Search Results (675)

An adult female bottlenose dolphin (Tursiops truncatus) housed at a public oceanarium presented with acute anorexia and lethargy. A blood analysis demonstrated mild leukocytosis, marked azotemia, hyperkalemia, and hyperphosphatemia suggestive of acute kidney injury or renal insufficiency. Ultrasound examination of the dolphin revealed ascites, pleural effusion, bilateral nephrolithiasis, mild hydronephrosis, and bilateral hydroureter consistent with bilateral post-renal obstruction. Initial treatment consisted of antibiotics, oral fluids, and anti-inflammatory treatment. Further imaging diagnosed bilateral obstructing ureteroliths at both ureteral orifice junctions of the urinary bladder. The dolphin’s azotemia and hyperkalemia were nonresponsive to traditional medical management; therefore, peritoneal dialysis was performed for emergent clinical stabilization. Peritoneal dialysis was conducted over 3 days and facilitated the patient to undergo laser lithotripsy of the offending ureteral obstruction. The dolphin made a full recovery following months of intensive medical treatment for complications from peritoneal dialysis and secondary peritonitis. This is the first documented case of successful, though complicated, peritoneal dialysis in a cetacean. Full article

Exosomes are membranous vesicles that play a crucial role as intercellular messengers. Cells secrete exosomes, which can be found in a variety of bodily fluids such as amniotic fluid, semen, breast milk, tears, saliva, urine, blood, bile, ascites, and cerebrospinal fluid. Exosomes have a distinct bilipid protein structure and can be as small as 30–150 nm in diameter. They may transport and exchange multiple cellular messenger cargoes across cells and are used as a non-invasive biomarker for various illnesses. Due to their unique features, exosomes are recognized as the most effective biomarkers for cancer and other disease detection. We give a review of the most current applications of exosomes derived from various sources in the prognosis and diagnosis of multiple diseases. This review also briefly examines the significance of exosomes and their applications in biomedical research, including the use of aptamers and antibody–antigen functionalized biosensors. Full article

Background/Objectives: Clinically significant portal hypertension (CSPH) in cirrhotic patients impacts mortality rates and quality of life. CSPH increases the risk of systemic decompensation and could predispose to the deterioration of portal hypertension (PH)–gastric complications, such as portal hypertensive gastropathy (PHG) and portal hypertensive polyps (PHPs). In the management of CSPH with high-risk varices, endoscopic band ligation (EBL) is effective in preventing variceal bleeding. However, this procedure has several drawbacks, ranging from its inability to treat PH to the potential development of significant PH–gastric complications. The aim of our study is to evaluate endoscopic changes in PHG, PHPs, and gastric varices before and after the obliteration of esophageal varices, highlighting the potential risks of EBL. Methods: We retrospectively evaluated forty-four patients who underwent EBL for esophageal varices in emergency and elective settings, according to Baveno VII guidelines. We assessed the presence and severity of PHG, the status of gastric varices, and the number of PHPs before and after the eradication of esophageal varices. We used Fisher’s exact test and t-tests to compare the endoscopic and clinical-laboratory data statistically. A p-value < 0.05 was considered statistically significant. Results: This study found that after the eradication of varices, there was a significant worsening of PHG in 28 patients (63%) compared to before the procedure (p < 0.05). The condition remained stable in 14 patients (31%). However, it is worth noting that 90% of the patients exhibited severe PHG at baseline. Additionally, the absence of ascites and the non-administration of beta blockers at baseline were independent risk factors for worsening PHG (p < 0.05). Along with the deterioration of PHG, three patients (7%) developed gastric varices, all classified as type 1 gastroesophageal varices, and in two patients (4.5%), PHPs were formed. In particular, out of these two cases, the number of PHPs increased from one to two compared to the baseline. Conclusions: Our study underscores the association of EBL with a general worsening of PH–gastric complications and the protective effect of beta blockers in this context. Despite these promising results, future studies are needed to assess whether the worsening of PH–gastric complications is sustained over time and whether it is associated with a deterioration in clinical outcomes in patients with cirrhosis. Such evidence could help guide a more informed therapeutic decision between EBL and beta blockers. Full article

Hyaloserositis, also known as the icing sugar phenomenon, may be commonly observed during autopsies; however, it is not a well-documented topic with varying nomenclature and etiology, which can be generally defined as an organ being covered with a shiny, fibrous hyaline membrane. In our work, we present the case of a 71-year-old female patient with alcohol-induced liver cirrhosis and subsequent ascites and recurrent peritonitis. During the autopsy, a cirrhotic liver and an enlarged spleen were observed, both exhibiting features consistent with hyaloserositis, accompanied by acute fibrinopurulent peritonitis. Histological examination revealed the classical manifestation of hyaloserositis, further proven by Crossmon staining. The cause of death was concluded as hepatic encephalopathy. During our literature review, a total of seven cases were found. It must be emphasized that no publication describing hyaloserositis from the perspective of a pathologist was discovered. Regarding etiology, abdominal presentations were most commonly caused by serohepatic tuberculosis, while pleural manifestation was observed following trauma. Hyaloserositis may prove to be a diagnostic difficulty in imaging findings, as it can mimic malignancy; therefore, a scientific synthesis is necessary. Full article

Aizoon africanum (L.) Klak (Synonym Galenia africana L.) is traditionally used for a variety of medicinal purposes; however, it has been reported to cause liver damage and severe ascites, particularly in sheep and Angora goats in the arid regions of the Western Cape. This study explores its cytotoxic properties to identify potential cytotoxic compound(s) in the plant. The methanolic extract of A. africanum was re-investigated and subjected to various chromatographic techniques, including preparative HPLC, resulting in the isolation of eight compounds (1–8). Structural elucidation was primarily based on NMR data. Among the isolated compounds, four were flavanones, one was a flavonone, and three were chalcones. Notably, compound 8 was identified as a new chalcone, while compounds 2 and 3 were reported for the first time from this plant. The toxicity of these isolated compounds was evaluated against the HepG2 and SH-SY5Y cancer cell lines using the MTT assay. We further investigated markers of cell death using spectrophotometric and luminometric methods. Among the isolated compounds, 7 and 8 exhibited cytotoxic activities within the range of 3.0–20.0 µg/mL. Notably, the compounds demonstrated greater cytotoxicity towards liver-derived HepG2 cells compared to the neuronal SH-SY5Y cell line. Compound 7 (2′,4′-dihydroxychalcone) was identified as inducing apoptosis through the intrinsic pathway without causing overt necrosis. The findings indicate that the phytochemicals derived from A. africanum exhibit differential cytotoxic effects based on cell type, suggesting potential for developing novel anticancer agents, particularly compound 7. Additionally, the identification of compound 8 provides insight into the liver toxicity of this plant observed in sheep in South Africa. Full article

Background/Objectives: The transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension in patients with liver cirrhosis. While its use has increased and indications have broadened in recent years, recent comprehensive data on patient characteristics, trends, and in-hospital mortality in Germany are lacking. This study aimed to evaluate current clinical patterns and mortality outcomes associated with TIPS. Methods: This nationwide cross-sectional study used anonymized hospital data from the German InEK database between 2019 and 2023. TIPS procedures were identified using relevant OPS codes. Patient demographics, liver cirrhosis stage (Child–Pugh), hepatic encephalopathy grade, comorbid conditions, and in-hospital mortality were analyzed descriptively. Analyses were conducted using SAS 9.4. Results: A total of 12,905 TIPS procedures were documented. Annual case numbers rose from 2180 in 2019 to 2954 in 2023. Most patients were male (66.3%) and aged 60–74 years. Ascites (68.6%) was the most frequent associated diagnosis, followed by variceal bleeding (16.4%) and hepatorenal syndrome (14.9%). The average hospital stay decreased from 19.6 to 16.8 days. Overall in-hospital mortality was 8.5%, increasing with age (13.0% in ≥75 years), Child–Pugh C cirrhosis (14.9%), PCCL grade 4 (17.6%), hepatorenal syndrome (16.7%), and grade 4 hepatic encephalopathy (56.1%). Conclusions: TIPS usage in Germany has increased over the past five years, with a shift toward earlier disease stages. Higher in-hospital mortality in clinically complex patients underscores the importance of careful patient selection and tailored management strategies in high-risk groups. Full article

Myxoma virus (MYXV), a rabbit-specific poxvirus and non-pathogenic in humans and mice, is an excellent candidate oncolytic virus for cancer therapy. MYXV also has immunotherapeutic benefits. In ovarian cancer (OC), immunosuppressive tumor-associated macrophages (TAMs) are key to inhibiting antitumor immunity while hindering therapeutic benefit by chemotherapy and dendritic cell (DC) vaccine. Because MYXV favors binding/entry of macrophages/monocytes, we examined the therapeutic potential of MYXV against TAMs. We found previously that a replication-defective MYXV with targeted deletion of an essential gene, M062R, designated ΔM062R MYXV, activated both the host DNA sensing pathway and the SAMD9 pathway. Treatment with ΔM062R confers therapeutic benefit comparable to that of wild-type replicating MYXV in preclinical models. Here we found that ΔM062R MYXV, when integrated with cisplatin and DC immunotherapy, further improved treatment benefit, likely through promoting tumor antigen-specific T cell function. Moreover, we also tested ΔM062R MYXV in targeting human immunosuppressive TAMs from OC patient ascites in a co-culture system. We found that ΔM062R treatment subverted the immunosuppressive properties of TAMs and elevated the avidity of cytokine production in tumor antigen-specific CD4⁺ T cells. Overall, ΔM062R presents a promising immunotherapeutic platform as a beneficial adjuvant to chemotherapy and DC vaccine. Full article

The assessment of systemic congestion in acute heart failure (AHF) remains clinically challenging, particularly across different left ventricular ejection fraction (LVEF) phenotypes. This study aimed to evaluate whether differences exist in the degree of congestion, assessed through a multimodal approach including physical examination, biomarkers (NT-proBNP, CA125), and point-of-care ultrasound using the Venous Excess Ultrasound (VExUS) protocol, between patients with preserved (HFpEF) and reduced ejection fraction (HFrEF). We conducted a prospective observational study involving 90 hospitalized AHF patients, 80 of whom underwent a complete VExUS assessment. Although patients with HFrEF exhibited higher levels of NT-proBNP and CA125, and more frequent signs of third-space fluid accumulation such as pleural effusion and ascites, no statistically significant differences were found in VExUS grades between the two groups. These findings suggest that the VExUS protocol provides consistent and reproducible information on systemic venous congestion, regardless of LVEF phenotype. Its integration into clinical practice may help refine congestion assessment and optimize diuretic therapy. Further multicenter studies with larger populations are warranted to validate its diagnostic and prognostic utility and to determine its potential role in guiding individualized treatment strategies in AHF. Full article

Background/Objectives: Ascites is a major complication in patients with decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP), an infection of the ascitic fluid, is a life-threatening condition in patients with cirrhosis. This study aimed to assess the utility of Tm mapping, a novel high-efficacy method for bacterial detection and quantification, in the early diagnosis of SBP and its pathogenesis. Methods: Ascitic fluid samples from 29 patients with cirrhosis were analyzed using Tm mapping for bacterial identification. Inflammatory cytokine and pathogen-associated molecular pattern levels in ascitic fluid were measured and correlated with SBP pathophysiology. Additionally, the role of ascitic macrophages was investigated in vitro. Results: Tm mapping detected bacteria more effectively than conventional culture methods. In samples where bacteria were identified, ascitic interleukin (IL)-6 levels were elevated. A positive correlation was observed between extracellular vesicle (EV) levels and IL-6, suggesting a role for EVs in peritoneal inflammation. Furthermore, EVs derived from Gram-negative bacteria induced M1 macrophage differentiation via the signal transducer and activator of transcription 1 signaling pathway. Conclusions: Tm mapping is a valuable tool for the early detection of bacteria in ascitic fluid. Additionally, EVs promote M1 macrophage differentiation, implicating them in the pathogenesis of cirrhotic complications, including SBP. Full article

Background/Objectives: Endometriosis and high-grade serous ovarian cancer (HGS-OC) share common features within the peritoneal immune microenvironment, yet they exhibit divergent clinical outcomes. This study aimed to dissect the immune–metabolic landscape of the peritoneal cavity in patients with endometriosis and ovarian cancer by evaluating macrophage polarization, intracellular signaling pathways, and iron-driven oxidative stress. Methods: A prospective cohort study enrolled 40 patients with endometriosis, 198 with ascitic ovarian cancer (178 HGS-OC), and 200 controls with benign gynecological conditions. Peritoneal and peripheral blood samples were analyzed via flow cytometry for macrophage (M1/M2) polarization markers, mTOR/AKT expression, and glucose uptake. Inflammatory markers (IL-6, CRP), oxidative stress (ROS), and iron metabolism parameters (hepcidin, ferritin, transferrin, serum/free iron) were quantified. Results: HGS-OC displayed a predominance of M1-polarized tumor-associated macrophages (TAMs) (CD14⁺/CD80⁺/Glut1⁺) and a high M1/M2 ratio (2.5 vs. 0.8 and 0.9; p = 0.019), correlating positively with IL-6 (p = 0.015), ROS (p = 0.023), hepcidin (p = 0.038), and ferritin (p = 0.043). Conversely, endometriosis showed a dominant M2 profile (CD14⁺/CD163⁺), elevated intracellular mTOR and AKT expression in both TAMs and epithelial cells (p < 0.01), and significantly higher ascitic ROS and free iron levels (p = 0.047 and p < 0.0001, respectively). In endometriosis, the M1/M2 ratio correlated inversely with free iron (p = 0.041), while ROS levels were directly associated with iron overload (p = 0.0034). Conclusions: Endometriosis exhibits a distinct immune–metabolic phenotype characterized by M2 macrophage predominance and iron-induced oxidative stress, contrasting with the inflammatory, M1-rich profile of HGS-OC. These findings suggest that iron metabolism and macrophage plasticity contribute to disease persistence in endometriosis and may inform future immunomodulatory strategies. Full article

Background and Objectives. Umbilical hernia is particularly common among patients with liver cirrhosis, affecting about 20% of this group, compared to 3–8.5% in healthy individuals. This increased prevalence is mainly due to weakened abdominal fascia, elevated intra-abdominal pressure, and malnutrition. The rapid progression of umbilical hernias often leads to complications such as skin necrosis, perforation, and strangulation. Historically, patients with liver cirrhosis and complicated umbilical hernia have faced high morbidity and mortality rates. However, recent advancements in perioperative management, especially in controlling ascites, have improved outcomes in elective treatments. Despite these advancements, managing patients with decompensated liver cirrhosis and complicated umbilical hernia in emergency settings remain a significant surgical challenge. Materials and Methods: We conducted a retrospective review of patients treated for complicated umbilical hernia at the University Medical Centre Ljubljana from 2015 to 2024, using prospectively collected data. This analysis involved implementing hernioplasty combined with incisional negative pressure wound therapy (iNPWT) as part of the surgical protocol. The primary endpoint of our study was the rate of local complications, while the secondary endpoints included the rate of systemic complications and 90-day mortality. Results: We treated 28 consecutive patients with complicated umbilical hernia and liver cirrhosis. Local wound complications were observed in three (10.7%) patients. Systemic complications developed in 10 patients (35.7%). The median duration of hospitalization was 8 days (range: 5–29), and no readmissions were recorded within the 30-day period. Two (7.1%) patients died within 90 days. Conclusions: Our experience indicates that iNPWT, when combined with surgical repair, can be safely utilized, yielding outcomes comparable to elective hernia repairs, even in emergency contexts. Further randomized controlled trials are necessary to validate these findings and optimize treatment protocols. Full article

Dengue mortality has traditionally been associated with severe thrombocytopenia and hemorrhagic complications. However, during 2024, dengue virus serotype 3 (DENV-3) increased significantly in western Mexico, leading to the emergence of a distinct clinical pattern. We conducted a retrospective cohort study of hospitalized dengue patients at the General Hospital of Colima (January–August 2024). Clinical features, laboratory parameters, and outcomes were compared between survivors and non-survivors. Among 201 hospitalized patients, 6 (3.0%) died. All deceased patients presented with generalized seizures, polyserositis (pleural effusion and/or ascites), and required mechanical ventilation. Contrary to classical patterns, they did not have severe thrombocytopenia. Instead, they showed significantly higher white blood cell counts and notably increased levels of serum urea and BUN, suggesting early renal impairment. ROC analysis indicated that BUN (AUC 0.904) and urea (AUC 0.906) were good to excellent discriminators of mortality. During 2024, with an increase in DENV-3 circulation, mortality was associated with neurological and systemic complications, including seizures and polyserositis, as well as biochemical evidence of renal dysfunction—but not with severe thrombocytopenia. These findings challenge current paradigms and highlight the need for early recognition of atypical clinical patterns. Full article

Filipendula vulgaris Moench (syn. F. hexapetala Gilib., dropwort, Rosaceae) is widely used in folk medicine as an antitumour agent, but there is a lack of scientific knowledge about it. This research aimed to study the phytochemical composition and cytotoxic and antitumour activity of aqueous and aqueous–alcoholic extracts from rhizomes with roots of F. vulgaris to investigate their effect on the development of experimental Ehrlich ascites carcinoma in mice, and their effect on the animals’ lifespan. A total of 10 phenolics and 14 amino acids were determined by HPLC in the extracts. The dominant phenolic compounds were procyanidins B1, B2, and C1, as well as metabolites of the tannins (+)-catechin and epicatechin gallate. For the first time, 27 volatile substances were identified and semiquantified using GC-MS. The principal volatile components were palmitic acid (41.0%), methyl salicylate (24.2%), and benzyl salicylate (17.5%). The aqueous–alcoholic extract was significantly more effective than the aqueous one. The treatment of mice with Ehrlich carcinoma using the F. vulgaris aqueous–alcoholic extract normalised the studied indicators. The growth inhibition coefficient of Ehrlich ascites carcinoma was 62.3% and 65.8% on the 7th and 14th days, respectively. This was manifested in the inhibition of tumour growth based on a decrease in the content of ascites fluid in the abdominal cavity; a more intense manifestation of cytotoxic action on cancer cells; improvements in haematopoiesis, the antioxidant defence system, and the content of the studied bioelements in the blood serum; and an increase in the lifespan of experimental animals by around two times. The study results allow us to consider F. vulgaris rhizomes with roots as a promising anticancer agent for the design of pharmaceutical preparations and further study their effects on the human body. Full article

Background/Objectives: Carbohydrate antigen 125 (CA125) is a glycoprotein commonly overexpressed in epithelial ovarian cancer and widely recognized as a tumor marker. However, elevated CA125 levels are also observed in various non-malignant conditions, including diseases affecting mucosal surfaces, pleural or peritoneal effusions, cirrhosis (with or without ascites), endometriosis, uterine fibroids, adenomyosis, pelvic inflammatory disease, and pregnancy. This review aims to explore the role of CA125 in non-malignant serous effusions, highlighting its diagnostic and prognostic potential beyond the realm of oncology. Methods: A comprehensive literature search was conducted across multiple databases and clinical trial registries. Eligible studies included full-text original research articles, reviews, and case reports published in English over the past 10 years. Inclusion criteria were limited to studies involving human subjects and focused on the role of CA125 in non-malignant serous effusions. Results: CA125 is produced by coelomic epithelial cells lining the ovary, pleura, pericardium, and peritoneum. Its serum concentration is not significantly influenced by age, body weight, or renal function, even in the advanced stages of the disease. In peritoneal conditions, CA125 is synthesized by mesothelial cells and serves as a potential marker of peritoneal involvement. The prevailing pathophysiological mechanism suggests that mechanical stretching of mesothelial cells due to ascitic pressure stimulates CA125 release. Similarly, in heart failure, mesothelial cells of the pericardium produce CA125, which correlates with congestion severity, supports risk stratification, and may inform diuretic therapy. Conclusions: While a threshold of 35 U/mL is established for malignancy, no standardized cutoff exists for CA125 in non-malignant conditions. The utility of CA125 measurement in peritoneal, pleural, or pericardial effusions—and cardiovascular diseases such as acute heart failure—for purposes of differential diagnosis, treatment guidance, or prognostication warrants further investigation through prospective clinical trials. Full article

Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with limited treatment options in advanced stages. Recently, targeted therapies against fibroblast growth factor receptor 2 (FGFR2) fusions have emerged as a promising approach for selected patients. Tasurgratinib, a selective FGFR1–3 inhibitor, was approved in Japan in 2024 for second-line treatment of FGFR2 fusion-positive biliary tract cancer. We report the case of a 55-year-old female with advanced iCCA harboring an FGFR2-BICC1 fusion, who experienced a rapid clinical response to tasurgratinib following disease progression on gemcitabine, cisplatin, and durvalumab (GCD). Following the failure of GCD therapy, treatment with oral tasurgratinib was initiated at 140 mg/day and subsequently reduced to 105 mg/day due to Grade 2 diarrhea. Within weeks, imaging and tumor markers indicated a partial response, accompanied by a reduction in ascites, and improved performance status. The response sustained for several months without evidence of disease progression. Notably, no substantial clinical hyperphosphatemia or anorexia was observed during treatment. This is the first report to describe the real-world clinical efficacy of tasurgratinib in an iCCA patient with FGFR2-BICC1 fusion. Our findings suggest that tasurgratinib can provide a rapid and durable response with manageable toxicity in molecularly selected patients who have progressed on standard therapies. Full article