Influences of sodium and glycosaminoglycans on skin oedema and the potential for ulceration: a finite-element approach

Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion

Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.

Free and bound sodium identification by skin dielectric properties separation algorithm of bioelectrical impedance spectroscopy (spa-BIS) in human skin model

Free and bound sodium in human skin models have been identified by two proposals: skin's phantom fabrication and skin's dielectric properties separation algorithm of bioelectrical impedance spectroscopy (spa-BIS). Thespa-BIS consist of conductivity-permittivity separation, contact impedance compensation, and a correlation score algorithm based on the vessel with a bipolar electrode. The skin phantom fabrication comprises a recipe combination with temperature-controlled protocol and sodium molarity calculation. In experiments, the human skin models are created to mimic the electrical properties of skin under1MHzwith several different sodium molarities. Based on five types of human skin models with five samples of each group, the free sodium type conductivity and concentration resultsR2=0.9903-following a linear trendline of concentration change in skin tissues theorems with the fRequency range from1kHzto1MHz,while the bound sodium type resultsR2=0.9061-.Thespa-BIS compensate7-16Ωof vessel contact impedance. The dielectric properties of each type have been extracted with less than 10% of the average standard deviation, which is considered an accurate identification method of dermis dielectric properties. The algorithm successfully identifies sodium type: free sodium has a negative, and bound sodium has a positive correlation score trend. As an additional discussion, the different time-dependent effects, the different water content, and different agar content analyses have been provided in this study. As a robust analysis method, thespa-BIS has a prominent performance to replace a²³Na-MRI in terms of free and bound sodium identification.

Solid state structure of sodium β-1-thiophenyl glucuronate identifies 5-coordinate sodium with three independent glucoronates

Glucuronic acid is a key component of the glycosaminoglycans (GAGs) Chrondroitin Sulfate (CS), Heparin/Heparan sulfate (HS) and Hyaluronic Acid (HA), as well an important metabolite derivative. In biological systems the carboxylate of uronic acids in GAGs is involved in important H-binding interactions, and the role of metal coordination, such as sodiated systems, has indications associated with a number of biological effects, and physiological GAG-related processes. In synthetic approaches to GAG fragments, thioglycoside intermediates, or derivatives from these, are commonly employed. Of the reported examples of sodium coordination in carbohydrates, 6-coordinate systems are usually observed often with water ligands involved, Herein we report an unexpected 5-coordinate sodiated GlcA crystal structure of the parent GlcA, but as a thioglycoside derivative, whose crystal coordination differs from previous examples, with no involvement of water as a ligand and containing a distorted trigonal bypramidal sodium with each GlcA having five of 6 oxygens sodium-coordinated.