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
BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female pat...BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.展开更多
Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely availabl...Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.展开更多
This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024...This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024 and December 2024 were randomly assigned to two groups,with the observation group receiving APD and the reference group receiving CAPD.Renal function indicators,nutritional indicators,mineral metabolism,urine volume,and ultrafiltration volume changes were compared between the two groups.After treatment,the observation group showed lower renal function indicators,higher nutritional indicators,and better mineral metabolism levels compared to the reference group(P<0.05).While there was no significant difference in urine volume between the two groups(P>0.05),the observation group demonstrated superior ultrafiltration volume(P<0.05).These findings suggest that APD offers better clinical outcomes than CAPD by improving renal function,nutritional status,mineral metabolism regulation,and ultrafiltration efficiency in patients with end-stage renal disease.展开更多
BACKGROUND End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy.Urgent-start peritoneal dialysis(PD)has emerged as a viable alternative to hemodialy...BACKGROUND End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy.Urgent-start peritoneal dialysis(PD)has emerged as a viable alternative to hemodialysis particularly in resourcelimited settings.However,concerns remain regarding catheter-related complications associated with early initiation of PD.Automated PD(APD)offers enhanced flexibility and fluid management,but evidence regarding its safety and outcomes in urgent-start scenarios with shortened break-in periods is limited.AIM To evaluate the clinical outcomes and biochemical changes associated with urgent-start APD with a shortened break-in period.METHODS This was a single center,observational study that included 62 patients with endstage kidney disease who required urgent-start dialysis,underwent PD catheter placement,and received APD.Patients were stratified based on catheter opening time(<12 hours vs>12 hours).Catheter-related complications,biochemical parameters,and dialysis efficacy were analyzed.RESULTS The median catheter opening time was 11 h(interquartile range:8-14 hours).No significant differences in catheterrelated complications were observed between groups(P>0.05).Catheter dysfunction,migration,leakage,and replacement occurred in 14.5%,9.7%,12.9%,and 11.3%of patients,respectively.APD led to significant reductions in serum creatinine,blood urea nitrogen,urea,phosphorus,and potassium(P<0.05),alongside correction of metabolic acidosis.No cases of peritonitis or hemoperitoneum were observed.CONCLUSION Urgent-start APD with shortened break-in appears safe with low complication rates and improved biochemical outcomes.展开更多
BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperiton...BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.展开更多
BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection ...BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.展开更多
Rationale:Fereydounia(F.)khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.Patient concerns:A 61-year-old male with end-stage...Rationale:Fereydounia(F.)khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.Patient concerns:A 61-year-old male with end-stage renal failure on continuous ambulatory peritoneal dialysis,who presented with generalized abdominal pain,turbid dialysate and fever.Diagnosis:Peritoneal fluid culture revealed the presence of yeast cells.F.khargensis was identified by polymerase chain reaction method.Interventions:Removal of Tenckhoff catheter and intravenous fluconazole.Outcomes:He succumbed after two weeks of hospitalization.Lessons:This case report highlights the significance of a rare fungal pathogen,F.khargensis,which has been implicated in the mortality of an immunocompromised patient.Due to its rarity,F.khargensis poses significant challenges associated with its identification and has profound implications for clinical practice.展开更多
BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to...BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to fungal infections.To date,the incidence of spontaneous fungal peritonitis(SFP)has not been determined in Mexico;this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment,which may increase mortality.AIM To report the incidence of SFP in patients presenting with decompensated LC with ascites.METHODS This was a prospective,single-center,descriptive,observational and crosssectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City.Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days,and molecular tests(the API 20 C AUX test)were used for molecular characterization.RESULTS Of the 48 patients included,54.2%were women,77.1%had a comorbidity,47.9%had LC secondary to metabolic dysfunction,43.8%were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22,and 10.4%were in secondary prophylaxis for spontaneous bacterial peritonitis(SBP).Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated,with two of the four patients being positive for Rhodotorula minuta;an SBP incidence of 8.3%was thus calculated.Chronic kidney disease[P=0.012 and relative risk(RR)=15]and secondary prophylaxis for SBP(P=0.049 with RR=8.6)were statistically significant and associated with a high mortality risk(P=0.001 with RR=33).CONCLUSION The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short-and medium-term mortality;therefore,it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures,and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP.Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture.Thus,treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.展开更多
Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen r...Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen ratio(AFR)for PC in patients with gastric cancer and to develop two preoperative prediction models.Methods A total of 745 gastric cancer patients were included in this study.Preoperative AFR,along with other serum markers and clinical tumor characteristics,was assessed.Univariate and multivariate logistic regression analyses were performed to determine the odds ratios(ORs)and 95%confidence intervals(CIs)of the independent variables.Propensity score matching(PSM)was used to control for potential confounders,and one-way ANOVA was conducted to evaluate differences in distribution between groups.Two prediction models incorporating the independent predictive indicators were constructed and validated via receiver operating characteristic(ROC)curves.Results Poorly differentiated type(OR 2.679;P=0.001),nondiffuse morphological type(OR 2.123;P=0.040),BMI<23.550 kg/m^(2)(OR 4.635;P=0.001),AFR<11.275(OR 2.895;P=0.003)and CA199≥73.615 U/mL(OR 2.040;P=0.037)were identified as independent risk factors for PC in patients with gastric cancer.After PSM,the AFR remained the only inflammatory marker that was independently associated with PC(P=0.003).AFR demonstrated consistent robustness in predicting PC across multiple sample sets.Among all the independent risk factors,the AFR had the highest area under the curve(AUC)for ROC analysis(AUC 0.648;95%CI 0.580–0.715).Two combination models incorporating the AFR demonstrated enhanced predictive ability:Combination Model 1(AUC 0.759;95%CI 0.699–0.820)and Combination Model 2(AUC 0.801;95%CI 0.744–0.859).Conclusions The preoperative AFR serves as a useful indicator for predicting PC.Two reliable prediction models based on the AFR have been developed.展开更多
The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte rati...The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.展开更多
BACKGROUND Refractory ascites(RA)and spontaneous bacterial peritonitis(SBP)are severe complications of decompensated cirrhosis,contributing to high morbidity and mortality.RA develops when ascites persists despite max...BACKGROUND Refractory ascites(RA)and spontaneous bacterial peritonitis(SBP)are severe complications of decompensated cirrhosis,contributing to high morbidity and mortality.RA develops when ascites persists despite maximum diuretic therapy,while SBP arises from bacterial translocation and immune dysfunction in cirrhotic patients with ascites.Identifying key risk factors associated with these conditions is crucial for early intervention and improved patient outcomes.AIM To assess clinical and biochemical predictors of RA and SBP in a cohort of hospitalized patients with cirrhotic ascites.METHODS A retrospective chart review was conducted on patients with cirrhotic ascites diagnosed with RA or SBP at University Medical Center,El Paso,from July 1,2013 to December 31,2023.Patient demographics,clinical history,laboratory parameters,ascitic fluid analysis,and cirrhosis severity scores[Model for End-Stage Liver Disease-Sodium(MELD-Na)and Child-Pugh]were recorded.Statistical analyses,including multivariate logistic regression,were performed to identify independent predictors of RA and SBP,with a significance threshold of P<0.05.RESULTS A total of 179 patients were included,with a mean age of 59.08±13.04 years,predominantly male(55.9%)and Hispanic(98.3%).The most common etiology of cirrhosis was alcohol-related liver disease(45.3%),and most patients had Grade III ascites(95.5%).Among them,115(64.2%)had RA,and 57(31.8%)had SBP.RA was significantly associated with abnormal serum potassium levels[odds ratio(OR)=2.27,95%CI:1.06–4.84,P=0.034],while SBP was independently predicted by gastrointestinal bleeding(OR=2.59,95%CI:1.18–5.64,P=0.017)and thrombocytopenia(platelet count<50000;OR=3.27,95%CI:1.08–9.88,P=0.035).CONCLUSION RA and SBP are major complications of cirrhosis,with electrolyte imbalances and coagulopathy playing key roles in their development.Our study confirms that abnormal potassium levels significantly predict RA,while gastrointestinal bleeding and thrombocytopenia are strong predictors of SBP.These findings emphasize the need for early risk stratification and targeted management strategies to improve outcomes in high-risk cirrhotic patients,particularly in minority populations with limited healthcare access.Further prospective studies are warranted to validate these results and explore potential interventions to reduce RA and SBP incidence.展开更多
Objective:To explore the application of“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”four-dimensional linkage care model in peritoneal dialysis patients.Methods:99 cases of p...Objective:To explore the application of“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”four-dimensional linkage care model in peritoneal dialysis patients.Methods:99 cases of peritoneal dialysis patients were divided into 47 cases in the control group and 52 cases in the intervention group.In the control group,the routine discharge follow-up model was adopted;in the intervention group,the hospital-led medical unit was adopted as the basis of the“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”quadruple linkage care model,and the patients’systolic blood pressure was compared with those in the control group before and after discharge.The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and sodium were compared between the two groups.Results:The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and blood sodium of patients in the intervention group were significantly better than those of the control group(all P<0.001).Conclusion:Based on the“tertiary hospital-secondary hospital and nursing home-community-family”quadratic care model,the blood pressure control rate of elderly peritoneal dialysis patients can be increased to meet the standard,reduce the symptoms of the disease,and improve the satisfaction.展开更多
As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is...As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is maximal cytoreductive surgery(CRS)combined with platinum-based chemotherapy.Compared with intravenous chemotherapy,traditional intraperitoneal(IP)chemotherapy exhibits obvious pharmacokinetic(PK)advantages and systemic safety and has shown significant survival benefits in several clinical studies of OC patients.However,there remain several challenges in traditional IP chemotherapy,such as insufficient drug retention,a lack of tumor targeting,inadequate drug penetration,gastrointestinal toxicity,and limited inhibition of tumor metastasis and chemoresistance.Nanomedicine-based IP targeting delivery systems,through specific drug carrier design with tumor cells and tumor environment(TME)targeting,make it possible to overcome these challenges and maximize local therapy efficacy while reducing side effects.In this review article,the rationale and challenges of nanomedicine-based IP chemotherapies,as well as their in vivo fate after IP administration,which are crucial for their rational design and clinical translation,are firstly discussed.Then,current strategies for nanomedicine-based targeting delivery systems and the relevant clinical trials in IP chemotherapy are summarized.Finally,the future directions of the nanomedicine-based IP targeting delivery system for OC and its peritoneal metastasis are proposed,expecting to improve the clinical development of IP chemotherapy.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.展开更多
Peritoneal dialysis(PD)is a predominant modality of renal replacement therapy(RRT)for individuals suffering from end-stage renal disease(ESRD).Peritoneal dialysis-associated peritonitis(PDAP)represents a frequent comp...Peritoneal dialysis(PD)is a predominant modality of renal replacement therapy(RRT)for individuals suffering from end-stage renal disease(ESRD).Peritoneal dialysis-associated peritonitis(PDAP)represents a frequent complication among patients undergoing PD,significantly contributing to adverse clinical outcomes.This review comprehensively examines the diagnosis,classification,and risk factors associated with PDAP,aiming to offer clinical practitioners essential guidance and a foundational framework for effective clinical management.展开更多
Objectiveperitoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer. This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic con...Objectiveperitoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer. This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging (GRASP DCE-MRI) to predict the presence of peritoneal free cancer cells in gastric cancer patients.MethodsAll enrolled patients were consecutively divided into analysis and validation groups. Preoperative magnetic resonance imaging (MRI) scans and perfusion were performed in patients with gastric cancer undergoing surgery, and peritoneal lavage specimens were collected for examination. Based on the peritoneal lavage cytology (PLC) results, patients were divided into negative and positive lavage fluid groups. The data collected included clinical and MR information. A nomogram prediction model was constructed to predict the positive rate of peritoneal lavage fluid, and the validity of the model was verified based on data from the verification group.ResultsThere was no statistical difference between the proportion of PLC-positive cases predicted by GRASP DCE-MR and the actual PLC test. MR tumor stage, tumor thickness, and perfusion parameter Tofts-Ketty model volume transfer constant (Ktrans) were independent predictors of positive peritoneal lavage fluid. The nomogram model featured a concordance index (C-index) of 0.785 and 0.742 for the modeling and validation groups, respectively.ConclusionsGRASP DCE-MR could effectively predict peritoneal free cancer cells in gastric cancer patients. The nomogram model constructed using these predictors may help clinicians to better predict the risk of peritoneal free cancer cells being present in gastric cancer patients.展开更多
Objective:Peritoneal fibrosis(PF)is the main cause of declining efficiency and ultrafiltration failure of the peritoneum,which restricts the long-term application of peritoneal dialysis(PD).This study aimed to investi...Objective:Peritoneal fibrosis(PF)is the main cause of declining efficiency and ultrafiltration failure of the peritoneum,which restricts the long-term application of peritoneal dialysis(PD).This study aimed to investigate the therapeutic effects and mechanisms of bone marrow mesenchymal stem cells-derived exosomes(BMSC-Exos)on PF in response to PD.Methods:Small RNA sequencing analysis of BMSC-Exos was performed by second-generation sequencing.C57BL/6J mice were infused with 4.25%glucose-based peritoneal dialysis fluid(PDF)for 6 consecutive weeks to establish a PF model.A total of 36 mice were randomly divided into 6 groups:control group,1.5%PDF group,2.5%PDF group,4.25%PDF group,BMSC-Exos treatment group,and BMSC-Exos+TP53 treatment group.Reverse transcription quantitative polymerase chain reaction(RT-qPCR)was performed to measure the expression level of miR-27a-3p in BMSC-Exos and peritoneum of mice treated with different concentrations of PDF.HE and Masson staining were performed to evaluate the extent of PF.The therapeutic potential of BMSC-Exos for PF was examined through pathological examination,RT-qPCR,Western blotting,and peritoneal function analyses.Epithelial-mesenchymal transition(EMT)of HMrSV5 was induced with 4.25%PDF.Cells were divided into control group,4.25%PDF group,BMSC-Exos treatment group,and BMSC-Exos+TP53 treatment group.Cell Counting Kit-8 assay was used to measure cell viability,and transwell migration assay was used to verify the capacity of BMSC-Exos to inhibit EMT in HMrSV5 cells.Results:Small RNA sequencing analysis showed that miR-27a-3p was highly expressed in BMSC-derived exosomes compared to BMSCs.The RT-qPCR results showed that the expression of miR-27a-3p was upregulated in BMSC-Exos,but decreased in PD mice.We found that PF was glucose concentration-dependently enhanced in the peritoneum of the PD mice.Compared with the control mice,the PD mice showed high solute transport and decreased ultrafiltration volume as well as an obvious fibroproliferative response,with markedly increased peritoneal thickness and higher expression ofα-SMA,collagen-I,fibronectin,and ECM1.The mice with PD showed decreased miR-27a-3p.Peritoneal structural and functional damage was significantly attenuated after BMSC-Exos treatment,while PF and mesothelial damage were significantly ameliorated.Additionally,markers of fibrosis(α-SMA,collagen-I,fibronectin,ECM1)and profibrotic cytokines(TGF-β1,PDGF)were downregulated at the mRNA and protein levels after BMSC-Exos treatment.In HMrSV5 cells,BMSC-Exos reversed the decrease in cell viability and the increase in cell migratory capacity caused by high-glucose PDF.Western blotting and RT-qPCR analysis revealed that BMSC-Exos treatment resulted in increased expression of E-cadherin(epithelial marker)and decreased expression ofα-SMA,Snail,and vimentin(mesenchymal markers)compared to those of the 4.25%PDF-treated cells.Importantly,a dual-luciferase reporter assay showed that TP53 was a target gene of miR-27a-3p.TP53 overexpression significantly reversed the decreases in PF and EMT progression induced by BMSC-Exos.Conclusion:The present results demonstrate that BMSC-Exos showed an obvious protective effect on PD-related PF and suggest that BMSC-derived exosomal miR-27a-3p may exert its inhibitory effect on PF and EMT progression by targeting TP53.展开更多
AIM:To investigate the performance and diagnostic accuracy of interferon-gamma(IFN-γ) for tuberculous peritonitis(TBP) by meta-analysis.METHODS:A systematic search of English language studies was performed.We searche...AIM:To investigate the performance and diagnostic accuracy of interferon-gamma(IFN-γ) for tuberculous peritonitis(TBP) by meta-analysis.METHODS:A systematic search of English language studies was performed.We searched the following electronic databases:MEDLINE,EMBASE,Web of Science,BIOSIS,LILACS and the Cochrane Library.The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies.Sensitivity,specificity,and other measures of the accuracy of IFN-γ concentration in the diagnosis of peritoneal effusion were pooled using random-effects models.Receiver operating characteristic(ROC) curves were applied to summarize overall test performance.Two reviewers independently judged study eligibility while screening the citations.RESULTS:Six studies met the inclusion criteria.The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.92.Analysis of IFN-γ level for TBP diagnosis yielded a summary estimate:sensitivity,0.93(95%CI,0.87-0.97);specificity,0.99(95%CI,0.97-1.00);positive likelihood ratio(PLR),41.49(95%CI,18.80-91.55);negative likelihood ratio(NLR),0.11(95%CI,0.06-0.19);and diagnostic odds ratio(DOR),678.02(95%CI,209.91-2190.09).χ 2 values of the sensitivity,specificity,PLR,NLR and DOR were 5.66(P = 0.3407),6.37(P = 0.2715),1.38(P = 0.9265),5.46(P = 0.3621) and 1.42(P = 0.9220),respectively.The summary receiver ROC curve was positioned near the desirable upper left corner and the maximum joint sensitivity and specificity was 0.97.The area under the curve was 0.99.The evaluation of publication bias was not significant(P = 0.922).CONCLUSION:IFN-γ may be a sensitive and specific marker for the accurate diagnosis of TBP.The level of IFN-γ may contribute to the accurate differentiation of tuberculosis(TB) ascites from non-TB ascites.展开更多
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.
文摘BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.
文摘Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.
文摘This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024 and December 2024 were randomly assigned to two groups,with the observation group receiving APD and the reference group receiving CAPD.Renal function indicators,nutritional indicators,mineral metabolism,urine volume,and ultrafiltration volume changes were compared between the two groups.After treatment,the observation group showed lower renal function indicators,higher nutritional indicators,and better mineral metabolism levels compared to the reference group(P<0.05).While there was no significant difference in urine volume between the two groups(P>0.05),the observation group demonstrated superior ultrafiltration volume(P<0.05).These findings suggest that APD offers better clinical outcomes than CAPD by improving renal function,nutritional status,mineral metabolism regulation,and ultrafiltration efficiency in patients with end-stage renal disease.
文摘BACKGROUND End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy.Urgent-start peritoneal dialysis(PD)has emerged as a viable alternative to hemodialysis particularly in resourcelimited settings.However,concerns remain regarding catheter-related complications associated with early initiation of PD.Automated PD(APD)offers enhanced flexibility and fluid management,but evidence regarding its safety and outcomes in urgent-start scenarios with shortened break-in periods is limited.AIM To evaluate the clinical outcomes and biochemical changes associated with urgent-start APD with a shortened break-in period.METHODS This was a single center,observational study that included 62 patients with endstage kidney disease who required urgent-start dialysis,underwent PD catheter placement,and received APD.Patients were stratified based on catheter opening time(<12 hours vs>12 hours).Catheter-related complications,biochemical parameters,and dialysis efficacy were analyzed.RESULTS The median catheter opening time was 11 h(interquartile range:8-14 hours).No significant differences in catheterrelated complications were observed between groups(P>0.05).Catheter dysfunction,migration,leakage,and replacement occurred in 14.5%,9.7%,12.9%,and 11.3%of patients,respectively.APD led to significant reductions in serum creatinine,blood urea nitrogen,urea,phosphorus,and potassium(P<0.05),alongside correction of metabolic acidosis.No cases of peritonitis or hemoperitoneum were observed.CONCLUSION Urgent-start APD with shortened break-in appears safe with low complication rates and improved biochemical outcomes.
文摘BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.
文摘BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.
文摘Rationale:Fereydounia(F.)khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.Patient concerns:A 61-year-old male with end-stage renal failure on continuous ambulatory peritoneal dialysis,who presented with generalized abdominal pain,turbid dialysate and fever.Diagnosis:Peritoneal fluid culture revealed the presence of yeast cells.F.khargensis was identified by polymerase chain reaction method.Interventions:Removal of Tenckhoff catheter and intravenous fluconazole.Outcomes:He succumbed after two weeks of hospitalization.Lessons:This case report highlights the significance of a rare fungal pathogen,F.khargensis,which has been implicated in the mortality of an immunocompromised patient.Due to its rarity,F.khargensis poses significant challenges associated with its identification and has profound implications for clinical practice.
文摘BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to fungal infections.To date,the incidence of spontaneous fungal peritonitis(SFP)has not been determined in Mexico;this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment,which may increase mortality.AIM To report the incidence of SFP in patients presenting with decompensated LC with ascites.METHODS This was a prospective,single-center,descriptive,observational and crosssectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City.Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days,and molecular tests(the API 20 C AUX test)were used for molecular characterization.RESULTS Of the 48 patients included,54.2%were women,77.1%had a comorbidity,47.9%had LC secondary to metabolic dysfunction,43.8%were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22,and 10.4%were in secondary prophylaxis for spontaneous bacterial peritonitis(SBP).Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated,with two of the four patients being positive for Rhodotorula minuta;an SBP incidence of 8.3%was thus calculated.Chronic kidney disease[P=0.012 and relative risk(RR)=15]and secondary prophylaxis for SBP(P=0.049 with RR=8.6)were statistically significant and associated with a high mortality risk(P=0.001 with RR=33).CONCLUSION The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short-and medium-term mortality;therefore,it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures,and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP.Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture.Thus,treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.
文摘Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen ratio(AFR)for PC in patients with gastric cancer and to develop two preoperative prediction models.Methods A total of 745 gastric cancer patients were included in this study.Preoperative AFR,along with other serum markers and clinical tumor characteristics,was assessed.Univariate and multivariate logistic regression analyses were performed to determine the odds ratios(ORs)and 95%confidence intervals(CIs)of the independent variables.Propensity score matching(PSM)was used to control for potential confounders,and one-way ANOVA was conducted to evaluate differences in distribution between groups.Two prediction models incorporating the independent predictive indicators were constructed and validated via receiver operating characteristic(ROC)curves.Results Poorly differentiated type(OR 2.679;P=0.001),nondiffuse morphological type(OR 2.123;P=0.040),BMI<23.550 kg/m^(2)(OR 4.635;P=0.001),AFR<11.275(OR 2.895;P=0.003)and CA199≥73.615 U/mL(OR 2.040;P=0.037)were identified as independent risk factors for PC in patients with gastric cancer.After PSM,the AFR remained the only inflammatory marker that was independently associated with PC(P=0.003).AFR demonstrated consistent robustness in predicting PC across multiple sample sets.Among all the independent risk factors,the AFR had the highest area under the curve(AUC)for ROC analysis(AUC 0.648;95%CI 0.580–0.715).Two combination models incorporating the AFR demonstrated enhanced predictive ability:Combination Model 1(AUC 0.759;95%CI 0.699–0.820)and Combination Model 2(AUC 0.801;95%CI 0.744–0.859).Conclusions The preoperative AFR serves as a useful indicator for predicting PC.Two reliable prediction models based on the AFR have been developed.
文摘The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.
文摘BACKGROUND Refractory ascites(RA)and spontaneous bacterial peritonitis(SBP)are severe complications of decompensated cirrhosis,contributing to high morbidity and mortality.RA develops when ascites persists despite maximum diuretic therapy,while SBP arises from bacterial translocation and immune dysfunction in cirrhotic patients with ascites.Identifying key risk factors associated with these conditions is crucial for early intervention and improved patient outcomes.AIM To assess clinical and biochemical predictors of RA and SBP in a cohort of hospitalized patients with cirrhotic ascites.METHODS A retrospective chart review was conducted on patients with cirrhotic ascites diagnosed with RA or SBP at University Medical Center,El Paso,from July 1,2013 to December 31,2023.Patient demographics,clinical history,laboratory parameters,ascitic fluid analysis,and cirrhosis severity scores[Model for End-Stage Liver Disease-Sodium(MELD-Na)and Child-Pugh]were recorded.Statistical analyses,including multivariate logistic regression,were performed to identify independent predictors of RA and SBP,with a significance threshold of P<0.05.RESULTS A total of 179 patients were included,with a mean age of 59.08±13.04 years,predominantly male(55.9%)and Hispanic(98.3%).The most common etiology of cirrhosis was alcohol-related liver disease(45.3%),and most patients had Grade III ascites(95.5%).Among them,115(64.2%)had RA,and 57(31.8%)had SBP.RA was significantly associated with abnormal serum potassium levels[odds ratio(OR)=2.27,95%CI:1.06–4.84,P=0.034],while SBP was independently predicted by gastrointestinal bleeding(OR=2.59,95%CI:1.18–5.64,P=0.017)and thrombocytopenia(platelet count<50000;OR=3.27,95%CI:1.08–9.88,P=0.035).CONCLUSION RA and SBP are major complications of cirrhosis,with electrolyte imbalances and coagulopathy playing key roles in their development.Our study confirms that abnormal potassium levels significantly predict RA,while gastrointestinal bleeding and thrombocytopenia are strong predictors of SBP.These findings emphasize the need for early risk stratification and targeted management strategies to improve outcomes in high-risk cirrhotic patients,particularly in minority populations with limited healthcare access.Further prospective studies are warranted to validate these results and explore potential interventions to reduce RA and SBP incidence.
文摘Objective:To explore the application of“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”four-dimensional linkage care model in peritoneal dialysis patients.Methods:99 cases of peritoneal dialysis patients were divided into 47 cases in the control group and 52 cases in the intervention group.In the control group,the routine discharge follow-up model was adopted;in the intervention group,the hospital-led medical unit was adopted as the basis of the“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”quadruple linkage care model,and the patients’systolic blood pressure was compared with those in the control group before and after discharge.The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and sodium were compared between the two groups.Results:The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and blood sodium of patients in the intervention group were significantly better than those of the control group(all P<0.001).Conclusion:Based on the“tertiary hospital-secondary hospital and nursing home-community-family”quadratic care model,the blood pressure control rate of elderly peritoneal dialysis patients can be increased to meet the standard,reduce the symptoms of the disease,and improve the satisfaction.
基金supported by the National Key R&D Program of China(No.2020YFE0201700)the Liaoning Revitalization Talents Program(No.XLYC1908031)。
文摘As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is maximal cytoreductive surgery(CRS)combined with platinum-based chemotherapy.Compared with intravenous chemotherapy,traditional intraperitoneal(IP)chemotherapy exhibits obvious pharmacokinetic(PK)advantages and systemic safety and has shown significant survival benefits in several clinical studies of OC patients.However,there remain several challenges in traditional IP chemotherapy,such as insufficient drug retention,a lack of tumor targeting,inadequate drug penetration,gastrointestinal toxicity,and limited inhibition of tumor metastasis and chemoresistance.Nanomedicine-based IP targeting delivery systems,through specific drug carrier design with tumor cells and tumor environment(TME)targeting,make it possible to overcome these challenges and maximize local therapy efficacy while reducing side effects.In this review article,the rationale and challenges of nanomedicine-based IP chemotherapies,as well as their in vivo fate after IP administration,which are crucial for their rational design and clinical translation,are firstly discussed.Then,current strategies for nanomedicine-based targeting delivery systems and the relevant clinical trials in IP chemotherapy are summarized.Finally,the future directions of the nanomedicine-based IP targeting delivery system for OC and its peritoneal metastasis are proposed,expecting to improve the clinical development of IP chemotherapy.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
基金PhD project of Management and Science University(MSU)“Determination of Risk Factors Leading to Peritoneal Dialysis-Associated Peritonitis and Development of Clinical Prediction Models for Peritoneal Dialysis-Associated Peritonitis in Jiangsu Province,China”2022 High-Level Talent Research Project of Jiangsu Medicine College“Construction and Verification of Clinical Prediction Models for Peritoneal Dialysis-Associated Peritonitis”。
文摘Peritoneal dialysis(PD)is a predominant modality of renal replacement therapy(RRT)for individuals suffering from end-stage renal disease(ESRD).Peritoneal dialysis-associated peritonitis(PDAP)represents a frequent complication among patients undergoing PD,significantly contributing to adverse clinical outcomes.This review comprehensively examines the diagnosis,classification,and risk factors associated with PDAP,aiming to offer clinical practitioners essential guidance and a foundational framework for effective clinical management.
基金supported by the Ningbo Public Welfare Fund(No.2021S185).
文摘Objectiveperitoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer. This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging (GRASP DCE-MRI) to predict the presence of peritoneal free cancer cells in gastric cancer patients.MethodsAll enrolled patients were consecutively divided into analysis and validation groups. Preoperative magnetic resonance imaging (MRI) scans and perfusion were performed in patients with gastric cancer undergoing surgery, and peritoneal lavage specimens were collected for examination. Based on the peritoneal lavage cytology (PLC) results, patients were divided into negative and positive lavage fluid groups. The data collected included clinical and MR information. A nomogram prediction model was constructed to predict the positive rate of peritoneal lavage fluid, and the validity of the model was verified based on data from the verification group.ResultsThere was no statistical difference between the proportion of PLC-positive cases predicted by GRASP DCE-MR and the actual PLC test. MR tumor stage, tumor thickness, and perfusion parameter Tofts-Ketty model volume transfer constant (Ktrans) were independent predictors of positive peritoneal lavage fluid. The nomogram model featured a concordance index (C-index) of 0.785 and 0.742 for the modeling and validation groups, respectively.ConclusionsGRASP DCE-MR could effectively predict peritoneal free cancer cells in gastric cancer patients. The nomogram model constructed using these predictors may help clinicians to better predict the risk of peritoneal free cancer cells being present in gastric cancer patients.
基金supported by the Technology Development Program of Shanghai Pudong New District(No.PKJ2021-Y34)the Excellent Young Medical Talent Training Program of Pudong Health Commission of Shanghai(No.PWRq2022-18).
文摘Objective:Peritoneal fibrosis(PF)is the main cause of declining efficiency and ultrafiltration failure of the peritoneum,which restricts the long-term application of peritoneal dialysis(PD).This study aimed to investigate the therapeutic effects and mechanisms of bone marrow mesenchymal stem cells-derived exosomes(BMSC-Exos)on PF in response to PD.Methods:Small RNA sequencing analysis of BMSC-Exos was performed by second-generation sequencing.C57BL/6J mice were infused with 4.25%glucose-based peritoneal dialysis fluid(PDF)for 6 consecutive weeks to establish a PF model.A total of 36 mice were randomly divided into 6 groups:control group,1.5%PDF group,2.5%PDF group,4.25%PDF group,BMSC-Exos treatment group,and BMSC-Exos+TP53 treatment group.Reverse transcription quantitative polymerase chain reaction(RT-qPCR)was performed to measure the expression level of miR-27a-3p in BMSC-Exos and peritoneum of mice treated with different concentrations of PDF.HE and Masson staining were performed to evaluate the extent of PF.The therapeutic potential of BMSC-Exos for PF was examined through pathological examination,RT-qPCR,Western blotting,and peritoneal function analyses.Epithelial-mesenchymal transition(EMT)of HMrSV5 was induced with 4.25%PDF.Cells were divided into control group,4.25%PDF group,BMSC-Exos treatment group,and BMSC-Exos+TP53 treatment group.Cell Counting Kit-8 assay was used to measure cell viability,and transwell migration assay was used to verify the capacity of BMSC-Exos to inhibit EMT in HMrSV5 cells.Results:Small RNA sequencing analysis showed that miR-27a-3p was highly expressed in BMSC-derived exosomes compared to BMSCs.The RT-qPCR results showed that the expression of miR-27a-3p was upregulated in BMSC-Exos,but decreased in PD mice.We found that PF was glucose concentration-dependently enhanced in the peritoneum of the PD mice.Compared with the control mice,the PD mice showed high solute transport and decreased ultrafiltration volume as well as an obvious fibroproliferative response,with markedly increased peritoneal thickness and higher expression ofα-SMA,collagen-I,fibronectin,and ECM1.The mice with PD showed decreased miR-27a-3p.Peritoneal structural and functional damage was significantly attenuated after BMSC-Exos treatment,while PF and mesothelial damage were significantly ameliorated.Additionally,markers of fibrosis(α-SMA,collagen-I,fibronectin,ECM1)and profibrotic cytokines(TGF-β1,PDGF)were downregulated at the mRNA and protein levels after BMSC-Exos treatment.In HMrSV5 cells,BMSC-Exos reversed the decrease in cell viability and the increase in cell migratory capacity caused by high-glucose PDF.Western blotting and RT-qPCR analysis revealed that BMSC-Exos treatment resulted in increased expression of E-cadherin(epithelial marker)and decreased expression ofα-SMA,Snail,and vimentin(mesenchymal markers)compared to those of the 4.25%PDF-treated cells.Importantly,a dual-luciferase reporter assay showed that TP53 was a target gene of miR-27a-3p.TP53 overexpression significantly reversed the decreases in PF and EMT progression induced by BMSC-Exos.Conclusion:The present results demonstrate that BMSC-Exos showed an obvious protective effect on PD-related PF and suggest that BMSC-derived exosomal miR-27a-3p may exert its inhibitory effect on PF and EMT progression by targeting TP53.
文摘AIM:To investigate the performance and diagnostic accuracy of interferon-gamma(IFN-γ) for tuberculous peritonitis(TBP) by meta-analysis.METHODS:A systematic search of English language studies was performed.We searched the following electronic databases:MEDLINE,EMBASE,Web of Science,BIOSIS,LILACS and the Cochrane Library.The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies.Sensitivity,specificity,and other measures of the accuracy of IFN-γ concentration in the diagnosis of peritoneal effusion were pooled using random-effects models.Receiver operating characteristic(ROC) curves were applied to summarize overall test performance.Two reviewers independently judged study eligibility while screening the citations.RESULTS:Six studies met the inclusion criteria.The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.92.Analysis of IFN-γ level for TBP diagnosis yielded a summary estimate:sensitivity,0.93(95%CI,0.87-0.97);specificity,0.99(95%CI,0.97-1.00);positive likelihood ratio(PLR),41.49(95%CI,18.80-91.55);negative likelihood ratio(NLR),0.11(95%CI,0.06-0.19);and diagnostic odds ratio(DOR),678.02(95%CI,209.91-2190.09).χ 2 values of the sensitivity,specificity,PLR,NLR and DOR were 5.66(P = 0.3407),6.37(P = 0.2715),1.38(P = 0.9265),5.46(P = 0.3621) and 1.42(P = 0.9220),respectively.The summary receiver ROC curve was positioned near the desirable upper left corner and the maximum joint sensitivity and specificity was 0.97.The area under the curve was 0.99.The evaluation of publication bias was not significant(P = 0.922).CONCLUSION:IFN-γ may be a sensitive and specific marker for the accurate diagnosis of TBP.The level of IFN-γ may contribute to the accurate differentiation of tuberculosis(TB) ascites from non-TB ascites.
