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Combinatorial Chemistry & High... Jun 2024The occurrence of acute lung injury (ALI) caused by lipopolysaccharide (LPS) is prevalent and perilous among older individuals. Inflammation and oxidative stress are...
BACKGROUND
The occurrence of acute lung injury (ALI) caused by lipopolysaccharide (LPS) is prevalent and perilous among older individuals. Inflammation and oxidative stress are vital factors in the progression of ALI in this population. Dayuan Yin (DYY) is a classic Chinese herbal formula used for treating pulmonary diseases. Therefore,this situation can be well simulated by selecting suitable aged rats and induced by LPS, which is helpful to evaluate the role of DYY.
OBJECTIVE
The objective of this study is to assess the therapeutic efficacy of DYY in reducing pulmonary inflammation and oxidative stress injury in aged rats induced by LPS.
METHODS
In elderly male Sprague Dawley (SD) rats, the ALI model was induced by injecting LPS into the peritoneal cavity. The therapeutic effect of the DYY group was evaluated after 3 days of oral administration. Lung tissue damage was assessed using hematoxylin-eosin staining and the lung wet/dry (W/D) ratio. Inflammatory reaction in lung tissue was analyzed by counting inflammatory agents, measuring total protein (TP), and examining the concentration of inflammatory components in bronchoalveolar lavage fluid (BALF). Lung oxidative stress was assessed by measuring malondialdehyde (MDA), inducible nitric oxide synthase (iNOS), and superoxide dismutase (SOD) levels in BALF. The impact of DYY on the phosphorylation of PI3K, AKT, and NF-κBp65 protein was analyzed using Western Blot (WB).
RESULTS
The administration of DYY exhibited a dose-dependent reduction in the severity of lung injury caused by LPS, leading to a reversal of the LPS-induced lung W/D ratio. Furthermore, DYY treatment resulted in decreased levels of leukocytes, eosinophils, neutrophils, macrophages, lymphocytes, and total protein in BALF. Additionally, DYY significantly inhibited the upregulation of Interleukin -6, Interleukin -10, and Interleukin -1β (IL-6, IL-10, IL-1β) as well as Tumor necrosis factor-α(TNF-α) induced by LPS (P<0.01). The lungs experienced oxidative stress due to LPS, leading to the production of MDA and iNOS, as well as a decrease in SOD activity. DYY reduced oxidative stress in the lungs and inhibited the activation of p-PI3K, p-Akt, and p-NF-κBp65, with a greater effect at higher doses.
CONCLUSION
In a dose-dependent manner, DYY suppresses the inflammatory response and oxidative stress in the lung tissue of elderly rats, thereby reducing ALI caused by LPS. This effect may be attributed to the inhibition of the PI3K/AKT/NF-κB pathway activation.
PubMed: 38920065
DOI: 10.2174/0113862073294620240527102409 -
Clinical and Experimental Nephrology Jun 2024This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and... (Review)
Review
This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.
PubMed: 38914913
DOI: 10.1007/s10157-024-02531-5 -
Journal of Surgical Case Reports Jun 2024Uterine rupture is specified as a complete laceration of the uterine wall, including its serosa, leading to a connection between the endometrial and peritoneal chambers....
Uterine rupture is specified as a complete laceration of the uterine wall, including its serosa, leading to a connection between the endometrial and peritoneal chambers. It can occur in any stage of pregnancy and is considered a severe and perhaps fatal complication. A 35-year-old woman at 9 weeks of gestation with a medical history of five prior cesarean sections presented with lower abdominal pain that had lasted for 5 hr. We detected small amounts of free fluid in the Douglas pouch using ultrasound. Subsequently, a laparotomy revealed a cesarean scar dehiscence from a non-cesarean scar pregnancy. Patients who experience a uterine rupture may have vague symptoms, severe abdominal discomfort, abnormal uterine bleeding, and severe hemorrhagic shock, depending on their gestational age. Ultrasound imaging can be used to diagnose this fatal condition in addition to laparoscopy to immediately identify and treat the issue in urgent cases.
PubMed: 38912433
DOI: 10.1093/jscr/rjae422 -
International Journal of Nanomedicine 2024Endometriosis (EM) is an estrogen-dependent benign gynecologic disease affecting approximately 10% of reproductive-age women with a high recurrence rate, but lacks...
INTRODUCTION
Endometriosis (EM) is an estrogen-dependent benign gynecologic disease affecting approximately 10% of reproductive-age women with a high recurrence rate, but lacks reliable biomarkers. No previous studies have investigated the possible use of extracellular vesicle (EV)-associated micro RNAs (miRNAs) from menstrual blood (MB) as candidate diagnostic or prognostic markers of EM.
METHODS
Specimens were obtained from endometriosis and non-endometriosis patients at the International Peace Maternity and Child Health Hospital in Shanghai. Microarray was used to screen differentially expressed miRNAs among peritoneal fluid (PF), fallopian tube fluid (FF), and MB. Dual-luciferase reporter gene assay was carried out to verify the relationship between miR-4443 and ACSS2. Cell proliferation and Transwell invasion assays were performed in vitro after intervention on miR-4443 and ACSS2 in hEM15A human endometrial stromal cells and primary human endometrial stromal cells (hESCs). Spearman correlation analysis, receiver operating characteristic (ROC) curve analysis, and survival analysis were applied to clinical data, including severity of symptoms and relapse of EM among EM patients.
RESULTS
EV-associated miR-4443 was abundant in MB of endometriosis patients. ACSS2 knockdown and miR-4443 overexpression promoted cell proliferation and migration via the PI3K/AKT pathway. miR-4443 levels in MB-EVs were positively correlated with the degree of dyspareunia (r=0.64; P<0.0001) and dysmenorrhea (r=0.42; P<0.01) in the endometriosis group. ROC curve analyses showed an area under the curve (AUC) of 0.741 (95% CI 0.624-0.858; P<0.05) for miR-4443 and an AUC of 0.929 (95% CI 0.880-0.978; P<0.05) for the combination of miR-4443 and dysmenorrhea.
CONCLUSION
MB-derived EV-associated miR-4443 might participate in endometriosis development, thus providing a new candidate biomarker for the noninvasive prediction of endometriosis recurrence.
Topics: Humans; Endometriosis; Female; MicroRNAs; Extracellular Vesicles; Proto-Oncogene Proteins c-akt; Adult; Cell Proliferation; Phosphatidylinositol 3-Kinases; Disease Progression; Cell Movement; Signal Transduction; Cell Line; Endometrium
PubMed: 38911502
DOI: 10.2147/IJN.S456594 -
SAGE Open Medical Case Reports 2024Retroperitoneal cysts, a rare surgical phenomenon, present diagnostic challenges due to their typically asymptomatic nature. A 62-year-old male presented with a 4-month...
Retroperitoneal cysts, a rare surgical phenomenon, present diagnostic challenges due to their typically asymptomatic nature. A 62-year-old male presented with a 4-month history of abdominal distension and increased burping. Upon clinical examination, a soft, distended, nontender abdomen with a palpable mass extending from the epigastric region to 3 cm below the umbilicus was revealed. Imaging revealed a 14.6 cm × 15.8 cm × 16.4 cm nonenhancing retroperitoneal lesion, compressing the right ureter and causing mild right hydronephrosis. Multiple gall bladder calculi, an umbilical hernia, and lipomatous lesions associated with adrenal glands were also discovered. Laparoscopic retroperitoneal cystectomy, cholecystectomy, and umbilical hernia repair were performed. Intraoperatively, 150 ml ascitic fluid and 1200 ml cystic fluid were found. This case highlights the intricate clinical presentation of a retroperitoneal cyst, emphasizing the need for surgical exploration. Successful laparoscopic management contributes to the evolving understanding of optimal treatment strategies.
PubMed: 38911179
DOI: 10.1177/2050313X241263773 -
Journal of Controlled Release :... Jun 2024Peritoneal carcinomatosis (PC) is characterized by a high recurrence rate and mortality following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy...
Peritoneal carcinomatosis (PC) is characterized by a high recurrence rate and mortality following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), primarily due to incomplete cancer elimination. To enhance the standard of care for PC, we developed two cationic liposomal formulations aimed at localizing a toll-like receptor agonist, resiquimod (R848), in the peritoneal cavity to activate the immune system locally to specifically eradicate residual tumor cells. These formulations effectively extended R848 retention in the peritoneum by >10-fold, resulting in up to a 2-fold increase in interferon α (IFN-α) induction in the peritoneal fluid, without increasing the plasma levels. In a CT26 colon cancer model with peritoneal metastases, these liposomal R848 formulations, when combined with oxaliplatin (OXA)-an agent used in HIPEC that induces immunogenic cell death-increased tumor infiltration of effector immune cells, including DCs, CD4, and CD8 T cells. This led to the complete elimination of PC in 60-70% of the mice, while the control mice reached humane endpoints by 30 days. The cured mice developed specific antitumor immunity, as re-challenging them with the same tumor cells did not result in tumor establishment. However, inoculation with a different tumor line led to tumor development. Additionally, exposing CT26 tumor antigens to the splenocytes isolated from the cured mice induced the expansion of CD4 and CD8 T cells and the release of IFN-γ, demonstrating long-term immune memory to the specific tumor. The anti-tumor efficacy of these liposomal R848 formulations was mediated via CD8 T cells with different levels of involvement of CD4 and B cells, and the combination with an anti-PD-1 antibody achieved a cure rate of 90%.
PubMed: 38909698
DOI: 10.1016/j.jconrel.2024.06.041 -
International Journal of Surgery Case... Jun 2024Foreign body ingestion is frequent in younger children, with generally good outcome on conservative management. However, magnetic beads ingestion is an exceptional cause...
INTRODUCTION AND IMPORTANCE
Foreign body ingestion is frequent in younger children, with generally good outcome on conservative management. However, magnetic beads ingestion is an exceptional cause of intestinal perforation in the older children.
CASE PRESENTATION
An 8-year-old boy presented with clinical signs of generalized acute peritonitis. Abdominal plain X-ray confirmed the foreign object in the digestive tract and oriented the etiology by highlighting several air-fluid levels, distended small bowel loops, pneumoperitoneum and the presence of a bilobed foreign body projected adjacent to the 5th lumbar vertebra. Open surgical exploration was performed and revealed a peritoneal fluid, 2 perforations in the small bowel and 2 adhered pieces of magnets. A 20 cm ileal resection, including the segment with the 2 perforations, was performed followed by a terminal ileostomy. The restoration of gastrointestinal continuity was performed 16 days later. After a follow-up of 2 years and 8 months, the patient was free of any symptom.
CLINICAL DISCUSSION
In cases of acute peritonitis due to perforation, the general condition deteriorates progressively. Fever may be absent, as was the case with our patient. Abdominal pain is the predominant symptom, it is often accompanied by vomiting that can be alimentary, bilious, or even fecaloid and/or by cessation of bowel movements and/or gas. Abdominal rigidity is a major physical sign, sometimes replaced by generalized guarding.
CONCLUSION
Ingestion of gastrointestinal foreign bodies is rare in older children, the presence of more than one magnet can lead to peritonitis due to intestinal perforation.
PubMed: 38909390
DOI: 10.1016/j.ijscr.2024.109915 -
Abdominal Radiology (New York) Jun 2024Essential to understanding disease spread in abdomen is to separate the peritoneum from the extraperitoneum. These areas have distinct anatomy with well-define separate... (Review)
Review
Essential to understanding disease spread in abdomen is to separate the peritoneum from the extraperitoneum. These areas have distinct anatomy with well-define separate pathways. The peritoneum is comprised of connected recesses that are potential spaces, normally not imaged except when containing excess fluid or air. Peritoneal recesses are formed by the opposing peritoneal surfaces and subdivided by the attachments of the ligaments and mesenteries to the parietal peritoneum. Disease flows within the recesses by changes in abdominal pressure. This forms a distinct spread pattern. The extraperitoneum is traditionally stratified by the renal fascia into the anterior and posterior pararenal spaces and the perirenal space. The fascia contains and directs spread from the contained organs with the compartments. Each space has a unique spread pattern defined by the containing fascia. The extraperitoneum is connected to the mesenteries and ligaments forming the subperitoneal space. This space interconnects the extraperitoneum with the mesenteries allowing for the normal continuum of blood vessels, lymphatics, and nerves but also forms the pathways for bidirectional spread of disease.
PubMed: 38904709
DOI: 10.1007/s00261-024-04429-y -
International Urology and Nephrology Jun 2024Chloride, the predominant anion in extracellular fluid from humans, is essential to maintaining homeostasis. One important metric for thoroughly assessing kidney...
PURPOSE
Chloride, the predominant anion in extracellular fluid from humans, is essential to maintaining homeostasis. One important metric for thoroughly assessing kidney function is the estimated glomerular filtration rate (eGFR). However, the relationship between variations in serum chloride concentration and eGFR in general populations has been poorly studied. Therefore, the purpose of this study is to elucidate the correlation between serum chloride levels and eGFR within the United States' adult population.
METHODS
This cohort study was conducted using data from the National Health and Nutrition Examination Survey (NHANES), which covered the years 1999-2018. We employed multiple linear regression analysis and subgroup analysis to evaluate the correlation between serum chloride concentration and eGFR. To examine the nonlinear association between serum chloride levels and eGFR, restricted cubic spline analyses were employed.
RESULTS
Data from 49,008 participants in this cohort study were used for the chloride analysis. In the comprehensively adjusted model, a noteworthy inverse relationship was discovered between chloride plasma concentration and eGFR. Restricted cubic spline analyses revealed a significant nonlinear relationship between chloride levels and eGFR (P for overall < 0.001 and P for nonlinear < 0.001). A significant interaction was observed between eGFR and plasma chloride concentration (all P < 0.001 for interaction) among the subgroups characterized by sex, household income to poverty ratio, BMI, hypertension, and diabetes.
CONCLUSION
Our findings suggest that higher levels of chloride plasma concentration were linked to decreased eGFR. These findings underscore the significance of monitoring chloride plasma concentration as a potential indicator for identifying individuals at risk of developing chronic kidney disease (CKD).
PubMed: 38896370
DOI: 10.1007/s11255-024-04119-0 -
Pediatric Transplantation Aug 2024There are no standard management protocols for the treatment of bile leak (BL) after liver transplantation. The objective of this study is to describe treatment options...
UNLABELLED
There are no standard management protocols for the treatment of bile leak (BL) after liver transplantation. The objective of this study is to describe treatment options for BL after pediatric LT.
METHODS
Retrospective analysis (January 2010-March 2023).
VARIABLES STUDIED
preoperative data, status at diagnosis, and postoperative outcome. Four groups: observation (n = 9), percutaneous transhepatic cholangiography (PTC, n = 38), ERCP (2), and surgery (n = 27).
RESULTS
Nine hundred and thirty-one pediatric liver transplantation (859 LDLT and 72 DDT); 78 (8.3%) patients had BL, all in LDLT. The median (IQR) peritoneal bilirubin (PB) level and fluid-to-serum bilirubin ratio (FSBR) at diagnosis was 14.40 mg/dL (8.5-29), and 10.7 (4.1-23.7). Patients who required surgery for treatment underwent the procedure earlier, at a median of 14 days (IQR: 7-19) versus 22 days for PTC (IQR: 15-27, p = 0.002). PB and FSBR were significantly lower in the observation group. In 11 cases, conservative management had resolution of the BL in an average time of 35 days, and 38 patients underwent PTC in a median time of 22 days (15-27). Twenty-seven (34.6%) patients were reoperated as initial treatment for BL in a median time of 17 days (1-108 days); 25 (33%) patients evolved with biliary stricture, 5 (18.5%) after surgery, and 20 (52.6%) after PTC (p = 0.01).
CONCLUSION
Patients with BL who were observed presented significantly lower levels of PB and FSBR versus those who underwent PTC or surgery. Patients treated with PTC presented higher rates of biliary stricture during the follow-up.
Topics: Humans; Liver Transplantation; Retrospective Studies; Male; Female; Infant; Child, Preschool; Child; Postoperative Complications; Cholangiopancreatography, Endoscopic Retrograde; Cholangiography; Adolescent; Bile; Treatment Outcome
PubMed: 38895799
DOI: 10.1111/petr.14814