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International Journal of Molecular... Dec 2022Laparoscopy as a diagnostic tool for patients with suspected endometriosis is associated with several potentially life-threatening complications. Therefore, it is...
Laparoscopy as a diagnostic tool for patients with suspected endometriosis is associated with several potentially life-threatening complications. Therefore, it is imperative to identify reliable, non-invasive biomarkers of the disease. The aim of this study was to analyse the concentrations of fibronectin and type IV collagen in peritoneal fluid and plasma to assess their role as potential biomarkers in the diagnosis of endometriosis. Fibronectin and collagen IV protein levels were assessed by surface plasmon resonance imaging (SPRi) biosensors with the usage of monoclonal antibodies. All patients enrolled in the study were referred for laparoscopy for the diagnosis of infertility or chronic pelvic pain (n = 84). The study group included patients with endometriosis confirmed during surgery (n = 49). The concentration of fibronectin in the plasma (329.3 ± 98.5 mg/L) and peritoneal fluid (26.8 ± 11.1 μg/L) in women with endometriosis was significantly higher than in the control group (251.2 ± 84.0 mg/L, 7.0 ± 5.9 μg/L). Fibronectin levels were independent of endometriosis stage ( = 0.874, = 0.469). No significant differences were observed in collagen IV levels ( = 0.385, = 0.465). The presence of elevated levels of fibronectin may indicate abnormalities in cell-ECM signalling during the course of endometriosis, and may be a potential biomarker for early detection.
Topics: Humans; Female; Endometriosis; Ascitic Fluid; Fibronectins; Collagen Type IV; Biomarkers
PubMed: 36555313
DOI: 10.3390/ijms232415669 -
BMC Gastroenterology Sep 2022Malignancy-related ascites accounts for approximately 10% of causes of ascites. Our AIM was to characterize the ascites fluid and correlate clinical outcomes in those...
BACKGROUND
Malignancy-related ascites accounts for approximately 10% of causes of ascites. Our AIM was to characterize the ascites fluid and correlate clinical outcomes in those with extrahepatic malignancy and ascites.
METHODS
241 subjects with extrahepatic solid tumors and ascites were reviewed from 1/1/2000 to 12/31/2019, 119 without liver metastasis and 122 with liver metastasis.
RESULTS
Ascites fluid consistent with peritoneal carcinomatosis (PC) was most common, 150/241 (62%), followed by fluid reflecting the presence of portal hypertension (PH), 69/241 (29%). 22/241 (9%) had low SAAG and low ascites fluid total protein, with evidence of PC on cytology and or imaging in 20/22. Lung cancer was the most common malignancy in subjects with ascites due to PC at 36/150 (24%), pancreatic cancer was the most common in subjects with ascites with features of PH at 16/69 (23%). Chemotherapy or immunotherapy alone was the most common management approach. Significantly higher 5-year, 3-year and 1-year mortality rate were noted in subjects with evidence of PC on cytology/imaging versus subjects with no evidence of PC, and in subjects with liver metastasis compared to subjects without liver metastasis. Subjects with pancreatic cancer and evidence of PC on cytology/imaging had higher 1 and 5-year mortality rates compared to subjects without PC.
CONCLUSIONS
Ascites in solid tumor malignancy is most commonly due to PC. We also observed ascites fluid with characteristics of PH in 29% of subjects. Higher mortality rates in subjects with peritoneal carcinomatosis and liver metastasis were noted. These findings may help inform prognosis and treatment strategies.
Topics: Ascites; Ascitic Fluid; Humans; Hypertension, Portal; Liver Neoplasms; Pancreatic Neoplasms; Peritoneal Neoplasms
PubMed: 36064324
DOI: 10.1186/s12876-022-02487-4 -
Annals of the New York Academy of... Dec 2015Peritoneal B-1a cells are characterized by their expression of CD5 and enrichment for germline-encoded IgM B cell receptors. Early studies showing expression of a... (Review)
Review
Peritoneal B-1a cells are characterized by their expression of CD5 and enrichment for germline-encoded IgM B cell receptors. Early studies showing expression of a diverse array of VDJ sequences among purified B-1a cells provided a molecular basis for understanding the heterogeneity of the B-1a cell repertoire. Antigen-driven positive selection and the identification of B-1a specific progenitors suggest multiple origins of B-1a cells. The introduction of new markers such as PD-L2, CD25, CD73, and PC1 (plasma cell alloantigen 1, also known as ectonucleotide phosphodiesterase/pyrophosphatase 1) further helped to identify phenotypically and functionally distinct B-1a subsets. Among many B-1a subsets defined by these new markers, PC1 is unique in that it subdivides B-1a cells into PC1(hi) and PC1(lo) subpopulations with distinct functions, such as production of natural IgM and gut IgA, response to the pneumococcal antigen PPS-3, secretion of interleukin-10, and support for T helper 1 (TH 1) cell differentiation. RNA sequencing of these subsets revealed differential expression of genes involved in cellular movement and immune cell trafficking. We will discuss these new insights underlying the heterogeneous nature of the B-1a cell repertoire.
Topics: Animals; Ascitic Fluid; B-Lymphocyte Subsets; Cell Differentiation; Genetic Heterogeneity; Humans
PubMed: 25988856
DOI: 10.1111/nyas.12791 -
Klinicka Mikrobiologie a Infekcni... Dec 2016Spontaneous bacterial peritonitis (SBP) is the most frequent infectious complication of liver cirrhosis with serious consequences. Initially, SBP is always treated with...
AIM OF STUDY
Spontaneous bacterial peritonitis (SBP) is the most frequent infectious complication of liver cirrhosis with serious consequences. Initially, SBP is always treated with empirical, not targeted, antibiotic therapy. Since a retrospective study performed in our department showed suboptimal effectiveness (only 40 %) of empirical antibiotic therapy in accordance with the EASL guidelines, a decision was made to change the protocol. The aims of this prospective study were to determine: (1) the incidence and characteristics of SBP in real clinical practice - in a liver unit of a tertiary hospital, (2) the effectiveness of new antibiotic therapy selected based on analysis of the spectrum of pathogens and their resistance to antibiotics as identified in a retrospective cohort study on SBP carried out in our department, (3) mortality, and to compare these findings with the literature data.
MATERIAL AND METHODS
A prospective cohort observational pragmatic study.
SETTING
Department of Hepatology, Gastroenterology and Liver Transplantation, 2nd Internal Clinic, Slovak Medical University and F. D. Roosevelt Teaching Hospital with Polyclinic in Banska Bystrica. Time interval: November 2012-August 2013.
INCLUSION CRITERIA
hospitalization for liver cirrhosis, ascites ≥ grade 2, informed consent. The study was approved by the local ethics committee.
EXCLUSION CRITERIA
malignancy, secondary bacterial peritonitis.
DIAGNOSIS
SBP was defined by the count of neutrophil leukocytes in ascites ≥ 250/mm3). Positive ascitic fluid culture was not a necessary condition for the diagnosis. From each patient, 10 mL of ascitic fluid were sampled into two blood culture bottles, anaerobic and aerobic. Therapeutic response: defined as a decrease in NeA to 25 % of the baseline value after 48-72 hours, in accordance with the EASL guidelines. The absence of response was indication for change of the antibiotic therapy strategy. Empirical antibiotic therapy: The drug of choice was piperacillin/tazobactam 4 g/0.5 g i.v. every 8 hours for 5 days. Additionally, 20% human albumin at doses of 1.5 g/kg of patient weight on day 1 and 1.0 g/kg of patient weight on day 3 from the diagnosis was administered. If there was no response, (a) second choice antibiotic therapy according to analysis of the spectrum of pathogens and their resistance as identified in the former retrospective study on SBP, that is, ertapenem 1g i.v. every 24 hours for 5 days, or (b) targeted antibiotic therapy according to analysis of ascitic fluid culture performed in the meantime was initiated.
RESULTS
The inclusion criteria were met by 65 patients (99 episodes); the incidence of SBP was 9 out of 99 episodes (9.1 %); 5 out of the 9 cases had positive bacterial culture (56 %), with most of bacteria being Gram-positive (4 out of 5 cases, 89 %). Therapeutic response was documented in 7 out of the 9 cases (78 %). The in-hospital mortality of patients with SBP was 11 %.
CONCLUSIONS
SBP was detected in one out of ten patients with cirrhotic ascites. The selection of empirical therapy in accordance with the principles of antibiotic stewardship led to an increase in therapeutic response to more than 75 %. Effective treatment of SBP is a prerequisite for reduction of mortality.
Topics: Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cohort Studies; Humans; Liver Cirrhosis; Peritonitis; Prospective Studies; Treatment Outcome
PubMed: 28147426
DOI: No ID Found -
Acta Cytologica 2023Evaluation of peritoneal fluid cytology, either from ascitic fluids or as a result of peritoneal washings, is a fundamental aspect in the evaluation of women presenting... (Review)
Review
BACKGROUND
Evaluation of peritoneal fluid cytology, either from ascitic fluids or as a result of peritoneal washings, is a fundamental aspect in the evaluation of women presenting with clinically concerning or histologically confirmed gynecologic neoplasms.
SUMMARY
Ascitic fluid samples are often the initial and only source of diagnostic material in women presenting with gynecologic malignancies, and important therapeutic decisions will result from the information provided in the cytology report. On the other hand, cytologic evaluation of peritoneal washing specimens obtained during surgical excision of a presumed gynecologic neoplasm provides crucial information to the clinical team regarding tumor staging, often with significant therapeutic implications. While recognition of high-grade tumors in either of these samples is generally straightforward, low-grade tumors and unusual neoplasms can prove to be more difficult to recognize, differentiate from benign mimics, and correctly diagnose, particularly in low-cellularity specimens. Even with high-grade tumors, a mere diagnosis of "positive for malignancy" in diagnostic ascitic fluid specimens might not suffice to guide clinical management, and the use of ancillary techniques to further and more definitively characterize the lesional cells is required.
KEY MESSAGES
This review will focus on the clinically relevant issues surrounding interpretation of peritoneal fluid cytology specimens in the setting of gynecologic neoplasms, making emphasis on the salient cytomorphologic and immunocytochemical features of the various neoplastic processes, in an attempt to provide a practical yet effective guide on how to best evaluate, diagnose, and report these samples.
Topics: Female; Humans; Genital Neoplasms, Female; Ascitic Fluid; Peritoneal Lavage; Cytodiagnosis; Ovarian Neoplasms
PubMed: 36572015
DOI: 10.1159/000528800 -
Acta Cytologica 2019Serous fluids are a common but important specimen type in a cytopathology laboratory. There is as yet no agreed standardized terminology to allow uniformity in reporting...
Serous fluids are a common but important specimen type in a cytopathology laboratory. There is as yet no agreed standardized terminology to allow uniformity in reporting on these specimens. Given that serous fluids are a rich source of cytopathological as well as molecular information on a range of benign and often advanced malignant conditions, a unified approach to handling and reporting these specimens covering the pre-analytical, analytical and postanalytical stages seems timely. Representatives of the international cytology community have come together once again to develop an algorithmic diagnostic and management approach to the reporting of these samples.
Topics: Ascitic Fluid; Consensus; Cytodiagnosis; Humans; Peritoneal Lavage; Predictive Value of Tests; Reproducibility of Results; Terminology as Topic
PubMed: 31234178
DOI: 10.1159/000501536 -
Gynecological Endocrinology : the... 2020The present study was to find a pathogenic evidence for dopamine agonist application in patients with endometriosis associated pain syndrome.
OBJECTIVE
The present study was to find a pathogenic evidence for dopamine agonist application in patients with endometriosis associated pain syndrome.
PATIENTS AND TECHNIQUE
The study involved 227 patients of reproductive age with histologically confirmed genital endometriosis (GE) of I-III degree according to ASRM classification. The control group included 12 women with no laparoscope detected gynecologic pathology. The levels of prolactin (PRL), peripheral blood (PB), and peritoneal fluid (PF) were evaluated by chemiluminescence immune assay. The pain syndrome was measured by McGill visual analogue scale. Statistica10 program (StatSoft, Inc., Tulsa, OK) was applied for obtained data processing.
RESULTS
A correlation was established between GE rate and levels of PRL and PB (Rs = 0.28, < .05) as well as a correlation of PRL in PB and PF (Rs = 0.29, < .05). Patients receiving cabergoline combined with hormone therapy standard schemes manifested considerable pain syndrome relief.
CONCLUSIONS
PRL involvement in GE pathogenesis and more intense therapeutic impact on pain syndrome in case of combined administration of dopamine and standard hormone therapy prove cabergoline application in clinical practice.
Topics: Adult; Ascitic Fluid; Cabergoline; Dopamine Agonists; Drug Therapy, Combination; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Molecular Targeted Therapy; Pelvic Pain; Peritoneal Diseases; Prolactin; Russia; Syndrome; Treatment Outcome
PubMed: 33305662
DOI: 10.1080/09513590.2020.1816720 -
Vnitrni Lekarstvi Feb 2015Spontaneous bacterial peritonitis (SBP) represents a frequent and serious complication in patients with ascites in liver cirrhosis. Hospital mortality in patients with... (Review)
Review
Spontaneous bacterial peritonitis (SBP) represents a frequent and serious complication in patients with ascites in liver cirrhosis. Hospital mortality in patients with SBP reaches 10-20 %, so it is necessary to consider this diagnosis in every clinical decompensation of a cirrhotic patient, diagnose it early and treat it effectively. The clinical manifestation is nonspecific and variable, up to one third of patients might be asymptomatic. The diagnosis of SBP is based on the ascitic neutrophils count greater than 250 per mm3. Bacteriological examination of ascites fluid detects causative agents at less than half of the cases and the result is available after a few days. However, treatment should be initiated without delay. SBP is generally treated with antibiotics, the first choice therapy are the third generation cephalosporins, mostly cefotaxime, alternatively fluoroquinolones. Long-term prognosis of patients with the history of SBP is poor owing to its high recurrence rate, one-year survival after an episode of SBP is 30-40 %, 20 % at two years. Therefore, these patients should receive long-term antibiotic prophylaxis and should be evaluated for liver transplantation.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ascites; Ascitic Fluid; Bacterial Infections; Humans; Liver Cirrhosis; Liver Transplantation; Peritonitis; Prognosis
PubMed: 25813257
DOI: No ID Found -
European Journal of Gastroenterology &... Jun 2020Recurrence of spontaneous bacterial peritonitis (SBP) is still a matter of debate. We conducted this study to evaluate the probable factors that predict the recurrence...
BACKGROUND AND AIMS
Recurrence of spontaneous bacterial peritonitis (SBP) is still a matter of debate. We conducted this study to evaluate the probable factors that predict the recurrence of SBP in patients who recovered from the first episode of SBP and the long-term outcomes of SBP recurrence.
METHODS
One hundred twenty-four patients diagnosed with liver cirrhosis, SBP and did not receive secondary prophylaxis either with norfloxacin or other antibiotics were included in this prospective cohort pilot study. Clinical, biochemical and ascitic fluid analysis parameters were evaluated. Ascitic fluid interferon-γ-induced protein (IP-10), calprotectin, interleukin-6 and tumor necrosis factor-α were measured by ELISA.
RESULTS
Of these, 76 patients survived with an in-hospital mortality rate of 38.7%. The survivors were classified into two groups according to recurrence and nonrecurrence of SBP and survival time, clinical parameters and cause of death were investigated. Thirty-one participants had one or more attacks of SBP, with a recurrence rate of 40.8% within one-year follow-up. Before discharge, multivariate analysis showed that ascitic IP-10 (≥1220 pg/ml), ascitic calprotectin (≥550 ng/ml), serum albumin (≤2.5 g/dl), nonuse of prophylactic β-blockers and use of proton-pump inhibitors (PPIs) were the independent variables in predicting recurrent SBP. Sepsis-related organ failure was the most common etiology of mortality in the recurrent SBP group within 3 and 6 months.
CONCLUSION
Increased ascitic calprotectin and IP-10, hypoalbuminemia, nonuse of prophylactic β-blockers and use of PPI were independently associated with increased SBP recurrence rate. Sepsis-related organ failure was the most common etiology of mortality.
Topics: Adult; Aged; Ascites; Ascitic Fluid; Bacterial Infections; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Pilot Projects; Prospective Studies; Recurrence; Risk Factors
PubMed: 31651658
DOI: 10.1097/MEG.0000000000001578 -
Journal of Human Nutrition and... Jun 2020There is a high prevalence of malnutrition among people with decompensated liver disease. Standard nutritional screening tools use weight and body mass index (BMI) to... (Observational Study)
Observational Study
BACKGROUND
There is a high prevalence of malnutrition among people with decompensated liver disease. Standard nutritional screening tools use weight and body mass index (BMI) to identify risk, although these are difficult to measure for those with ascites, often secondary to liver cirrhosis. Dietetic guidance suggests adjusting for ascitic weight by 2.2-14 kg, although there is a lack of evidence to substantiate these values. The present study aimed to measure the contribution of ascitic fluid weight and compare this with the current guidance, as well as to examine whether girth circumference can be used to estimate ascitic weight.
METHODS
A cross-sectional, observational study was conducted over 13 weeks. Participants attending for paracentesis were weighed, their girths measured, and BMI was calculated pre- and post-paracentesis. Fluid removed via paracentesis was recorded. Ethical approval was received (IRAS project ID: 218747).
RESULTS
Eighteen participants underwent paracentesis. The range of ascitic fluid drained was 3.8-19 L [mean (SD) = 8.7 (3.7) L]. Weight difference between pre- and post-paracentesis was in the range 4.5-20 kg [mean (SD) = 8.7 (3.9) kg]. Ascitic fluid weight is shown to be higher in each category (minimal, moderate, severe ascites) than the current guidance values. Weight difference was greater than 14 kg in 11% (n = 2) of participants. A strong, statistically significant relationship (rho = 0.68, P ≤ 0.01) between ascitic weight and pre-paracentesis girth was found. An equation was formulated to enable the estimation of ascitic fluid from pre-paracentesis girth.
CONCLUSIONS
Current dietetic guidance should be re-evaluated to reflect the greater weight differences identified. Measuring girth pre-paracentesis may help to inform dry weight estimation. Further research is required to verify the accuracy of estimating ascitic weight from pre-paracentesis girth.
Topics: Aged; Ascites; Ascitic Fluid; Body Weight; Cross-Sectional Studies; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Nutrition Assessment; Nutritional Status; Paracentesis; Waist Circumference; Weight Gain
PubMed: 31775184
DOI: 10.1111/jhn.12721