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Desmoplastic Small Round Cell Tumor (DSRCT) is an aggressive neoplasm that classically grows in the peritoneal cavity and has poor prognosis. We describe a 13-year-old boy with testicular DSRCT, treated with orchiectomy and chemotherapy who is free of disease 102 months after diagnosis. This is the fifth case of primary DSRCT of the testis described in literature. Moreover, we present a literature review of 28 cases of testicular and paratesticular DSRCT.

Introduction In-body tissue architecture (iBTA) technology, based on cell-free tissue engineering, can produces collagenous tissues for implantation by subcutaneous embedding a designed mold. The aim of this study was to evaluate the biocompatibility of iBTA-induced “Biosheet®” collagenous sheets, as scaffold materials for bladder reconstruction. Methods Canine Biosheet® implants were prepared by embedding molds into subcutaneous pouches in beagles for 8 weeks. A part of canine bladder wall was excised (2 × 2 cm) and repaired by patching the same sized autologous Biosheet®. The Biosheet® implants were harvested 4 weeks (n = 1) and 12 weeks (n = 3) after the implantation and evaluated histologically. Results No disruption of the patched Biosheet® implants or urinary leakage into the peritoneal cavity was observed during the entire observation periods. There were no signs of chronic inflammation or Biosheet® rejection. The urine-contacting surface of luminal surface of the Biosheet® was covered with a multicellular layer of urothelium cells 4 weeks after implantation. α-SMA-positive muscle cells were observed at the margin of the Biosheet® implants at 12 weeks after the implantation. In addition, in the center of the Biosheet® implants, the formation of microvessels stained as α-SMA-positive was observed. Conclusion Biosheet® implants have biocompatibility as a scaffold for bladder reconstruction, indicating that they may be applicable for full-thickness bladder wall substitution. Further studies are required for definitive evaluation as a scaffold for bladder reconstruction.

Ovarian cancer cells mainly metastasise within the peritoneal cavity, the lethal consequence of tumour progression in this cancer type. Classically, changes in tumour cells, such as epithelial to mesenchymal transition, involve the down-regulatinon of E-cadherin, activation of extracellular proteases and integrin-mediated adhesion. However, our current understanding of ovarian tumour progression suggests the implication of both intrinsic and extrinsic factors. It has been proposed that ovarian cancer metastases are a consequence of the crosstalk between cancer cells and the tumour microenvironment by soluble factors and extracellular vesicles. Characterisation of the alterations in both the tumour cells and the surrounding microenvironment has emerged as a new research field to understand ovarian cancer metastasis. In this mini review, we will summarise the most recent findings, focusing our attention on the role of secreted factors and extracellular vesicles in ovarian cancer metastasis., Highlights • During ovarian cancer metastasis, tumour cells metastasise in the mesothelium as primarily ‘soil’ for ovarian cancer ‘seeds’. • Soluble factors and extracellular vesicles secreted by tumor cells are involved in the generation of the pre-metastatic niche. • Cancer-associated fibroblasts (CAFs) represent the majority of stromal cells in various types of human carcinoma, including ovarian cancer. • Analysis of early metastasis to the omentum indicates that ovarian cancer cells rely on the interaction with immune cells such as macrophages. • Liquid biopsy analyses in ovarian cancer may help to define novel biomarkers improving patient survival and reduce lethality.

Highlights • Gauze sponge transmigration over 5years from the peritoneal cavity to the external urethral meatus is rare but possible. • There have been few reported cases of gossypiboma due to under reporting for fear of litigation but the true incidence may be much higher. • Migration of gossypiboma from initial site is a rare entity and could pose some diagnostic difficulties. • High index of suspicion and prompt diagnosis of gossypiboma is key to management to help reduce the high morbidity that is associated with the condition. • Gossypiboma in the urinary bladder though rare but can be prevented through appropriate documentation and recounting of all surgical sponges and instruments used during surgeries., Introduction Gossypiboma denotes a mass of cotton retained in the body following surgery. Migration of gossypiboma from initial site is a rare entity and could pose some diagnostic difficulties. Migration of gauze sponge has been reported to occur in several organs of the body. There have been few reported cases but the true incidence may be much higher due to under reporting for fear of litigation. Presentation of case We present an unusual case of a 58-year-old grand multiparous woman who had gauze retention for 5 years following a hysterectomy and presented with acute urinary symptoms. The gauze sponge transmigrated from the peritoneal cavity to the bladder and was partially extruded through the external urethral meatus. She had laparotomy for the removal of gauze sponge with good outcome. Discussion Retained foreign body especially surgical sponges (gossypiboma) infrequently occurs and can be a source of great concern to the surgeon and patient. Foreign bodies inside the body cavities and organs can present with several non-specific clinical features that can make diagnosis difficult. Migration of surgical sponge (gauze, mops) into the urinary bladder is uncommon when compared to other abdominal and pelvic viscus. A gossypiboma in the peritoneal cavity creates a fistulous tract through the thick wall of the urinary bladder from long period of chronic inflammation as seen in the index case where the previous surgery was performed 5 years prior to onset of symptoms. Due to the non-specific presentations of gossypiboma, especially those in the bladder, several investigative modalities need to be employed to help make a prompt diagnosis. Most long-standing cases would require laparotomy due to the dense adhesions that occur around the site of the gossypiboma. Lack of appropriate diagnosis leaves the patient with recurrence of distressful symptoms and the consequent morbidities. Conclusion Transmigration of a gauze sponge over 5 years from the peritoneal cavity into the urinary bladder and through the external urethral meatus following a hysterectomy is a rare occurrence and can present diagnostic difficulties. High index of suspicion, prompt diagnosis and management will help reduce the high morbidity that is associated with the condition as in the case reported.

This case series showed the sonographic and magnetic resonance imaging findings of two patients with dermal sinuses in the lateral buttocks. According to the 2 present cases, and 8 cases previously reported, the distal sides of the sinuses may be connected to internal tissues, such as the subarachnoid, gluteal fissure, peritoneal cavity, or pelvic bone. Since it is difficult to predict the involvement of the distal side of a dermal sinus based on the dermal pit location, ultrasound and magnetic resonance imaging were postulated as a useful modality to aid evaluation. Based on these image findings, complete surgical resection was performed by surgeons. Keywords: Dermal sinus, Dermoid cyst, Magnetic resonance imaging, Sonography, Ultrasound

The instillation of local anesthetic into the peritoneal cavity at the time of various types of laparoscopic surgery has been found to improve postoperative pain as quantified by decreased time to discharge, decreased pain severity scores, and decreased amounts of rescue narcotic. No significant safety issues have been identified with the practice of intraperitoneal instillation of local anesthetic. Dosage, placement location and timing of local anesthetic administration has been evaluated in a variety of settings, for different procedures and prior to and after dissection. Although more research is needed to standardize the practice of intraperitoneal local anesthetic use, it has been demonstrated as helpful as an adjunct in managing the pain associated with laparoscopic surgery and should be considered for all patients undergoing laparoscopic surgery.

The ability of Russell's viper (Daboia siamensis) venom (total RVV) and phospholipase A2 (purified PLA2) to induce the local pathological effects were investigated by the local inflammatory events and the release of inflammatory mediators. Both 0.5 μg of total RVV/mouse and 0.15 μg of purified PLA2/mouse were administered via intra-peritoneal injection. After 30 min, 1 h, 2 h, and 4 h incubation time, the peritoneal cavity was flooded with normal saline and the total leukocytes were collected. The eicosanoids (lipid mediators) and the leukocyte expression of cyclooxygenase (COX-1 and COX-2) were investigated by ELISA assay and western blotting, respectively. The amounts of total leukocytes were increased from 30 min to 2 h, then decreased at 4 h, by both total RVV and purified PLA2. Both treatments also induced the expression of COX-2 which was increased at 2 h and then decreased at 4 h, whereas only purified PLA2 induced the expression level of a COX-1 protein which was increased at 30 min, then constantly expressed until 4 h. In addition, total RVV and purified PLA2 caused the release of the eicosanoids; PGE2, TXB2, and LTB4, which reached the peak after 2 h. The findings of this study indicate that purified PLA2 has the potential effects to induce the local inflammation relating the amounts of leukocytes cells, lipid mediators and COX-2 more than the total RVV.

Introduction and importance Peritoneal Tuberculosis is one of extrapulmonary tuberculosis that occurs in 1-2% of patients, its incidence is higher in developing countries. It is very difficult to diagnosed and can mimic advanced ovarian cases. Making an accurate diagnosis is vital, laparoscopy is a great modality for this purpose. Case presentation A 36 years-old woman got referred with abdominal distention and weight loss from an internist and digestive surgeon. The abdominal computed tomography said thickening of the stomach wall with ascites. Ultrasound concluded the uterus, ovary, and endometrium within normal. The CA 125 levels elevated to 1200 U/mL and the complete blood count was normal. We were making diagnosis of peritoneal tuberculosis, peritoneal carcinomatosis, and advanced ovarian cancer. We did the diagnostic laparoscopic and taking a biopsy sample, ascites with peritoneal carcinomatosis and omental cake were found, the peritoneal cavity was covered by miliary nodules. Histopathology results concluded peritoneal tuberculosis without malignancy signs. The patient was treated with tuberculosis drugs. The follow-up evaluations show significant clinical improvement. Clinical discussion When facing patients with massive ascites and elevated CA 125 without any ovary enlargement, a gynecologist should think that it may be a peritoneal TB case with peritoneal carcinomatosis and advance ovarian cancer possibility as differential diagnosis especially in developing countries. An exact diagnosis can be made using laparoscopy and histopathology examination. Conclusion Laparoscopy is the best modality to differentiate between peritoneal tuberculosis, peritoneal carcinomatosis, and advance ovarian cancer. The benefits are direct visualization and could take a biopsy for histology examination., Highlights • Peritoneal tuberculosis could mimics advanced ovarian cancer due to its abdominal distention, presentation of ascites, and elevated of CA-125 levels. • Consider peritoneal tuberculosis in women with abdominal distention with loss of appetite, weight loss especially in developing country. • Laparoscopy is crucial and also the best modality to differentiate between peritoneal tuberculosis, peritoneal carcinomatosis, and advanced ovarian cancer. • The benefits of laparoscopy are direct visualization and could take a biopsy for histology examination. • We should not rush into laparotomy procedure for this kind of case.

Ventriculoperitoneal (VP) shunting has been a suitable therapeutic method for hydrocephalus. Nonetheless, it could be accompanied by several problems and devastating outcomes. Shunt migration is an uncommon occurrence in one out of 1000 individuals who undergo a shunt procedure. We report an 8-months-old infant known case of previous VP shunting who presented with the enlargement of the left inguinoscrotal area. According to a radiology scan, the peritoneal catheter had slipped into the left scrotum. The patient underwent left inguinal exploration under general anesthesia. The bowel content and VP catheter were retrieved to the peritoneal cavity and the sac was ligated. There was no recurrence or complications after surgery.

Introduction Intra-abdominal adhesions are typically found after the most surgical procedures. Normally, most adhesions are asymptomatic; however, few individuals experience postoperative adhesion-related problems such as small bowel obstruction, pelvic pain, infertility, or other complications. We aimed to evaluate the preventive effect of the ascites fluid for postoperative peritoneal adhesions in rat models. Material and methods This experimental trial was conducted in Sixty Syrian male rat randomly assigned to six groups of 10 animals each as follows: control (group 1&4); normal saline (group 2&5): 2 mL of normal saline was poured into the peritoneal cavity; and case (group 3&6): 2 mL ascites fluid was poured into the peritoneal cavity. All animals in the six groups underwent laparotomy and measurable serosal injury were created with a standard technique. 10 and 30 days after initial surgery, the rats underwent another laparotomy in groups 1, 2, 3 and 4, 5, 6, respectively to assess macroscopic and microscopic adhesions, which were scored by an examiner who was blind to the animals̕ group assignment. Data analyzed by SPSS version 18, using the kruskal Wallis and Bonferroni-corrected Mann-Whitney U tests. P-values of less than 0.05 were considered significant. Results The mean scores of both microscopic and macroscopic adhesion were significantly different between all the groups (P 0.05). Conclusions Ascites fluid can decrease the possibility of post-operative intraperitoneal adhesion formation., Highlights • Ascites fluid decreases post-operative adhesion formation. • The intensity of adhesion did not differ over time. • Ideal adhesion-reducing substances are still under investigation.

Background & Aims Mucosal-associated invariant T (MAIT) cells are depleted from blood in patients with advanced liver disease and show features of immune dysfunction. Because circulating MAIT cells differ from organ-resident MAIT cells, we aimed to investigate the frequency, phenotype, and function of peritoneal MAIT cells from patients with cirrhosis and spontaneous bacterial peritonitis (SBP). Methods MAIT cells in blood and ascitic fluid from patients with cirrhosis were characterized using flow cytometry. Healthy individuals and noncirrhotic patients undergoing peritoneal dialysis served as controls. MAIT cell migration was studied in transwell assays. Cytokine release in response to infected ascitic fluid and bacterial products was assessed in vitro. Results Peritoneal CD3+ CD161hi Vα7.2+ T cells had an inflammatory, tissue retention phenotype, expressing the alpha E integrin, the chemokine receptors CCR5 and CXCR3, and the activation marker CD69 at higher levels than their circulating equivalents. Seventy-seven percent bound to MR1 tetramers loaded with the pyrimidine intermediate 5-(2-oxopropylideneamino)-6-d-ribitylaminouracil. The ratio of peritoneal to blood MAIT cell frequency increased from 1.3 in the absence of SBP to 2.6 at diagnosis and decreased by day 3. MAIT cells migrated toward infected ascitic fluid containing CCL5 and CCL20 and released cytokines in an MR1-restricted fashion. Whereas the depleted circulating MAIT cell pool displayed features of immune exhaustion, peritoneal MAIT cells remained competent producers of inflammatory cytokines in response to bacterial products. Peritoneal MAIT activation correlated with systemic inflammation, suggesting a possible link between peritoneal and systemic immunity. Conclusions Peritoneal MAIT cells phenotypically and functionally differ from circulating MAIT cells in decompensated cirrhosis and redistribute to the peritoneum during SBP., Graphical abstract

Background Ventriculoperitoneal shunt (VPS) is the most commonly performed procedure in the treatment of hydrocephalus in children. Shunt migration outside the peritoneal cavity is quite rare. This study describes one case of clear migration to the Fallopian tube and cerebrospinal fluid (CSF) discharge from the vagina. Case description A five-year-old female patient with VPS was admitted to the hospital with a 40-day history of abdominal pain, vomiting, and fever. She was in Glasgow Coma Scale 15, and she presented CSF discharge from the vagina. Abdominal ultrasonography and tomography showed a heterogeneous cyst involving the distal tip of the catheter close to the Fallopian tube. The patient underwent laparotomy with the aid of pediatric surgeons, which confirmed that the end of the distal catheter was present inside the right Fallopian tube. The catheter was repositioned in the peritoneal cavity without intercurrences. CSF examination showed absence of infection and negative culture. The patient was discharged from the hospital cured without requiring antibiotics. Conclusion Abdominal complications involving the distal VPS catheter are frequently reported in the literature; distal catheter migration to the Fallopian tube with CSF discharge from the vagina, however, is a very rare presentation. Surgical repair, with a multidisciplinary team, to reposition the distal catheter in the peritoneal cavity was sufficient for adequate treatment of this patient.

Highlights • Serous borderline tumor outside of the peritoneal cavity is rare. • Involvement of cardiophrenic lymph nodes with serous borderline tumor can occur. • Preoperative imaging may aid surgical planning even in serous borderline tumor cases. • Sequencing can help confirm a diagnosis of serous borderline tumor at distant sites.

Highlights • Patients with ovarian cancer were treated with intraperitoneal submicron particle paclitaxel after debulking surgery. • Following surgery, patients received IV chemotherapy without evidence of enhanced systemic toxicity. • By RECIST 1.1 criteria, 66% of patients had progression free survival at 6 months and 1-year following surgery., Submicron particles (~800 nm) of paclitaxel (SPP) contain 1–2 billion molecules of pure drug that release tumoricidal levels of paclitaxel over many weeks. This study compared two dose-levels of SPP instilled into the peritoneal cavity (IP) in 200 ml of saline post-cytoreductive surgery. Eligible patients with primary (n = 6) or recurrent (n = 4) epithelial ovarian cancer who underwent complete cytoreductive surgery were enrolled to receive a single instillation of IP SPP followed by standard IV carboplatin and paclitaxel. Endpoints were PFS and evaluation of treatment emergent adverse events. Clinical response was determined by symptoms, physical exams, CT scans, and serum CA-125 measurements. Of the 24 subjects screened, 10 were enrolled and received treatment: seven patients received 100 mg/m2 and three received 200 mg/m2. Seven subjects completed the 12-month follow-up period. Six patients were evaluable due to one subject who had unevaluable scans throughout the follow-up period and was thus excluded from PFS determination. Upon completion of planned chemotherapy post-SPP instillation, the PFS at 6 months was 66% (4/6) and at 12-months 66% (4/6) using RECIST 1.1. One subject had a complete response at the end of IV treatment but died (unrelated to study treatment) before PFS evaluation. There was one case of incision dehiscence and one case of vaginal cuff leakage after surgery. This pilot study supports further evaluation of IP SPP to treat peritoneal carcinomas.

Introduction Spontaneous bladder rupture is a rare condition, especially after a nontraumatic vaginal delivery. Case presentation A 32-year-old patient who had had a nontraumatic vaginal delivery presented to the emergency room with abdominal pain and anuria. Computed tomography showed free fluid in the peritoneal cavity. An exploratory laparoscopy revealed a perforation on the bladder dome that was laparoscopically sutured. Conclusion In the presence of an acute abdominal pain with free fluid in the peritoneal cavity after a nontraumatic vaginal delivery, a differential diagnosis should be a spontaneous rupture of the bladder.

Mature ovarian cystic teratoma (MOCT) is the most common benign neoplasm of the ovary and has a wide spectrum of radiological presentations. Our aim was to present the radiological characteristics and pathologic findings of a patient with an atypical manifestation of this common disease. A 52-year-old Japanese woman was admitted to our hospital with a large cystic mass in the pelvis and an elevated squamous cell carcinoma antigen level. Computed tomography revealed disseminated cystic lesions in the intraperitoneal and intrathoracic spaces. The lesions contained fat and featured calcifications. Laparotomy revealed many white, spherical nodules in the peritoneal cavity. The results of pathologic examination led to a presumed diagnosis of a foreign body reaction to the contents of an MOCT that leaked into the peritoneal cavity. The patient has been followed up for 13 months and remains free of symptoms without additional treatment. We describe a rare presentation of MOCT, in which we initially strongly suspected an advanced malignancy based on the results of imaging. To make an accurate diagnosis, it is necessary to understand the rare findings associated with MOCT, as well as the common signs on different imaging modalities. Keywords: Dissemination, Imaging, Teratoma, Ovary, Calcifications

Ovarian cancer, the most deadly gynecological malignancy in U.S. women, metastasizes uniquely, spreading through the peritoneal cavity and often generating widespread metastatic sites before diagnosis. The vast majority of ovarian cancer cases occur in women over 40 and the median age at diagnosis is 63. Additionally, elderly women receive poorer prognoses when diagnosed with ovarian cancer. Despite age being a significant risk factor for the development of this cancer, there are little published data which address the impact of aging on ovarian cancer metastasis. Here we report that the aged host is more susceptible to metastatic success using two murine syngeneic allograft models of ovarian cancer metastasis. This age-related increase in metastatic tumor burden corresponds with an increase in tumor infiltrating lymphocytes (TILs) in tumor-bearing mice and alteration of B cell-related pathways in gonadal adipose tissue. Based on this work, further studies elucidating the status of B cell TILs in mouse models of metastasis and human tumors in the context of aging are warranted.

The purpose of this study was to determine the outcome for patients with recurrent ovarian cancer treated with surgical resection alone. Consecutive patients were identified who had complete resection of a surgically isolated metastasis of recurrent high-grade ovarian cancer between 1/2006 and 1/2018 who did not receive adjuvant chemotherapy. Eight such patients were identified. The mean age was 54.4 yrs. (range, 46.1–62.9 yrs). Six of the 8 patients (75%) had a complete resection at initial surgery and all but one (88%) were initially treated with intraperitoneal chemotherapy. The median time from completion of primary chemotherapy to recurrence was 38.7 mo (14.4–96.4 mo). Sites of recurrence included lymph nodes (n = 2), spleen (n = 1), and peritoneal cavity (n = 5). Minimally invasive surgical techniques were used in 7 of the 8 patients. Mean progression-free survival after secondary surgery was 19.8 mo (95% CI, 15.8-N.R.) and mean overall survival was 64.8 mo (95% CI, 54.6-N.R.). With a median follow-up of 65.2 months (23.3–84.6 mo) from the secondary resection, 4 of 8 patients remain without evidence of recurrence. Only 1 of the 5 patients with peritoneal recurrence remains disease-free. All 4 patients in remission have a post-resection time longer than the time from initial treatment to the surgery for recurrence. This study finds that it may be reasonable to omit chemotherapy in highly selected patients after complete secondary surgical resection. Resection of isolated recurrences can be accomplished with minimally invasive surgery, and these patients have an excellent prognosis. Non-peritoneal recurrences may have a better prognosis after secondary surgery., Highlights • Surgery alone for recurrent ovarian cancer has an excellent prognosis in selected patients. • Half of patients remain with no evidence of recurrence, with follow-up from 23.3 to 84.6 months. • Non-peritoneal recurrences appear to be associated with better prognosis.

Background Interleukin-33 (IL-33) is an alarmin cytokine that binds to the interleukin 1 receptor-like 1 protein ST2. Clock is a key circadian gene that is essential for endogenous clockworks in mammals. This study investigated whether Clock temporally regulated IL-33-mediated responses in mast cells. Methods The kinetics of IL-33-mediated IL-6, IL-13, and TNF-α productions were compared between bone marrow-derived mast cells (BMMCs) from wild-type and Clock -mutated mice ( Clock Δ19/Δ19 mice). The kinetics of the neutrophil influx into the peritoneal cavity or expression of IL-13 and Gob-5 in the lung in response to IL-33 were compared between wild-type and Clock Δ19/Δ19 mice. We also examined the kinetics of ST2 expression in mast cells and its association with Clock expression. Results There was a time-of-day-dependent variation in IL-33-mediated IL-6, IL-13, and TNF-α production in wild-type BMMCs, which was absent in Clock -mutated BMMCs. IL-33-induced neutrophil infiltration into the peritoneal cavity also showed a time-of-day-dependent variation in wild-type mice, which was absent in Clock Δ19/Δ19 mice. Furthermore, IL-33-induced IL-13 and Gob-5 expression in the lung exhibited a time-of-day-dependent variation in wild-type mice. These temporal variations in IL-33-mediated mast cell responses were associated with temporal variations of ST2 expression in mast cells. In addition, CLOCK bound to the promoter region of ST2 and Clock deletion resulted in down-regulation of ST2 expression in mast cells. Conclusions CLOCK temporally gates mast cell responses to IL-33 via regulation of ST2 expression. Our findings provide novel insights into IL-33/mast cell-associated physiology and pathologies.

Ureteral trauma is a rare case and generally results from severe trauma events. A 6-year-old boy came with the chief complaint open wound in the lower right abdomen after falling from the bike. Abdominal MSCT with contrast showed the free liquid in the peritoneal cavity, and Retrograde Pyelogram showed the contrast extravasation. According to the algorithm, a surgical exploration must be performed because of the contrast extravasation. In this case, there found a total rupture of right distal ureter. Debridement was performed, and Double J Stent was implanted. This patient got treatment quickly so he didn't suffer disability and death.

Highlights • Lumbar-peritoneal (LP) and ventriculo-peritoneal (VP) shunt placement is the treatment of choice for diversion of cerebrospinal fluid (CSF) from the subarachnoid space into the peritoneal cavity. • Perforation of the bowel by lumbar-peritoneal or ventriculo-peritoneal shunt is an extremely rare complication. • We report a case of a 72 old female patient with LP shunt for raised intracranial pressure, who presented with LP shunt catheter protruding from anus. • She was surgically treated with removal of the distal part of the shunt, external drainage of the proximal part and primary closure of the perforation., Introduction Lumbar-peritoneal (LP) and ventriculo-peritoneal (VP) shunt placement is the treatment of choice for diversion of cerebrospinal fluid (CSF) from the subarachnoid space into the peritoneal cavity. This invasive procedure has been associated with several complications, most commonly infection and obstruction. Perforation of the bowel is an extremely rare complication. Case presentation We report a case of a 72 old female patient with LP shunt for raised intracranial pressure, who presented with LP shunt catheter protruding from anus. This was due to bowel perforation in the recto-sigmoid junction by the distal tip of lumbar-peritoneal shunt. She was surgically treated with removal of the distal part of the shunt, external drainage of the proximal part and primary closure of the perforation. Discussion The mortality after perforation is relatively high, approaching 15–18%, and it is further increased when infection is present up to 22% with central nervous system (CNS) infection such as meningitis, encephalitis, or brain abscesses (Vinchon, 2006) and 33% with intra-abdominal infection. Conclusion Clinical suspicion of abdominal complications by the LP should be raised when patient with hydrocephalus develops acute abdominal symptoms or infection with unusual positive CSF cultures.

Macrophages are highly plastic in their pro-inflammatory/anti-inflammatory roles. Type I and II interferons (IFNs) are known to modulate macrophage activation. Tyrosine kinase 2 (Tyk2) has an intimate relationship with type I and II IFN signaling. Animal studies have shown that Tyk2 knock-out (KO) in mice is associated with reduced inflammatory responses in various mouse models of diseases. To investigate the role of Tyk2 in inflammation in more detail, we intraperitoneally injected heat-killed Propionibacterium acnes (P. acnes) to Tyk2 KO mice. P. acnes-induced acute peritoneal inflammation, assessed by neutrophil infiltration, was reduced in Tyk2 KO mice. The reduction was accompanied with diminished productions of inflammatory cytokines and an enhanced production of anti-inflammatory IL-10. Unexpectedly, pre-treatment of wild-type mice with the neutralizing antibodies for IFNs did not affect P. acnes-induced neutrophil infiltration. A neutralizing antibody for the IL-10 receptor in Tyk2 KO mice restored P. acnes-induced peritoneal inflammation. Enhanced production of IL-10 from Tyk2 KO peritoneal cells was suppressed by either the cyclooxygenase inhibitor diclofenac or protein kinase A inhibitor H-89. The level of prostaglandin E-2 (PGE(2)) in the steady-state peritoneal cavity in Tyk2 KO mice was higher than that in wild-type mice. Tyk2 KO macrophages showed an enhanced CREB phosphorylation induced by P. acnes plus PGE(2). Taken together, these results showed that Tyk2 deficiency potentiates the PGE(2)-protein kinase A-IL-10 pathway in macrophages, and thereby contributes to potentiation of the immunosuppressive phenotype.

Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and the most common cause is portal hypertension related to cirrhosis. Ascites is found in up to 60% of patients at the time of the diagnosis of cirrhosis and is associated with increased morbidity and mortality. The complications of ascites include spontaneous bacterial peritonitis, refractory ascites, hyponatremia, and hepatorenal syndrome, which can further lead to worsened survival. The timely recognition and management of ascites can have important prognostic implications. This chapter focuses on the pathophysiology, differential diagnosis, and management of ascites. The management of spontaneous bacterial peritonitis and refractory ascites are also discussed.

Peritoneal dialysis (PD) is a life-saving form of renal replacement therapy for those with end-stage kidney disease. Mesothelial cells (MCs) line the peritoneal cavity and help define peritoneal response to treatment-associated injury, a major reason for treatment failure. miRNAs are important regulators, but their roles in peritoneal fibrosis are largely unknown. In this study, miR-21 was one of the most abundant miRNAs in primary MCs, and was up-regulated by the profibrotic cytokine transforming growth factor-β1 and in PD effluent-derived MCs exhibiting mesenchymal phenotypic change. Increased miR-21 was found in peritoneal membrane biopsy specimens from PD patients compared to healthy controls (PD biocompatible, 5.86×, P = 0.0001; PD conventional, 7.09×, P n = 11 per group). In PD effluent from a cohort of 230 patients, miR-21 was higher in those receiving the therapy long-term compared to new starters ( n = 230, miR-21 3.26×, P = 0.001) and associated with icodextrin use ( R = 0.52; 95% CI, 0.20–0.84), peritonitis count ( R = 0.16; 95% CI, 0.03–0.29), and dialysate cytokines. miR-21 down-regulated programmed cell death 4 and programmed cell death 4 protein was decreased in peritoneal membrane biopsy specimens from PD patients compared to healthy controls. New miR-21 targets were identified that may be important during PD fibrogenesis. These data identify miR-21 as an important effector of fibrosis in the peritoneal membrane, and a promising biomarker in the dialysis effluent for membrane change in patients receiving PD.

17α-Ethynylestradiol (EE2), a synthetic estrogen used in most oral contraceptives pills and hormone replacement therapies, is found in many water bodies, where it can modulate the fish immune response. EE2 acts as an endocrine disruptor in gilthead seabream, Sparus aurata L., a marine teleost fish of great economic value in Mediterranean aquaculture, as it induces hepatic vitellogenin gene (vtg) expression. Moreover, EE2 also alters the capacity of gilthead seabream to appropriately respond to infection although it does not behave as an immunosuppressor. Nevertheless, these previous studies have mainly focused on the head kidney leukocytes and no information exists on peritoneal leukocytes, including mast cells. In the present work, juvenile gilthead seabream fish were fed a pellet diet supplemented with EE2 for 76 days and intraperitoneally injected with hemocyanin plus imject alum adjuvant at the end of EE2 treatment and 92 days later, and the peritoneal immune response was analyzed. EE2 supplementation induced vtg expression but returned to basal levels by 3 months post-treatment. Interestingly, gilthead seabream peritoneal leukocytes express the genes encoding for the nuclear estrogen receptor α and the G protein-coupled estrogen receptor 1 and the dietary intake of EE2 induced these expression. Moreover, EE2 induced an inflammatory response in the peritoneal cavity in unvaccinated fish, which was largely maintained for several months after the cessation of the treatment. However, the impact of EE2 in vaccinated fish was rather minor and transient. Taken together, the study provides fresh information about endocrine immune disruption, focusing on peritoneal leukocytes.

This report aimed to investigate the chemical composition and possible antinociceptive and anti-inflammatory effects of the essential oil from fresh leaves of Myrcia pubiflora DC., Myrtaceae (EOMP), through different experimental tests. The essential oil of M. pubiflora (EOMP) was obtained by hydrodistillation, analyzed by GC-MS, and tested at doses of 25, 50, and 100 mg/kg (i.p.) in three different tests of nociception (acetic acid-induced writhing test, formalin test, and hot plate test) and one test of inflammation (leukocyte migration to the peritoneal cavity) in order to evaluate the motor activity in mice treated with EOMP. The major component of EOMP was caryophyllene oxide (22.16%). This oil significantly reduced the number of writhes in an acetic acid test and the time spent licking the paw at the second phase of the formalin test. Furthermore, EOMP inhibited the carrageenan-induced leukocyte migration to the peritoneal cavity. However, administration of EOMP did not alter reaction time in the hot plate test, and did not affect the motor coordination test. These results indicate antinociceptive and anti-inflammatory properties of EOMP probably mediated via inhibition of inflammatory mediator synthesis or other peripheral pathway.

Sulfated polysaccharides were extracted with acetone from brown algae Padina gymnospora. The fraction precipitated with 1.5 volumes of acetone (F1.5) purified in Sephadex G-75 was characterized by infrared and nuclear magnetic resonance of 13C and ¹H, through which the presence of sulfate groups on the C4 of α-L-fucose could be observed. This polysaccharide showed that an MW of 25,000 Da was effective in reducing leukocyte influx into the peritoneal cavity in mice at 10 mg/kg and 25 mg/kg body weight, causing a decrease of 60 and 39%, respectively. In the present study, it was observed that this fucan has anti-inflammatory properties but no cytotoxic action, indicating its potential use in the pharmaceutical industry.

Erythrina mulungu Mart. ex Benth., Fabaceae, popularly known as mulungu, is used for the treatment of insomnia and disorders of the central nervous system. This study examined the antinociceptive effects of the hydroalcoholic extracts (HAE), the ethyl acetate and chloroformic fractions from E. mulungu in four experimental models of nociception using laboratory mice. The extracts and fractions were administered orally to mice at doses of 100 mg/kg. Inhibition of abdominal contractions were observed for all the extracts and fractions tested, as compared to controls. All extracts and fractions from E. mulungu reduced the nociception activity produced by formalin in the 2nd phase. In the hot plate test no significant effect was observed for any extract or fraction. In the peritonitis test induced by Zymosan, all of the tested extracts and the chloroformic fraction, except for the ethyl acetate phase, reduced cell migration of the peritoneal cavity. We concluded that E. mulungu shows antinociceptive effects, which are independent of the opioid system.

The present work investigated the antinociceptive and antiinflammatory activities of the Porophyllum ruderale (Jacq.) Cass., Asteraceae, aqueous extract (PRAE). For this purpose, acetic acid writhing, paw licking induced by formalin, hot-plate and pleurisy tests were performed. The doses of 100, 200 and 400 mg/kg (p.o.) significantly inhibited the writhing 63.4, 89.6 and 94.8%, respectively, in comparison with control group. The lick of the paw 1st phase was reduced at the dose of 400 mg/ kg (24.9%), while the 2nd phase had reduction at doses 200 and 400 mg/ kg (23.1 and 34.4%), respectively. The PRAE inhibited the carrageenaninduced neutrophil migration to the peritoneal cavity in a higher dose (p

We previously reported that the endogenous ATP-binding cassette transporter (ABC)A7 strongly associates with phagocytic function rather than biogenesis of high-density lipoprotein (HDL), being regulated by sterol-regulatory element binding protein (SREBP)2. Phagocytic activity was found enhanced by apolipoprotein (apo)A-I and apoA-II more than twice the maximum in J774 and mouse peritoneal macrophages. Therefore we investigated the molecular basis of this reaction in association with the function of ABCA7. Similar to ABCA1, ABCA7 was degraded, likely by calpain, and apoA-I and apoA-II stabilize ABCA7 against degradation. Cell surface biotinylation experiments demonstrated that endogenous ABCA7 predominantly resides on the cell surface and that the apolipoproteins increase the surface ABCA7. The increase of phagocytosis by apolipoproteins was retained in the J774 cells treated with ABCA1 siRNA and in the peritoneal macrophages from ABCA1-knockout mice, but it was abolished in the J774 cells treated with ABCA7 siRNA and in the peritoneal macrophages from ABCA7-knockout mice. Phagocytosis was decreased in the cells in the peritoneal cavity of the ABCA7-knockout mouse compared with the wild-type control. We thus concluded that extracellular helical apolipoproteins augment ABCA7-associated phagocytosis by stabilizing ABCA7. The results demonstrated direct enhancement of the host defense system by HDL components.

We performed this study to demonstrate the applicability of the microelectrode array (MEA) to study electrophysiological changes of rat peritoneal mast cells in the presence of compound 48/80 under normal, Ca2+-free, Ca2+-free with EDTA, and Cl−-free conditions. The use of high extracellular K+ (KCl, 150 mM), charybdotoxin (ChTX, 100 nM), and Cl−-free containing ChTX buffers verified that the hyperpolarizing signal was due to the activation of mainly K+ and, to a lesser extent, Cl− channels. Compound 48/80 concentration-dependently shortened the latent periods (the onset of response) and increased both the spatial (the K+ and Cl− hyperpolarizing field potentials, HFP) and temporal measurements (the duration of response). Ca2+-free buffer had no effect on the latent period of compound 48/80 but increased the HFP at high concentrations. The latent period increased while the HFP diminished when cells were equilibrated in Ca2+-free buffer containing EDTA. Durations of the HFP were generally longer when cells were in either Ca2+-free or Ca2+-free containing EDTA buffers than when cells were in normal buffer. The EC50 values confirmed that effects were only affected in Ca2+-free buffer containing EDTA but not in Ca2+-free or Cl−-free buffers, further reinforcing the hypothesis that the presence of Ca2+ is not essential to the action of compound 48/80. The present study is the first application of MEA to study rat peritoneal mast cells, and our results indicate that it could be of value in future pharmacological research on other non-excitable cells. Keywords:: rat peritoneal mast cell, hyperpolarizing field potential, potassium channel, calcium channel, microelectrode array

application/pdf, Neutrophils play a central role in host defenses against infectious microbial pathogens. However, molecular basis for their triggering signals has been incompletely understood. Here, we show molecular and functional characteristics of myeloid-associated immunoglobulin-like receptor (MAIR)-IV. MAIR-IV was preferentially expressed on neutrophils in the peripheral blood, bone marrow, peritoneal cavity and spleen. MAIR-IV physically associates with immunoreceptor tyrosine based activating motif (ITAM)-bearing adaptor FcRγ chain. Cross-linking MAIR-IV with anti-MAIR-IV monoclonal antibody significantly induced secretion of proinflammatory cytokines TNF-α and IL-6 from neutrophils. Thus, MAIR-IV may regulate activation of neutrophils and play an important role for innate immunity.

While interferon alpha (IFNα) is used in several viral and cancer contexts, its efficacy against ovarian cancer (OC) is far from being incontrovertibly demonstrated and, more importantly, is hindered by heavy systemic side effects. To overcome these issues, here we propose a strategy that allows a targeted delivery of the cytokine, by conjugating IFNα2a with an aldehyde-modified form of hyaluronic acid (HA). The resulting HA-IFNα2a bioconjugate was biochemically and biologically characterized. The conjugation with HA did not substantially modified both the antiviral function and the anti-proliferative activity of the cytokine. Moreover, the induction of STAT1 phosphorylation and of a specific gene expression signature in different targets was retained. In vivo optical imaging biodistribution showed that the i.p.-injected HA-IFNα2a persisted into the peritoneal cavity longer than IFNα2a without being toxic for intraperitoneal organs, thus potentially enhancing the loco-regional therapeutic effect. Indeed, in OC xenograft mouse models bioconjugate significantly improved survival as compared to the free cytokine. Overall, HA-IFNα2a bioconjugate disclosed an improved anticancer efficacy, and can be envisaged as a promising loco-regional treatment for OC.

Summary Objective Mature cystic teratoma with gliomatosis peritonei is an uncommon condition, with the implantation of nodules of mature glial tissue within the peritoneal cavity, which may be mistaken for peritoneal carcinomatosis or peritoneal tuberculosis. Here, we present a case of mature cystic teratoma with mature gliomatosis peritonei. Case Report A 36-year-old woman had been suffering from progressive abdominal distension for 2 months. Sonography revealed a heterogeneous echo-complex mass measuring 15 × 12.7 × 10 cm in the pelvis. Computed tomography scan revealed a pelvic mass with calcification in the peritoneal cavity. A right ovarian tumor was found at laparotomy, and right salpingo-oophorectomy was performed. Miliary tumors were also noted on the omentum and peritoneal surfaces. Omentectomy and peritoneal biopsy were performed. The pathology report showed a mature cystic teratoma with mature gliomatosis peritonei. The patient was followed-up for 1 year, with no evidence of recurrence up to the time of writing. Conclusion Gliomatosis peritonei is considered to be a benign lesion accompanying cystic teratoma. Extensive sampling is essential to exclude the presence of immature elements, which may imply a poor prognosis and require aggressive therapy.

To elucidate the anti-inflammatory action of nicotine-induced corticosterone elevation on the passive skin Arthus reaction (PSAR), we investigated the inflammatory process in the PSAR. The polymorphonuclear leukocyte (PMNs) infiltration was observed just before as well as after elicitation by measuring extractable myeloperoxidase. The plasma exudation was significantly inhibited by anti-rat tumor necrosis factor (TNF)-α antibody (5 μg/site, i.d.) at the time of sensitization or by superoxide dismutase (52500 units/kg, i.p.) 1 h before elicitation or NG-nitro-L-arginine-methyl ester (100 mg/kg, i.v.) just at elicitation. Pretreatment with a single injection of nicotine (0.8 mg/kg, i.p.) 30 min before elicitation suppressed the plasma exudation but not the PMNs infiltration. This nicotine-induced decreasing effect was abolished in animals supplemented with L-arginine (300 mg/kg, i.v.) just at elicitation. The production of nitric oxide (NO) in peritoneal PMNs derived from an animal injected peritoneally with oyster glycogen was significantly suppressed by pretreatment with nicotine (0.8 mg/kg, i.v.) 30 min prior to harvesting. This inhibitory action of nicotine was abolished in animals pretreated with mifepristone (30 mg/kg, s.c.), a glucocorticoid receptor antagonist. These findings indicate that a single systematic administration of nicotine may attenuate the plasma exudation in the PSAR by suppressing the production of NO in the PMNs primed with TNF-α via nicotine-induced endogenous glucocorticoid. Keywords:: passive skin Arthus reaction, nicotine, tumor necrosis factor-α, superoxide, nitric oxide

Global gene profiling using the data we generated for the ImmGen Consortium allows us to address three issues in B cell function and development: (1) progression through transitional stages in spleen; (2) differences in signaling networks among mature B cell populations; and (3) variation in follicular-type (Fo) B cells with tissue location. For the first issue, we focused on the third transitional stage, T3, asking whether it was a pure population of anergic cells and concluding that only a small fraction of T3 is anergic. For the second, we clustered genes up- and downregulated distinctively in three mature populations, relating these gene sets to differences in B cell receptor signaling that distinguish these subsets. Finally, for the third issue, we identified differences in gene expression in the Fo B cell pool present in spleen, bone marrow, peritoneal cavity, and lymph nodes and found that peritoneal cavity Fo B cells were enriched for apoptosis-related genes compared with spleen, and that lymph node resident cells appeared most functionally mature. These analyses highlight the complexity of gene regulation in different maturation stages and subpopulations of B cells and also the richness of information in the ImmGen data sets.

Revealing the mechanisms of neoplastic disease and enhancing our ability to intervene in these processes requires an increased understanding of cellular and molecular changes as they occur in intact living animal models. We have begun to address these needs by developing a method of labeling tumor cells through constitutive expression of an optical reporter gene, and noninvasively monitoring cellular proliferation in vivo using a sensitive photon detection system. A stable line of HeLa cells that expressed a modified firefly luciferase gene was generated, and proliferation of these cells in irradiated severe combined immunodeficiency (SCID) mice was monitored. Tumor cells were introduced into animals via subcutaneous, intraperitoneal and intravenous inoculation and whole body images, that revealed tumor location and growth kinetics, were obtained. The number of photons that were emitted from the labeled tumor cells and transmitted through murine tissues was sufficient to detect 1x10(3) cells in the peritoneal cavity, 1x10(4) cells at subcutaneous sites and 1x10(6) circulating cells immediately following injection. The kinetics of cell proliferation, as measured by photon emission, was exponential in the peritoneal cavity and at subcutaneous sites. Intravenous inoculation resulted in detectable colonies of tumor cells in animals receiving more than 1x10(6) cells. Our demonstrated ability to detect small numbers of tumor cells in living animals noninvasively suggests that therapies designed to treat minimal disease states, as occur early in the disease course and after elimination of the tumor mass, may be monitored using this approach. Moreover, it may be possible to monitor micrometastases and evaluate the molecular steps in the metastatic process. Spatiotemporal analyses of neoplasia will improve the predictability of animal models of human disease as study groups can be followed over time, and this method will accelerate development of novel therapeutic strategies.