A Clinical Study on Post-operative Outcome in Perforation Peritonitis Patients with Reference to the History of Nonsteroidal Anti-inflammatory Drugs Use

Background: Perforation peritonitis is a commonly encountered surgical emergency and it is defined as inflammation of the serosal membrane that lines the abdominal cavity and the visceral organs. The objective of this study is to predict a correlation between post-operative outcomes in perforation peritonitis patients with reference to the history of nonsteroidal anti-inflammatory drugs (NSAIDs) use. Materials and Methods: A total of 209 cases were studied with hollow viscous perforation peritonitis admitted in the surgical wards in Sanjay Gandhi Memorial Hospital associated with S. S. Medical College, Rewa (M.P.), India, in the period from June 1, 2018, to May 31, 2019. All necessary investigations were carried out. X-ray, ultrasonography abdomen, and blood investigations were done. Patient underwent emergency exploratory laparotomy and a careful record of pre-operative and post-operative findings was made and was carefully filled in the pro forma. All the patients were advised to attend surgical OPD for follow-up. Results: Most of the patients (73.2%) of perforation peritonitis had a history of NSAID intake, out of which 81.6% recovered from the disease while mortality rate in perforation peritonitis associated with NSAID use was found to be 18.4%. Those patients with no history of NSAID use (26.8%) had a mortality rate of 9% while 91% of patients of perforation peritonitis were recovered from the disease. Conclusion: In this study, it is concluded that the outcome of the patients of the perforation peritonitis is not dependent on the history of NSAIDs use, but NSAIDs abuse is one of the etiological factors in the pathogenesis of the perforation peritonitis

Effect of Oral Administration of Diclofenac Sodium on Coagulation Factors and Some Hematological Parameters in Wister Rats

Diclofenac sodium is a nonsteroidal anti-inflammatory drug often obtainable as a prescription drug or over the counter. It is very effective in the control of inflammation and pain due to arthritis or pains arising following many disease conditions becauseof its antipyretic, anti inflammatory and analgesic potentials. Despite the beneficial effects of diclofenac sodium, it has been implicated in some adverse effects. In this study, we examined the effect of acute and chronic administration of diclofenac sodium on some hematological (PCV, WBC differentials) and coagulation (prothrombin time, activated partial prothrombin time and platelets count) parameters of albino Wister rats using the standard methods. Twenty four Albino Wister rats were divided intothree groups of 8 rats and grouped as control, acute study and chronic study. The rats were administered 0.2 mg of diclofenac sodium for 24 hours for acute and 3 weeks for chronic studies respectively. The rats were sacrificed and blood collected for analysis of PCV, WBC differentials, prothrombin time, activated partial prothrombin time and platelets count using the standard methods. Results show that acute administration of diclofenac sodium at 0.2 mg has no effect on hematological and coagulation parameters, but chronic administration could instigate significant reduction in PCV, platelets count, neutrophils and monocytes (p<0.001), whilethere is a significant increase in PT, INR, lymphocytes (p<0.001). Considering these alterations, it is advisable that this drug should be made a strictly prescription drug in order to prevent indiscriminate use of this medication and to prevent attendant anemia and coagulopathy that may follow chronic use.

Cyclo-oxygenase-2 promotes migration and invasion of breast cancer MDA-MB231 cells by regulating EMT / 中国肿瘤生物治疗杂志

@#Objective:To investigate the role of cyclo-oxygenase-2 (COX-2) in breast cancer metastasis and its possible mechanism. Methods: A total of 45 cases of primary breast cancer tissues and brain metastatic breast cancer tissues were collected from patients, who underwent mastectomy in Yunnan Cancer Hospital from October 2015 to April 2018, including 30 cases of primary lesions and 15 cases of brain metastasis. qPCR was used to detect the expression of COX-2 in breast cancer tissues and brain metastatic breast cancer tissues. Recombinant viruses with COX-2 over-expression (LV6-COX2) or COX-2 knockdown (LV3-COX2 shRNA1, LV3-COX2 shRNA2) were transfected into human breast cancer MDA-MB-231 cells; After obtaining the stable expression cell lines, the effect of COX-2 expression on the proliferation of MDA-MB-231 cells was detected by CCK-8, and the effects of COX-2 expression on the migration and invasion of MDA-MB-231 cells were detected by scratch test and Transwell assay, respectively. The mRNAand protein expressions of COX-2 in each group were examined by qPCR and WB, respectively. The effect of COX-2 expression on the expression of EMT-related genes in MDA-MB-231 cells was analyzed by qPCR. Results: The expression of COX-2 in tissues of patients with brain metastases was significantly higher than that in patients with primary breast cancer tissues (P<0.01), and it was correlated with tumor TMN stage in breast cancer patients. MDA-MB-231 cell lines with stable COX-2 over-expression/knockout were successfully constructed. Over-expression of COX-2 promoted the migration and invasion of MDA-MB-231 cells (all P<0.01), and significantly increased the expressions of MMP2, MMP1, N-cadherin and vimentin (all P<0.01), but exerted insignificant effect on cell proliferation. The effect of COX-2 silence exerted the opposite effect and promoted cell proliferation (P<0.05). Conclusion: COX-2 is highly expressed in brain metastatic breast cancer tissues, which may promote the migration and invasion of breast cancer MDA-MB-231 cells by regulating EMT processes.

Efficacy of Indomethacin in Pharmacological Closure of PDA in Preterm Neonates: A Prospective Study from Tertiary Care Centre in Rural India

Background Patent ductusarteriosus (PDA) is a fetal shunt necessary for intrauterine survival of the baby, however its closure at birth occurs as pulmonary vascular resistance drops and lungs get expanded for participating in ventilation. However, PDA remains patent in a large proportion of preterm babies and by day -7, 87% of babies <24 wk gestation have a PDA which hinders in ventilation and causes ductal steal to vital organs. Hence, we aimed to study pharmacological closure of ductus in preterm babies. Aims and Objectives 1) To study the efficacy of COX inhibitor, Indomethacin in ductal closure in preterm babies <34 wk gestation. 2) To compare the symptomatology of PDA in different groups of preterm babies <34 wk GA. Methods A Hospital-based prospective study was conducted in tertiary care NICU.A total of 104 consecutive, eligible preterm babies <34 wk with echocardiographically documented PDA. Indomethacin (COX inhibitor) was administered orally in a dose of 0.2 mg/kg 12 h for 3 doses and the babies underwent Echo study in first 48 h, after2 days, 7days, and weekly thereafter till PDA closure. A second cycle of indomethacin was repeated if PDA did not respond to the initial treatment. Results 75/104 (72%) PDAs closed with indomethacin while 13(12.5%) did not respond, and 16(15.38%) showed a reduction in the calibre of PDA. 26–30 wk group showed a brisk response to ductal closure with indomethacin within 108.1±12.44 h, and a mean no. of cycles of indomethacin of 0.98±5.75. Conclusion With indomethacin we achieved 72% (75/104) closure rates. The best response to indomethacin was noted in 30–32 wk GA group, while maximum nonresponders were in 32–34 wk; suggesting as gestation increases, response to PG inhibitors decreases.

Expressions of TREM-1 and COX-2 in rectal carcinomaand their relationship with prognosis / 西安交通大学学报(医学版)

Objective To detect the differences of triggering receptor expressed on myeloid cells-1 (TREM-1) and cyclo-oxygenase-2 (COX-2) expressions in rectal cancer tissues and carcinoma adjacent tissues so as to explore the relationship between the two factors and clinical pathological characteristics and their effects on the patients` survival.Methods The expressions of TREM-1 and COX-2 were analyzed in 68 cases of rectal cancer tissues and 58 cases of carcinoma adjacent tissues with the method of immunohistochemical staining.We made a regular follow-up of the patients, analyzed the relationship between the two factors and prognosis of rectal cancer.Results The positive expression rates of TREM-1 and COX-2 in rectal cancer tissues were higher than those in carcinoma adjacent tissues (P<0.05).The expression of TREM-1 was related to lymph node metastasis, while COX-2 was related to pathological stage and lymph node metastasis (P<0.05).However, the two factors were not related to age, sex, histological differentiation or tumor size.The expressions of the two factors were positively correlated (r=0.550, P<0.001).The overall survival (OS) of TREM-1 and COX-2 positive expression groups was shorter than that of the negative groups (P<0.05).Cox multiple regression analysis showed that the expression of TREM-1, pathological stage, lymph node metastasis and tumor size affected the prognosis.Conclusion The expressions of COX-2 and TREM-1 in rectal cancer increase, suggesting that the two factors may promote the development and lymph node metastasis of rectal cancer, and the expressions of the two factors are related to the patients` poor prognosis.

Growth factors and cox2 in wound healing: an experimental study with ehrlich tumors / Avaliação dos fatores de crescimento e cox-2 na cicatrização de camundongos com neoplasia de ehrlich

ABSTRACT Background: Healing is an innate biological phenomenon, and carcinogenesis acquired, but with common humoral and cellular elements. Carcinogenesis interferes negatively in healing. Aim: To evaluate the histological changes in laparotomy scars of healthy Balb/c mice and with an Ehrlich tumor in its various forms of presentation. Methods: Fifty-four mice were divided into three groups of 18 animals. First group was the control; the second had Ehrlich tumor with ascites; and the third had the subcutaneous form of this tumor. Seven days after tumor inoculation, all 54 mice were submitted to laparotomy. All of the animals in the experiment were operated on again on 7th day after surgery, with resection of the scar and subsequent euthanasia of the animal. The scars were sent for histological assessment using immunohistochemical techniques to evaluate Cox-2 (cyclooxygenase 2), VEGF (vascular endothelial growth factor) and FGF (fibroblast growth factor). Semi-quantitatively analysis was done in the laparotomy scars and in the abdominal walls far away from the site of the operation. Results: Assessing the weight of the animals, the correct inoculation of the tumor and weight gain in the group with tumoral ascites was observed. The histological studies showed that groups with the tumor showed a statistically significant higher presence of Cox-2 compared to the control. In the Cox-2 analysis of the abdominal wall, the ascites group showed the most significant difference. VEGF did not present any significant differences between the three groups, regardless of the site. The FGF showed a significant increase in animals with the tumor. Conclusion: Histological findings in both laparotomy scar and the abdominal wall showed that with Ehrlich's neoplasia there was an exacerbated inflammatory response, translated by more intense expression of Cox-2 and greater fibroblast proliferation, translated by more intense expression of FGF, that is, it stimulated both the immediate inflammatory reactions, observed with Cox-2 reactions, and late scarring by fibroblasts and FGF.

RESUMO Racional: A cicatrização é fenômeno biológico inato, e a carcinogênese adquirido, mas com elementos humorais e celulares comuns. A carcinogênese interfere de forma negativa na cicatrização. Objetivo: Avaliar as modificações histológicas nas cicatrizes laparotômicas de camundongos Balb/c sadios como controles, e com a neoplasia de Ehrlich, em suas diferentes formas de apresentação. Métodos: Foram utilizados 54 camundongos, divididos em três grupos de 18 animais cada um. O primeiro era controle; o segundo com a neoplasia de Ehrlich em sua forma ascítica; e o terceiro na forma subcutânea. Sete dias após a inoculação do tumor, todos os 54 camundongos foram submetidos à laparotomia e reoperados no sétimo dia de pós-operatório, com ressecção da cicatriz e posterior eutanásia. As cicatrizes foram encaminhadas para estudo histológico com técnicas imunoistoquímicas para avaliar Cox-2 (ciclo-oxigenase 2), VEGF (fator de crescimento do endotélio vascular) e FGF (fator de crescimento dos fibroblastos) e analisadas de forma semiquantitativana tanto na cicatriz laparotômica como na parede abdominal mais distante do local operado. Resultados: Avaliando o peso, observou-se a correta inoculação do tumor e o aumento de peso no grupo com a neoplasia na modalidade ascítica. Os estudos histológicos mostraram que os grupos com a neoplasia apresentaram maior presença da Cox-2 em relação ao controle, estatisticamente significante. No estudo da Cox-2 da parede abdominal foi o local em que o grupo ascítico apresentou a diferença mais expressiva. O VEGF não apresentou diferenças significantes entre os três grupos, independentemente do local estudado. O FGF teve aumento significante nos animais com neoplasia. Conclusão: Os achados histológicos encontrados tanto na cicatriz das laparotomias quanto na parede abdominal mostraram que com a neoplasia de Ehrlich houve resposta inflamatória exacerbada, traduzida por expressão mais intensa da Cox-2 e maior proliferação fibroblástica, traduzida por expressão mais intensa do FGF, ou seja, estimulou tanto as reações inflamatórias imediatas, observadas nas reações da Cox-2, como nas cicatriciais tardias com os fibroblastos e o FGF.

Liraglutide promotes the reduction of blood pressure and drives the water and salt through in renal medulla of type 2 diabetes rats / 天津医药

Objective To observe the effects of glucagon like peptide-1 (GLP-1) analogues liraglutide on expressions of nitric oxide synthase (NOS) and cyclo-oxygen-ase (COX)2 in renal medulla of type 2 diabetes rats, and the mechanism of its lowering blood pressure and promoting excretion of water and salt in kidney. Methods Type 2 diabetes model rats were generated by high-fat and high-sugar feeding for 8 weeks followed by intraperitoneal injection of streptozotocin (STZ). Subse?quently, eighteen type 2 diabetes rats were divided into two groups: liraglutide treatment group (DMT) and diabetes group (DM). Twelve normal rats were divided into two groups: liraglutide treatment wild type group (WTT) and wild type group (WT). DMT and WTT groups were given liraglutide (200μg/kg) by subcutaneous injection, DM and WT groups were given equivalent normal saline by the same way. The levels of blood glucose and blood pressure were detected at 0, 2, 4 and 6 weeks after treatment in groups of rats. Samples of urine were collected for detecting ion concentrations (K+, Na+and Cl-) af?ter treatment for six weeks. Rats were sacrificed and blood samples were collected for detecting ion concentrations (K+, Na+and Cl-). The expression levels of NOS and COX2 mRNA and protein in renal medulla were detected by real-time PCR and Western blot assay. Results After treating with liraglutide, the values of blood glucose (F=5.933, P sure (F=22.070, P<0.05) were gradually decreased in DMT group. After treatment with liraglutide for 6 weeks, the values of blood glucose (mmol/L:12.78 ± 3.82 vs. 18.75 ± 1.68) and blood pressure (mmHg:119.98 ± 4.43 vs. 136.42 ± 4.48) were signifi?cantly decreased (P<0.05) in DMT group than those of DM group (P<0.05). There were no significant differences in the concentrations of K+, Na+and Cl-between the two groups. There were higher levels of K+(mmol/L:46.55 ± 6.43 vs. 33.13 ± 9.71), Na+(mmol/L:56.33±8.83 vs. 41.20±7.25) and Cl-(mmol/L:159.81±25.06 vs. 71.44±12.99) in urine in DMT group than those of DM group (P<0.05). The mRNA levels and protein expressions of NOS and COX2 in renal medulla were significant?ly increased in DMT group than those of DM group (P<0.05). Conclusion GLP-1 analogues liraglutide may enhance the expression of COX2 by increasing the expression of NOS to excrete water and salt, and decrease blood pressure.

Inhibitory effect of ferulic acid on neuroinflammation in LPS-activated microglia / 中国药理学通报

Aim To evaluate the effects of ferulic acid ( FA ) on lipopolysaccharide ( LPS )-induced neuroin-flammation in microglia cells and its potential mecha-nisms. Methods Microglial activation was induced by stimulation with LPS, and the effects of FA pretreat-ment on microglial activation and production of proin-flammatory mediators, nitric oxide/iNOS were investi-gated. The role of the mitogen-activated protein kinases in the antiinflammatory actions of FA in LPS-stimulated microglia was further elucidated. Results Cell viabil-ity experiments revealed that FA did not produce cyto-toxicity in microglia. FA significantly inhibited LPS-in-duced production of tumour necrosis factor-alpha ( TNF-α) , interleukin-6 ( IL-6 ) , interleukin-1 beta ( IL-1β) , and nitric oxide ( NO ) . Protein and mRNA levels of COX-2 and inducible nitric oxide synthase ( iNOS) were also attenuated by FA. Further experi-ments on intracellular signalling mechanisms showed that inhibition of extracellular regulated kinase ( ERK) contributed to the anti-neuroinflammatory actions of FA. Conclusion The results suggest that FA inhibits LPS-induced microglial inflammation by partial targe-ting of ERK signalling and attenuation of ERK.

The Association between Cyclo-oxygenase Inhibitor Medications and Clinical Relapse in Inflammatory Bowel Disease: Review of Current Perspectives.

Background: Patients with inflammatory bowel disease (IBD) often have associated conditions which may benefit from treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or selective cyclo-oxygenase-2 (COX-2) inhibitors. However, evidence has suggested there may be an association between COX- inhibition and relapse in IBD, which leads to clinicians being reluctant to prescribe these agents. Aims: The aim of this review is to review the possible biological mechanisms, linking NSAIDs and IBD-relapse and current knowledge on the possible association of NSAIDs and clinical relapse in IBD. Results: IBD relapse due to NSAID use is most likely due to prostaglandin inhibition via dual COX inhibition, although the topical effect of NSAIDs on the intestine may also play a role. The evidence for an association between NSAIDs and IBD relapse is contradictory and generally weak, but it is likely a small percentage of patients relapse when taking NSAIDs, but it is not known which patients are at risk. Mixed results have also been obtained from studies examining COX-2 selective agents; although a single randomized controlled-trial showed that celecoxib is safe in ulcerative colitis in the short term. Conclusions: At present the data are contradictory and most published studies have serious flaws. Overall the association between use of NSAIDs and IBD-relapse seems rather weak, Cyclooxygenase inhibitors should not be withheld from stable IBD patients, if clinically indicated and appropriate cautions and monitoring are used. Celecoxib would seem a sensible first choice. Further studies are needed to help identify which patients are at risk of relapse with NSAIDs.

Comparative Study for Preventive Effects of Intra-Abdominal Adhesion Using Cyclo-Oxygenase-2 Enzyme (COX-2) Inhibitor, Low Molecular Weight Heparin (LMWH), and Synthetic Barrier

PURPOSE: Postoperative adhesion is the most frequent complication of abdominal surgery. Therefore, we investigated the individual effects of synthetic barrier [hyaluronic acid/carboxymethylcellulose (HA/CMC)] and pharmacologic agents [low molecular weight heparin (LMWH) cyclo-oxygenase-2 inhibitor (COX-2 inhibitor)] using animal model of intra-abdominal adhesion. MATERIALS AND METHODS: The cecum was rubbed with sterile alcohol wet gauze until subserosal haemorrhage and punctate bleeding developed under the general anesthesia. Five animal groups were prepared using the film HA/CMC, gel HA/CMC, LMWH and COX-2 inhibitor. RESULTS: The grade of adhesion by modified Leach method for group I (control), II (film type HA/CMC), III (gel type HA/CMC), IV (LMWH) and V (COX-2 inhibitor) were 5.35+/-1.8, 6.15+/-1.3, 4.23+/-2.6, 5.05+/-0.7 and 5.50+/-0.9, respectively. Group III showed the least grade of adhesion and it is statistically significant in adhesion formation (p=0.028). The numbers of lymphocytes were significantly low in group III and group V compared to the control group (lymphocyte: p=0.004). The mast cell counts were generally low except for the control group (I: 1.05, II: 0.35, III: 0.38, IV: 0.20, V: 0.37), however, it was not statistically significant (p=0.066). CONCLUSION: The gel barriers were shown to be partly efficient in inhibiting the formation of postoperative adhesions and might provide an option for abdominal surgery to reduce postoperative adhesions. The LMWH and COX-2 inhibitor had been known for their inhibitor effect of fibrin formation and anti-angiogenic/anti-fibroblastic activity, respectively. However, their preventive effects of adhesion and fibrosis were found to be obscure.

Radiosensitization of celecoxib on human lung adenocarcinoma cell line A549 and inhibition of migration ability in vitro / 中华放射医学与防护杂志

Objective To investigate the effects of radiosensitivity enhancement and inhibition of migration ability of human lung adenocarcinoma cells by celecoxib,a selective cyclooxygenase (COX)-2 inhibitor.Methods Human lung adenocarcinoma cells of the line A549 were cultured and then inoculated into six-well plates and randomly divided into 4 groups:control group,celecoxib group administered with celecoxib at the subtoxic doses 30 and 50 μmol/L,irradiated group exposed to 0,1,2,4,6,or 8 Gy by linear accelerator,and combined treatment (celecoxib + irradiation) group.The radiosensitizing effect of celecoxib was assessed by clonogenic cell survival test.The migration ability of the A549 cells was measured by scratch-wound test and the content of metalloproteinase-2 (MMP-2) in culture supernatant was detected with ELISA.Results The sensitization enhancement ratio of the celexib group was increased dosedependently.The values of D0 ,Dq,SF2 and D0.01 of the celecoxib + irradiation group were all significantly lower than those of the irradiated group.Scratch-wound test showed that the no-scratch area of the celecoxib + irradiation group and celecoxib group were all significantly wider than those of the mere irradiation and control groups and there was a dose-dependent manner,and the no-scratch area of the celecoxib + irradiation group was wlider than that of the celecoxib group.ELISA showed that the MMP-2 levels in the supernatant of the celecoxib group and celecoxib + irradiation group were respectively significantly lower than those of the control group and mere irradiated group (t = 3.78,5.79、3.15,P ＜ 0.05),however,there was not significant difference between the mere irradiation and control groups (t = 2.73,2.38,P ＞ 0.05).Conclusions Celecoxib enhances concentration-dependently the radiosensitivity of human lung carcinoma cell and inhibits the secretion of MMP-2 of the carcinoma cells,thus inhibiting their migration ability.

Cyclo-oxygenase-2 and p53 Immunoreactivity in Superficial Early Colorectal Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: De novo colorectal carcinoma shows more aggressive behavior including submucosal invasiveness. Both p53 and cyclo-oxygenase-2 (COX-2) have been shown to be involved in colon carcinogenesis, progression from adenoma to carcinoma, and submucosal invasion by tumor. We performed this study to evaluate the expression of p53 and COX-2 protein in de novo carcinoma, compared with ex-adenoma carcinoma. METHODS: Twenty three flat adenomas, 19 ex-adenoma carcinomas, 6 de novo carcinomas were included in this study. The expression of p53, COX-2 and Ki-67 were examined immunohistochemically. RESULTS: Both ex- adenoma carcinomas and de novo carcinomas showed similar size and shape. Positive staining for p53 was detected in 3 of 23 (13%) flat adenomas, in 11 of 19 (57.8%) ex-adenoma carcinomas (p<0.05), and in 1 of 6 (16.6%) de novo carcinomas. Increased numbers of COX-2 positive tumor cells were observed in 1 of 23 (4.3%) flat adenomas, in 2 of 19 (10.5%) ex-adenoma carcinomas, and in 3 of 6 (50%) de novo carcinomas. COX-2 positive expression showed increased tendency in de novo carcinoma (p=0.073). There was no correlation between COX-2, p53, and Ki-67 expression. CONCLUSION: De novo carcinoma shows increased tendency of COX-2 expression, but decreased p53 expression when compared to ex-adenoma carcinoma. These immunohistochemical findings are in accordance with the fact that de novo carcinoma has no preceding adenoma, with more frequent submucosal invasion despite the small lesion size.

The Role of Prostaglandins in Surgically Induced Miosis

In cataract surgery, the surgically induced miosis complicate the removal of lens materials and implantation of a posterior chamber intraocular lens, which increase the risk of ocular trauma and its associated complication. The refore maintenance of mydriasis during cataract syrgery makes the operation easier and brings a good results. This study was performed in rabbit and human eyes to assess the role of the prostaglandins in surgically induced miosis by observing the reduction of pupillary constriction and by measuring the amount of prostaglandins in aqueous humor when the 1.0% suprofen, cyclo-oxygenase inhibitor, was used, and to assess the effect of suprofen in intraocular pressure. In the results, suprofen inhibits syrgically induced miosis (p value: <0.01, human <0.01) without intraocular pressure change, and for this miosis, prostaglans and for this miosis, prostaglandins are at least partially responsible.