A recent single-center retrospective study by Rao et al has offered valuable insights into the prognostic utility of ascitic fluid characteristics in acute pancreatitis.Their findings,which demonstrate associations be...A recent single-center retrospective study by Rao et al has offered valuable insights into the prognostic utility of ascitic fluid characteristics in acute pancreatitis.Their findings,which demonstrate associations between ascitic color,turbidity,and elevated lactate dehydrogenase levels with organ failure,infected pancreatic necrosis,and in-hospital mortality provide a valuable contribution to a relatively underexplored area in pancreatology.However,the reliance on subjective visual assessment and a single time-point evaluation raises concerns regarding reproducibility and dynamic disease monitoring.Furthermore,the lack of integration with objective indicators such as polymorphonuclear cell counts,microbiological cultures,and exudative vs transudative analysis limits the interpretability of the results.Despite these limitations,the study provides a clinically relevant framework that supports further investigation and refinement through prospective,multicenter validation.展开更多
Introduction: After an episode of spontaneous infection of ascitic fluid (ISLA). The recurrence of ISLA at one year is greater than 70%. We studied the risk factors associated with the occurrence of recurrence. Patien...Introduction: After an episode of spontaneous infection of ascitic fluid (ISLA). The recurrence of ISLA at one year is greater than 70%. We studied the risk factors associated with the occurrence of recurrence. Patients and methods: this was a retrospective, descriptive and analytical study of patient files, hospitalized in the department for 12 months, the choice of the sample was of convenience. Results: We have 1347 patient files collected including 389 cases of cirrhosis. We had 37 files of cirrhotic patients with ISLA including 28 cures without recurrence of ISLA, 08 files of patients with recurrence of ISLA and 03 excluded, i.e. a hospital prevalence of recurrence of 0.6% and a prevalence in cirrhotic patients of 23.5%. The most common antecedents were: hospital contact recent (35.3%), the concept of iterative ascites punctures (32.3%), the presence of HCC (29.4%), hepatic encephalopathy (20.6%) and digestive hemorrhage (14.7%). In univariate analysis, recent digestive bleeding was associated with an increased risk of recurrence (OR 7.2, 95% CI 0.96 - 67.1). HBV (62.5%) is the main etiology of cirrhosis. The PNN rate at 250 - 499 mm3 (62.5%), the protein level 3 (75%). Patients on secondary prophylaxis with NORFLOXACIN were 25%. Recurrence of ISLA was treated with CEFTRIAXONE 2 g/24 hours. Conclusion: Recurrence of ISLA is serious, the predictive factors for recurrence are, hospital contact recent, the concept of iterative ascites punctures, the presence of HCC, the presence of hepatic encephalopathy and digestive bleeding.展开更多
Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual co...Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an "instant" bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic effi cacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.展开更多
Objective: To evaluate the effects of methanol root extract of Mahonia leschenaultii and berberine of Mahonia leschenaultii on Dalton’s ascitic lymphoma in Swiss Albino mice. Methods: The methanol root extracts of Ma...Objective: To evaluate the effects of methanol root extract of Mahonia leschenaultii and berberine of Mahonia leschenaultii on Dalton’s ascitic lymphoma in Swiss Albino mice. Methods: The methanol root extracts of Mahonia leschenaultii(200 and 400 mg/kg) were given orally, and berberines(10 and 20 mg/kg) were injected intra-peritoneally for 14 successive days in tumor bearing mice. Hematological parameters(white and red blood cells, haemoglobin level, granulocytes, and agranulocytes), lipid parameters(total cholesterol and triglycerides), serum enzymes(serum glutamate pyruvate transaminases, serum glutamate oxaloacetate transaminases, and alkaline phosphatise) and mean survival and solid tumor growth were determined and compared with untreated mice. 5-fluorouracil(20 mg/kg) was used as a reference standard drug. Results: Mahonia leschenaultii and berberine reduced the hematocrit significantly. Furthermore, Mahonia leschenaultii and berberine improved the survival of mice significantly and restored the affected hematological and lipid parameters similar to the normal levels. Conclusions: These observations show a strong anticancer effect of methanol root extract of Mahonia leschenaultii and berberine in suppressing Dalton’s ascitic lymphoma cancer cell growth in a mouse model by controlling haematological, lipid, serum enzymes, and other derived parameters effectively.展开更多
AIM: Sargassum wightii Greville is a marine brown alga belonging to the Sargassaceae family which has about 200 species. The ethanolic extract of the whole dry plant powder contained numerous phytoconstituents, includ...AIM: Sargassum wightii Greville is a marine brown alga belonging to the Sargassaceae family which has about 200 species. The ethanolic extract of the whole dry plant powder contained numerous phytoconstituents, including flavonoids. The study was focused on the anticancer activity of Sargassum wightii in mice. METHOD: The ethanolic extract of Sargassum wightii(EESW) at two dose levels was used to examine the anticancer activity in mice using DAL cell lines to induce cancer. The body weight, viable and non-viable tumor cell count, mean survival time, increase in life span, and hematological parameters were observed for anticancer activity of EESW. RESULTS: The intraperitoneal inoculation of DAL cells in mice significantly increased cancer cell count. The decrease in the cancer cell number observed in the EESW-treated group cancer animals indicates that the test drug has a significant inhibitory effect on the tumor cell proliferation. Treatment with EESW also showed a significant decrease in tumor weight, and hence increased the lifespan of DAL-treated mice. In addition, EESW administration significantly restored the hematological parameters in DAL-treated mice. CONCLUSION: The present study results suggest that administration of extract offers enhanced antioxidant potential. Therefore it can be concluded from this study that EESW possesses anticancer activity.展开更多
AIM: To examine body fluids such as ascitic fluid (AF),saliva,bile and pleural effusions for the presence of hepcidin using a novel radioimmunoassay (RIA).METHODS: Serum samples were collected from 25 healthy voluntee...AIM: To examine body fluids such as ascitic fluid (AF),saliva,bile and pleural effusions for the presence of hepcidin using a novel radioimmunoassay (RIA).METHODS: Serum samples were collected from 25 healthy volunteers (mean age: 36 ± 11.9 years,11 males,14 females).In addition bile was obtained from 12 patients undergoing endoscopic retrograde cholangiopancreatography (mean age: 66.9 ± 16.7 years,M:F = 5:7).Saliva was collected from 17 healthy volunteers (mean age: 35 ± 9.9 years,M:F = 8:9).Pleural and AF were collected from 11 and 16 patients [(mean age: 72 ± 20.5 years,M:F = 7:4) and (mean age: 67.32 ± 15.2 years,M:F = 12:4)],respectively.All biological fluid samples (serum,exudative and transudative fluids) were tested for the presence of hepcidin-25 molecule using RIA.RESULTS: Hepcidin-25 was detected in all biological fluids tested.The mean ± SD hepcidin-25 in serum was 15.68 ± 15.7 ng/mL,bile 7.37 ± 7.4 ng/mL,saliva 3.4 ± 2.8 ng/mL,exudative fluid 65.64 ± 96.82 ng/mL and transudative fluid 14.1 ± 17.8 ng/mL.CONCLUSION: We provide clear evidence that hepcidin-25 is present in bile,saliva,pleural and ascitic fluids.Hepcidin is likely to play a role here in innate immunity.展开更多
Chromosomes in 1620 metaphases of ascitic fluid cells in 20 cases of ovariancarcinoma were analyzed.The results showed that there were marked structuralaberrations aside from significant increase in chromosomal numeri...Chromosomes in 1620 metaphases of ascitic fluid cells in 20 cases of ovariancarcinoma were analyzed.The results showed that there were marked structuralaberrations aside from significant increase in chromosomal numerical aberrations(85.2%).In the ascitic fluid cells from 12 patients,15 types of marker chromosomes were found,among which t(6;14)(q21;q24)and t(2;6)(q35;p12)were more frequently noted witha rate of 7.84% and 7.59% respectively,which was significantly higher than that of othermarker chromosomes(P【0.01).The findings suggested that,besides t(6;14)(q21;q24),t(2;6)(q35;p12)may also be a specific marker chromosome of ovarian carcinoma.展开更多
In mixed lymphocyte-tumor all culture in vitro, the ability of thymus lymphocytes adhering to tumor cells was found to be essentially consistent with its emperipolesis index, though not synchronous. Tumor cells at dif...In mixed lymphocyte-tumor all culture in vitro, the ability of thymus lymphocytes adhering to tumor cells was found to be essentially consistent with its emperipolesis index, though not synchronous. Tumor cells at different progressive stages and in the mixed cultures with or without Con A stimulation also varied in the sensitivity to lymphocyte adhesion and emperipolesis. Tumor adhesiveness anl emperipolesis of theymus lymphocytes and their PNA-, PNA+ subgroups were shown to be different significantly from splenic lymphocytes. Thymosin exhibited certain promotive effect on lymphocyte-tumor adhesion and emperipolesis.展开更多
The mature Shiga toxin B （StxB） gene was optimized and generated by overlapping PCR. Recombinant expression vector pQE40-DHFR/StxB was constructed when the gene was cloned into pQE fusion expression vector. Induced ...The mature Shiga toxin B （StxB） gene was optimized and generated by overlapping PCR. Recombinant expression vector pQE40-DHFR/StxB was constructed when the gene was cloned into pQE fusion expression vector. Induced by Isopropyl β-D-thiogalactoside （IPTG）, the DHFR/StxB fusion protein was highly expressed to the level of 41.36% in E. coli MI5 cells. The 35 kDa fusion protein with a 6 His-tag was one-step purified from inclusion bodies using Ni-NTA affinity chromatography column under denaturing conditions, and was refolded by dialyzing with a decreasing urea gradient. Purified DHFR/StxB fusion protein was used to immunize Kunming mice for generating the ascitic polyclonal antibody against recombinant StxB protein by injecting sarcoma 180 cells and the titer ofascitic polyclonal antibody is up to 1： 1× 10^6 detected by the indirect enzyme linked immunosorbent assy （ELISA）. Western immunoblotting analysis revealed that the ascitic polyclonal antibody against StxB had a specific affinity for a 70 kDa shiga toxin protein of Shigella dysenteriae type 1. It is a new simple and quick method to produce a large amount of ascitic polyclonal antibody. The antibody is used to develop immunological method for detecting shiga toxin.展开更多
AIM: To evaluate the diagnostic capability of calprotectin in ascitic fluid for detecting a polymorphonuclear (PMN) cell count > 250/μL ascites. METHODS: In this prospective observational study, a total of 130 asc...AIM: To evaluate the diagnostic capability of calprotectin in ascitic fluid for detecting a polymorphonuclear (PMN) cell count > 250/μL ascites. METHODS: In this prospective observational study, a total of 130 ascites samples were analysed from 71 consecutive patients referred for paracentesis. Total and differential leukocyte cell counts were determined manually with a Neubauer chamber and gentianviolet stain. Calprotectin was measured in 1 mL ascetic fluid by enzyme-linked immunosorbent assay (ELISA) and a point-of-care (POC) lateral flow assay with the Quantum Blue Reader (Bühlmann Laboratories). All measurements were carried out in a central laboratory by senior personnel blinded to patient history. A PMN count > 250/μL was the primary endpoint of the study. The diagnostic value of ascitic calprotectin measurement was assessed by comparing to the final diagnosis of each patient that had been adjudicated by investigators blinded to calprotectin values. RESULTS: The PMN count was > 250/μL in 19 samples (14.6%) from 15 patients (21.1%) and varied widely among the study population (range 10-19 800/mL and 1-17 820/mL, respectively). Spontaneous bacterial peritonitis (SBP) was the final diagnosis in four patients (5.6%). All patients with PMN ≤ 250/μL had negative bacterial culture. PMN count was elevated in five patients with peritoneal carcinomatosis, three with lymphoma, one with neuroendocrine carcinoma, and two with secondary peritonitis due to abdominal perforation. PMN cell counts correlated with ascitic calprotectin values (Spearman's rho; r = 0.457 for ELISA, r = 0.473 for POC). A considerable range of ascitic calprotectin concentrations was detected by ELISA [median 0.43 μg/mL, interquartile range (IQR) 0.23-1.23 (range 0.10-14.93)] and POC [median 0.38 μg/mL, IQR 0.38-0.56 (range 0.38-13.31)]. Ascitic calprotectin levels were higher in samples with PMN > 250/μL, by both ELISA [median (IQR) 2.48 μg/mL (1.61-3.65) vs 0.10 μg/mL (0.10-0.36), P < 0.001] and POC [2.78 μg/mL (2.05-5.37) vs 0.38 μg/mL (0.38-0.41), P < 0.001]. The area under the receiver operating characteristics curve for identifying an elevated PMN count was 0.977 (95%CI: 0.933 to 0.995) for ELISA and 0.982 (95%CI: 0.942 to 0.997) for POC (P = 0.246 vs ELISA). Using the optimal cut-off value for ELISA (0.63 μg/mL), ascitic calprotectin had 94.8% sensitivity, 89.2% specificity, positive and negative likelihood ratios of 8.76 and 0.06 respectively, positive and negative predictive values of 60.0% and 99.0% respectively, and 90.0% overall accuracy. Using the optimal cut-off value for POC (0.51 μg/mL), the respective values were 100.0%, 84.7%, 6.53, 0.00, 52.8%, 100% and 87.7%. Correlation between ELISA and POC was excellent (r = 0.873, P < 0.001). The mean ± SD of the difference was -0.11 ± 0.48 μg/mL with limits of agreement of + 0.8 μg/mL (95%CI: 0.69 to 0.98) and -1.1 μg/mL (95%CI: -1.19 to -0.91). CONCLUSION: Ascitic calprotectin reliably predicts PMN count > 250/μL, which may prove useful in the diagnosis of SBP, especially with a readily available bedside testing device.展开更多
Angeloni et al published a landmark study on the use of Coulter counters in spontaneous bacterial peritonitis(SBP)diagnosis.Riggio and Angeloni have recently published an editorial on the ascitic fluid analysis in dia...Angeloni et al published a landmark study on the use of Coulter counters in spontaneous bacterial peritonitis(SBP)diagnosis.Riggio and Angeloni have recently published an editorial on the ascitic fluid analysis in diagnosis and monitoring of SBP.Herein,some points of interest are discussed.展开更多
BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM...BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM-CART).The tumor cells derived via KM-CART were utilized secondarily in an in vitro cell growth assay using the collagen gel droplet-embedded culture drug sensitivity test(CD-DST)to investigate anticancer drug susceptibility.CASE SUMMARY A 56-year-old man presented with recurrent malignant mesothelioma with massive ascites;more than 4000 mL of ascitic fluid was removed,filtered,and concentrated using KM-CART,and the cell-free ascitic fluid was reinfused into the patient to improve quality of life.Cancer cells isolated secondarily in an in vitro proliferation assay using CD-DST exhibited low sensitivity to pemetrexed and high sensitivity to gemcitabine.Treatment with gemcitabine maintained stable disease for 4 mo.CONCLUSION The combination of KM-CART and CD-DST may be a promising treatment option for malignant ascites associated with malignant mesothelioma.展开更多
BACKGROUND Periodontitis has been associated with various liver diseases.However,the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive.In particular,it is unclear whether th...BACKGROUND Periodontitis has been associated with various liver diseases.However,the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive.In particular,it is unclear whether the common periodontitis pathogens,Porphyromonas gingivalis(P.gingivalis)and Actinobacillus actinomycetemcomitans(A.actinomycetemcomitans),can be detected not only in the oral mucosa but also in ascites and stool.AIM To investigate the significance of periodontitis,P.gingivalis,and A.actinomycetemcomitans in cirrhosis patients with ascitic decompensation.METHODS This prospective study was conducted at the University Hospital Hamburg Eppendorf,a tertiary center in Northern Germany.A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis,as well as patient outcomes.PCR was used to test gingival samples,ascites,and stool for the presence of P.gingivalis and A.actinomycetemcomitans.Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab.RESULTS Periodontitis was diagnosed in 22 out of 27(82%)ascite patients,which is significantly more common than in a control cohort of 100 unselected patients(59%,P=0.04).P.gingivalis was detected in the gingiva of six patients,and one of them also had P.gingivalis in their stool.However,P.gingivalis was not found in the ascites of any patient.Five out of six patients with P.gingivalis had periodontitis(83%).A.actinomycetemcomitans was not detected in any sample.Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis,and survival(Kaplan-Meier analysis)was longer in patients with periodontitis(P=0.02).Transplantfree survival was also more common in patients with periodontitis compared to those without(63%vs 0%,P=0.02).CONCLUSION Decompensated cirrhotic patients frequently suffer from periodontitis.However,there was no evidence of the translocation of P.gingivalis or A.actinomycetemcomitans into ascites.The survival of cirrhotic patients with periodontitis was not reduced.展开更多
Objective:To evaluate the therapeutic effect of Qinggan Huayu granule on mice with H22 liver cancer ascites tumor.Methods:A H22 liver cancer ascites mouse model was established by intraperitoneally injecting H22 liver...Objective:To evaluate the therapeutic effect of Qinggan Huayu granule on mice with H22 liver cancer ascites tumor.Methods:A H22 liver cancer ascites mouse model was established by intraperitoneally injecting H22 liver cancer cells.Mice were randomly divided into the model group,the Ganfule group(1.35 g/kg),the fluorouracil group(50 mg/kg i.p),the Qinggan Huayu granule groups at low(0.67 g/kg),medium(1.34 g/kg),and high(2.68 g/kg)doses.Then the mice were administered continuously for 10 days and body weight and abdominal circumference were monitored every 3 days.On day 11,eight rats in each group were randomly selected for dissection to detect the amount of peritoneal water,peritoneal permeability and histopathological changes.The remaining mice were observed for survival.In addition,the vascular endothelial growth factor A(VEGFA)and vascular endothelial growth factor receptor 2(VEGFR2)were determined by Western blotting.Results:Compared with the model group,the weight growth of mice in the fluorouracil group and the medium-dose and high-dose Qinggan Huayu granule groups was slower(P<0.05).Moreover,the abdominal circumference of mice in each treatment group was increased slowly.There were significant differences in abdominal circumference between the fluorouracil group,the medium-dose group and the control group from day 6(P<0.05)while the abdominal circumference of the high dose group was significantly smaller than that of the control group from day 12(P<0.05).Moreover,compared with the model group,the amount of ascites in the medium-and high-dose Qinggan Huayu granule groups was decreased significantly(P<0.05).The optical density value of ascites supernatant in medium-and high-dose Qinggan Huayu granule group and the fluorouracil group decreased significantly(P<0.05)and the survival period of the medium-dose Qinggan Huayu granule group and the fluorouracil group was prolonged prominently(P<0.05).There was no significant difference in the low-dose Qinggan Huayu granule group and the Ganfule group.Peritoneal histopathological assay showed more complete peritoneal structure,less edema and less angiogenesis of the peritoneum in the fluorouracil group and the medium-and high-dose Qinggan Huayu granule group,which was better than that of the Ganfule group and the low-dose group.Compared with the model group,the expressions of VEGFA and VEGFR2 in the medium-dose Qinggan Huayu granule group decreased significantly(P<0.05,P<0.01).Conclusion:Qinggan Huayu granule can inhibit ascites production in the mice model with H22 liver cancer ascites tumor,prolong the survival of mice,and reduce peritoneal permeability and suppress the increase of peritoneal neovascularization.The mechanism may be related to the inhibition of VEGF/VEGFR pathway.展开更多
Spontaneous bacterial peritonitis(SBP)is a common complication of liver failure.It is an acute bacterial infection of the ascitic fluid in patients with liver cirrhosis.SBP presents a significant challenge for hepatol...Spontaneous bacterial peritonitis(SBP)is a common complication of liver failure.It is an acute bacterial infection of the ascitic fluid in patients with liver cirrhosis.SBP presents a significant challenge for hepatologists owing to its associated complications.While diagnostic paracentesis with polymorphonuclear count is highly accurate,it can be troublesome for some patients as it is an invasive procedure with associated risks.Several studies have proposed new diagnostic methods to improve current practices,many of which remain invasive.Although some serum tests show promise in the diagnosis of SBP,the results are still preliminary.Recent advancements in artificial intelligence and machine learning have introduced predictive models and scoring systems for diagnosis.However,these models still lack sufficient sensitivity,specificity,and the ability to effe-ctively assess treatment response.展开更多
Ascites is the pathologic accumulation of fluid within the peritoneal cavity.Because many diseases can cause ascites,in particular cirrhosis,samples of ascitic fluid are commonly analyzed in order to develop a differe...Ascites is the pathologic accumulation of fluid within the peritoneal cavity.Because many diseases can cause ascites,in particular cirrhosis,samples of ascitic fluid are commonly analyzed in order to develop a differential diagnosis.The concept of transudate versus exudate,as determined by total protein measurements,is outdated and the use of serumascites albumin gradient as an indicator of portal hypertension is more accurate.Lactate dehydrogenase (LDH),vascular endothelial growth factor (VEGF),and other tumor markers can be helpful in distinguishing between malignant and benign conditions.Glucose and adenosine deaminase levels may support a diagnosis of tuberculous disease,and amylase level may indicate a diagnosis of pancreatitis.Given the specificity and sensitivity of laboratory results,accurate diagnosis should be based on both laboratory data and clinical iudgment.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has an important role in the therapy of complications of portal-hypertension-related ascites.Various guidelines now indicate that TIPS is indicated for ref...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has an important role in the therapy of complications of portal-hypertension-related ascites.Various guidelines now indicate that TIPS is indicated for refractory ascites(RA),but TIPS for recurrent nonrefractory ascites(RNRA)achieved better clinical results.AIM To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.METHODS There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021.In category 1,patients had ascites without cirrhotic gastrointestinal bleeding.The patients were divided into group A(RNRA,n=183)and group B(RA,n=217).In category 2,patients had ascites and cirrhotic gastrointestinal bleeding.The patients were divided into group C(RNRA,n=328)and group D(RA,n=135).The clinical outcomes were probability of total hepatic impairment,incidence of hepatic encephalopathy(HE)and mortality.RESULTS The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B(P=0.032),and in group C compared with group D(P=0.027).By the end of follow-up,there were significant differences in the rate of RA in group A compared with group B(P=0.016),and in group C compared with group D(P=0.012).The probability of total hepatic impairment was significantly different in group A compared with group B(P=0.024),and in group C compared with group D(P=0.019).The total incidence of HE was significantly different in group A compared with group B(P=0.008),and in group C compared with group D(P=0.004).The 6-month,and 1-,2-and 3-year survival rates were significantly different between groups A and B(all P<0.05),and between groups C and D(all P<0.05).CONCLUSION TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension,and early TIPS for RNRA can prolong survival,and prevent progression to RA.展开更多
Acute pancreatitis(AP)is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course,ranging from mild,selflimiting episodes to severe necrotizing forms.Among its common co...Acute pancreatitis(AP)is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course,ranging from mild,selflimiting episodes to severe necrotizing forms.Among its common complications ascites has traditionally been viewed as a passive byproduct of peritoneal inflammation and enzymatic leakage with limited diagnostic or prognostic utility.However,growing evidence challenges this perspective,suggesting that ascitic fluid in AP represents a dynamic and clinically meaningful component of disease progression.In this editorial we reflected on the findings presented by Rao et al,who highlighted the diagnostic,prognostic,and therapeutic significance of ascitic fluid in AP.Easily accessible markers such as lactate dehydrogenase may provide early prognostic insight while emerging molecular biomarkers and cytokine pro-files offer promise for more precise risk stratification and individualized therapy.We argue that the systematic evaluation of ascitic fluid should be integrated into the clinical management of moderate to severe AP.Incorporating ascites analysis into standard diagnostic protocols may enhance early risk assessment,inform therapeutic decisions,and ultimately improve patient outcomes.Ascitic fluid should be recognized as a clinically valuable marker and an important source of information in the evolving landscape of AP care.展开更多
In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was...In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was later termed hepatorenal syndrome(HRS).HRS primarily affects cirrhotic patients with ascites and often follows severe infections,digestive hemorrhages,or high-volume paracentesis.Pathophysiologically,HRS involves low glomerular filtration rate,hypotension,renin-angiotensin axis activation,water clearance,hyponatremia,and minimal urinary sodium excretion.These conditions mimic those seen in decreased effective circulatory volume(ECV)scenarios such as septic shock or heart failure.HRS represents a specific form of prerenal acute kidney injury(AKI)in patients with baseline renal ischemia,where the kidney attempts to correct decreased ECV by retaining sodium and water.Intense renal vasoconstriction,passive hyperemia from ascites,and acute tubular necrosis(ATN)with specific urinary sediment changes are observed.Persistent oliguria may transition HRS to ATN,although this shift is less straightforward than in other prerenal AKI contexts.Notably,liver grafts from HRS patients can recover function more rapidly than those from other ischemic conditions.Experimental studies,such as those by Duailibe et al,using omega-3 fatty acids in cirrhotic rat models,have shown promising results in reducing oxidative stress and improving kidney function.These findings suggest potential therapeutic strategies and underscore the need for further research to understand the mechanisms of HRS and explore possible treatments.Future research should address the impact of omega-3 on survival and secondary outcomes,as well as consider the balance of therapeutic risks and benefits in severe liver disease.展开更多
文摘A recent single-center retrospective study by Rao et al has offered valuable insights into the prognostic utility of ascitic fluid characteristics in acute pancreatitis.Their findings,which demonstrate associations between ascitic color,turbidity,and elevated lactate dehydrogenase levels with organ failure,infected pancreatic necrosis,and in-hospital mortality provide a valuable contribution to a relatively underexplored area in pancreatology.However,the reliance on subjective visual assessment and a single time-point evaluation raises concerns regarding reproducibility and dynamic disease monitoring.Furthermore,the lack of integration with objective indicators such as polymorphonuclear cell counts,microbiological cultures,and exudative vs transudative analysis limits the interpretability of the results.Despite these limitations,the study provides a clinically relevant framework that supports further investigation and refinement through prospective,multicenter validation.
文摘Introduction: After an episode of spontaneous infection of ascitic fluid (ISLA). The recurrence of ISLA at one year is greater than 70%. We studied the risk factors associated with the occurrence of recurrence. Patients and methods: this was a retrospective, descriptive and analytical study of patient files, hospitalized in the department for 12 months, the choice of the sample was of convenience. Results: We have 1347 patient files collected including 389 cases of cirrhosis. We had 37 files of cirrhotic patients with ISLA including 28 cures without recurrence of ISLA, 08 files of patients with recurrence of ISLA and 03 excluded, i.e. a hospital prevalence of recurrence of 0.6% and a prevalence in cirrhotic patients of 23.5%. The most common antecedents were: hospital contact recent (35.3%), the concept of iterative ascites punctures (32.3%), the presence of HCC (29.4%), hepatic encephalopathy (20.6%) and digestive hemorrhage (14.7%). In univariate analysis, recent digestive bleeding was associated with an increased risk of recurrence (OR 7.2, 95% CI 0.96 - 67.1). HBV (62.5%) is the main etiology of cirrhosis. The PNN rate at 250 - 499 mm3 (62.5%), the protein level 3 (75%). Patients on secondary prophylaxis with NORFLOXACIN were 25%. Recurrence of ISLA was treated with CEFTRIAXONE 2 g/24 hours. Conclusion: Recurrence of ISLA is serious, the predictive factors for recurrence are, hospital contact recent, the concept of iterative ascites punctures, the presence of HCC, the presence of hepatic encephalopathy and digestive bleeding.
文摘Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an "instant" bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic effi cacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.
文摘Objective: To evaluate the effects of methanol root extract of Mahonia leschenaultii and berberine of Mahonia leschenaultii on Dalton’s ascitic lymphoma in Swiss Albino mice. Methods: The methanol root extracts of Mahonia leschenaultii(200 and 400 mg/kg) were given orally, and berberines(10 and 20 mg/kg) were injected intra-peritoneally for 14 successive days in tumor bearing mice. Hematological parameters(white and red blood cells, haemoglobin level, granulocytes, and agranulocytes), lipid parameters(total cholesterol and triglycerides), serum enzymes(serum glutamate pyruvate transaminases, serum glutamate oxaloacetate transaminases, and alkaline phosphatise) and mean survival and solid tumor growth were determined and compared with untreated mice. 5-fluorouracil(20 mg/kg) was used as a reference standard drug. Results: Mahonia leschenaultii and berberine reduced the hematocrit significantly. Furthermore, Mahonia leschenaultii and berberine improved the survival of mice significantly and restored the affected hematological and lipid parameters similar to the normal levels. Conclusions: These observations show a strong anticancer effect of methanol root extract of Mahonia leschenaultii and berberine in suppressing Dalton’s ascitic lymphoma cancer cell growth in a mouse model by controlling haematological, lipid, serum enzymes, and other derived parameters effectively.
文摘AIM: Sargassum wightii Greville is a marine brown alga belonging to the Sargassaceae family which has about 200 species. The ethanolic extract of the whole dry plant powder contained numerous phytoconstituents, including flavonoids. The study was focused on the anticancer activity of Sargassum wightii in mice. METHOD: The ethanolic extract of Sargassum wightii(EESW) at two dose levels was used to examine the anticancer activity in mice using DAL cell lines to induce cancer. The body weight, viable and non-viable tumor cell count, mean survival time, increase in life span, and hematological parameters were observed for anticancer activity of EESW. RESULTS: The intraperitoneal inoculation of DAL cells in mice significantly increased cancer cell count. The decrease in the cancer cell number observed in the EESW-treated group cancer animals indicates that the test drug has a significant inhibitory effect on the tumor cell proliferation. Treatment with EESW also showed a significant decrease in tumor weight, and hence increased the lifespan of DAL-treated mice. In addition, EESW administration significantly restored the hematological parameters in DAL-treated mice. CONCLUSION: The present study results suggest that administration of extract offers enhanced antioxidant potential. Therefore it can be concluded from this study that EESW possesses anticancer activity.
基金Supported by Grant from Ealing Hospital NHS Trust,Imperial College,United Kingdom
文摘AIM: To examine body fluids such as ascitic fluid (AF),saliva,bile and pleural effusions for the presence of hepcidin using a novel radioimmunoassay (RIA).METHODS: Serum samples were collected from 25 healthy volunteers (mean age: 36 ± 11.9 years,11 males,14 females).In addition bile was obtained from 12 patients undergoing endoscopic retrograde cholangiopancreatography (mean age: 66.9 ± 16.7 years,M:F = 5:7).Saliva was collected from 17 healthy volunteers (mean age: 35 ± 9.9 years,M:F = 8:9).Pleural and AF were collected from 11 and 16 patients [(mean age: 72 ± 20.5 years,M:F = 7:4) and (mean age: 67.32 ± 15.2 years,M:F = 12:4)],respectively.All biological fluid samples (serum,exudative and transudative fluids) were tested for the presence of hepcidin-25 molecule using RIA.RESULTS: Hepcidin-25 was detected in all biological fluids tested.The mean ± SD hepcidin-25 in serum was 15.68 ± 15.7 ng/mL,bile 7.37 ± 7.4 ng/mL,saliva 3.4 ± 2.8 ng/mL,exudative fluid 65.64 ± 96.82 ng/mL and transudative fluid 14.1 ± 17.8 ng/mL.CONCLUSION: We provide clear evidence that hepcidin-25 is present in bile,saliva,pleural and ascitic fluids.Hepcidin is likely to play a role here in innate immunity.
文摘Chromosomes in 1620 metaphases of ascitic fluid cells in 20 cases of ovariancarcinoma were analyzed.The results showed that there were marked structuralaberrations aside from significant increase in chromosomal numerical aberrations(85.2%).In the ascitic fluid cells from 12 patients,15 types of marker chromosomes were found,among which t(6;14)(q21;q24)and t(2;6)(q35;p12)were more frequently noted witha rate of 7.84% and 7.59% respectively,which was significantly higher than that of othermarker chromosomes(P【0.01).The findings suggested that,besides t(6;14)(q21;q24),t(2;6)(q35;p12)may also be a specific marker chromosome of ovarian carcinoma.
文摘In mixed lymphocyte-tumor all culture in vitro, the ability of thymus lymphocytes adhering to tumor cells was found to be essentially consistent with its emperipolesis index, though not synchronous. Tumor cells at different progressive stages and in the mixed cultures with or without Con A stimulation also varied in the sensitivity to lymphocyte adhesion and emperipolesis. Tumor adhesiveness anl emperipolesis of theymus lymphocytes and their PNA-, PNA+ subgroups were shown to be different significantly from splenic lymphocytes. Thymosin exhibited certain promotive effect on lymphocyte-tumor adhesion and emperipolesis.
文摘The mature Shiga toxin B （StxB） gene was optimized and generated by overlapping PCR. Recombinant expression vector pQE40-DHFR/StxB was constructed when the gene was cloned into pQE fusion expression vector. Induced by Isopropyl β-D-thiogalactoside （IPTG）, the DHFR/StxB fusion protein was highly expressed to the level of 41.36% in E. coli MI5 cells. The 35 kDa fusion protein with a 6 His-tag was one-step purified from inclusion bodies using Ni-NTA affinity chromatography column under denaturing conditions, and was refolded by dialyzing with a decreasing urea gradient. Purified DHFR/StxB fusion protein was used to immunize Kunming mice for generating the ascitic polyclonal antibody against recombinant StxB protein by injecting sarcoma 180 cells and the titer ofascitic polyclonal antibody is up to 1： 1× 10^6 detected by the indirect enzyme linked immunosorbent assy （ELISA）. Western immunoblotting analysis revealed that the ascitic polyclonal antibody against StxB had a specific affinity for a 70 kDa shiga toxin protein of Shigella dysenteriae type 1. It is a new simple and quick method to produce a large amount of ascitic polyclonal antibody. The antibody is used to develop immunological method for detecting shiga toxin.
基金Supported by Unrestricted Research Grants (to Burri E) by the Freiwillige Akademische Gesellschaft (Basel, Switzerland) and the Gottfried und Julia Bangerter-Rhyner-Stiftung (Bern,Switzerland)Bühlmann Laboratories AG (Sch nenbuch, Switzerlanfd) provided the assays to measure ascitic calprotectin
文摘AIM: To evaluate the diagnostic capability of calprotectin in ascitic fluid for detecting a polymorphonuclear (PMN) cell count > 250/μL ascites. METHODS: In this prospective observational study, a total of 130 ascites samples were analysed from 71 consecutive patients referred for paracentesis. Total and differential leukocyte cell counts were determined manually with a Neubauer chamber and gentianviolet stain. Calprotectin was measured in 1 mL ascetic fluid by enzyme-linked immunosorbent assay (ELISA) and a point-of-care (POC) lateral flow assay with the Quantum Blue Reader (Bühlmann Laboratories). All measurements were carried out in a central laboratory by senior personnel blinded to patient history. A PMN count > 250/μL was the primary endpoint of the study. The diagnostic value of ascitic calprotectin measurement was assessed by comparing to the final diagnosis of each patient that had been adjudicated by investigators blinded to calprotectin values. RESULTS: The PMN count was > 250/μL in 19 samples (14.6%) from 15 patients (21.1%) and varied widely among the study population (range 10-19 800/mL and 1-17 820/mL, respectively). Spontaneous bacterial peritonitis (SBP) was the final diagnosis in four patients (5.6%). All patients with PMN ≤ 250/μL had negative bacterial culture. PMN count was elevated in five patients with peritoneal carcinomatosis, three with lymphoma, one with neuroendocrine carcinoma, and two with secondary peritonitis due to abdominal perforation. PMN cell counts correlated with ascitic calprotectin values (Spearman's rho; r = 0.457 for ELISA, r = 0.473 for POC). A considerable range of ascitic calprotectin concentrations was detected by ELISA [median 0.43 μg/mL, interquartile range (IQR) 0.23-1.23 (range 0.10-14.93)] and POC [median 0.38 μg/mL, IQR 0.38-0.56 (range 0.38-13.31)]. Ascitic calprotectin levels were higher in samples with PMN > 250/μL, by both ELISA [median (IQR) 2.48 μg/mL (1.61-3.65) vs 0.10 μg/mL (0.10-0.36), P < 0.001] and POC [2.78 μg/mL (2.05-5.37) vs 0.38 μg/mL (0.38-0.41), P < 0.001]. The area under the receiver operating characteristics curve for identifying an elevated PMN count was 0.977 (95%CI: 0.933 to 0.995) for ELISA and 0.982 (95%CI: 0.942 to 0.997) for POC (P = 0.246 vs ELISA). Using the optimal cut-off value for ELISA (0.63 μg/mL), ascitic calprotectin had 94.8% sensitivity, 89.2% specificity, positive and negative likelihood ratios of 8.76 and 0.06 respectively, positive and negative predictive values of 60.0% and 99.0% respectively, and 90.0% overall accuracy. Using the optimal cut-off value for POC (0.51 μg/mL), the respective values were 100.0%, 84.7%, 6.53, 0.00, 52.8%, 100% and 87.7%. Correlation between ELISA and POC was excellent (r = 0.873, P < 0.001). The mean ± SD of the difference was -0.11 ± 0.48 μg/mL with limits of agreement of + 0.8 μg/mL (95%CI: 0.69 to 0.98) and -1.1 μg/mL (95%CI: -1.19 to -0.91). CONCLUSION: Ascitic calprotectin reliably predicts PMN count > 250/μL, which may prove useful in the diagnosis of SBP, especially with a readily available bedside testing device.
文摘Angeloni et al published a landmark study on the use of Coulter counters in spontaneous bacterial peritonitis(SBP)diagnosis.Riggio and Angeloni have recently published an editorial on the ascitic fluid analysis in diagnosis and monitoring of SBP.Herein,some points of interest are discussed.
文摘BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM-CART).The tumor cells derived via KM-CART were utilized secondarily in an in vitro cell growth assay using the collagen gel droplet-embedded culture drug sensitivity test(CD-DST)to investigate anticancer drug susceptibility.CASE SUMMARY A 56-year-old man presented with recurrent malignant mesothelioma with massive ascites;more than 4000 mL of ascitic fluid was removed,filtered,and concentrated using KM-CART,and the cell-free ascitic fluid was reinfused into the patient to improve quality of life.Cancer cells isolated secondarily in an in vitro proliferation assay using CD-DST exhibited low sensitivity to pemetrexed and high sensitivity to gemcitabine.Treatment with gemcitabine maintained stable disease for 4 mo.CONCLUSION The combination of KM-CART and CD-DST may be a promising treatment option for malignant ascites associated with malignant mesothelioma.
文摘BACKGROUND Periodontitis has been associated with various liver diseases.However,the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive.In particular,it is unclear whether the common periodontitis pathogens,Porphyromonas gingivalis(P.gingivalis)and Actinobacillus actinomycetemcomitans(A.actinomycetemcomitans),can be detected not only in the oral mucosa but also in ascites and stool.AIM To investigate the significance of periodontitis,P.gingivalis,and A.actinomycetemcomitans in cirrhosis patients with ascitic decompensation.METHODS This prospective study was conducted at the University Hospital Hamburg Eppendorf,a tertiary center in Northern Germany.A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis,as well as patient outcomes.PCR was used to test gingival samples,ascites,and stool for the presence of P.gingivalis and A.actinomycetemcomitans.Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab.RESULTS Periodontitis was diagnosed in 22 out of 27(82%)ascite patients,which is significantly more common than in a control cohort of 100 unselected patients(59%,P=0.04).P.gingivalis was detected in the gingiva of six patients,and one of them also had P.gingivalis in their stool.However,P.gingivalis was not found in the ascites of any patient.Five out of six patients with P.gingivalis had periodontitis(83%).A.actinomycetemcomitans was not detected in any sample.Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis,and survival(Kaplan-Meier analysis)was longer in patients with periodontitis(P=0.02).Transplantfree survival was also more common in patients with periodontitis compared to those without(63%vs 0%,P=0.02).CONCLUSION Decompensated cirrhotic patients frequently suffer from periodontitis.However,there was no evidence of the translocation of P.gingivalis or A.actinomycetemcomitans into ascites.The survival of cirrhotic patients with periodontitis was not reduced.
基金Fund Project:Beiing Municipal Science and Techoology Commission G20 Engineering Innovation Research for Ten Diseases Ten Drugs Research and Development Projec(N.Z171100001717008)National Key Research and Development Plan for Precision Medicine Research Key Phriject(No.2017YF0910002)。
文摘Objective:To evaluate the therapeutic effect of Qinggan Huayu granule on mice with H22 liver cancer ascites tumor.Methods:A H22 liver cancer ascites mouse model was established by intraperitoneally injecting H22 liver cancer cells.Mice were randomly divided into the model group,the Ganfule group(1.35 g/kg),the fluorouracil group(50 mg/kg i.p),the Qinggan Huayu granule groups at low(0.67 g/kg),medium(1.34 g/kg),and high(2.68 g/kg)doses.Then the mice were administered continuously for 10 days and body weight and abdominal circumference were monitored every 3 days.On day 11,eight rats in each group were randomly selected for dissection to detect the amount of peritoneal water,peritoneal permeability and histopathological changes.The remaining mice were observed for survival.In addition,the vascular endothelial growth factor A(VEGFA)and vascular endothelial growth factor receptor 2(VEGFR2)were determined by Western blotting.Results:Compared with the model group,the weight growth of mice in the fluorouracil group and the medium-dose and high-dose Qinggan Huayu granule groups was slower(P<0.05).Moreover,the abdominal circumference of mice in each treatment group was increased slowly.There were significant differences in abdominal circumference between the fluorouracil group,the medium-dose group and the control group from day 6(P<0.05)while the abdominal circumference of the high dose group was significantly smaller than that of the control group from day 12(P<0.05).Moreover,compared with the model group,the amount of ascites in the medium-and high-dose Qinggan Huayu granule groups was decreased significantly(P<0.05).The optical density value of ascites supernatant in medium-and high-dose Qinggan Huayu granule group and the fluorouracil group decreased significantly(P<0.05)and the survival period of the medium-dose Qinggan Huayu granule group and the fluorouracil group was prolonged prominently(P<0.05).There was no significant difference in the low-dose Qinggan Huayu granule group and the Ganfule group.Peritoneal histopathological assay showed more complete peritoneal structure,less edema and less angiogenesis of the peritoneum in the fluorouracil group and the medium-and high-dose Qinggan Huayu granule group,which was better than that of the Ganfule group and the low-dose group.Compared with the model group,the expressions of VEGFA and VEGFR2 in the medium-dose Qinggan Huayu granule group decreased significantly(P<0.05,P<0.01).Conclusion:Qinggan Huayu granule can inhibit ascites production in the mice model with H22 liver cancer ascites tumor,prolong the survival of mice,and reduce peritoneal permeability and suppress the increase of peritoneal neovascularization.The mechanism may be related to the inhibition of VEGF/VEGFR pathway.
文摘Spontaneous bacterial peritonitis(SBP)is a common complication of liver failure.It is an acute bacterial infection of the ascitic fluid in patients with liver cirrhosis.SBP presents a significant challenge for hepatologists owing to its associated complications.While diagnostic paracentesis with polymorphonuclear count is highly accurate,it can be troublesome for some patients as it is an invasive procedure with associated risks.Several studies have proposed new diagnostic methods to improve current practices,many of which remain invasive.Although some serum tests show promise in the diagnosis of SBP,the results are still preliminary.Recent advancements in artificial intelligence and machine learning have introduced predictive models and scoring systems for diagnosis.However,these models still lack sufficient sensitivity,specificity,and the ability to effe-ctively assess treatment response.
基金This project was sponsored in part by grants from the National Natural Science Foundation of China(#81072044)the Guangdong Natural Science Foundation(#S2011010004653)
文摘Ascites is the pathologic accumulation of fluid within the peritoneal cavity.Because many diseases can cause ascites,in particular cirrhosis,samples of ascitic fluid are commonly analyzed in order to develop a differential diagnosis.The concept of transudate versus exudate,as determined by total protein measurements,is outdated and the use of serumascites albumin gradient as an indicator of portal hypertension is more accurate.Lactate dehydrogenase (LDH),vascular endothelial growth factor (VEGF),and other tumor markers can be helpful in distinguishing between malignant and benign conditions.Glucose and adenosine deaminase levels may support a diagnosis of tuberculous disease,and amylase level may indicate a diagnosis of pancreatitis.Given the specificity and sensitivity of laboratory results,accurate diagnosis should be based on both laboratory data and clinical iudgment.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has an important role in the therapy of complications of portal-hypertension-related ascites.Various guidelines now indicate that TIPS is indicated for refractory ascites(RA),but TIPS for recurrent nonrefractory ascites(RNRA)achieved better clinical results.AIM To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.METHODS There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021.In category 1,patients had ascites without cirrhotic gastrointestinal bleeding.The patients were divided into group A(RNRA,n=183)and group B(RA,n=217).In category 2,patients had ascites and cirrhotic gastrointestinal bleeding.The patients were divided into group C(RNRA,n=328)and group D(RA,n=135).The clinical outcomes were probability of total hepatic impairment,incidence of hepatic encephalopathy(HE)and mortality.RESULTS The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B(P=0.032),and in group C compared with group D(P=0.027).By the end of follow-up,there were significant differences in the rate of RA in group A compared with group B(P=0.016),and in group C compared with group D(P=0.012).The probability of total hepatic impairment was significantly different in group A compared with group B(P=0.024),and in group C compared with group D(P=0.019).The total incidence of HE was significantly different in group A compared with group B(P=0.008),and in group C compared with group D(P=0.004).The 6-month,and 1-,2-and 3-year survival rates were significantly different between groups A and B(all P<0.05),and between groups C and D(all P<0.05).CONCLUSION TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension,and early TIPS for RNRA can prolong survival,and prevent progression to RA.
文摘Acute pancreatitis(AP)is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course,ranging from mild,selflimiting episodes to severe necrotizing forms.Among its common complications ascites has traditionally been viewed as a passive byproduct of peritoneal inflammation and enzymatic leakage with limited diagnostic or prognostic utility.However,growing evidence challenges this perspective,suggesting that ascitic fluid in AP represents a dynamic and clinically meaningful component of disease progression.In this editorial we reflected on the findings presented by Rao et al,who highlighted the diagnostic,prognostic,and therapeutic significance of ascitic fluid in AP.Easily accessible markers such as lactate dehydrogenase may provide early prognostic insight while emerging molecular biomarkers and cytokine pro-files offer promise for more precise risk stratification and individualized therapy.We argue that the systematic evaluation of ascitic fluid should be integrated into the clinical management of moderate to severe AP.Incorporating ascites analysis into standard diagnostic protocols may enhance early risk assessment,inform therapeutic decisions,and ultimately improve patient outcomes.Ascitic fluid should be recognized as a clinically valuable marker and an important source of information in the evolving landscape of AP care.
文摘In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was later termed hepatorenal syndrome(HRS).HRS primarily affects cirrhotic patients with ascites and often follows severe infections,digestive hemorrhages,or high-volume paracentesis.Pathophysiologically,HRS involves low glomerular filtration rate,hypotension,renin-angiotensin axis activation,water clearance,hyponatremia,and minimal urinary sodium excretion.These conditions mimic those seen in decreased effective circulatory volume(ECV)scenarios such as septic shock or heart failure.HRS represents a specific form of prerenal acute kidney injury(AKI)in patients with baseline renal ischemia,where the kidney attempts to correct decreased ECV by retaining sodium and water.Intense renal vasoconstriction,passive hyperemia from ascites,and acute tubular necrosis(ATN)with specific urinary sediment changes are observed.Persistent oliguria may transition HRS to ATN,although this shift is less straightforward than in other prerenal AKI contexts.Notably,liver grafts from HRS patients can recover function more rapidly than those from other ischemic conditions.Experimental studies,such as those by Duailibe et al,using omega-3 fatty acids in cirrhotic rat models,have shown promising results in reducing oxidative stress and improving kidney function.These findings suggest potential therapeutic strategies and underscore the need for further research to understand the mechanisms of HRS and explore possible treatments.Future research should address the impact of omega-3 on survival and secondary outcomes,as well as consider the balance of therapeutic risks and benefits in severe liver disease.
