Septic Peritonitis Research Articles

Anatomopathological Evaluation of Fecal Peritonitis Complications in Horses Treated with Peritoneal Lavage

Background: Reproductive management in horses when performed with malpractice or by an unqualified person can cause many lesions of various degrees. When the rectum is affected it can compromise the mucous layer of the rectal ampulla and may even cause total perforation of this intestinal segment. Once the rectum ruptured, its contents gets into the abdominal cavity and generates severe abdominal infection, which may cause intense adhesions between organs and even to the abdominal wall and requires a particular intensive intervention. This work reports the use of peritoneal lavage protocol in three horses with septic peritonitis caused by rectal laceration, correlating with post-mortem findings.Cases: Three horses were referred to the Veterinary Hospital Rancho Belo Vista, in the city of Serra - ES, with an accident report during reproductive management in different properties. In all cases, blood loss and loss of continuity of the rectal mucosa were reported by the technicians. Patients were referred at different post-accident times. When they arrived at the hospital, they were examined and a sample of blood and peritoneal fluid were collected and sent to the laboratory. They presented intense apathy, mucosa coloration ranging from hyperemic to pale with halo toxemia, high cardiac and respiratory rate, reduction of globular volume and prolonged time of capillary refill. Patients were given fluid therapy support with lactated Ringer’s solution and systemic therapy protocols such as antibiotic therapy, peritoneal lavage with antibiotic containing solution and anticoagulant, and other supportive treatments were instituted. Peritoneal lavages were instituted every eight hours, in the first 48 hours and every twelve hours, until five days were completed. All patients had to be sacrificed. Euthanasia occurred at different times according to response to treatment and onset of clinical signs of shock. Significant variations were observed among patients at necropsy. The patient submitted to fewer wash cycles had severe adhesions. The other two patients who underwent more wash cycles presented less severe adhesion and less fibrin deposition in the abdominal viscera.Discussion: The use of peritoneal lavage associated with systemic treatment has been shown to be beneficial for the treatment of peritonitis since the initial condition and alteration in the results of laboratory tests. However, the time elapsed between rectal laceration and referral to a specialized technical unit was a decisive factor, together with the severity of the lesion, that were determinant for the increased response and consequent chance of treatment success and chances of survival. Although they received a combination of systemic therapy with broad-spectrum antibiotics and peritoneal lavage associated with daily washing cycles, the patients were euthanized, reiterating the lethality of the disease. At necropsy it was possible to evaluate the extent of contamination and adhesions, as well as to find the lacerated segment, the main source of contamination of the peritoneum. The difference between the degrees of adhesion is evident when compared to the patients who went through more cycles of peritoneal lavage with the ones that went through fewer cycles. Thus, it is possible to estimate that the patients who received a greater number of peritoneal lavage cycles with the drugs used in the same route presented a reduced number of adhesions between similar structures (same organs) and between the organs and the abdominal wall. There is a need for more controlled studies to evaluate the effectiveness of serial peritoneal lavage treatments in horses, as well as the application of drugs that seek to reduce abdominal inflammation, fibrin production and adhesions.

Combined bacteriophages and antibiotics as an efficient therapy against VRE Enterococcus faecalis in a mouse model

Clinical applications of bacteriophage therapy have been recently gathering significant attention worldwide, used mostly as rescue therapy in cases of near-fatal antibiotic failure. Thus, clinically relevant in-vivo models presenting both short- and long-term implications of phage therapy given as rescue treatment for fulminant infections are of highest importance. In this study, a cocktail consisting of two lytic bacteriophages was used to evaluate the therapeutic efficacy of phage therapy as a rescue treatment for severe septic peritonitis in a mouse model. We established that a single injection of the bacteriophage cocktail was sufficient to completely reverse a 100% mortality trend caused by Vancomycin-Resistant Enterococcus faecalis, with significant improvement in both the clinical state and laboratory test results, and without harmful effects on the microbiome. The combination of bacteriophages with a suboptimal antibiotic regimen imparts an additional beneficial effect on the treatment success.

Mycobacterium tuberculosis PPE18 Protein Reduces Inflammation and Increases Survival in Animal Model of Sepsis.

Mycobacterium tuberculosis PPE18 is a member of the PPE family. Previous studies have shown that recombinant PPE18 (rPPE18) protein binds to TLR2 and triggers a signaling cascade which reduces levels of TNF-α and IL-12, and increases IL-10 in macrophages. Because TNF-α is a major mediator of the pathophysiology of sepsis and blocking inflammation is a possible line of therapy in such circumstances, we tested the efficacy of rPPE18 in reducing symptoms of sepsis in a mouse model of Escherichia coli-induced septic peritonitis. rPPE18 significantly decreased levels of serum TNF-α, IL-1β, IL-6, and IL-12 and reduced organ damage in mice injected i.p. with high doses of E. coli Peritoneal cells isolated from rPPE18-treated mice had characteristics of M2 macrophages which are protective in excessive inflammation. Additionally, rPPE18 inhibited disseminated intravascular coagulation, which can cause organ damage resulting in death. rPPE18 was able to reduce sepsis-induced mortality when given prophylactically or therapeutically. Additionally, in a mouse model of cecal ligation and puncture-induced sepsis, rPPE18 reduced TNF-α, alanine transaminase, and creatinine, attenuated organ damage, prevented depletion of monocytes and lymphocytes, and improved survival. Our studies show that rPPE18 has potent anti-inflammatory properties and can serve as a novel therapeutic to control sepsis.

Effects of hyaluronate-carboxymethylcellulose membranes on the clinical outcome of horses undergoing emergency exploratory celiotomy.

To determine the influence of hyaluronate-carboxymethylcellulose (HA-CMC) membranes applied to intestinal anastomoses or enterotomies on postoperative complications after emergency exploratory celiotomy. Multicenter retrospective case-controlled series. Adult horses (59 in the HA-CMC group and 91 controls). Medical records from 4 referral hospitals were searched for horses ≥1 year of age, treated between 2008 and 2014 with emergency exploratory celiotomy, and surviving at least 24 hours postoperatively. Horses receiving repeat celiotomy during the same hospitalization were excluded. Horses who received HA-CMC were matched with controls who did not receive HA-CMC but had similar intestinal lesions and procedures at the same referral hospital. Postoperative complications (colic, nasogastric reflux, fever, incisional infection, and septic peritonitis), duration of hospitalization, and survival were compared between groups. Data were compared between horses by t test, Wilcoxon signed rank test, and χ2 test. The volume of nasogastric reflux at admission (P = .02) and the duration of administration of lidocaine after surgery (P = .02) were greater in horses with HA-CMC membranes than in controls. No difference in postoperative complications or survival was detected between groups: 48 of 59 (81%) horses treated with HA-CMC survived until discharge from the hospital compared with 80 of 91 (88%) horses in the control group (P = .27). Fifteen of 21 horses treated with HA-CMC and 30 of 43 horses in the control group survived >12 months after hospital discharge. Application of HA-CMC membranes to anastomoses or intestinal incisions did not influence postoperative complications or survival after emergency celiotomy compared with controls. The safety and efficacy of HA-CMC membrane application to intestinal sites during colic surgery in horses is equivocal.

Intestinal lymphoma in dogs: 84 cases (1997-2012).

OBJECTIVE To describe signalment, clinicopathologic features, and outcomes of dogs with confirmed primary intestinal lymphoma and assess factors associated with survival times in these patients. DESIGN Retrospective case series. ANIMALS 84 client-owned dogs. PROCEDURES Medical records from 7 veterinary institutions were retrospectively reviewed to identify dogs with primary intestinal lymphoma. Data collected included signalment, clinical signs, anatomic location of tumors, diagnostic procedures, treatment, outcome, and dates of diagnosis and death. RESULTS Overall median survival time (MST) was 62 days (range, 1 to 537 days). Factors associated with shorter survival time on univariate analysis included anorexia or septic peritonitis at the time of diagnosis and tumor location (intestinal tract only, intestinal tract and abdominal lymph nodes, or intestinal tract and extraintestinal organs). The most commonly noted changes in the intestinal tract were altered wall thickening with loss of layering (41 dogs) and presence of ≥ 1 discrete mass (24 dogs). Protocols based on cyclophosphamide, doxorubicin, vincristine, and prednisone with or without l-asparaginase (48 dogs) or 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (14 dogs) were most commonly used as first-line treatment; the MSTs of dogs receiving these treatments (60 and 144 days, respectively) did not differ significantly. CONCLUSIONS AND CLINICAL RELEVANCE The MST of dogs with primary intestinal lymphoma was poor, regardless of first-line treatment used. Anorexia and septic peritonitis were associated with poor prognosis.

COMPARISON BETWEEN DELAYED PRIMARY CLOSURE AND IMMEDIATE PRIMARY CLOSURE OF ABDOMINAL INCISIONS IN PATIENTS WITH SEPTIC PERITONITIS.

Background: It is still a point of controversy if performing delayed primary closure (DPC) of abdominal incisions in cases of abdominal septic operations could be able to reduce incidence of surgical-site infection and its bad long term sequels in comparison with immediate primary closure (PC). The Aim: To compare between delayed primary closure and immediate primary closure of abdominal incisions, in patients with peritonitis that results from septic operations regarding superficial surgical site infection. Patients & Methods: we have carried out such study on 60 patients with septic peritonitis that were collected and operated surgically during 2 years in in Department of General Surgery, Zagazig University Hospital. We have divided our cases into 2 groups; Group (1): cases that are managed by immediate PC of the skin and subcutaneous tissue using polypropylene sutures and insertion of subcutaneous drain. Group (2): included cases that are managed by DPC of the skin and subcutaneous tissue, using polypropylene sutures and without insertion of drain. We have followed all patients for 2 weeks for; infection or dehiscence of the wound and for occurrence of burst abdomen, seroma or sub cutaneous collection. Results: we have detected that DPC is better than immediate PC as regard decreasing incidence of wound infection & dehiscence (p=0,009), less liability for occurrence of burst abdomen (p=0.042), sub cutaneous collection (p=0.003) and seroma (p<0.001). Conclusion: performing DPC will be better than immediate PC in management of patients with septic peritonitis.

COMPARISON BETWEEN DELAYED PRIMARY CLOSURE AND IMMEDIATE PRIMARY CLOSURE OF ABDOMINAL INCISIONS IN PATIENTS WITH SEPTIC PERITONITIS.

04Jan 2018 COMPARISON BETWEEN DELAYED PRIMARY CLOSURE AND IMMEDIATE PRIMARY CLOSURE OF ABDOMINAL INCISIONS IN PATIENTS WITH SEPTIC PERITONITIS. Ahmed Raafat , Fady M. Habib , Ahmed M. Sallam and Loay M. Gertallah. Department of General surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Canine Uterine Rupture with Septic Peritonitis Results from Adenocarcinoma in a 2-year-old Maltese Dog

A 2-year-old female Maltese dog was presented with a history of anemia and vaginal hemorrhagic discharge. Physical examination revealed severe vaginal hemorrhagic discharge, abdominal pain, pale mucous membranes, low blood pressure and dehydration. Results of serum biochemistry, hematology, venous blood gas, and electrolyte canine C-reactive protein (CRP) test revealed severe normocytic normochromic anemia, severe neutropenia, a high level of CRP, hypoglycemia, and imbalanced electrolytes. Abdominal ultrasound examination showed focal hypoechoic defect with loss of layering in uterine horn wall. A laparotomy revealed a clear reddish fluid in the abdomen, the fistula of left and right uterine horn, the purulent discharge from fistula, and symptoms of septic peritonitis near by the fistula site. The bitch underwent ovariohysterectomy and recovered without complication. Histopathological diagnosis of the uterine fistula site was adenocarcinoma.

Lactate in intensive care unit

Lactate is produced in cells under anaerobic conditions. Hyperlactatemia is the increase of the plasma lactateconcentration and lactic acidosis is the elevation in lactate concentration with a decrease in arterial pH. Hyperlactatemia and lactic acidosis are common in shock, but may also occur in many other clinical syndromes. Clinical studies in humans have reported that lactate concentration may contribute to the diagnosis of diseases in an intensive care unit and the estimation of the prognosis. In veterinary literature, clinical trials on lactate concentration in critical patients are rare, however, there are reports indicating its potential significance. Moreover, the severity of disease is linked to high lactate concentrations in the arterial blood, which is considered to be a negative prognostic index, at least in dogs. Lactate is formed in skeletal muscles, brain, heart, skin, intestinal tract, red and white blood cells. In the liver and kidneys it is metabolized up to 50%. In most human cases in intensive care units, hyperlactatemia and lactic acidosis are the result of hypoxia and tissue hypoperfusion. These patients are in a great risk of developing multi-organ failure and they present with high mortality rates. The persistent systemic acidosis affects myocardial contractility, reduces cardiac output and organ perfusion and leads to severe hypoxia. The causes of hyperlactatemia are: high glycolytic flux (alkalosis, release of catecholamine), high production of pyruvate acid and increased metabolic state conditions. Lactic acidosis may be of type A or type B. Lactate concentration can be measured either in whole blood or plasma by two methods: enzymatic chromatography and enzymatic amperometry. The lactate measurement in intensive care units is important, as it can be used to assess organ hypoperfusion and hypoxia, effectiveness of treatment and prognosis of various pathological conditions, such as septic peritonitis, gastric volvulus, pyometra and babesiosis. The treatment of lactic acidosis depends on the severity and management of the underlying disease. The goal of treatment is adequate tissue perfusion and oxygenation, which is achieved by ventilation and fluid therapy. The microbial infections are treated with antibiotics. The use of bicarbonate is still controversial.

Septic peritonitis secondary to a perforating gastric foreign body in an Irish Sport Horse gelding

SummaryA 17‐year‐old Irish Sport Horse gelding was referred to the University College Dublin Veterinary Hospital for low‐grade colic that had been nonresponsive to medical treatment. Diagnostic investigation revealed a marked septic peritonitis. The inciting cause was detected by gastroscopy to be a perforating foreign body in the pylorus of the stomach from a briar of a blackthorn plant (Prunus spinosa spp.). Successful removal of the foreign body was achieved surgically via gastrotomy. The horse subsequently developed a multi‐drug resistant abdominal incision site infection, which was successfully managed over a 2‐month period. Abdominal incisional herniation occurred thereafter. Six months post‐operatively, the horse was back in light work and no further adverse sequelae had been noted.

In Adult Horses With Septic Peritonitis, Does Peritoneal Lavage Combined With Antibiotic Therapy Compared to Antibiotic Therapy Alone Improve Survival Rates?

&lt;p&gt;The quality of evidence in equids is insufficient to direct clinical practice aside from the following:&lt;/p&gt;&lt;p&gt;The use of antiseptic solution to lavage the abdomen causes inflammation and is detrimental to the patient.&lt;/p&gt;&lt;p&gt;For peritonitis caused by Actinobacillus equuli, treatment with antibiotics alone may be sufficient. A variety of antibiotics were used in the two reported studies.&lt;/p&gt;&lt;br /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /&gt;

Clinical, laboratory, and hemostatic findings in cats with naturally occurring sepsis.

OBJECTIVE To characterize clinical and laboratory findings in cats with naturally occurring sepsis, emphasizing hemostasis-related findings, and evaluate these variables for associations with patient outcomes. DESIGN Prospective, observational, clinical study. ANIMALS 31 cats with sepsis and 33 healthy control cats. PROCEDURES Data collected included history; clinical signs; results of hematologic, serum biochemical, and hemostatic tests; diagnosis; and outcome (survival vs death during hospitalization or ≤ 30 days after hospital discharge). Differences between cats with and without sepsis and associations between variables of interest and death were analyzed statistically. RESULTS The sepsis group included cats with pyothorax (n = 10), septic peritonitis (7), panleukopenia virus infection (5), bite wounds (5), abscesses and diffuse cellulitis (3), and pyometra (1). Common clinical abnormalities included dehydration (21 cats), lethargy (21), anorexia (18), pale mucous membranes (15), and dullness (15). Numerous clinicopathologic abnormalities were identified in cats with sepsis; novel findings included metarubricytosis, hypertriglyceridemia, and high circulating muscle enzyme activities. Median activated partial thromboplastin time and plasma D-dimer concentrations were significantly higher, and total protein C and antithrombin activities were significantly lower, in the sepsis group than in healthy control cats. Disseminated intravascular coagulopathy was uncommon (4/22 [18%] cats with sepsis). None of the clinicopathologic abnormalities were significantly associated with death on multivariate analysis. CONCLUSIONS AND CLINICAL RELEVANCE Cats with sepsis had multiple hematologic, biochemical, and hemostatic abnormalities on hospital admission, including several findings suggestive of hemostatic derangement. Additional research including larger numbers of cats is needed to further investigate these findings and explore associations with outcome.

Spred2-deficiecy Protects Mice from Polymicrobial Septic Peritonitis by Enhancing Inflammation and Bacterial Clearance

Sepsis is an infection-induced systemic inflammatory syndrome and a major cause of death for critically ill patients. Here, we examined whether the absence of Sprouty-related EVH1-domain-containing protein 2 (Spred2), a negative regulator of the Ras/Raf/ERK/MAPK pathway, influences host defense against polymicrobial sepsis (PMS) induced by cecal ligation and puncture (CLP). Compared to wild-type mice, Spred2−/− mice exhibited higher survival rates with increased level of leukocyte infiltration and local chemokine production and reduced plasma and peritoneal bacterial loads after CLP. The MEK inhibitor U0126 significantly reduced LPS-induced chemokine production by Spred2−/− resident macrophages in vitro, and decreased CLP-induced leukocyte infiltration in vivo. Spred2−/− resident macrophages, but not neutrophils or elicited macrophages, exhibited increased phagocytic activity. Interestingly, surface expression of complement receptor 1/2 (CR1/2) was increased in Spred2−/− resident macrophages in response to lipopolysaccharide in a manner dependent on the ERK/MAPK pathway, and blocking CR1/2 in vivo resulted in reduced leukocyte infiltration and increased bacterial loads after CLP. Taken together, our results indicate that Spred2-deficiency protects mice from PMS via increased activation of the ERK/MAPK pathway and subsequent increase in innate immune responses. Thus, inhibiting Spred2 may present a novel means to prevent the development of PMS.

Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs: A retrospective review of 210 anastomoses.

To determine the influence of preoperative septic peritonitis (PSP) and stapled versus hand-sewn anastomoses on the dehiscence of intestinal resection and anastomosis (IRA). We hypothesized that the incidence of IRA dehiscence would be greater (1) when performed with PSP and (2) for hand-sewn anastomoses. Retrospective. Client-owned dogs at Michigan State University Veterinary Teaching Hospital. Records of dogs surviving 72 hours after IRAs between 2003 and 2013 were reviewed for age, gender, neuter status, weight, presence of PSP, preoperative albumin, IRA indication and location, anastomotic technique, suture type, postoperative dehiscence and timing, duration of hospitalization, last follow-up, and other complications. Univariate logistic regression and chi-square analysis were used to screen prognostic factors; factors with P < .3 were included in a multivariate analysis. Two hundred and ten IRAs in 198 dogs fulfilled the inclusion criteria. Dehiscence was diagnosed in 11.4% cases, 6.6% without PSP, and 21.1% with PSP (P = .01). Indication for IRA did not influence the risk of dehiscence. No association was detected between anastomotic technique and IRA dehiscence in dogs without PSP (stapled 4.2%, hand-sewn 8.1%); however, stapled anastomoses were less likely to dehisce in dogs with PSP (stapled 9.7%, hand-sewn 28.9%). Risk factors for dehiscence included PSP (P = .005) and hand-sewn technique (P = .02). Our results confirmed that PSP is a risk factor for dehiscence of IRA and suggest that patients with PSP may be a unique surgical population, in which stapling may be preferred over hand-sewn anastomoses after enterectomies.

A pilot study evaluating the prognostic utility of platelet indices in dogs with septic peritonitis.

To characterize platelet indices at time of diagnosis of septic peritonitis in dogs and to assess the relationship between platelet parameter data and survival to discharge in dogs treated surgically. Retrospective, observational, descriptive pilot study from 2009 to 2014. University teaching hospital. Forty-eight dogs diagnosed with septic peritonitis were included in this study. Thirty-six dogs had surgical source control. Blood samples from 46 healthy control dogs were used for reference interval (RI) generation. None. Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) with increased proportions of dogs having values above the RI compared to healthy dogs. A significantly increased proportion of dogs with septic peritonitis had platelet counts above (12.5%) and below (8.3%) the RI, with no significant difference in mean platelet count compared to healthy dogs. No significant differences in the mean platelet count, MPV, PCT, or PDW were found between survivors and nonsurvivors in dogs with surgical source control; however, dogs with MPV values above the RI had significantly increased mortality compared to dogs within the RI (P = 0.025). Values outside the RI for other platelet parameters were not associated with significant differences in mortality. Dogs with septic peritonitis have increased frequency of thrombocytosis and thrombocytopenia with increased MPV, PCT, and PDW. An increased MPV may be a useful indicator of increased risk of mortality in dogs treated surgically.

A Case of Delayed Presentation of Uterine Perforation Following Unsafe Abortion As Septic Peritonitis

A Case of Delayed Presentation of Uterine Perforation Following Unsafe Abortion As Septic Peritonitis

Disrupting ceramide-CD300f interaction prevents septic peritonitis by stimulating neutrophil recruitment

Sepsis is a serious clinical problem. Negative regulation of innate immunity is associated with sepsis progression, but the underlying mechanisms remains unclear. Here we show that the receptor CD300f promotes disease progression in sepsis. CD300f−/− mice were protected from death after cecal ligation and puncture (CLP), a murine model of septic peritonitis. CD300f was highly expressed in mast cells and recruited neutrophils in the peritoneal cavity. Analysis of mice (e.g., mast cell-deficient mice) receiving transplants of wild-type or CD300f−/− mast cells or neutrophils indicated that CD300f deficiency did not influence intrinsic migratory abilities of neutrophils, but enhanced neutrophil chemoattractant production (from mast cells and neutrophils) in the peritoneal cavity of CLP-operated mice, leading to robust accumulation of neutrophils which efficiently eliminated Escherichia coli. Ceramide-CD300f interaction suppressed the release of neutrophil chemoattractants from Escherichia coli-stimulated mast cells and neutrophils. Administration of the reagents that disrupted the ceramide-CD300f interaction prevented CLP-induced sepsis by stimulating neutrophil recruitment, whereas that of ceramide-containing vesicles aggravated sepsis. Extracellular concentrations of ceramides increased in the peritoneal cavity after CLP, suggesting a possible role of extracellular ceramides, CD300f ligands, in the negative-feedback suppression of innate immune responses. Thus, CD300f is an attractive target for the treatment of sepsis.

PG2, a botanically derived drug extracted from Astragalus membranaceus, promotes proliferation and immunosuppression of umbilical cord-derived mesenchymal stem cells

Ethnopharmacological relevanceAstragalus membranaceus is used to manage the deficiency of vital energy in traditional Chinese medicine and confirmed to have many biological functions. Mesenchymal stem cells (MSCs) possess immunosuppressive effects, and are widely used for regenerative medicine and immune disorders. Aims of studyThis study investigated the effects of Astragalus polysaccharides (APS) on umbilical cord-derived MSCs (UCMSCs), including morphology, surface marker expression, proliferation, differentiation, and in-vitro and in-vivo immunosuppressive capacities. Materials and methodsMSCs isolated from umbilical cords were used. PG2 injection, a botanically derived drug containing a mixture of APS, was added into the culture medium to prepare PG2-treated UCMSCs. The morphology, surface marker expression, proliferation, and differentiation of UCMSCs were determined. The in-vitro immunosuppressive effects of UCMSCs were examined by peripheral blood mononuclear cell (PBMC) proliferation assay. The in-vivo effects were evaluated by circulatory inflammation-associated cytokine levels in mice with septic peritonitis induced by cecal ligation and puncture (CLP) operation. ResultsCompared with control UCMSCs, UCMSCs had higher population doublings when exposed to PG2-containing medium (P = 0.003). The reduction rates of PBMC proliferation after phytohemagglutinin stimulation increased significantly when UCMSCs were treated with PG2 (P = 0.004). The serum levels of inflammation-associated cytokines, including TNF-α, IL-6, MCP-1, IFN-γ, and IL-1β, were significantly lower at 6h after CLP in the mice receiving PG2-treated UCMSCs. ConclusionsOur results demonstrated that PG2 can enhance UCMSC proliferation and their in-vitro and in-vivo immunosuppressive effects. Consequently, UCMSCs can be obtained in earlier passages to avoid senescence, and sufficient cells can be acquired faster for clinical use. With stronger immunosuppressive effects, UCMSCs may treat immune disorders more effectively. Further studies are warranted.

An AAAG-Rich Oligodeoxynucleotide Rescues Mice from Bacterial Septic Peritonitis by Interfering Interferon Regulatory Factor 5.

A previous study found that an AAAG-rich Oligodeoxynucleotide (ODN), designated as MS19, could lessen the acute lung inflammatory injury (ALII) in mice infected by influenza viruses. Bioinformatics analysis found that MS19 is consensus with the binding site of interferon regulatory factor 5 (IRF5) in the regulatory elements of pro-inflammatory genes. This study established a septic peritonitis model in Institute of Cancer Research (ICR) mice infected with Escherichia coli (E. coli), and found that MS19 prolonged the survival of the mice and down-regulated the expression of inducible nitric oxide synthase (iNOS), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). In cultured RAW264.7 cells, MS19 significantly reduced the expression of iNOS, IRF5, IL-6, and TNF-α and inhibited the nuclear translocation of IRF5. This data may provide a new insight for understanding how MS19 reduces the excessive inflammatory responses in sepsis.

Evaluation of the diagnostic value of serum level of total bilirubin in patients with suspected acute appendicitis.

IntroductionClinical diagnosis of acute appendicitis still remains a problem. Delays in diagnosis of acute appendicitis may cause perforation and septic peritonitis which result in increasing morbidity and mortality. The aim of this study was to determine the sensitivity, specificity and the diagnostic value of total serum bilirubin levels as a predictor of acute appendicitis.MethodsIn this cross-sectional study, patients who underwent appendectomy with the diagnosis of acute appendicitis from April 2012 to March 2013 at Emam Reza Hospital in Mashhad (Iran) were enrolled. Serum bilirubin-Total and Direct-, were measured. Then based on the final pathologic reports, patients were categorized into five groups of normal appendix, chronic inflammatory changes, acute appendicitis, gangrenous and/or necrotic changes, and perforated appendicitis. Independent sample t-test, ANOVA, and Chi-square test were used for data analysis by SPSS version 16.ResultsThere were 174 patients studied, (117 male, 57 female) with a mean age of 27.15±0.7 years. All of the patients had rebound tenderness; 75.3% had nausea, 58.6% had anorexia and 21.3% had fever. The histological reports of all patients showed 76.4% acute appendicitis. Analyzing p-values for SGPT, SGOT, WBC was (p=0.903) and differential count was (p=0.959). The study showed no significant difference between the pathological groups. However, there were no significant differences in serum total bilirubin levels between the pathological groups. Total bilirubin showed sensitivity of 48% and specificity of 61% in the diagnosis of acute appendicitis. Total serum bilirubin more than 0.85 mg/dl was the cut-off value with the best performance for diagnosis of appendicitis.ConclusionBilirubin levels are reliable, sensitive and specific to diagnosis and a prediction of complicated appendicitis.