Impact of hyperthermic intraperitoneal chemotherapy on Hsp27 protein expression in serum of patients with peritoneal carcinomatosis

Despite the strong rationale for combining cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis, thermotolerance and chemoresistance might result from heat shock protein overexpression. The aim of the present study was thus to determine whether the heat shock protein 27 (Hsp27), a potential factor in resistance to treatment, could have a higher level in serum from patients under this combined therapy. Patients receiving CRS plus HIPEC for peritoneal carcinomatosis (group 1), patients with cancer or a history of cancer undergoing abdominal surgery (group 2), and patients without malignancies undergoing abdominal surgery (group 3) were included. Hsp27 serum levels were determined before and at different times following CRS and HIPEC using enzyme-linked immunosorbent assay. In group 1 (n = 25), the high Hsp27 levels, observed at the end of surgery compared with before (p < 0.0001), decreased during HIPEC, but remained significantly higher than before surgery (p < 0.0005). In groups 2 (n = 11) and 3 (n = 15), surgery did not significantly increase Hsp27 levels. A targeted molecular strategy, inhibiting Hsp27 expression in tumor tissue, could significantly reduce resistance to the combined CRS plus HIPEC treatment. This approach should be further assessed in a clinical phase I trial.     

The role of mitochondria in sepsis-induced cardiomyopathy

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Myocardial dysfunction, often termed sepsis-induced cardiomyopathy, is a frequent complication and is associated with worse outcomes. Numerous mechanisms contribute to sepsis-induced cardiomyopathy and a growing body of evidence suggests that bioenergetic and metabolic derangements play a central role in its development; however, there are significant discrepancies in the literature, perhaps reflecting variability in the experimental models employed or in the host response to sepsis. The condition is characterised by lack of significant cell death, normal tissue oxygen levels and, in survivors, reversibility of organ dysfunction. The functional changes observed in cardiac tissue may represent an adaptive response to prolonged stress that limits cell death, improving the potential for recovery. In this review, we describe our current understanding of the pathophysiology underlying myocardial dysfunction in sepsis, with a focus on disrupted mitochondrial processes.     

腹水降钙素原诊断肝硬化自发性腹膜炎的临床价值研究

目的:探讨腹水中降钙素原(PCT)诊断晚期肝硬化腹水并发自发性细菌性腹膜炎(SBP)的临床价值,并确定其参考值水平。方法:选择42例肝硬化失代偿期患者为研究对象(伴SBP22例,非SBP 20例),抽取其住院时、住院后24 h和48 h外周血及腹水标本各一次,进行腹水中有核细胞数计数,并采用免疫荧光层析法同时测定和比较其血清及腹水中PCT的含量。结果:22例伴SBP的患者血清和腹水PCT含量均明显高于20例不伴有SBP的患者(P0.01),而伴SBP的患者腹水PCT含量和同时间点血清PCT含量比较差异均无统计学意义(P0.05)。以入院时腹水PCT含量诊断SBP的ROC曲线的AUC为0.986,而血清PCT、腹水PMN计数的AUC分别为0.942、0.868;入院后24时腹水PCT和血清PCT诊断SBP的ROC曲线的AUC分别为0.998和0.986;入院后48时腹水PCT和血清PCT诊断SBP的ROC曲线的AUC为0.986和0.990。结论:腹水降钙素原可用于晚期肝硬化腹水并发SBP的诊断,且较血清降钙素原和腹水中有核细胞计数具有更高的诊断价值。入院时、入院后24 h和48 h时,腹水PCT大于0.565 ng/m L、0.545 ng/m L和0.410 ng/m L提示患SBP可能性大。     

肝硬化并自发性细菌性腹膜炎的观察和护理

目的探讨肝硬化并自发性细菌性腹膜炎有效的观察方法和护理措施。方法对152例肝硬化并自发性细菌性腹膜炎的观察方法和护理措施进行回顾性分析。结果152例患者通过治疗及护理配合,治愈好转129例,死亡和自动出院23例。结论加强病情观察及实施有效的护理措施对促进患者康复、减少并发症,降低死亡率有重要的意义。     

微生态制剂对预防肝硬化自发性腹膜炎再发的疗效观察及护理体会

目的探讨常规保肝基础上联合微生态制剂对肝硬化自发性腹膜炎再发的疗效及护理措施。方法选取选取2011年10月至2013年6月来我院治疗的肝硬化自发性腹膜炎患者48例,随机分为微生态治疗组及对照组,微生态治疗组行常规保肝治疗并加用微生态制剂,对照组仅行常规保肝治疗,比较1年内两组患者自发性腹膜炎的再发情况及再发时各症状缓解时间的变化,并总结护理措施。结果微生态治疗组再发率明显低于与对照组再发率,差异有统计学意义(P0.05);微生态治疗组的各项症状的缓解时间也明显少于对照组,差异有统计学意义(P0.05)。结论在常规保肝基础上加服微生态制剂可以有效地预防肝硬化患者自发性腹膜炎再发,并能显著缩短再发时各症状的缓解时间。同时,护理人员的正确护理是保证治疗顺利进行,并改善患者预后的关键。     

Interleukin-12 genetic administration suppressed metastatic liver tumor unsusceptible to CTL

A cytokine gene therapy approach was conducted against metastatic lesions of cytotoxic T lymphocyte (CTL)-unsusceptible tumor in mice. The EBV-based and conventional plasmid vectors that encode murine interleukin-12 (IL-12) gene (pGEG.mIL-12 and pG.mIL-12, respectively) were intravenously transfected into the mice that had received a subcutaneous inoculation of M5076 sarcoma cells. The pGEG.mIL-12 transfection drastically suppressed the subcutaneous as well as hepatic metastatic tumors, resulting in significant prolongation of survival period of the animals. Although single administration with pG.mIL-12 was not effective, repetitive transfection with the plasmid significantly prolonged the longevity of the mice-bearing the metastatic liver tumors. Multiple transfection with either pGEG.mIL-12 or pG.mIL-12 also suppressed peritoneal carcinomatosis in mice that had been injected with M5076 cells into the peritoneal cavity. It was suggested that a high level IL-12 production elicited by the intravenous delivery of the cytokine gene may be quite effective in inhibiting metastatic and CTL-unsusceptible neoplasms.     

老年肝硬化并发自发性腹膜炎临床特点及病原学分析

目的探讨老年肝硬化并发自发性腹膜炎(SBP)患者的临床特点及腹水病原菌分布及其耐药情况,指导临床合理用药。方法回顾性分析老年肝硬化并发SBP患者的临床特点,并对118例腹水病原菌培养结果阳性的120株病原菌进行鉴定和耐药分析。结果365例SPB患者治愈113例(31.0%),好转99例(27.1%),病情恶化自动出院及死亡153例(41.9%)。发病隐匿164例(44.9%),急性发病201例(55.1%)。365例SBP患者腹水病原菌培养阳性118例(32.3%),共分离出病原菌120株,其中大肠埃希菌检出率最高,占40.0%(48/120),其次为肺炎克雷伯菌,占12.5%(15/120)。分离菌株的耐药情况比较严重,特别是大肠埃希菌对多种抗菌药物的耐药率60%。结论老年肝硬化并发SBP患者病情复杂,病死率高,且细菌耐药比较严重,应尽早进行腹水培养,依据药物敏感试验结果合理选用抗菌药物。     

地衣芽胞杆菌治疗肝硬化并自发性细菌性腹膜炎的临床疗效研究

目的观察益生菌治疗肝硬化自发性细菌性腹膜炎（SBP）患者的效果。方法将60例肝硬化自发性细菌性腹膜炎随机分成2组,对照组30例,予抗感染、保肝、降门脉高压、利尿、营养支持治疗;治疗组30例,在对照组的综合治疗基础上加用地衣芽胞杆菌胶囊,每日3次,每次2粒,连服21d后观察感染控制及肝功能变化情况。结果治疗组总有效率明显高于对照组,除了腹痛、腹部压痛无差异外,发热、腹泻消失、腹水常规、肝功能改善方面与对照组比较差异存在统计学意义（P〈0．05）。结论益生菌对肝硬化并发自发性腹膜炎有一定治疗效果。     

实验性腹膜炎肺损伤时大黄的保护作用

目的探讨大黄对实验性腹膜炎时肺损伤的保护作用.方法用酵母多糖A腹腔注射制备大鼠急性腹膜炎模型,诱发肺脏损伤.将SD大鼠随机分为4组:(1)正常组,(2)模型组,(3)大黄实验组,(4)抗生素实验组(氨苄西林组).测定肺组织匀浆中丙二醛(MDA)、黄嘌呤氧化酶(XOD)、谷光甘肽(GSH)和血清内毒素水平,并进行血气分析及外周血WBC计数.结果大黄组内毒素、肺组织匀浆中MDA和XOD,以及白细胞计数均明显低于模型组(P＜0.05),而还原GSH变化不明显.结论大黄可能通过降低外周及门静脉血内毒素水平,抑制脂质过氧化和加强自由基的清除,从而减轻实验性腹膜炎引起的肺损伤.     

实验性腹膜炎时内毒素血症及肺脏的变化

目的探讨实验性腹膜炎时,内毒素与肺损伤的变化.方法用酵母多糖A腹腔注射制备大鼠急性实验性腹膜炎模型,随机分为模型组和对照组;观察实验性腹膜炎时,肺损伤变化.结果模型组内毒素、肺匀浆脂质过氧化物,以及白细胞计数均明显增高;而还原谷胱甘肽(GSH)明显降低,与对照组比差异有显著性(P＜0.05).结论实验性腹膜炎时,内毒素的形成、细菌因子的释放及脂质过化与肺损害有一定的联系.