Effect of epidural block on restoration of protease inhibitors in patients with local kidney cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 593-593
Author(s):  
Oleg Ivanovich Kit ◽  
Dmitry A. Rozenko ◽  
Elena Frantsiyants ◽  
Larisa S. Kozlova ◽  
Valeria A. Bandovkina ◽  
...  
Keyword(s):  
Blood Plasma ◽  
Kidney Cancer ◽  
Proteinase Inhibitor ◽  
Epidural Block ◽  
Warm Ischemia ◽  
Previous Measurement ◽  
Endogenous Inhibitors ◽  
Healthy Donors ◽  
Α2 Macroglobulin ◽  
Measurement Results

593 Background: The purpose of the study was to reveal the effect of the epidural block (EB) on the dynamics of the main universal inhibitors in the blood plasma and urine of patients with local kidney cancer. Methods: 58 patients aged 56.5±8.7 years underwent partial nephrectomy with warm ischemia for 15-20 minutes (EB – 35 patients, standard anesthesia (SA) - 23 patients). EB involved catheterization of the epidural space at Th10-L1 with the following infusion of a mixture of ropivacaine 2 mg/ml and epinephrine 2 μg/ml at 6-10 ml/hr using a syringe doser, intraoperatively and within the first three postoperative days. α2-Macroglobulin (α2M) and α1-proteinase inhibitor (α1PI) were studied by ELISA and spectrophotometry in the blood plasma and urine of patients before the surgery (b/s), 40 min after the start of the surgery (40' s/s) and on days 1 and 3 after the surgery (a/s). Results were compared to the levels in the blood plasma and urine of 29 healthy donors (N). Results: α2M and α1PI in the blood plasma and urine of all patients b/s were lower than N (p < 0.05). α2M in the blood plasma of all patients 40' s/s was similar to N. Normal α2M levels were maintained in the blood plasma in EB on days 1-3 a/s, while in SA they increased by 2.8 times on day 1 and decreased by 3.4 times on day 3, compared to the previous measurement results. α1PI in EB began to increase since 40' s/s with its normalization by the day 3 a/s; α1PI in SA was decreased in the blood plasma and urine during the whole study period. The urine/blood plasma ratio for α2M (α2Mu/α2Mb) was increased b/s in all patients, with its normalization on days 1-3 in EB and its decrease by 9.5-3.1 times on days 1 and 3 in SA. The α1PIu/α1PIb ratio was increased b/s on average by 2.1 times in all patients, with its normalization 40' s/s in EB, and remained similar to N by the day 3. Normalization was not observed in SA; α1PIu/α1PIb was decreased since 40' s/s to the day 3 by 1.8-1.4 times (p < 0.05), compared to N. The results showed that in SA, the proteolysis was not controlled in the kidney due to the inhibitor deficiency. Conclusions: The epidural block contributes to the restoration of the activity of α2M and α1PI universal endogenous inhibitors during and after surgery, in contrast to the standard anesthesia.

Interaction of α2-macroglobulin with kallikrein and plasmin in ascitic fluid in ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17030-e17030
Author(s):  
Tatiana Moiseenko ◽  
Elena Mikhaylovna Frantsiyants ◽  
Larisa Kozlova ◽  
Lyudmila Dmitriyevna Tkalya ◽  
Meri Viktorovich Adamyan ◽  
...  
Keyword(s):  
Blood Plasma ◽  
Protein Content ◽  
Ascitic Fluid ◽  
Malignant Tumors ◽  
Limited Proteolysis ◽  
Healthy Donors ◽  
Α2 Macroglobulin ◽  
Double Beam ◽  
Endogenous Protection ◽  
Biological Environment

e17030 Background: The kallikrein (KLKs) family is considered to be a regulator of many systems of limited proteolysis but can also be involved into pathology. Plasmin (P) regulates functions and density of the extracellular matrix, angiogenesis, maturation of gametes, sanation of cavities, tissues and body fluids, development of inflammation and malignant tumors. α2-Macroglobulin (α2M) is a molecular component of the body's endogenous protection. Ascitic fluid (AF) in various diseases of the ovaries is the biological environment valuable for the study of the affected organism containing protein about 20-50 g/L. KLKs, their proenzymes (pro-KLKs), Р, plasminogen (PG) and α2М in AF are poorly studied. Our purpose was to analyze the proteinase-inhibitory balance in AF of patients with ovarian cystadenocarcinoma (CAC) and tuberculosis of the uterine appendages (TA) to reveal its role in the development of the diseases and targets for the therapy. Methods: KLKs, pro-KLKs, Р, PG and α2М in AF in CAC of one ovary (n=26, T3-4N0M0) were compared with the levels in AF of TA patients before treatment (n=11). All women were menopausal, aged 56.5±2.6 years. KLKs, pro-KLKs, Р, PG and α2М were determined before treatment using the U-2900 UV Solutions double-beam spectrophotometer (USA), the result was calculated per 1 mg of protein (by Lowry). The protein content in AF was comparable to the blood plasma one, so we took the values in the plasma of healthy donors as the norm (N). The data were processed using the Statistica 10 program. Results: The exudate is believed to occur mainly from inflammation-damaged vessels. High protein content in AF in CAC and TA allowed us to consider AF as the exudates. The pro-KLKs/KLKs ratio reflecting the rates of KLKs formation in AF was decreased in TA and CAC by 4.6 and 6.7 times compared to N. The РG/Р ratio in AF in CAC was decreased by 3.8 times; in TA it was similar to N with increased PG and P. The KLKs/α2М ratio in TA and CAC exceeded N by 4.6 and 2.7 times. The Р/α2М ratio in TA and CAC was 6.5 and 4.5 times higher than N. Conclusions: Activity of KLKs and P in AF in CAC and TA was higher than in the blood plasma of healthy donors. Activity of α2М in AF in CAC and TA was not sufficient to control KLKs and P.

Epidural block in local kidney cancer as a way to preserve the adrenal function influencing urine formation processes.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 592-592
Author(s):  
Elena Frantsiyants ◽  
Oleg Ivanovich Kit ◽  
Larisa S. Kozlova ◽  
Dmitry A. Rozenko ◽  
Valeria A. Bandovkina ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Blood Plasma ◽  
Kidney Cancer ◽  
Epidural Block ◽  
The Body ◽  
Adrenal Function ◽  
Formation Processes ◽  
The Central Nervous System ◽  
Urine Formation

592 Background: Our purpose was to study the dynamics of cortisol (C) and aldosterone (A) in the blood plasma in patients receiving surgery with the epidural block (EB) for local kidney cancer. Methods: 58 patients aged 56.5±8.7 years underwent partial nephrectomy with warm ischemia for 15-20 minutes (EB – 35 patients, standard anesthesia (SA) - 23 patients). EB involved catheterization of the epidural space at Th10-L1 with the following infusion of a mixture of ropivacaine 2 mg/ml and epinephrine 2 μg/ml at 6-10 ml/hr using a syringe doser, intraoperatively and within the first three postoperative days. The levels of C and A were studied by radioimmunoassay in the blood plasma of patients before the surgery (b/s), 40 min after the start of the surgery (40' s/s) and on days 1 and 3 after the surgery (a/s). Results were compared to the levels in the blood plasma of 32 healthy donors (N). Results: C and A exceeded N in all patients b/s (p < 0.01). C increased by an order of magnitude 40' s/s only in SA (p < 0.001), while A increased in all patients, compared to the levels b/s. C decreased by 1.5 times in EB on day 1 a/s; C in SA was similar to the levels b/s; A decreased to similar levels in all patients but was still higher than N by 1.4 times on average (p < 0.01). The C levels remained stable in all patients on day 3; A levels became normal in EB only, while in SA they were 2.1 times lower which caused the loss of salts and fluid. Conclusions: SA affected the regulation of the adrenal function by the central nervous system and urine formation processes in the kidney. In SA, abnormal C and A levels preserve for a longer period of time enhancing the water and salt imbalance in the body. Significant decrease of C and the normalization of A in EB indicate the preservation of the adrenal function influencing urine formation processes in the kidney. In local kidney cancer, it is advisable to use epidural block instead of standard anesthesia as the latter blocks regulatory functions of the central nervous system.

Gene Expression of the High Molecular Weight Proteinase Inhibitor α2-Macroglobulin

1992 ◽  
Vol 373 (2) ◽  
pp. 509-516 ◽  
Author(s):  
EVA KRAUSE ◽  
URSULA WEGENKA ◽  
GARSTEN MÖLLER ◽  
FRIEDEMANN HORN ◽  
PETER C. HEINRICH
Keyword(s):  
Gene Expression ◽  
Molecular Weight ◽  
High Molecular Weight ◽  
Proteinase Inhibitor ◽  
Α2 Macroglobulin

Elastase inhibitors in sputum from bronchitic patients with and without α1-proteinase inhibitor deficiency: partial characterization of a hitherto unquantified inhibitor of neutrophil elastase

1987 ◽  
Vol 73 (1) ◽  
pp. 19-28 ◽  
Author(s):  
H. M. Morrison ◽  
J. A. Kramps ◽  
S. C. Afford ◽  
D. Burnett ◽  
J. H. Dijkman ◽  
...  
Keyword(s):  
Neutrophil Elastase ◽  
Proteinase Inhibitor ◽  
Gel Filtration ◽  
Prolonged Incubation ◽  
Α2 Macroglobulin ◽  
Group A ◽  
Hydrolysis Of ◽  
Molecular Weight Fractions ◽  
Deficient Group

1. Anti-elastase function in sputum sol-phase from patients with α1-proteinase inhibitor (α1PI) deficiency was compared with sol-phase from patients with cigarette smoke-induced bronchitis and emphysema. 2. Both α1PI (2P < 0.01) and anti-leucoprotease (ALP) (2P < 0.01) concentrations were lower in sol-phase from the α1PI-deficient group, although α2-macroglobulin (α2M) levels were similar. 3. There was no difference in α1PI function between the two groups, but the inhibitor was only ≃ 30% active. 4. The absolute neutrophil elastase (NE) inhibitory capacity was similar in both groups (median 185 μg of NE inhibited/ml of sputum, range 80–480, for the α1PI-deficient group; median 175, range 80–300, for the bronchitic group). A substantial proportion of NE inhibition in secretions could not be accounted for by the amount of α1PI, ALP and α2M present (median 74.8%, range 43.2–97.4, for α1PI-deficient sol-phase; median 50.0%, range 0–80.8, for bronchitic sol-phase). 5. Gel filtration of sol-phase demonstrated the presence of NE inhibition in the low molecular weight fractions which was markedly sensitive to changes in substrate concentration and ionic strength, in contrast to purified α1PI and ALP. 6. Sputum sol-phase from both groups failed to prevent hydrolysis of elastin–fluorescein or succinyltrialanyl-p-nitroanilide by NE completely during prolonged incubation in the presence of an excess of functional inhibitors. This was more apparent in secretions from subjects with α1PI deficiency and may explain why such patients have a more rapidly progressive form of emphysema.

Organ-preserving surgery for localized renal cell carcinoma: Current approaches.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16077-e16077
Author(s):  
Sergey N Dimitriadi ◽  
Oleg Ivanovich Kit ◽  
Elena Mikhaylovna Frantsiyants ◽  
Natalya Dmitrievna Ushakova ◽  
Dmitry Rozenko ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Partial Nephrectomy ◽  
Kidney Cancer ◽  
Renal Cancer ◽  
Kidney Injury ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Ischemia Time ◽  
Delayed Bleeding ◽  
Localized Renal Cell Carcinoma

e16077 Background: Introduction of modern organ-preservingapproaches in surgical treatment of kidney cancer is limited by the duration of warm ischemia used during the partial nephrectomy (PN), including surgery for elective indications. Some resection procedures require prolonged warm ischemia time resulting in acute kidney injury and development of renal failure in the postoperative period. The purpose of the study was to analyze the effectiveness of a new organ-preserving surgery method for kidney cancer. Methods: 46 patients with clinically localized renal cancer, R.E.N.A.L. score 6-10, underwent PN for elective indications. Patients were divided into two groups: the first group – 20 patients (8 patients – laparoscopic PN (LPN), 12 – open PN (OPN)) with bilateral perirenal procaine blockade (BPPB) before the resection. The second group included 26 patients (19- LPN, 7– OPN) receiving surgery without BPPB. BPPB was performed under US-control. 50 ml of 0.25% procaine solution was successively injected to the perinephric fat in upper, middle and lower kidney segments at both sides. Acute kidney injury (AKI) was diagnosed by serum creatinine level increase by 50% of the initial level and higher. Results: Patients in both groups were comparable by age – 58.35±7.5 (44–70) and 58.7±5.6 (50–65) years, and resection difficulty by R.E.N.A.L. score – 7.35±1.1 (6–10) and 7.15±1.2 (6–10), respectively. Median warm ischemia time did not differ significantly in both groups and was 20.0±2.99 (15–25) and 18.42±2.93 (15–25) min., respectively. Morphologically, all patients were diagnosed with renal cancer, surgical margins were negative. 9 (34.6%) patients of the second group developed AKI, while no AKI was registered in the first group. Urinary fistula and delayed bleeding were not observed. Conclusions: The results suppose renal protective effect of BPPB during partial nephrectomy for kidney cancer with warm ischemia time of 15-25-minutes.

Protease/protease inhibitor balance in blood plasma to predict postoperative complications in operated patients with pancreatic head cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 258-258
Author(s):  
Oleg Ivanovich Kit ◽  
Elena Frantsiyants ◽  
Larisa S. Kozlova ◽  
Valeria A. Bandovkina ◽  
Evgeniy N. Kolesnikov ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Protease Inhibitor ◽  
Blood Plasma ◽  
Pancreatic Head ◽  
Head Cancer ◽  
Pancreatic Head Cancer ◽  
Postoperative Pancreatitis ◽  
Healthy Donors ◽  
Before And After ◽  
Microsoft Office

258 Background: Our purpose was to study the protease/protease inhibitor (P/PI) balance in the blood plasma of patients with cancer of the head of the pancreas before and after pancreatoduodenal resection (PDR) with postoperative complications. Methods: The study was performed using clinical observation, biochemical examinations and statistical analysis in Microsoft Office Excel 2010. The blood plasma of 92 patients with pancreatic head cancer (53 men and 39 women aged 45-76 years, Т2-4N0M0) was studied before the surgery (b/s) and on days 1, 7, 14 and 17 after PDR. The patients were divided into two groups: g1 – 69 patients without postoperative (p/o) complications and g2 – 23 patients with p/o complications: generalization – 7, thrombosis - 8, acute postoperative pancreatitis - 2, gastrostasis - 2, anastomotic leakage - 4 patients. Kinetics of trypsin-like proteases (TLP) and α-1-proteinase inhibitor (α1PI) was studied by spectrophotometry. The data were compared with the blood plasma of 39 healthy donors (N). Results: TLP activity b/s exceeded N in g1 and g2 by 4.1 and 10.6 times; TLP in g2 was 2.6 times higher than in g1. The α1PI activity b/s was higher than N by 1.2 times (p < 0.05) in g1 and lower than N by 2.0 times in g2; α1PI in g2 was 2.4 times lower than in g1. After PDR, activity of TLP increased in all patients on day 1 but decreased on days 7-14 in g1 remaining 2.7 times higher than N by the discharge. The TLP activity in g2 by the discharge was similar to levels b/s and exceeded g1 by 4.4 and N by 12.1 times. The α1PI activity after PDR increased in all patients on days 1-17, but in g1 by the discharge it was similar to N and in g2 it was 1.5 times lower than N. The TLP/α1PI ratio was higher in g2 than in g1 at all times. Conclusions: A high TLP activity and a low α1PI activity, compared to N, were maintained in the blood plasma of all patients with p/o complications, despite their types. The P/PI balance in g2 was shifted to the left being 5.5-9.0 times higher than in g1 at all times which allowed the prognosis of postoperative complications before the surgery, perioperatively or on day 1 after the surgery.

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