Ertapenem combined with metronidazole for treatment of complex abdominal infections: Efficacy and impact on serum inflammatory indicators and T lymphocyte subsets

BACKGROUND

Complex intra-abdominal infections (cIAIs), often associated with abdominal trauma, have a complex etiology, are acute and severe, and have a high risk. They are an important cause of death in patients with abdominal trauma. Safe and effective treatment strategies are the factors affecting the prognosis of such patients.

AIM

To investigate the efficacy and safey of ertapenem combined with metronidazole in the treatment of cIAIs as well as the impact on serum inflammatory markers and T lymphocyte subsets, recovery status, and treatment costs.

METHODS

A total of 92 patients with cIAIs treated at our hospital from June 2021 to January 2023 were randomly divided into a control group and a study group, with 46 cases in each group. After admission, both groups received puncture drainage, continuous double-cannula irrigation, anti-infection therapy, organ function support, nutritional support, and other treatments. On this basis, the control group was treated with piperacillin/tazobactam combined with metronidazole, while the study group was treated with ertapenem combined with metronidazole. The therapeutic effects, recovery conditions, treatment costs, serum inflammatory indicators [procalcitonin (PCT), Toll-like receptor 4 (TLR-4), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP)], T lymphocyte subsets (CD3⁺, CD4⁺, and CD4⁺/CD8⁺ ratio), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, adverse reactions, and bacterial culture results were compared between the two groups.

RESULTS

The total effective rate of the study group was 93.48%, significantly higher than that of the control group (78.26%; P < 0.05). After 3 d and 7 d of treatment, the levels of serum PCT, TLR-4, TNF-α, and CRP in the study group were significantly lower and the levels of serum CD3⁺ and CD4⁺ T lymphocytes and CD4⁺/CD8⁺ ratio were significantly higher than those of the control group (P < 0.05). The APACHEⅡ score and SOFA score of the study group were significantly lower than those of the control group after 3 d and 7 d of treatment (P < 0.05). The time to fever resolution, ICU stay duration, and hospital stay in the study group were significantly shorter than those of the control group, and the costs of drugs and other resources were less than those of the control group (P < 0.05). The incidence of adverse reactions in the study group was 4.35%, significantly lower than that of the control group (17.39%; P < 0.05). There was no significant difference in the distribution of pathogenic bacteria between the two groups before and after treatment (P > 0.05).

CONCLUSION

Ertapenem combined with metronidazole is effective in the treatment of cIAIs, which can reduce inflammation, improve immune function, control disease progression, reduce the risk of organ failure, reduce the economic burden of patients, and improve treatment safety.

Carrilizumab for treatment of advanced colorectal cancer: Short-term efficacy and impact on immune function and PD-1/PD-L1 signaling pathway

BACKGROUND

Colorectal cancer is one of the most prevalent malignant tumours in China, and chemotherapy is the main treatment modality for patients with advanced colorectal cancer, which results in toxic side effects and reduces patients' quality of life. Since the occurrence of toxic side effects is related to patients' immunity and other factors, it is important to study whether the combined injection of carrilizumab with chemotherapy can positively affect patients' conditions by influencing the programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) signalling pathway.

AIM

To investigate the possible mechanism of carrilizumab for injection to improve immune function in advanced colorectal cancer, and to analyze its regulatory effect on the PD-1/ PD-L1 signaling pathway.

METHODS

A prospective randomised controlled study (RCT) was performed to include 127 patients with advanced colorectal cancer admitted to our hospital from January 2019 to October 2021, and they were divided into a control group (n = 63) and a study group (n = 64) using the computerised random number method. The control group was given oxaliplatin + capecitabine, and the study group was given oxaliplatin + capecitabine + carrilizumab for injection. The therapeutic effect, toxicity and side effects, survival status, PD-1/PD-L1 signaling pathway, tumor markers [carbohydrate antigen 125 (CA125), carbohydrate antigen 242 (CA242), thymidine kinase 1 (TK1), and carcinoembryonic antigen (CEA)], and nutritional status indicators [albumin (ALB), hemoglobin (HGB), prealbumin (PA), transferrin (TF), and patient-generated subjective global assessment (PG-SGA)] before and after treatment were compared between the two groups.

RESULTS

After four cycles of treatment, the disease control rate of the study group was higher than that of the control group (P < 0.05); the mRNA and protein levels of PD-1 and PD-L1 in the study group were lower than those in the control group (P < 0.05); serum ALB, PA, and TF levels and PG-SGA scores in the study group were higher than those in the control group (P < 0.05); and serum CA125, CA242, TK1, and CEA in the study group were lower than those in the control group (P < 0.05). There was no significant difference in the incidence of toxic and side effects or survival rate between the two groups (P > 0.05).

CONCLUSION

Camrelizumab for injection combined with oxaliplatin and capecitabine in the treatment of advanced colorectal cancer can improve the disease control rate, may reduce the impact of chemotherapy drugs on the nutritional status of the body by inhibiting the activation of PD-1/PD-L1 signal pathway, thus improving the immune function of the body, and has good safety.

Development and characterization of 70 novel microsatellite markers for the sea cucumber (Apostichopus japonicus)

The sea cucumber (Apostichopus japonicus) is an important item in Asian cuisine. It is currently produced through aquaculture, especially in China, after being overexploited in the wild in the 1990s. We isolated 70 novel polymorphic microsatellite loci using an enrichment-colony hybridization protocol. All loci were characterized in 48 individuals from a natural population in Rongcheng (Shandong, China) using genomic DNA isolated from muscle tissue. The number of alleles ranged from 2 to 17 (mean 7.0), and the observed and expected heterozygosities varied from 0.0010 to 1.0000 and from 0.2125 to 0.9477, respectively. Thirty-one of the 70 loci exhibited departure from Hardy-Weinberg equilibrium. These microsatellite markers should be useful resources for population genetic studies and for molecular marker-assisted breeding of A. japonicus.