Tissue Inhibitor of Metalloproteinase-1 Concentrations are Attenuated in Peritoneal Fluid and Sera of Women with Endometriosis and Restored in Sera by Gonadotropin-Releasing Hormone Agonist Therapy

Objective: To establish tissue inhibitor of metalloproteinase-1 (TIMP-1) concentrations in peritoneal fluid (PF) and sera of women with endometriosis and compare them to disease-free controls.

Design: Prospective randomized study.

Setting: Academic medical center.

Patient(s): Women with laparoscopically documented endometriosis and disease-free women of reproductive age.

Intervention(s): Peritoneal fluid and sera were collected, and some women received gonadotropin-releasing hormone agonist (GnRH-a) therapy for endometriosis.

Main Outcome Measure(s): Peritoneal fluid and sera TIMP-1 concentrations were measured with a specific RIA.

Result(s): The TIMP-1 concentrations were significantly lower in PF and sera of women with endometriosis compared with disease-free women. The GnRH-a therapy restored serum TIMP-1 concentrations.

Conclusion(s): Aberrant expression and localization of TIMP-1 may derange the proteolytic milieu of the peritoneal cavity and contribute to the etiology and underlying physiologic sequelae associated with endometriosis. Measurement of TIMP-1 in serum may aid in diagnosing endometriosis and assist with monitoring treatment efficacy in women with this disease.     

黄芪对小鼠腹腔巨噬细胞吞噬能力的影响

目的:研究黄芪水煎剂(HQD)对小鼠腹腔巨噬细胞吞噬能力的影响。方法:取18~22 g昆明小鼠100只,随机分10组,每组10只。分别为对照组,灌服不同剂量黄芪水煎剂组,同剂量不同给药途径组,黄芪与地塞米松并用组。各处理组每天给药1次,连续6 d。结果:在不同剂量灌服给药组中,高、中、低剂量试验组吞噬百分率和吞噬指数均高于对照组(P<0.01),其中以高剂量组效果最好;在不同给药途径组中,吞噬百分率以腹腔注射的效果优于皮下注射和灌服(P<0.01),但各组间的吞噬指数差异不明显(P>0.05);在黄芪与地塞米松并用组中,黄芪能明显对抗地塞米松的免疫抑制作用(P<0.01)。结论:黄芪不同剂量、不同给药途径给药对小鼠腹腔巨噬细胞吞噬能力均有不同程度的增强作用,并能对抗地塞米松对其抑制作用。     

At the heart of the problem: congestive cardiac failure as a cause of ascites: A narrative review

Heart failure leading to cardiac ascites is an extremely rare and underrecognized entity in clinical practice. Recognizing cardiac ascites can be difficult, especially since patients presenting with ascites may have more than 1 etiology. Various biomarkers are available to aid in the diagnosis of cardiac ascites, though with differing sensitivities and specificities. Such biomarkers include serum albumin, ascitic albumin and protein, as well as serum N-terminal pro-brain natriuretic peptide (NT-proBNP). While serum NT-proBNP is a powerful biomarker in distinguishing the etiology of ascites and monitoring treatment progression, its cost can be prohibitive in low-resource settings. Clinicians practicing under these circumstances may opt to rely on other parameters to manage their patients. We go on further to report a series of 3 patients with cardiac ascites to illustrate how these biomarkers may be employed in the management of this patient population. Clinicians should always keep in mind the differential diagnosis of cardiac failure as a cause of ascites. The resolution of cardiac ascites may serve as a surrogate clinical marker for response to antifailure therapy in lieu of NT-proBNP at resource-scarce centers.     

A Young Patient with Microscopic Polyangiitis Requiring Hemodialysis with Complications of Repeated Episodes of Posterior Reversible Encephalopathy Syndrome Probably Due to Different Etiologies

A young woman with microscopic polyangiitis (MPA) requiring hemodialysis showed repeated posterior reversible encephalopathy syndrome (PRES) with spatiotemporal multiple lesions over a period of two months. The first PRES episode with confusion and the second PRES episode with vertigo and nausea were caused by MPA, hypertension and renal failure. These symptoms were improved by the reinforcement of MPA treatment and blood pressure management. The third PRES episode with nausea, headache, seizure and visual changes was induced by rituximab infusion and hypertension. The PRES was improved with blood pressure and convulsant management. These conditions are challenging to diagnose and treat.     

High hemoglobin fluctuation was a protective factor for cardiovascular‐related death in peritoneal dialysis (PD) patients: A retrospective analysis of 232 patients with PD

ObjectivesThis study aimed to investigate the effect of hemoglobin (Hb) fluctuation after dialysis on the prognosis of cardiovascular‐related and all‐cause deaths in peritoneal dialysis (PD).MethodsAccording to the Hb fluctuation, patients were divided into low fluctuation group, moderate fluctuation group, and high fluctuation group, and then, the effects of Hb fluctuation after dialysis on the prognosis of cardiovascular‐related and all‐cause death in PD were analyzed by regression analysis.ResultsA total of 232 patients were selected in this study. Compared with the low Hb fluctuation group, the moderate and high fluctuation groups had lower body mass index (BMI), estimated glomerular filtration rate (eGFR), and baseline Hb, and the moderate fluctuation group had less erythropoietin (EPO) and dialysis dose. Compared with survivors, patients with cardiovascular‐related and all‐cause deaths had lower mean Hb and Hb fluctuation (all p < 0.05). Cox regression analysis showed that before and after adjusting for confounding factors, Hb fluctuation was still independently correlated with cardiovascular prognosis, and higher Hb fluctuation was still a protective factor for cardiovascular‐related death in the Hb‐substandard group, but there was no significant correlation between Hb fluctuation and all‐cause death. Multivariate linear regression analysis revealed that Hb fluctuation was positively correlated with Kt/V and EPO dosage, but negatively correlated with the baseline Hb.ConclusionHigh Hb fluctuation was a protective factor for cardiovascular‐related death in PD with substandard Hb. Compared with Hb fluctuation, correction of anemia timely and making Hb reaches the standard level had a greater impact on reducing cardiovascular‐related death in PD.     

MINOCYCLINE EXCRETION AND DISTRIBUTION IN RELATION TO RENAL FUNCTION IN MAN

SUMMARY 1. The biological half-life of minocycline in serum has been studied in twenty-one patients and shown to have no relationship to renal function. There is very little excretion of minocycline by the kidney, and practically none is removed by dialysis.
2. In normal subjects, minocycline therapy is not accompanied by a significant rise in blood urea concentration or urinary urea excretion. However, high doses may produce a marked increase in urea excretion.
3. Of eight patients with impaired renal function who were treated with a normal therapeutic dose of minocycline (200 mg/day), one showed a significant increase in urea excretion and a rise in plasma urea concentration. Two patients with severe unstable renal failure required dialysis following therapy.
4. Minocycline is unlikely to accumulate in patients with renal failure due to its predominantly gastrointestinal excretion and is therefore safe to use. However, its protein catabolic effect is dose dependent and if renal function is impaired, even a small increase in urea production may be sufficient to aggravate uraemia. In such patients the normal therapeutic dose (200 mg/day) should not be exceeded and monitoring of renal function is advisable.     

内镜监视下置管腹膜透析在重症急性胰腺炎治疗中的应用及护理

目的 探讨腹膜透析对重症急性胰腺炎(SAP)的疗效及护理.方法 选择2004年1月～2007年3月在我院接受治疗的60例SAP患者作为研究对象,其中以施行腹膜透析的28例患者作为治疗组,以未行腹膜透析的32例患者作为对照组,两组患者入院情况基本相似.两组患者除腹膜透析外,均接受相同的常规治疗.比较两组治疗前后的血淀粉酶值、血白细胞计数、血Ca2+浓度、血氧分压(PaO2)、腹痛腹胀缓解时间、住院时间、治愈率.重症急性胰腺炎患者置管腹膜透析术前、术中、术后均给予高质量的护理.结果 治疗组的血淀粉酶值与对照组比较,两组的好转趋势不同,治疗组优于对照组.血白细胞计数、血Ca2+浓度、血氧分压(PaO2)、腹痛腹胀缓解时间、住院时间均优于对照组.结论 腹膜透析能明显减轻SAP患者的一般情况,改善患者预后,值得临床推广应用.高质量的腹膜透析护理是治疗重症急性胰腺炎的重要因素之一.     

Inhibition of pro-inflammatory mediators and tumor cell proliferation by Anisomeles indica extracts

Anisomeles indica (L.) Kuntze (Labiatae), is a traditional anti-inflammatory herb used in Taiwan. The aqueous and methanolic extracts of whole plants, leaves, flowers and stems; and chloroform and n-butanol fractions of methanol extract, from A. indica were investigated for their anti-inflammatory activity on murine peritoneal macrophages. In addition, the tumor cells proliferation inhibition activities of these extracts were also evaluated against a panel of tumor cell lines such as Colon 205, PC 3, HepG2 and MCF 7. Treatment with A. indica extracts did not reduce cell viability at any dose used. However, all the extracts significantly inhibited the enhanced production of NO radicals, and pro-inflammatory cytokines (TNF-alpha, and IL-12) induced by LPS/IFN-gamma in a dose-dependent manner. Furthermore, methanolic extracts of leaves and flowers significantly and dose-dependently arrest mitogen-stimulated spleen cells in G0/G1 stage, in addition to their cell proliferation inhibition against Colon 205, MCF 7 and PC 3 by 94, 82; 98, 71; 82, 98%, respectively, at 200 microg/mL concentration. This is the first report on A. indica extracts for their growth inhibitory activities, against inflammatory mediator production, and human tumor cell lines, colon, prostate, hepatoma and breast cells proliferation.     

Pregnancy in uremic patients: an eventful journey

Renal damage, which can be caused by gestational anomalies such as pre-eclampsia, carries a risk of gestational complications; the greatest risk being in women who become pregnant while on hemodialysis or peritoneal dialysis. If this rare event occurs, there is a marked increase in the risk of pre-eclampsia, early uterine contractions and hydramnios, hypertensive crisis, preterm delivery and intrauterine growth retard. Furthermore, newborns are almost always of low birthweight. Patients who undergo renal transplantation are another high-risk category. In such cases, the pregnancy itself can compromise the success of the transplant and the immunosuppressive therapy correlated to it can become a threat to the course of the pregnancy and normal fetal growth. Therefore, in view of the lack of appropriate guidelines for the best possible approach to the treatment of women on dialysis or of those with a renal transplantation, it is best to advise these patients against becoming pregnant and/or to provide a valid counselling service illustrating the extreme difficulties and dangers involved in becoming pregnant.