerous problems linked with this chronic illness.