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Iorga C, Iorga CR, Andreiana I, Stancu SH, Constantin T, Strambu V. Peritoneal Dialysis-Induced Encapsulating Peritonitis: Diagnostic and Therapeutic Challenges in Women with Benign Gynecological Pathology. J Clin Med 2024; 13:2921. [PMID: 38792461 PMCID: PMC11121892 DOI: 10.3390/jcm13102921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a form of renal function substitution. Medical or surgical treatments can be applied, but morbidity and mortality have high rates. This condition typically presents clinically as an intestinal obstruction caused by the inclusion of the intestinal loops in the peritoneal fibrous membrane. Methods: Herein, we present data from a single tertiary surgery center that has dedicated teams for patients receiving dialysis. Over 12 years, we analyzed a group of 63 patients admitted for catheter replacement/removal or for acute surgical pathology. In five cases (7.9%), we diagnosed EPS. Two patients with EPS presented with atypical abdominal pathologies requiring emergency surgery: one case of hemoperitoneum caused by a ruptured ovarian cyst and one case of uterine fibroids and metrorrhagia. Results: The definitive diagnoses were established intraoperatively and by analyzing the morpho-pathological changes in the peritoneum. The possible intraoperative challenges included laborious dissection, difficulties in restoring the correct anatomical landmarks, an increased duration of the surgical intervention and a high rate of incidents and accidents. Conclusions: The aim of the present study was to emphasize the possibility of other surgical pathologies overlapping with EPS, increasing the complexity of the surgical intervention.
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Affiliation(s)
- Cristian Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Cristina Raluca Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Iuliana Andreiana
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Nephrology Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Simona Hildegard Stancu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Nephrology Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Traian Constantin
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Department of Urology, “Prof. Dr. Th. Burghele” Hospital, 050652 Bucharest, Romania
| | - Victor Strambu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
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Moinuddin Z, Wang K, Fullwood C, Wiredu E, Hutchison A, Vardhan A, Herrick SE, Summers A, Augustine T, van Dellen D. Renal hyperparathyroidism- a risk factor in the development of encapsulating peritoneal sclerosis. Front Endocrinol (Lausanne) 2024; 15:1282925. [PMID: 38567303 PMCID: PMC10985182 DOI: 10.3389/fendo.2024.1282925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a rare complication of prolonged peritoneal dialysis (PD) exposure, characterised by peritoneal thickening, calcification, and fibrosis ultimately presenting with life-threatening bowel obstruction. The presence or role of peritoneal calcification in the pathogenesis of EPS is poorly characterised. We hypothesise that significantly aberrant bone mineral metabolism in patients on PD can cause peritoneal calcification which may trigger the development of EPS. We compared the temporal evolution of bone mineral markers during PD in EPS patients with non-EPS long-term PD controls. Methods Linear mixed model and logistic regression analysis were used to compare four-monthly serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase (ALP) over the duration of PD exposure in 46 EPS and 46 controls (PD, non-EPS) patients. Results EPS patients had higher mean calcium (2.51 vs. 2.41 mmol/L) and ALP (248.00 vs. 111.13 IU/L) levels compared with controls (p=0.01 and p<0.001 respectively, maximum likelihood estimation). Logistic regression analysis demonstrated that high serum calcium and phosphate levels during PD were associated with a 4.5 and 2.9 fold increase in the risk of developing EPS respectively. Conclusion High levels of calcium and phosphate in patients on PD were identified to be risk factors for EPS development. Possible reasons for this may be an imbalance of pro-calcifying factors and calcification inhibitors promoting peritoneal calcification which increases peritoneal stiffness. Mechanical alterations may trigger, unregulated fibrosis and subsequent development of EPS. Improved management of secondary hyperparathyroidism during PD may ultimately diminish the EPS risk.
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Affiliation(s)
- Zia Moinuddin
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kelvin Wang
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Catherine Fullwood
- Department of Statistics, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Elizabeth Wiredu
- Medical Statistics, Data Solution Services, Liverpool, United Kingdom
| | - Alastair Hutchison
- Department of Nephrology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Anand Vardhan
- Department of Nephrology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Sarah E. Herrick
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Angela Summers
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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3
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Ola M, Zahra EMF, Amine C, Mohamed A, Jamal F, Rachida S. Bowel obstruction complicating an encapsulating peritoneal sclerosis: A case report. Radiol Case Rep 2024; 19:1141-1143. [PMID: 38259719 PMCID: PMC10801128 DOI: 10.1016/j.radcr.2023.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/24/2024] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare pathological entity that can be classified into an idiopathic or secondary affection. Bowel obstruction is a frequent complication that has a characteristic radiological finding, with a cocoon appearance. We present the case of a 40-year-old man who suffered an absolute constipation. He underwent a CT scan that was suggestive of encapsulating peritoneal sclerosis or abdominal cocoon responsible for small bowel obstruction.
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Affiliation(s)
- Messaoud Ola
- Radiology Department, Military Hospital Mohamed V Rabat, Morocco
| | | | - Cherraqi Amine
- Radiology Department, Military Hospital Mohamed V Rabat, Morocco
| | | | - Fenni Jamal
- Radiology Department, Military Hospital Mohamed V Rabat, Morocco
| | - Saouab Rachida
- Radiology Department, Military Hospital Mohamed V Rabat, Morocco
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Tanriover C, Copur S, Basile C, Ucku D, Kanbay M. Dialysis after kidney transplant failure: how to deal with this daunting task? J Nephrol 2023; 36:1777-1787. [PMID: 37676635 DOI: 10.1007/s40620-023-01758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/06/2023] [Indexed: 09/08/2023]
Abstract
The best treatment for patients with end-stage kidney disease is kidney transplantation, which, if successful provides both a reduction in mortality and a better quality of life compared to dialysis. Although there has been significant improvement in short-term outcomes after kidney transplantation, long-term graft survival still remains insufficient. As a result, there has been an increase in the number of individuals who need dialysis again after kidney transplant failure, and increasingly contribute to kidney transplant waiting lists. Starting dialysis after graft failure is a difficult task not only for the patients, but also for the nephrologists and the care team. Furthermore, recommendations for management of dialysis after kidney graft loss are lacking. Aim of this narrative review is to provide a perspective on the role of dialysis in the management of patients with failed kidney allograft. Although numerous studies have reported higher mortality in patients undergoing dialysis following kidney allograft failure, reports are contrasting. A patient-centered, individualized approach should drive the choices of initiating dialysis, dialysis modality, maintenance of immunosuppressive drugs and vascular access.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Via Battisti 192, 74121, Taranto, Italy.
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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Quevedo-Reina JC, Marrero-Robayna S, Gonzalez-Cabrera F, Valga F, Vega-Diaz N. Evolution of peritoneal function in sclerosating encapsulating peritonitis: a case report. Nefrologia 2023; 43:494-496. [PMID: 37659956 DOI: 10.1016/j.nefroe.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/25/2021] [Indexed: 09/04/2023] Open
Affiliation(s)
| | - Silvia Marrero-Robayna
- Hospital Universitario de Gran Canaria Doctor Negrín, Serviciode Nefrologia, Las Palmas, Spain.
| | - Fayna Gonzalez-Cabrera
- Hospital Universitario de Gran Canaria Doctor Negrín, Serviciode Nefrologia, Las Palmas, Spain.
| | - Francisco Valga
- Hospital Universitario de Gran Canaria Doctor Negrín, Serviciode Nefrologia, Las Palmas, Spain.
| | - Nicanor Vega-Diaz
- Hospital Universitario de Gran Canaria Doctor Negrín, Serviciode Nefrologia, Las Palmas, Spain.
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A Rare Case of Extensive Eggshell Intestinal Wall Peritoneal Calcification in a Long-Term Continuous Peritoneal Dialysis Patient. Case Rep Nephrol 2022; 2022:2104120. [PMID: 36200067 PMCID: PMC9529488 DOI: 10.1155/2022/2104120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but rather serious complication of long-term peritoneal dialysis. The etiology of EPS is multifactorial, with long-term peritoneal dialysis, multiple peritonitis episodes, and uncontrolled hyperparathyroidism considered to be major risk factors for this often life-threatening condition. We report a case of a 55-year-old female patient with Down syndrome and end-stage renal disease (ESRD) on long-term peritoneal dialysis (PD) with extensive intestinal peritoneal calcifications and a rather uncomplicated long follow-up.
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Sharma V, Moinuddin Z, Summers A, Shenoy M, Plant N, Vranic S, Prytula A, Zvizdic Z, Karava V, Printza N, Vlot J, van Dellen D, Augustine T. Surgical management of Encapsulating Peritoneal Sclerosis (EPS) in children: international case series and literature review. Pediatr Nephrol 2022; 37:643-650. [PMID: 34448023 PMCID: PMC8921033 DOI: 10.1007/s00467-021-05243-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Encapsulating Peritoneal Sclerosis (EPS) is a rare phenomenon in paediatric patients with kidney failure treated with peritoneal dialysis (PD). This study highlights clinical challenges in the management of EPS, with particular emphasis on peri-operative considerations and surgical technique. METHODS Retrospective analysis of all paediatric patients with EPS treated at the Manchester Centre for Transplantation. RESULTS Four patients were included with a median duration of 78 months on PD. All patients had recurrent peritonitis (> 3 episodes), and all had symptoms within three months of a change of dialysis modality from PD to haemodialysis or transplant. In Manchester, care was delivered by a multi-disciplinary team, including surgeons delivering the adult EPS surgical service with a particular focus on nutritional optimisation, sepsis control, and wound management. The surgery involved laparotomy, lavage, and enterolysis of the small bowel + / - stoma formation, depending on intra-abdominal contamination. Two patients had a formal stoma, which were reversed at three and six months, respectively. Two patients underwent primary closure of the abdomen, whereas two patients had re-look procedures at 48 h with secondary closure. One patient had a post-operative wound infection, which was managed medically. One patient's stoma became detached, leading to an intra-abdominal collection requiring re-laparotomy. The median length of stay was 25 days, and patients were discharged once enteral feeding was established. All patients remained free of recurrence with normal gut function and currently two out of four have functioning transplants. CONCLUSIONS This series demonstrates 100% survival and parenteral feed independence following EPS surgery. Post-operative morbidity was common; however, with individualised experience-based decision-making and relevant additional interventions, patients made full recoveries. Health and development post-surgery continued, allowing the potential for transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Zia Moinuddin
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Angela Summers
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Mohan Shenoy
- grid.498924.a0000 0004 0430 9101Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas Plant
- grid.498924.a0000 0004 0430 9101Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Semir Vranic
- grid.412603.20000 0004 0634 1084College of Medicine, QU Health, Qatar University, Doha, Qatar ,grid.412603.20000 0004 0634 1084Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | - Agnieszka Prytula
- grid.410566.00000 0004 0626 3303Paediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | - Zlatan Zvizdic
- grid.411735.50000 0004 0570 5069Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Vasiliki Karava
- grid.4793.90000000109457005Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoleta Printza
- grid.4793.90000000109457005Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Vlot
- grid.5645.2000000040459992XSophia Children’s Hospital, Erasmus MC: University Medical Centre, Rotterdam, The Netherlands
| | - David van Dellen
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK ,grid.462482.e0000 0004 0417 0074Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, UK
| | - Titus Augustine
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK ,grid.462482.e0000 0004 0417 0074Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, UK
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8
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Quevedo-Reina JC, Marrero-Robayna S, Gonzalez-Cabrera F, Valga F, Vega-Diaz N. Evolution of peritoneal function in sclerosating encapsulating peritonitis: a case report. Nefrologia 2021; 43:S0211-6995(21)00156-9. [PMID: 34404567 DOI: 10.1016/j.nefro.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Silvia Marrero-Robayna
- Hospital Universitario de Gran Canaria Doctor Negrín, Servicio de Nefrologia, Las Palmas, España
| | - Fayna Gonzalez-Cabrera
- Hospital Universitario de Gran Canaria Doctor Negrín, Servicio de Nefrologia, Las Palmas, España
| | - Francisco Valga
- Hospital Universitario de Gran Canaria Doctor Negrín, Servicio de Nefrologia, Las Palmas, España
| | - Nicanor Vega-Diaz
- Hospital Universitario de Gran Canaria Doctor Negrín, Servicio de Nefrologia, Las Palmas, España
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Sutherland TE, Shaw TN, Lennon R, Herrick SE, Rückerl D. Ongoing Exposure to Peritoneal Dialysis Fluid Alters Resident Peritoneal Macrophage Phenotype and Activation Propensity. Front Immunol 2021; 12:715209. [PMID: 34386014 PMCID: PMC8353194 DOI: 10.3389/fimmu.2021.715209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/09/2021] [Indexed: 01/22/2023] Open
Abstract
Peritoneal dialysis (PD) is a more continuous alternative to haemodialysis, for patients with chronic kidney disease, with considerable initial benefits for survival, patient independence and healthcare costs. However, long-term PD is associated with significant pathology, negating the positive effects over haemodialysis. Importantly, peritonitis and activation of macrophages is closely associated with disease progression and treatment failure. However, recent advances in macrophage biology suggest opposite functions for macrophages of different cellular origins. While monocyte-derived macrophages promote disease progression in some models of fibrosis, tissue resident macrophages have rather been associated with protective roles. Thus, we aimed to identify the relative contribution of tissue resident macrophages to PD induced inflammation in mice. Unexpectedly, we found an incremental loss of homeostatic characteristics, anti-inflammatory and efferocytic functionality in peritoneal resident macrophages, accompanied by enhanced inflammatory responses to external stimuli. Moreover, presence of glucose degradation products within the dialysis fluid led to markedly enhanced inflammation and almost complete disappearance of tissue resident cells. Thus, alterations in tissue resident macrophages may render long-term PD patients sensitive to developing peritonitis and consequently fibrosis/sclerosis.
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Affiliation(s)
- Tara E. Sutherland
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Manchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, United Kingdom
- Wellcome Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom
| | - Tovah N. Shaw
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Manchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, United Kingdom
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah E. Herrick
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Dominik Rückerl
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
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AlZabali SM, AlAnazi A, Rahim KA, Faqeehi HY. Clinical improvement of encapsulating peritoneal sclerosis after challenging course and 6 months of total parenteral nutrition in child with nephronophthisis: a case report. J Med Case Rep 2021; 15:366. [PMID: 34253224 PMCID: PMC8276428 DOI: 10.1186/s13256-021-02905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis is a rare but potentially lethal complication of long-term peritoneal dialysis that is associated with significant morbidity and mortality. The occurrence of encapsulating peritoneal sclerosis varies worldwide, but is increased in patients maintained on peritoneal dialysis for 5-8 years. The etiology of encapsulating peritoneal sclerosis remains unidentified, and a high index of clinical suspicion is required for diagnosis. CASE PRESENTATION We report a 5-year-old Saudi female with end-stage renal disease secondary to nephronophthisis type 2. She underwent peritoneal dialysis for 30 months, with four episodes of peritonitis. She presented with clinical signs of peritonitis. Three days later, she developed septic shock, which required pediatric intensive care unit admission. The peritoneal dialysis catheter was removed because of refractory peritonitis. Her course was complicated by small bowel perforation, and severe adhesions were revealed on abdominal ultrasound and computed tomography, consistent with a diagnosis of EPS. This finding was later confirmed by diagnostic laparotomy performed twice and complicated by recurrent abdominal wall fistula. She received total parenteral nutrition for 6 months and several courses of antibiotics. The patient received supportive treatment including nutritional optimization and treatment for infection. No other treatments, such as immunosuppression, were administered to avoid risk of infection. Following a complicated hospital course, the patient restarted oral intake after 6 months of total parenteral nutrition dependency. Her abdominal fistula resolved completely, and she was maintained on hemodialysis for few years before she received a kidney transplant. CONCLUSION When treating patients using peritoneal dialysis, it is important to consider encapsulating peritoneal sclerosis with refractory peritonitis, which is not always easy to identify, particularly if the patient has been maintained on peritoneal dialysis for less than 3 years. Early identification of encapsulating peritoneal sclerosis and appropriate conservative treatment, including nutritional optimization and treatment of infections, are essential to achieve a better prognosis.
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Affiliation(s)
- Saeed Mohammed AlZabali
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Abdulkarim AlAnazi
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khawla A Rahim
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hassan Y Faqeehi
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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11
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Fragkou PC, Karofylakis E, Oikonomopoulos N, Piperaki ET, Tsiodras S, Kavvatha D. A case of encapsulating peritoneal sclerosis in a patient with chronic schistosomiasis. IDCases 2021; 24:e01123. [PMID: 33912393 PMCID: PMC8065271 DOI: 10.1016/j.idcr.2021.e01123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic schistosomiasis leads to immune dysregulation and organ fibrosis. Encapsulating peritoneal sclerosis (EPS) is a potentially fatal condition, if left untreated. Inflammatory pathways promote mesothelial proliferation leading to EPS development. EPS has never been described in patients with chronic schistosomiasis. A rare case of a patient with concurrent schistosomiasis and EPS is presented here.
Encapsulating peritoneal sclerosis (EPS) is a debilitating condition, mainly associated with long-term peritoneal dialysis, where up-regulation of intra-abdominal inflammatory pathways leads to a fibrocollagenous peritoneal membrane formation resembling a cocoon. EPS causes intestinal encapsulation leading to bowel obstruction and dilatation. Chronic schistosomiasis is characterized by dysregulation of pro-inflammatory and anti-inflammatory cytokines. EPS has never been reported before in patients with chronic schistosomiasis. We report the first, to our knowledge, case of a 57-year-old male originated from Burkina Faso with chronic intestinal and urogenital schistosomiasis and EPS. Although causality cannot be established solely by this case, we hypothesize that EPS may be the result of chronic inflammatory activation, due to immune dysregulation driven by chronic schistosomiasis. The potential pathogenetic linkage between these two conditions should be further explored.
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Affiliation(s)
- Paraskevi C Fragkou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Chaidari, Athens, 12462, Greece
| | - Emmanouil Karofylakis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Chaidari, Athens, 12462, Greece
| | - Nikolaos Oikonomopoulos
- 2nd Laboratory of Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Chaidari, Athens, 12462, Greece
| | - Evangelia T Piperaki
- Parasitology Unit, Microbiology Laboratory of Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, Athens, 11527, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Chaidari, Athens, 12462, Greece
| | - Dimitra Kavvatha
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Chaidari, Athens, 12462, Greece
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Hamada C, Tomino Y. Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan. Blood Purif 2021; 50:719-728. [PMID: 33567422 DOI: 10.1159/000510282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
The thin peritoneum covering the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) because it is highly vascularized and has a large body surface area. However, it has been reported that peritoneal membranes affected by peritonitis, as well as those exposed to the nonphysiological high glucose levels containing PD dialysate, may undergo histological and functional changes. Patients undergoing PD may experience encapsulating peritoneal sclerosis (EPS), which is a life-threatening serious complication of PD that can significantly impair activities of daily living. The incidence of EPS was 1.4-7.3% of maintenance PD patients in the 1980s. The incidence has improved to 1.0% after a neutral dialysate became the standard PD treatment in Japan. Furthermore, the pathogenesis of EPS is uncertain although its onset may be explained by the "two-hit theory," in which some factors leading to impairment had an additive effect on simple peritoneal sclerosis. The evaluation of histopathological findings has shown the impact of the neutral dialysate on peritoneal deterioration as well as its role in the development of functional changes. In the present report, we discuss the advances in the understanding of peritoneal deterioration based on histological and macroscopic evaluations of the peritoneum of patients undergoing PD. We also discuss the recent treatment for PD patients.
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Affiliation(s)
- Chieko Hamada
- Advanced Research Institute for Health Science, Faculty of Medicine, Juntendo University, Tokyo, Japan,
| | - Yasuhiko Tomino
- Asian Pacific Renal Research Promotion Office, Medical Corporation SHOWAKAI, Tokyo, Japan
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13
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Miao C, Xue X, Dai L, Zhao R, Zhao Z, Song H, Jin H, Li S, Xue Z. The calcium concentration of peritoneal dialysis solution modifies levels of key mediators of peritoneal fibrosis. Semin Dial 2021; 34:51-56. [PMID: 33029812 PMCID: PMC7891347 DOI: 10.1111/sdi.12916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND To explore the effects of different calcium concentrations of peritoneal dialysis solution (PDS) on continuous ambulatory peritoneal dialysis (CAPD) and expression of vimentin (VIM), fibroblast-specific protein (FSP1), and E-cadherin. MATERIALS AND METHODS This was a pilot study (#ChiCTR1900021387) conducted from January 2017 to December 2019 at the Hospital. The patients were randomized to undergo CAPD using PDS with a calcium concentration of 1.25 mmol/L (low concentration group) or 1.75 mmol/L (high concentration group). Changes in biochemistry before dialysis and at 6 and 12 months were analyzed. RESULTS There were 50 and 52 participants in the low and high calcium groups. The blood biochemical indexes were all different between the two groups (all Ptime < .05, Pgroup < .05, Pinteraction < .05), but they remained within their normal ranges. VIM and FSP1 increased over 12 months (Ptime < .05); VIM and FSP1 levels in the high concentration group were higher than in the low concentration group (Pgroup < .05, Pinteraction < .05), while E-cadherin showed the inverse association (Ptime < .001, Pgroup < .001, Pinteraction < .001). There was no difference in complications (P = .973). CONCLUSION The calcium concentration in PDS might be an important factor affecting the progression of peritoneal fibrosis.
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Affiliation(s)
- Chusheng Miao
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | | | - Li Dai
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | - Ruiyu Zhao
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | - Zhangjian Zhao
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | - Hanlei Song
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | - Huanlin Jin
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | - Shanshan Li
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
| | - Zengqi Xue
- Department of NephrologyRui'an People's HospitalRui'an CityZhejiang ProvinceChina
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14
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Gopireddy DR, Soule E, Arif-Tiwari H, Sharma S, Kanmaniraja D, Jain K, Letter H, Lall C. Spectrum of CT Findings Related to Bowel Adhesions Without Bowel Obstruction: A Comprehensive Imaging Review. J Clin Imaging Sci 2020; 10:80. [PMID: 33365202 PMCID: PMC7749936 DOI: 10.25259/jcis_126_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022] Open
Abstract
Post-operative adhesions can occur following abdominal or pelvic surgery and are a significant cause of morbidity and mortality. Adhesions are an important cause of abdominal complaints, especially chronic abdominal pain, infertility, and bowel obstruction; responsible for an estimated $2.3 billion annual burden in the United States alone. There is a paucity of literature describing CT findings indicative of the presence of adhesions, however, findings suggestive of this entity may be discovered by a discerning eye. Early recognition and diagnosis may be beneficial for reducing consumption of health-care resources related to abdominal complaints. In addition, these findings may impact surgical planning and facilitate recognition of adhesion-related complications, said to be responsible for a significant number of malpractice claims. The following review discusses various CT findings which may indicate the presence of adhesions. These findings may initially be overlooked, but remain valuable as the clinical presentation evolves to become consistent with adhesive disease. Detection of bowel and peritoneal adhesions can be recognized on imaging modalities based on distortion of bowel loops. This pictorial review illustrates the spectrum of findings related to bowel adhesions encountered on computed tomography imaging.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Erik Soule
- Department of Interventional Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Smita Sharma
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Devaraju Kanmaniraja
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Kapila Jain
- Department of Radiology, East and North Hertfordshire NHS Trust, Coreys Mill Lane, United Kingdom
| | - Haley Letter
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
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15
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Tanitame K. Encapsulating Peritoneal Sclerosis after Long-term Peritoneal Dialysis Treatment. Intern Med 2020; 59:2797-2798. [PMID: 32641660 PMCID: PMC7691025 DOI: 10.2169/internalmedicine.5170-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Keizo Tanitame
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, Japan
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16
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Reprogramming of Mesothelial-Mesenchymal Transition in Chronic Peritoneal Diseases by Estrogen Receptor Modulation and TGF-β1 Inhibition. Int J Mol Sci 2020; 21:ijms21114158. [PMID: 32532126 PMCID: PMC7312018 DOI: 10.3390/ijms21114158] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
In chronic peritoneal diseases, mesothelial-mesenchymal transition is determined by cues from the extracellular environment rather than just the cellular genome. The transformation of peritoneal mesothelial cells and other host cells into myofibroblasts is mediated by cell membrane receptors, Transforming Growth Factor β1 (TGF-β1), Src and Hypoxia-inducible factor (HIF). This article provides a narrative review of the reprogramming of mesothelial mesenchymal transition in chronic peritoneal diseases, drawing on the similarities in pathophysiology between encapsulating peritoneal sclerosis and peritoneal metastasis, with a particular focus on TGF-β1 signaling and estrogen receptor modulators. Estrogen receptors act at the cell membrane/cytosol as tyrosine kinases that can phosphorylate Src, in a similar way to other receptor tyrosine kinases; or can activate the estrogen response element via nuclear translocation. Tamoxifen can modulate estrogen membrane receptors, and has been shown to be a potent inhibitor of mesothelial-mesenchymal transition (MMT), peritoneal mesothelial cell migration, stromal fibrosis, and neoangiogenesis in the treatment of encapsulating peritoneal sclerosis, with a known side effect and safety profile. The ability of tamoxifen to inhibit the transduction pathways of TGF-β1 and HIF and achieve a quiescent peritoneal stroma makes it a potential candidate for use in cancer treatments. This is relevant to tumors that spread to the peritoneum, particularly those with mesenchymal phenotypes, such as colorectal CMS4 and MSS/EMT gastric cancers, and pancreatic cancer with its desmoplastic stroma. Morphological changes observed during mesothelial mesenchymal transition can be treated with estrogen receptor modulation and TGF-β1 inhibition, which may enable the regression of encapsulating peritoneal sclerosis and peritoneal metastasis.
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Jagirdar RM, Bozikas A, Zarogiannis SG, Bartosova M, Schmitt CP, Liakopoulos V. Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options. Int J Mol Sci 2019; 20:ijms20225765. [PMID: 31744097 PMCID: PMC6887950 DOI: 10.3390/ijms20225765] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.
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Affiliation(s)
- Rajesh M. Jagirdar
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Andreas Bozikas
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Sotirios G. Zarogiannis
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
- Department of Physiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
- Correspondence: ; Tel.: +30-2310-994694
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18
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Abrahams AC, Dendooven A, van der Veer JW, Wientjes R, Toorop RJ, Bleys RL, Hendrickx AP, van Leeuwen MS, de Lussanet QG, Verhaar MC, Stapper G, Nguyen TQ. Direct Comparison of the Thickness of the Parietal Peritoneum Using Peritoneal Biopsy and Ultrasonography of the Abdominal Wall in Patients Treated with Peritoneal Dialysis. Perit Dial Int 2019; 39:455-464. [DOI: 10.3747/pdi.2018.00108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/19/2019] [Indexed: 11/15/2022] Open
Abstract
Background Long-term treatment with peritoneal dialysis (PD) results in peritoneal fibrosis. Peritoneal biopsies have been used to determine the severity of fibrosis. Ultrasonography (US) of the abdominal wall has been used to measure peritoneal thickness non-invasively. However, direct comparison of both methods in the same patient has never been done. Furthermore, the validity of US to measure peritoneal thickness has not been investigated. Methods We performed 3 studies: 1) a human biopsy study to compare US measurement of peritoneal thickness with histological examination; 2) a human cadaver study to investigate the effect of removing the peritoneum on US results; and 3) a phantom study in which we used US to measure the thickness of membrane-like structures with a known thickness to investigate the influence of different US settings. Results The median thickness in biopsies of the peritoneum was 113 μm (interquartile range [IQR] 72 –129 μm), while this was 370 μm (IQR 324 – 458 μm) when measured by US ( p < 0.0001). The mean difference between the 2 measures was -257 μm (limits of agreement -4.6 and -511 μm). In the cadaver study, removal of the peritoneum did not have an effect on the presence or thickness of the hyperechoic line reported to represent the peritoneum. In the phantom study, results were highly dependent on frequency of the transducer, scan depth, and gain settings. Conclusions Ultrasonography results differ markedly from histological measurement using peritoneal biopsies. However, the hyperechoic line generated by US represents the interface between 2 neighboring tissues and not a separate morphological structure. Moreover, its thickness is greatly influenced by user-defined US settings.
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Affiliation(s)
- Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Amélie Dendooven
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pathology, University Hospital of Antwerp, Edegem, Belgium
| | - Jan Willem van der Veer
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rens Wientjes
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Raechel J. Toorop
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald L.A.W. Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Antoni P.A. Hendrickx
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerard Stapper
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tri Q. Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
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19
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Crucial Role of NLRP3 Inflammasome in the Development of Peritoneal Dialysis-related Peritoneal Fibrosis. Sci Rep 2019; 9:10363. [PMID: 31316105 PMCID: PMC6637185 DOI: 10.1038/s41598-019-46504-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/27/2019] [Indexed: 12/22/2022] Open
Abstract
Long-term peritoneal dialysis (PD) therapy leads to peritoneal inflammation and fibrosis. However, the mechanism underlying PD-related peritoneal inflammation and fibrosis remains unclear. NLRP3 inflammasome regulates the caspase-1-dependent release of interleukin-1β and mediates inflammation in various diseases. Here, we investigated the role of NLRP3 inflammasome in a murine model of PD-related peritoneal fibrosis induced by methylglyoxal (MGO). Inflammasome-related proteins were upregulated in the peritoneum of MGO-treated mice. MGO induced parietal and visceral peritoneal fibrosis in wild-type mice, which was significantly reduced in mice deficient in NLRP3, ASC, and interleukin-1β (IL-1β). ASC deficiency reduced the expression of inflammatory cytokines and fibrotic factors, and the infiltration of macrophages. However, myeloid cell-specific ASC deficiency failed to inhibit MGO-induced peritoneal fibrosis. MGO caused hemorrhagic ascites, fibrin deposition, and plasminogen activator inhibitor-1 upregulation, but all of these manifestations were inhibited by ASC deficiency. Furthermore, in vitro experiments showed that MGO induced cell death via the generation of reactive oxygen species in vascular endothelial cells, which was inhibited by ASC deficiency. Our results showed that endothelial NLRP3 inflammasome contributes to PD-related peritoneal inflammation and fibrosis, and provide new insights into the mechanisms underlying the pathogenesis of this disorder.
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20
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Lee SK, Yoon S, Kim C, Choi J. Triple-phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs. Vet Radiol Ultrasound 2019; 60:493-501. [PMID: 31237070 DOI: 10.1111/vru.12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/09/2019] [Accepted: 04/27/2019] [Indexed: 12/26/2022] Open
Abstract
Computed tomography angiography is widely used for the assessment of various mesenteric vascular and bowel diseases in humans. However, there are only few studies that describe CT angiography application to mesenteric vessels in dogs. In this prospective, experimental, exploratory study, the mesenteric vasculature and enhancement pattern of the intestinal wall were evaluated on triple-phase CT angiography, and improvement of the visibility of vasculature was assessed on multiplanar reformation, maximum intensity projection, and volume rendering technique. After test bolus scanning at the level of the cranial mesenteric artery arising from the aorta, mesenteric CT angiography was performed in 10 healthy, male, Beagle dogs. Scan delay was set based on time-to-attenuation curves, drawn by placing the regions of interest over the aorta, intestinal wall, and cranial mesenteric vein. Visualization and enhancement of mesenteric arteries and veins were evaluated with multiplanar reformation, maximum intensity projection, and volume rendering techniques. The degree of intestinal wall enhancement was assessed on the transverse images in precontrast, arterial, intestinal, and venous phases. Pure arterial images were obtained in the arterial phase. Venous phase images allowed good portal vascular mapping. All CT angiography images were of high quality, allowing for excellent visualization of the anatomy of mesenteric vasculature including the small branches, particularly on maximum intensity projection and volume rendering technique. Distinct contrast enhancement of the intestinal wall was observed in both intestinal and venous phases. Findings indicated that this technique is feasible for the evaluation of mesenteric circulation in dogs.
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Affiliation(s)
- Sang-Kwon Lee
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Sooa Yoon
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Cheolhyun Kim
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
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21
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Dave A, McMahon J, Zahid A. Congenital peritoneal encapsulation: A review and novel classification system. World J Gastroenterol 2019; 25:2294-2307. [PMID: 31148901 PMCID: PMC6529893 DOI: 10.3748/wjg.v25.i19.2294] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/23/2019] [Accepted: 03/30/2019] [Indexed: 02/06/2023] Open
Abstract
Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood, underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the diagnosis. Management of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and adhesiolysis. Prognosis following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.
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Affiliation(s)
- Aneesh Dave
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
- Sydney Medical School, Edward Ford Building, the University of Sydney, Camperdown 2006, New South Wales, Australia
| | - James McMahon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
- Sydney Medical School, Edward Ford Building, the University of Sydney, Camperdown 2006, New South Wales, Australia
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22
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Shimomura Y, Sakai S, Ueda H, Fujikura K, Imai Y, Ishikawa T. Encapsulating peritoneal sclerosis in a patient after allogeneic hematopoietic stem cell transplantation: a case report. BMC Gastroenterol 2019; 19:12. [PMID: 30665354 PMCID: PMC6341688 DOI: 10.1186/s12876-019-0933-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/16/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a chronic clinical syndrome of acute or subacute gastrointestinal obstruction seen mainly in patients undergoing peritoneal dialysis. Although there are a few reports on EPS developing in non-peritoneal dialysis patients, it has not been reported in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). Here, we report a case of EPS after a second HSCT. CASE PRESENTATION A 46-year-old man with myelodysplastic syndrome showed relapse after HSCT and received a second HSCT. The patient was diagnosed with chronic graft-versus-host disease (cGVHD)-associated serositis because of persistent ascites. His ascites improved gradually and disappeared without immunosuppressive therapy. He presented with nausea, weight loss, and constipation 1 year after improvement of ascites. Computed tomography revealed no organic obstruction, but did reveal dilated, thickened, and adhered small bowel loops with a mass-like appearance. He was diagnosed with EPS on the basis of clinical symptoms and image findings. He received corticosteroid therapy (20 mg/body) without any improvement in symptoms. He developed recurrence of myelodysplastic syndrome at 1 month after initiation of corticosteroid therapy. This progressed into acute myeloid leukaemia after 3 months. He died 31 months after the second HSCT. At autopsy, the small and large intestines had formed extensive adhesions and showed signs of progressive fibrosis with peritoneal sclerosis, fibroblast swelling, fibrin deposition, and inflammatory cell infiltration, which confirmed the diagnosis of EPS. CONCLUSION This case suggests that EPS may complicate patients with cGVHD-associated serositis. Although the mechanism of EPS development is not clear, clinicians should be aware of this eventuality.
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Affiliation(s)
- Yoshimitsu Shimomura
- Department of Hematology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047 Japan
| | - Shinsuke Sakai
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Ueda
- Department of Diagnostic Radiology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kohei Fujikura
- Department of Clinical Pathology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047 Japan
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23
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Jagdale A, Cooper DKC, Iwase H, Gaston RS. Chronic dialysis in patients with end-stage renal disease: Relevance to kidney xenotransplantation. Xenotransplantation 2018; 26:e12471. [PMID: 30456901 DOI: 10.1111/xen.12471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
Abstract
Renal allotransplantation clearly offers better survival and quality of life for end-stage renal disease (ESRD) patients than chronic dialysis. The median waiting time for a deceased donor kidney in a suitable ESRD patient is 3.9 years. The initial candidates for pig kidney xenotransplantation will be those with ESRD unlikely to receive an allograft within a reasonable period of time. It is thus reasonable to ascertain whether clinical trials of xenotransplantation might likewise offer superior outcomes. Chronic dialysis in patients with ESRD is associated with poor quality of life, significant morbidity, and relatively high mortality, with only 56% surviving 3 years and 42% at 5 years. However, a significant number of these patients, because of comorbidities, frailty, etc, would not be considered for renal allotransplantation and likely not for xenotransplantation. As genetically engineered pig kidneys have satisfactorily supported life in immunosuppressed nonhuman primates for many months or even more than a year, consideration in carefully selected patients could be given to pig kidney xenotransplantation. We suggest that, in order to give a patient the best possible outcome, the pig kidney could be transplanted pre-emptively (before dialysis is initiated). If it fails at any stage, the patient would then begin chronic dialysis and continue to await an allograft. The present (limited) evidence is that failure of a pig graft would not be detrimental to a subsequent allograft.
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Affiliation(s)
- Abhijit Jagdale
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hayato Iwase
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert S Gaston
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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24
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Danford CJ, Lin SC, Smith MP, Wolf JL. Encapsulating peritoneal sclerosis. World J Gastroenterol 2018; 24:3101-3111. [PMID: 30065556 PMCID: PMC6064970 DOI: 10.3748/wjg.v24.i28.3101] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/07/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents (i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPS-specific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is time-consuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.
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Affiliation(s)
- Christopher J Danford
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Steven C Lin
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Martin P Smith
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Jacqueline L Wolf
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
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25
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Fujii K, Washida N, Arai E, Tsuruta M, Wakino S, Itoh H. Adhesive intestinal obstruction increases the risk of intestinal perforation in peritoneal dialysis patients: a case report. BMC Nephrol 2018; 19:153. [PMID: 29954334 PMCID: PMC6022445 DOI: 10.1186/s12882-018-0954-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
Background Peritonitis secondary to bowel perforation is a rare and potentially fatal complication in peritoneal dialysis (PD) patients. However, the early diagnosis of bowel perforation is difficult in PD patients because the initial symptoms and signs of bowel perforation are similar to those of PD-associated peritonitis. Furthermore, the risk of bowel perforation in PD patients is unclear. Here, we present a case of intestinal perforation located at the site of adhesive intestinal obstruction in a PD patient. Case presentation A 73-year-old man on PD presented with progressive worsening of abdominal pain and cloudy peritoneal fluid. The peritoneal fluid cell count was increased to 980/ml and peritoneal dialysis-associated peritonitis was diagnosed. Computed tomography showed local adhesions causing agglomeration of the dilated intestine. He initially responded to antibiotic treatment; however, his abdominal pain was rapidly worsened after resumption of oral intake. On hospital day 23, computed tomography showed loss of contents from the dilated intestine and discharge of fecal material from the PD tube was noted. Thus, small bowel perforation was diagnosed, and he underwent ileocecal resection with colostomy creation. As indicators of EPS was not evident, PD catheter was removed. Since then, he has been on maintenance of hemodialysis since then. Conclusion The findings of the present case suggest that adhesive intestinal obstruction in PD patients can increase the risk of intestinal perforation. Careful monitoring for the early detection of intestinal perforation is required in such cases.
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Affiliation(s)
- Kentaro Fujii
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Naoki Washida
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3 Kouzunomori, Narita, Chiba, 286-8686, Japan
| | - Eri Arai
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shu Wakino
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Wilson RB. Hypoxia, cytokines and stromal recruitment: parallels between pathophysiology of encapsulating peritoneal sclerosis, endometriosis and peritoneal metastasis. Pleura Peritoneum 2018; 3:20180103. [PMID: 30911653 PMCID: PMC6405013 DOI: 10.1515/pp-2018-0103] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/01/2018] [Indexed: 02/06/2023] Open
Abstract
Peritoneal response to various kinds of injury involves loss of peritoneal mesothelial cells (PMC), danger signalling, epithelial-mesenchymal transition and mesothelial-mesenchymal transition (MMT). Encapsulating peritoneal sclerosis (EPS), endometriosis (EM) and peritoneal metastasis (PM) are all characterized by hypoxia and formation of a vascularized connective tissue stroma mediated by vascular endothelial growth factor (VEGF). Transforming growth factor-β1 (TGF-β1) is constitutively expressed by the PMC and plays a major role in the maintenance of a transformed, inflammatory micro-environment in PM, but also in EPS and EM. Persistently high levels of TGF-β1 or stimulation by inflammatory cytokines (interleukin-6 (IL-6)) induce peritoneal MMT, adhesion formation and fibrosis. TGF-β1 enhances hypoxia inducible factor-1α expression, which drives cell growth, extracellular matrix production and cell migration. Disruption of the peritoneal glycocalyx and exposure of the basement membrane release low molecular weight hyaluronan, which initiates a cascade of pro-inflammatory mediators, including peritoneal cytokines (TNF-α, IL-1, IL-6, prostaglandins), growth factors (TGF-α, TGF-β, platelet-derived growth factor, VEGF, epidermal growth factor) and the fibrin/coagulation cascade (thrombin, Tissue factor, plasminogen activator inhibitor [PAI]-1/2). Chronic inflammation and cellular transformation are mediated by damage-associated molecular patterns, pattern recognition receptors, AGE-RAGE, extracellular lactate, pro-inflammatory cytokines, reactive oxygen species, increased glycolysis, metabolomic reprogramming and cancer-associated fibroblasts. The pathogenesis of EPS, EM and PM shows similarities to the cellular transformation and stromal recruitment of wound healing.
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Affiliation(s)
- Robert Beaumont Wilson
- Upper GI Surgery Department, Liverpool Hospital, Elizabeth St, Liverpool, 2170, NSW, Australia
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Poppelaars F, Faria B, Gaya da Costa M, Franssen CFM, van Son WJ, Berger SP, Daha MR, Seelen MA. The Complement System in Dialysis: A Forgotten Story? Front Immunol 2018; 9:71. [PMID: 29422906 PMCID: PMC5788899 DOI: 10.3389/fimmu.2018.00071] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/11/2018] [Indexed: 12/20/2022] Open
Abstract
Significant advances have lead to a greater understanding of the role of the complement system within nephrology. The success of the first clinically approved complement inhibitor has created renewed appreciation of complement-targeting therapeutics. Several clinical trials are currently underway to evaluate the therapeutic potential of complement inhibition in renal diseases and kidney transplantation. Although, complement has been known to be activated during dialysis for over four decades, this area of research has been neglected in recent years. Despite significant progress in biocompatibility of hemodialysis (HD) membranes and peritoneal dialysis (PD) fluids, complement activation remains an undesired effect and relevant issue. Short-term effects of complement activation include promoting inflammation and coagulation. In addition, long-term complications of dialysis, such as infection, fibrosis and cardiovascular events, are linked to the complement system. These results suggest that interventions targeting the complement system in dialysis could improve biocompatibility, dialysis efficacy, and long-term outcome. Combined with the clinical availability to safely target complement in patients, the question is not if we should inhibit complement in dialysis, but when and how. The purpose of this review is to summarize previous findings and provide a comprehensive overview of the role of the complement system in both HD and PD.
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Affiliation(s)
- Felix Poppelaars
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Bernardo Faria
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
- Nephrology and Infectious Diseases Research and Development Group, University of Porto, Porto, Portugal
- Department of Nephrology, Hopsital Braga, Braga, Portugal
| | - Mariana Gaya da Costa
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Casper F. M. Franssen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Willem J. van Son
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Stefan P. Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Mohamed R. Daha
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
- Department of Nephrology, Leiden University Medical Centre, Leiden, Netherlands
| | - Marc A. Seelen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands
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Du C, Mendelson AA, Guan Q, Dairi G, Chafeeva I, da Roza G, Kizhakkedathu JN. Hyperbranched polyglycerol is superior to glucose for long-term preservation of peritoneal membrane in a rat model of chronic peritoneal dialysis. J Transl Med 2016; 14:338. [PMID: 27964722 PMCID: PMC5153908 DOI: 10.1186/s12967-016-1098-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Replacing glucose with a better biocompatible osmotic agent in peritoneal dialysis (PD) solutions is needed in PD clinic. We previously demonstrated the potential of hyperbranched polyglycerol (HPG) as a replacement for glucose. This study further investigated the long-term effects of chronic exposure to HPG as compared to a glucose-based conventional PD solution on peritoneal membrane (PM) structure and function in rats. Methods Adult male Wistar rats received once-daily intraperitoneal injection of 10 mL of HPG solution (1 kDa, HPG 6%) compared to Physioneal™ 40 (PYS, glucose 2.27%) or electrolyte solution (Control) for 3 months. The overall health conditions were determined by blood chemistry analysis. The PM function was determined by ultrafiltration, and its injury by histological and transcriptome-based pathway analyses. Results Here, we showed that there was no difference in the blood chemistry between rats receiving the HPG and the Control, while PYS increased serum alkaline phosphatase, globulin and creatinine and decreased serum albumin. Unlike PYS, HPG did not significantly attenuate PM function, which was associated with smaller change in both the structure and the angiogenesis of the PM and less cells expressing vascular endothelial growth factor, α-smooth muscle actin and MAC387 (macrophage marker). The pathway analysis revealed that there were more inflammatory signaling pathways functioning in the PM of PYS group than those of HPG or Control, which included the signaling for cytokine production in both macrophages and T cells, interleukin (IL)-6, IL-10, Toll-like receptors, triggering receptor expressed on myeloid cells 1 and high mobility group box 1. Conclusions The results from this experimental study indicate the superiority of HPG to glucose in the preservation of the peritoneum function and structure during the long-term PD treatment, suggesting the potential of HPG as a novel osmotic agent for PD. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1098-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caigan Du
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada. .,Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada.
| | - Asher A Mendelson
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,London Health Sciences Centre, London, ON, Canada
| | - Qiunong Guan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ghida Dairi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Irina Chafeeva
- Department of Pathology and Laboratory Medicine, Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Gerald da Roza
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
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29
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Allam H, Al Yahri O, Mathew S, Darweesh A, Suliman AN, Abdelaziem S, Khairat M, Toro A, Di Carlo I. The enigma of primary and secondary encapsulating peritoneal sclerosis. BMC Surg 2016; 16:81. [PMID: 27964725 PMCID: PMC5153754 DOI: 10.1186/s12893-016-0198-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022] Open
Abstract
Background Encapsulating Peritoneal Sclerosis (EPS) describes a variety of diseases that are frequently confused with different names and different etiopathogeneses. The aim of this article is to report personal experience of focusing on correct classification and the status of current diagnosis and treatment. Methods A retrospective analysis was performed. Age, sex, ethnic origin, past medical history, symptoms and their duration, radiological tools and signs, laboratory tests, preoperative diagnosis, surgical approach, intraoperative findings, pathological findings, hospital stay, morbidity and mortality were studied. Results A total of seven patients, including six males and one female, aged from 24 to 72 years were observed. Four patients had recurrent abdominal colic pain for 3 months, 1, 2 and 9 years; two patients also reported recurrent attacks but without any specification of the duration. All seven patients presented at the emergency department with abdominal pain that was mainly diffused over the entire abdomen. Six patients were submitted to a CT scan. Only in two patients was the diagnosis of EPS made preoperatively. All seven patients were submitted to open surgery. The hospital stay was between 4 and 60 days. One patient had morbidity, and one patient died of MOF. Conclusions Currently, the correct identification of EPS is more easily possible than in the past, but the diagnosis is still a challenge. Surgery must be performed as soon as possible to avoid a poorer quality of life.
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Affiliation(s)
- Hisham Allam
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Omer Al Yahri
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Sharon Mathew
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Adham Darweesh
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Ahmed Nafea Suliman
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Sherif Abdelaziem
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Mohamed Khairat
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Adriana Toro
- Department of General Surgery, Barone I. Romeo Hospital, Patti, Messina, Italy
| | - Isidoro Di Carlo
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar. .,Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
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30
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Lee CC, Tu KH, Chen HH, Chang MY, Hung CC. Risk factors for drainage-requiring ascites after refractory peritonitis in peritoneal dialysis patients. Int Urol Nephrol 2016; 48:1721-30. [PMID: 27495322 DOI: 10.1007/s11255-016-1376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Refractory peritonitis remains a thorny issue for patients with chronic peritoneal dialysis (PD). Shortly after catheter removal, some patients develop persistent peritoneal inflammation and ascites formation, which require percutaneous drainage for symptom relief. Our study aimed at finding the risk factors for this kind of event. METHODS A total of 47 PD patients complicated with refractory peritonitis who underwent catheter removal between January 2009 and December 2011 were enrolled in this study. Data were compared between patients with and without the development of symptomatic ascites requiring drainage during hospitalization. RESULTS Among the 47 refractory peritonitis patients, 15 patients developed symptomatic ascites that needed further drainage shortly after catheter removal during hospitalization. The following factors were associated with an increased risk: longer dialysis duration, higher peritoneal Kt/V urea, and a significant rise in serum C-reactive protein (CRP) level after catheter removal. These patients had a prolonged hospital stay (62 vs 21 days, P < 0.001) and a significantly higher risk of recurrent loculated ascites during subsequent 6 months of follow-up (33.3 vs 6.2 %, P = 0.022) compared with patients who did not develop ascites requiring drainage during hospitalization. CONCLUSION A significant portion of patients with refractory PD peritonitis experienced ascites requiring drainage shortly after catheter removal, which led to a prolonged hospitalization. Whether routine drain placement at the time of catheter removal for this high-risk group would be of benefit warrants further prospective studies.
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Affiliation(s)
- Cheng-Chia Lee
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Hui Chen
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
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Zhou Q, Bajo MA, Del Peso G, Yu X, Selgas R. Preventing peritoneal membrane fibrosis in peritoneal dialysis patients. Kidney Int 2016; 90:515-24. [PMID: 27282936 DOI: 10.1016/j.kint.2016.03.040] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/13/2016] [Accepted: 03/24/2016] [Indexed: 12/11/2022]
Abstract
Long-term peritoneal dialysis causes morphologic and functional changes in the peritoneal membrane. Although mesothelial-mesenchymal transition of peritoneal mesothelial cells is a key process leading to peritoneal fibrosis, and bioincompatible peritoneal dialysis solutions (glucose, glucose degradation products, and advanced glycation end products or a combination) are responsible for altering mesothelial cell function and proliferation, mechanisms underlying these processes remain largely unclear. Peritoneal fibrosis has 2 cooperative parts, the fibrosis process itself and the inflammation. The link between these 2 processes is frequently bidirectional, with each one inducing the other. This review outlines our current understanding about the definition and pathophysiology of peritoneal fibrosis, recent studies on key fibrogenic molecular machinery in peritoneal fibrosis, such as the role of transforming growth factor-β/Smads, transforming growth factor-β β/Smad independent pathways, and noncoding RNAs. The diagnosis of peritoneal fibrosis, including effluent biomarkers and the histopathology of a peritoneal biopsy, which is the gold standard for demonstrating peritoneal fibrosis, is introduced in detail. Several interventions for peritoneal fibrosis based on biomarkers, cytology, histology, functional studies, and antagonists are presented in this review. Recent experimental trials in animal models, including pharmacology and gene therapy, which could offer novel insights into the treatment of peritoneal fibrosis in the near future, are also discussed in depth.
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Affiliation(s)
- Qin Zhou
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - M-Auxiliadora Bajo
- Nephrology Service, Hospital Universitario La Paz, IdiPAZ, REDinREN, Fibroteam, IRSIN, Madrid, Spain
| | - Gloria Del Peso
- Nephrology Service, Hospital Universitario La Paz, IdiPAZ, REDinREN, Fibroteam, IRSIN, Madrid, Spain
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rafael Selgas
- Nephrology Service, Hospital Universitario La Paz, IdiPAZ, REDinREN, Fibroteam, IRSIN, Madrid, Spain
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32
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Liappas G, González-Mateo GT, Sánchez-Díaz R, Lazcano JJ, Lasarte S, Matesanz-Marín A, Zur R, Ferrantelli E, Ramírez LG, Aguilera A, Fernández-Ruiz E, Beelen RHJ, Selgas R, Sánchez-Madrid F, Martín P, López-Cabrera M. Immune-Regulatory Molecule CD69 Controls Peritoneal Fibrosis. J Am Soc Nephrol 2016; 27:3561-3576. [PMID: 27151919 DOI: 10.1681/asn.2015080909] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/07/2016] [Indexed: 01/16/2023] Open
Abstract
Patients with ESRD undergoing peritoneal dialysis develop progressive peritoneal fibrosis, which may lead to technique failure. Recent data point to Th17-mediated inflammation as a key contributor in peritoneal damage. The leukocyte antigen CD69 modulates the setting and progression of autoimmune and inflammatory diseases by controlling the balance between Th17 and regulatory T cells (Tregs). However, the relevance of CD69 in tissue fibrosis remains largely unknown. Thus, we explored the role of CD69 in fibroproliferative responses using a mouse model of peritoneal fibrosis induced by dialysis fluid exposure under either normal or uremic status. We found that cd69-/- mice compared with wild-type (WT) mice showed enhanced fibrosis, mesothelial to mesenchymal transition, IL-17 production, and Th17 cell infiltration in response to dialysis fluid treatment. Uremia contributed partially to peritoneal inflammatory and fibrotic responses. Additionally, antibody-mediated CD69 blockade in WT mice mimicked the fibrotic response of cd69-/- mice. Finally, IL-17 blockade in cd69-/- mice decreased peritoneal fibrosis to the WT levels, and mixed bone marrow from cd69-/- and Rag2-/-γc-/- mice transplanted into WT mice reproduced the severity of the response to dialysis fluid observed in cd69-/- mice, showing that CD69 exerts its regulatory function within the lymphocyte compartment. Overall, our results indicate that CD69 controls tissue fibrosis by regulating Th17-mediated inflammation.
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Affiliation(s)
- Georgios Liappas
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Madrid, Spain
| | - Guadalupe Tirma González-Mateo
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Madrid, Spain
| | - Raquel Sánchez-Díaz
- Signaling and Inflammation Program, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Juan José Lazcano
- Signaling and Inflammation Program, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Sandra Lasarte
- Signaling and Inflammation Program, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Adela Matesanz-Marín
- Signaling and Inflammation Program, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Rafal Zur
- Department of Immunology and Oncology, Centro Nacional de Biotecnología Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Evelina Ferrantelli
- Department of Molecular Cell Biology and Immunology, Vrije Universiteit University Medical Center Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
| | | | | | | | - Robert H J Beelen
- Department of Molecular Cell Biology and Immunology, Vrije Universiteit University Medical Center Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
| | - Rafael Selgas
- Nephrology Department, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | - Francisco Sánchez-Madrid
- Signaling and Inflammation Program, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.,Immunology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; and
| | - Pilar Martín
- Signaling and Inflammation Program, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain;
| | - Manuel López-Cabrera
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Madrid, Spain;
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