Impact of Cerebrospinal Fluid Sample Handling on Cytokine Detection Results.

OBJECTIVE: To investigate the impact of different treatment methods on cerebrospinal fluid (CSF) cytokine detection. METHODS: CSF samples were collected from 25 patients. The levels of IL-6, IL-10, IFN-γ, and IL-2 were measured after CSF was stored at room temperature (25°C) or 4°C for 6, 12, and 24 hrs. The CSF was frozen at -80°C, thawed at room temperature for 1 hr every 8 hrs and then frozen. This process was repeated three times in a row, and then cytokine levels in CSF were detected again. RESULTS: The four cytokines were stable when the CSF was kept at room temperature for 6 hrs. After 12 hrs of storage, the levels of the four cytokines decreased, and the changes in IL-6 and IL-10 levels were statistically significant. After 24 hrs of storage, the levels of the four cytokines were further reduced, and the changes were statistically significant. Cytokines were stable when CSF was stored at 4°C, and only IL-10 exhibited statistically significant changes when stored for 24 hrs. IL-6, IL-10 IFN-γ, and IL-2 were stable in CSF samples after three freeze-thaw cycles. CONCLUSION: The stability of CSF cytokines is poor after storage at room temperature and good after storage at 4°C. Therefore, cytokine detection should be carried out after CSF collection as often as possible. If the detection cannot be done quickly enough, the specimens should be stored in cold storage for no more than 24 hrs.

Topical Application of Methyl Nicotinate Solution Enhances Peripheral Blood Collection.

OBJECTIVE: The purpose of this study was to investigate whether local application of methyl nicotinate solution can change the content and proportion of blood cells in peripheral blood samples and to determine whether this treatment is a safe and reliable method for improving peripheral blood collection. METHODS: Routine blood analysis and flow cytometry were used to analyze the contents and proportions of blood cells and T lymphocyte subsets in peripheral blood samples. Experimental blood specimens were collected from earlobes treated with different concentrations of methyl nicotinate solution, and the control group consisted of blood specimens collected from untreated earlobes. RESULTS: The blood flow in the earlobe was significantly increased after methyl nicotinate solution stimulation, especially when the methyl nicotinate solution concentration was greater than 10-4 mol/L. There were no significant changes in the proportions of white blood cells, red blood cells, platelets, neutrophils, eosinophils, basophils, monocytes, or lymphocytes in the peripheral blood obtained from earlobes treated with methyl nicotinate solution. The proportion of T lymphocytes increased in the experimental group, but this difference was not significant. CONCLUSION: Local application of methyl nicotinate solution is a feasible method for improving peripheral blood collection, especially for patients with venous blood collection phobia or an inability to provide venous blood samples.

Diagnostic Value of Tumor Markers in Peritoneal Lavage Fluid for Peritoneal Metastasis from Colorectal Cancer.

OBJECTIVE: To investigate the diagnostic value of tumor markers in peritoneal lavage fluid in the diagnosis of peritoneal metastasis from colorectal cancer. METHODS: One hundred eighty-six patients with colorectal cancer and 15 patients with benign disease who underwent surgical treatment were included. The abdominal cavity and pelvis of the patients were lavaged with 200 ml of normal saline immediately after abdominal cavity incision or pneumoperitoneum establishment. Five milliliters of lavage fluid was collected for peritoneal lavage fluid tumor marker detection (pCEA, pCA19-9, pCA125 and pCA724), and another 100 ml of lavage fluid was collected for cytological examination. RESULTS: There were 13 patients with abdominal and pelvic nodules found intraoperatively and confirmed by postoperative pathology as peritoneal metastasis, and 24 patients were cytologically peritoneal lavage-positive, with a positivity rate of 12.9%. Peritoneal metastasis from colorectal cancer was related to tumor T stage, N stage, and serum CEA and CA19-9 elevation. Peritoneal lavage fluid tumor markers had diagnostic value for patients with and without peritoneal metastasis from colorectal cancer, and the differences were statistically significant (P<0.05). Among them, pCA19-9 had the highest area under the curve (AUC), with 84.62% sensitivity and 85.19% specificity at the cutoff value. pCA19-9 had diagnostic value for peritoneal micrometastasis from colorectal cancer (P<0.05), with an AUC of 0.72. CONCLUSION: T stage, N stage, and serum CEA and CA19-9 elevation are associated with peritoneal metastasis from colorectal cancer. Peritoneal lavage fluid tumor markers have diagnostic value for peritoneal metastasis from colorectal cancer, among which pCA19-9 has the highest diagnostic value.

Changes and significance of plasma fibrinogen gamma-chain concentration in preeclampsia patients.

OBJECTIVE: To investigate the plasma fibrinogen gamma-chain concentration in preeclampsia patients and explore its value in preeclampsia prediction and auxiliary diagnosis. METHODS: Follow-up of pregnant women who regularly attended perinatal care at two hospitals in China was performed, and clinical data and plasma samples were collected at each examination until delivery. The gamma-chain concentration was detected by Western blotting, and Quantity One Software was used for gamma-chain grayscale value measurements. RESULTS: Forty-two patients with preeclampsia and 42 control patients completed the follow-up. In the control group, the gamma-chain concentration at 32 weeks of gestation was higher than that at 20 weeks of gestation, but the difference was not statistically significant (p > 0.05). In the experimental group, the gamma-chain concentration at preeclampsia diagnosis was significantly higher than that at 20 weeks of gestation (p < 0.05). Compared with the control group, the gamma-chain concentration was higher at 20 weeks of gestation in the experimental group, but the difference was not statistically significant. However, at 32 weeks of gestation and at the time of diagnosis, the gamma-chain concentration in the experimental group was significantly higher than that in the control group (p < 0.05). At 32 weeks of gestation and at the time of diagnosis, the AUCs from ROC curve analysis of plasma fibrinogen gamma-chain concentrations were 0.64 and 0.71, respectively. CONCLUSION: Plasma fibrinogen synthesis and degradation were disrupted in preeclampsia patients before and after diagnosis, and gamma-chain concentration was significantly increased. Plasma fibrinogen gamma chain may be of some value in preeclampsia prediction and auxiliary diagnosis.

Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China.

BACKGROUND: Many endoscopic procedures have been used to treat hepatolithiasis, including as laparoscopic hepatectomy (LH), laparoscopic intrahepatic duct exploration (LIDE), and endoscopic retrograde cholangiopancreatography (ERCP). However, long-term results of such treatments are rarely reported. The series aimed to evaluate the immediate outcomes and long-term results of these treatments and their optimal indications. METHODS: From January 2002 to April 2010, a total of 124 continuous patients with hepatolithiasis were primarily treated with endoscopic surgery, including LH (LH group, n = 37), LIDE (LIDE group n = 41), and ERCP (ERCP group, n = 46) at our two institutes. These cases were retrospectively reviewed. The patients' demographic variables, operative outcomes, complete clearance rate, and cholangitis recurrence rate were analyzed. RESULTS: Complete stone clearance was achieved in 94.6 % of LH, 78.0 % of LIDE, and 67.4 % of ERCP patients. After a median follow-up period of 5.0 years (rang 2-8 years), we observed stone recurrence in 26.6 % (33/124) of patients and recurrent cholangitis in 24.2 % (30/124) of patients. Stricture, stones in both lobes, and non-hepatectomy treatments were significant risk factors for incomplete stone clearance on multivariate analysis. In addition, recurrent cholangitis was associated with non-hepatectomy therapy, Sphincter of Oddi dysfunction, residual stones, and intrahepatic bile strictures. CONCLUSION: In this study with 2-8 years of follow-up, residual stones, biliary stricture, Sphincter of Oddi dysfunction, and ERCP therapy were associated with recurrent stones and/or cholangitis after treatment, indicating that the modification of Sphincter of Oddi function and maintaining its normal pressure are very important.

Stapleless laparoscopic splenectomy with individual vessel dissection in patients with splenomegaly.

BACKGROUND: Mechanical stapling devices have been established as a mainstay in laparoscopic splenectomy (LS), but limited data are available regarding stapleless LS for splenomegaly with individual vessel dissection (IVD). This study aimed to investigate the feasibility of stapleless LS for splenomegaly and its potential advantage over staple-based LS. METHODS: A total of 51 patients with splenomegaly underwent stapleless LS and were subsequently reviewed. The data collected include the patients' demographics, operative outcomes, and the rates of conversion to open surgery, complications, and mortality. Multiple linear and logistic regression analyses were used to assess the impact of the primary diagnosis, body mass index (BMI), and massive splenomegaly on the perioperative conversion rate. RESULTS: There were no deaths. The mean for various parameters are as follows: spleen length 21.6 cm; spleen weight 1,184 g, operating time 148 min, hospital stay 5.2 days, estimated blood loss 245 ml. The total conversion rate was 9.8 % (including one reoperation for bleeding). The presence of a BMI >30 % and hematologic malignancy-cofactors of portal hypertension (PH)-and a spleen weight >1,000 g were independent predictors of conversion to open surgery. CONCLUSIONS: Stapleless LS for splenomegaly is feasible and safe in selected patients. It has advantages over traditional procedures using staples, at least in patients with benign splenomegaly. Patients with hematologic malignancy, BMI >30 %, coexistence of PH, and spleen weight >1,000 g are susceptible to bleeding during dissection of the splenic hilum, with use of IVD being relatively limited.

Perioperative analysis of laparoscopic liver resection with different methods of hepatic inflow occlusion.

BACKGROUND: During liver resection, bleeding remains the most important challenge. A reduction in blood loss and avoiding the need for a blood transfusion are important objectives for liver surgeons today. The authors compared the intra- and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO), hemihepatic vascular occlusion (HVO), and selective vascular occlusion (SVO). SUBJECTS AND METHODS: Retrospective analysis was conducted of patient data from 41 cases of laparoscopic liver resection in three groups of patients under different occlusion methods, including 15 cases of IPO, 15 cases of HVO, and 11 cases of SVO. The advantages and disadvantages of the various methods were compared, as well as blood loss, operation time, changes in postoperative liver function, and complications. RESULTS: There was no operative death in any of the 41 patients. Generally, there was no significant difference among the three groups in blood loss, clamping time, or operative time. After the operation, the effect on liver function for the HVO and SVO groups was significantly less severe than that for the IPO group (P<.05). The incidence of postoperative complications was mainly related to IPO and the larger amount of bleeding. CONCLUSIONS: Both HVO and SVO are feasible in laparoscopic hepatectomy and have the advantage of reducing liver remnant ischemia injury and modality rate over IPO. HVO is easy to do for left lateral lobe or resection of the left half of the liver. SVO is suitable for right lobe resection.

Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review.

BACKGROUND: This study aimed to assess the efficacy and safety of repeat hepatectomy for recurrent hepatocellular carcinoma (HCC). METHODS: Thirty-seven patients who underwent a curative repeat hepatectomy in our hospital were retrospectively studied. An extensive database literature search was performed to obtain for all relevant studies. RESULTS: In our series, there were no perioperative deaths during repeat hepatectomy for recurrent HCC. Patients survival after repeat hepatectomy were similar to 429 patients undergoing initial hepatectomy. A computerized search of the Medline and PubMed databases found 29 retrospective studies providing relevant data in 1149 patients were included for appraisal and data extraction. After the repeat hepatectomy, postoperative morbidity ranged from 6.2% to 68.2% with a median per cohort of 23.5 per cent. There were 7 perioperative deaths (0.7 per cent of 993 for whom mortality data were provided). The overall median survival ranged from 21 to 61.5 months, with 1-, 3-, and 5-year survival of 69.0% to 100%, 21.0% to 87.0%, and 25.0% to 87.0%, respectively. CONCLUSIONS: Repeat hepatectomy can be performed safely and is associated with long-term survival in a subset of patients with recurrent HCC. However, the findings have to be carefully interpreted due to the lower level of evidence. A randomized controlled study is needed to compare repeat hepatectomy and other modalities for recurrent HCC.