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1.
Patryk Kambakamba Michael Linecker Marcel Schneider Cäcilia S. Reiner Thi Dan Linh Nguyen-Kim Perparim Limani Ivan Romic Joan Figueras Henrik Petrowsky Pierre-Alain Clavien Mickaël Lesurtel 《Surgery》2018,163(2):311-317
Background
Associating liver partition and portal vein ligation for staged hepatectomy induces an unprecedented liver hypertrophy and enables resection of otherwise unresectable liver tumors. The effect of associating liver partition and portal vein ligation for staged hepatectomy on tumor proliferation, however, remains a concern. This study investigated the impact of associating liver partition and portal vein ligation for staged hepatectomy on growth of colorectal metastases in mice and in humans.Methods
The effect of associating liver partition and portal vein ligation for staged hepatectomy and 90% portal vein ligation on colorectal liver and lung metastases was investigated in mice. In vivo tumor progression was assessed by magnetic resonance imaging, histology, and survival experiments. The effects of associating liver partition and portal vein ligation for staged hepatectomy, portal vein ligation, and control sera on cultures of several colorectal cancer cell lines (MC38 and CT26) were tested in vitro. Additionally, the international associating liver partition and portal vein ligation for staged hepatectomy registry enabled us to identify patients with remaining tumor in the future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy stage 1.Results
Two and 3 weeks after associating liver partition and portal vein ligation for staged hepatectomy stage 1, portal vein ligation, or sham surgery, liver magnetic resonance images showed similar numbers (P?=?.14/0.82), sizes (P?=?.45/0.98), and growth kinetics (P?=?.58/0.68) of intrahepatic tumor. Tumor growth was not different between the associating liver partition and portal vein ligation for staged hepatectomy and portal vein ligation groups after completion of stage 2. Median survival after tumor cell injection was similar after sham surgery (36 days; 95% confidence interval; 27–57 days), completion of associating liver partition and portal vein ligation for staged hepatectomy (42 days; 95% confidence interval; 35–49 days), and portal vein ligation (39 days; 95% confidence interval; 34–43 days, P?=?.237). Progression of pulmonary metastases and in vitro cell proliferation were comparable among groups.Observations in humans failed to identify any accelerated tumor growth in the future liver remnant within the regenerative phase after associating liver partition and portal vein ligation for staged hepatectomy stage 1.Conclusion
The accelerated regeneration process associated with associating liver partition and portal vein ligation for staged hepatectomy does not appear to enhance growth of colorectal metastases. 相似文献2.
Shi Chen Long Huang Fu-nan Qiu Song-qiang Zhou Mao-lin Yan Yan-nan Bai Zhi-de Lai Yi-feng Tian Yao-dong Wang 《Surgery》2018,163(4):714-720
Background
This trial was performed to compare short- and long-term outcomes after laparoscopic left-sided hepatectomy and open left-sided hepatectomy. Left-sided hepatectomy is a novel, minimally invasive operative technique for primary left-sided hepatolithiasis, but it has not been accepted widely due to the limited information about short- and long-term outcomes, effectiveness, and safety compared with the open approach.Methods
Patients who underwent left-sided hepatectomy between January 2007 and December 2016 were reviewed and grouped into the open left-sided hepatectomy and left-sided hepatectomy groups, according to propensity score matching in terms of age, sex, body mass index, liver function, location of stone, hepatitis serology, and comorbidity on a ratio of 1:1.Results
No significant differences were observed in the demographic characteristics of the 200 patients included in the study. For the left-sided hepatectomy group (100 patients) when compared to the open left-sided hepatectomy group (100 patients, the duration of hospital stay was less (10.3 vs 14.7 days, P?<?.001), the incidence of postoperative biliary fistulas (5% vs 14%, P?=?.003) and overall morbidity were less (25% vs 45%, P?=?.003), out of bed return to activity was expedited (2.0 vs 2.7 days, P?<?.001), and the rate of stone recurrence in the long-term follow-up was les (5.1% vs 17%, P?=?.003).Conclusion
Left-sided hepatectomy was associated with significantly lesser rate of stone recurrence, a shorter hospital stay, decreased morbidity and clinical biliary fistula rate, and expedited postoperative recovery compared with open left-sided hepatectomy. 相似文献3.
Kerollos Nashat Wanis Victoria Ardiles Fernando A. Alvarez Mauro Enrique Tun-Abraham David Linehan Eduardo de Santibañes Roberto Hernandez-Alejandro 《Surgery》2018,163(4):691-697
Background
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an innovative, 2-staged hepatectomy which has elicited controversy within the international hepatobiliary community. Uptake of ALPPS has been limited due to concerns related to evidence of high morbidity and mortality, and scant oncologic and outcome data on quality of life (Qol). Demonstrating reasonable long-term benefits with a short-term risk is necessary to support more widespread endorsement of ALPPS. Our aim was to describe the intermediate-term survival and patient-reported quality of life outcomes after an ALPPS.Methods
Prospectively collected data from 2 high-volume ALPPS centers, who were pioneers with the technique, were combined and analyzed for disease-free and overall survival from date of the ALLPS. Only patients treated for colorectal liver metastases with >6 month postoperative follow-up were included. All patients had bilateral colorectal liver metastases with an initially unresectable tumor load, and received preoperative chemotherapy. Information concerning the demographics of the patients, characteristics of the tumor, and treatment were analyzed. The well-validated European Organization for Research and Treatment for Cancer Quality of Life Core Questionnaire version 3.0 questionnaire was used to assess patient quality of life.Results
A total of 58 patients underwent ALPPS for colorectal liver metastases, and 47 patients met our inclusion criteria. There were no perioperative mortalities, and the rate of severe complications was 21%. At 3 years post-ALPPS, the overall survival was 50%, while the disease-free survival was 13%. The commonest site of first recurrence was the liver alone (38%). Patient-reported quality of life after ALPPS was similar to reference values for general population.Conclusion
In select patients operated at experienced centers, ALPPS results in low perioperative risk, satisfactory overall survival, and excellent quality of life. Hepatic recurrence and not systemic recurrence is the most common site of relapse after ALPPS. 相似文献4.
Nisha Narula Bradford J. Kim Catherine H. Davis Whitney L. Dewhurst Leigh A. Samp Thomas A. Aloia 《Surgery》2018,163(4):703-708
Background
After hepatectomy, 7%–19% of patients are readmitted within 30 days, accounting for substantial cost and poor patient experience. The purpose of this study was to analyze the impact of a proactive outreach intervention on readmissions.Methods
Consecutive patients undergoing hepatectomy by a single surgeon 2012–2016 were identified in a prospectively maintained database. In August 2013 a postoperative intervention was implemented; an advanced practice provider called each patient within 72 hours of discharge. Readmission rates were compared pre- and postintervention using standard statistics.Results
Two hundred thirty-one patients met the inclusion criteria and major hepatectomy was performed in 45.5% of patients. Although the complication rate was similar (25.0% preintervention and 19.4% postintervention, P?=?.324), readmissions within 30 days of operation decreased from 14.5% pre- to 6.5% postintervention (P?=?.046). Approximately 30% of outreach interactions required outpatient intervention. Factors associated with readmission on univariate analysis included increased operative time (P?=?.007), major hepatectomy (P?=?.012), hemi or extended hepatectomy (P?=?.032), second stage operation (P?=?.031), bile leak (P?=?0.022), and any complication/modified Accordion complication?≥?3 within 30 days (P?<.0001). On multivariate analysis, lack of post-discharge intervention (P?=?.012) and bile leak (P?=?.031) were independently associated with readmission.Conclusion
These data demonstrate the efficacy of a proactive communication intervention after discharge to decrease readmissions after hepatectomy. The additional work created by the intervention is likely offset by decreased inpatient care needs and costs. Identification of high-risk populations and application of technology are likely to lead to further improvements. 相似文献5.
Fernando A. Alvarez Denis Castaing Rodrigo Figueroa Marc Antoine Allard Nicolas Golse Gabriella Pittau Oriana Ciacio Antonio Sa Cunha Daniel Cherqui Daniel Azoulay René Adam Eric Vibert 《Surgery》2018,163(6):1257-1263
Background
Portal vein embolization (PVE) use is nowadays debated due to the risk of technical or biological unresectability after the period of time needed to achieve future liver remnant (FLR) hypertrophy. We evaluated the safety and efficacy of PVE in a single high-volume hepatobiliary center, with emphasis in the feasibility to achieve tumor resection.Methods
Patients undergoing PVE before major hepatectomy at our institution between 1993 and 2015 were retrospectively analyzed.Results
A total of 431 patients formed the study population. Morbidity and mortality rates of PVE were 16.7% and 0.2% respectively. Morbidity was similar between percutaneous and ileocolic approaches or between histoacryl and ethanol as embolization materials (P?>?0.05). On the contrary, the percutaneous ipsilateral approach was associated with significantly less complications than the contralateral approach (10.3% vs 19.4%; P?=?0.024). Almost all patients (96%) achieved sufficient FLR volume after embolization, but only 66% finally underwent planned liver resection. Disease progression was the most common cause of unresectability (67%). Patients with extrahepatic biliary tumors experienced significantly higher unresectability rates compared to other entities (45.1% vs 31.4%; P?=?0.019).Conclusion
PVE was not followed by hepatectomy in 34% of our patients. Biliary tumors displayed the higher dropout rates after PVE and the higher chances of tumor progression preventing curative resection. Although PVE may be performed with acceptable morbidity, PVE-related complications prevented curative resection in 5% of patients. Careful multidisciplinary selection is crucial to avoid PVE overuse in technically resectable patients who will experience a not negligible risk of futile use and non-therapeutic laparotomy. 相似文献6.
Gen Sugawara Yukihiro Yokoyama Tomoki Ebata Tsuyoshi Igami Junpei Yamaguchi Takashi Mizuno Tetsuya Yagi Masato Nagino 《Surgery》2018,163(5):1106-1113
Background
The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with extrahepatic bile duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens.Methods
Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance bile cultures.Results
In total, 565 patients underwent surgical resection. Based on the results of bile cultures, the patients were classified into three groups: group A, patients with negative bile cultures (n?=?113); group B, patients with positive bile cultures without multidrug-resistant pathogen growth (n?=?416); and group C, patients with multidrug-resistant pathogen–positive bile culture (n?=?36). The incidence of organ/space surgical site infection, bacteremia, median duration of postoperative hospital stay, and the mortality rate did not differ among the three groups. The incidence of incisional surgical site infection and infectious complications caused by multidrug-resistant pathogens was significantly higher in group C than in groups A and B. Fifty-two patients had postoperative infectious complications caused by multidrug-resistant pathogens. Multivariate analysis identified preoperative multidrug-resistant pathogen–positive bile culture as a significant independent risk factor for postoperative infectious complications caused by multidrug-resistant pathogens (P?<?.001).Conclusion
Major hepatectomy with extrahepatic bile duct resection after biliary drainage can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, even in patients with biliary colonization/infection caused by multidrug-resistant pathogens. 相似文献7.
Jin Yao Teo John Carson Allen David Chee Eng Ng Julianah Bee Abdul Latiff Su Pin Choo David Wai-Meng Tai Albert Su Chong Low Foong Koon Cheah Jason Pik Eu Chang Juinn Huar Kam Victor T.W. Lee Alexander Yaw Fui Chung Chung Yip Chan Pierce Kah Hoe Chow Brian K.P. Goh 《Surgery》2018,163(5):1008-1013
Background
Liver resection is a major curative option in patients presenting with hepatocellular carcinoma. An inadequate functional liver remnant is a major limiting factor precluding liver resection. In recent years, hypertrophy of the functional liver remnant after selective internal radiation therapy hypertrophy has been observed, but the degree of hypertrophy in the early postselective internal radiation therapy period has not been well studied.Methods
We conducted a prospective study on patients undergoing unilobar, Yttrium-90 selective internal radiation therapy for hepatocellular carcinoma to evaluate early hypertrophy at 4–6 weeks and 8–12 weeks after selective internal radiation therapy.Results
In the study, 24 eligible patients were recruited and had serial volumetric measurements performed. The median age was 66 years (38–75 years). All patients were either Child-Pugh Class A or B, and 6/24 patients had documented, clinically relevant portal hypertension; 15 of the 24 patients were hepatitis B positive. At 4–6 weeks, modest hypertrophy was seen (median 3%; range ?12 to 42%) and this increased at 8–12 weeks (median 9%; range ?12 to 179%). No preprocedural factors predictive of hypertrophy were identified.Conclusion
Hypertrophy of the functional liver remnant after selective internal radiation therapy with Yttrium-90 occurred in a subset of patients but was modest and unpredictable in the early stages. Selective internal radiation therapy cannot be recommended as a standard treatment modality to induce early hypertrophy for patients with hepatocellular carcinoma. (Surgery 2017;160:XXX-XXX.) 相似文献8.
Vikrom K. Dhar Young Kim Justin T. Graff Andrew D. Jung Jennifer Garrett Lauren E. Dick Jenifer Harris Shimul A. Shah 《Surgery》2018,163(3):565-570
Background
Despite the potential benefits of social media, health care providers are often hesitant to engage patients through these sites. Our aim was to explore how implementation of social media may affect patient engagement and satisfaction.Methods
In September 2016 a Facebook support group was created for liver transplant patients to use as a virtual community forum. Data including user demographics and group activity were reviewed. A survey was conducted evaluating users' perceptions regarding participation in the group.Results
Over 9 months, 350 unique users (50% liver transplant patients, 36% caregivers/friends, 14% health care providers) contributed 339 posts, 2,338 comments, and 6,274 reactions to the group; 98% of posts were reacted to or commented on by other group members. Patients were the most active users compared with health care providers and caregivers. A total of 95% of survey respondents reported that joining the group had a positive impact on their care; and 97% reported that their main motivation for joining was to provide or receive support from other patients.Conclusion
This pilot study indicates that the integration of social media into clinical practice can empower surgeons to synthesize effectively a patient support community that augments patient engagement and satisfaction. 相似文献9.
Sonia T. Orcutt Yazan Abuodeh Arash Naghavi Jessica Frakes Sarah Hoffe Bela Kis Daniel A. Anaya 《Surgery》2018,163(5):1020-1027
Background
Radioembolization induces liver hypertrophy, although the extent and rate of hypertrophy are unknown. Our goal was to examine the kinetics of contralateral liver hypertrophy after transarterial radioembolization.Methods
A retrospective study (2010–2014) of treatment-naïve patients with primary/secondary liver malignancies undergoing right lobe radioembolization was performed. Computed tomography volumetry was performed before and 1, 3, and 6 months after radioembolization. Outcomes of interest were left lobe (standardized future liver remnant) degree of hypertrophy, kinetic growth rate, and ability to reach goal standardized future liver remnant ≥40%. Medians were compared with the Kruskall-Wallis test. Time to event analysis was used to estimate time to reach goal standardized future liver remnant.Results
In the study, 25 patients were included. At 1, 3, and 6 months, median degree of hypertrophy was 4%, 8%, and 12% (P?<?.001), degree of hypertrophy relative to baseline future liver remnants was 11%, 17%, and 31% (P?=?.015), and kinetic growth rate was 0.8%, 0.5%, and 0.4%/week (P?=?.002). In patients with baseline standardized future liver remnant <40% (N?=?16), median time to reach standardized future liver remnant ≥40% was 7.3 months, with 75% accomplishing standardized future liver remnant ≥40% at 8.2 months.Conclusion
Radioembolization induces hypertrophy of the contralateral lobe to a similar extent as existing methods, although at a lower rate. The role of radioembolization as a dual therapy (neoadjuvant and hypetrophy-inducing) for selected patients needs to be studied. (Surgery 2017;160:XXX-XXX.) 相似文献10.
Tsuyoshi Yokoi Yukihiro Yokoyama Toshio Kokuryo Junpei Yamaguchi Masato Nagino 《Surgery》2018,163(2):270-276
Background
The objective of this study was to elucidate whether the inhibition of Toll-like receptor 4 attenuates liver injury ischemia/reperfusion in the cholestatic liver.Method
Rats were assigned into sham, bile duct ligation, sham ischemia/reperfusion (ischemia/reperfusion after laparotomy), and bile duct ligation ischemia/reperfusion (ischemia/reperfusion after bile duct ligation) groups. In some rats, TAK-242, an inhibitor of Toll-like receptor 4, was administered 15 minutes before ischemia/reperfusion. We measured intrahepatic Toll-like receptor 4 expression, serum hepatic marker expression, liver necrosis, gene expression of inflammation-associated factors, and serum high-mobility group box protein b1 levels.Results
Intrahepatic Toll-like receptor 4 expression was significantly greater in the bile duct ligation group than in the sham group. Toll-like receptor 4 expression was further increased after ischemia/reperfusion in bile duct ligation ischemia/reperfusion groups. The levels of serum hepatic markers were significantly greater in both the sham ischemia/reperfusion and bile duct ligation ischemia/reperfusion groups than in the groups without ischemia/reperfusion. Liver necrosis was greater in the bile duct ligation group than in the sham group and was further increased in the bile duct ligation ischemia/reperfusion group. Genomic expression of inflammation-associated factors was also significantly greater in the bile duct ligation ischemia/reperfusion group than in the sham group. Serum high-mobility groups box protein b1 levels were greater in the bile duct ligation ischemia/reperfusion group than in the sham group (28.1?ng/ml versus 9.2?ng/ml, P?=?.011) and the bile duct ligation group (28.1?ng/ml versus 10.6?ng/ml, P?=?.017). These changes in the bile duct ligation ischemia/reperfusion group were significantly attenuated by preconditioning with TAK242.Conclusions
Toll-like receptor 4 inhibition has a potential to minimize severe injury after ischemia/reperfusion in the cholestatic liver through inhibition of high-mobility groups box protein b1. 相似文献11.
Katia P. Souto Nelson G. Meinhardt Maurício J. Ramos Jane M. Ulbrich-Kulkzynski Airton T. Stein Daniel C. Damin 《Surgery for obesity and related diseases》2018,14(1):66-73
Background
Bariatric surgery has been investigated as a treatment option for obese patients with nonalcoholic fatty liver disease (NAFLD). Because patients with NAFLD and type 2 diabetes show accelerated progression from liver disease to cirrhosis, it has been suggested that surgery could be indicated for patients with lower degrees of obesity and type 2 diabetes.Objective
To analyze the degree of tissue damage in liver biopsies obtained from patients undergoing bariatric surgery, correlating histopathologic findings with their baseline glucose status.Setting
General hospital in the public health system.Methods
Intraoperative liver biopsies were obtained from 521 obese patients undergoing bariatric surgery. Patients were divided into 3 study groups according to their preoperative glucose levels: 167 (32.05%) type 2 diabetic, 132 (25.33%) prediabetic, and 222 (42.61%) normoglycemic patients. Tissue samples were classified in accordance with Brunt and Clinical Research Network Nonalcoholic Steatohepatis criteria.Results
Prevalence of NAFLD was 95%. Higher rates of hepatic fibrosis were observed in diabetic patients (56.4%) compared with prediabetic (29.2%), and normoglycemic patients (28.6%) (P<.001). Nonalcoholic steatohepatitis was diagnosed in 59.4% of the diabetics, in 49.2% of the prediabetics, and in 36% of the normoglycemic obese (P<.001). Only 1.5% of the diabetics had no histologic hepatic alterations.Conclusion
NAFLD is markedly more severe in diabetic patients. Our data suggest that intraoperative liver biopsy should be considered for diabetic patients undergoing bariatric surgery. Early bariatric surgery should be investigated as a means to prevent progression of NAFLD. 相似文献12.
Cyonna Holmes LaShondra Powell Nicholas S. Clarke Michael E. Jessen Matthias Peltz 《Surgery》2018,163(2):436-443
Background
The influence of diabetic therapies on myocardial substrate selection during cardiac surgery is unknown but may be important to ensure optimal surgical outcomes. We hypothesized that metformin and insulin alter myocardial substrate selection during cardiac surgery and may affect reperfusion cardiac function.Methods
Rat hearts (n?=?8 per group) were evaluated under 3 metabolic conditions: normokalemia, cardioplegia, or bypass. Groups were perfused with Krebs-Henseleit buffer in the presence of no additives, metformin, insulin, or both insulin and metformin. Perfusion buffer containing physiologic concentrations of energetic substrates with different carbon-13 (13C) labeling patterns were used to determine substrate oxidation preferences using 13C magnetic resonance spectroscopy and glutamate isotopomer analysis. Rate pressure product and oxygen consumption were measured.Results
Myocardial function was not different between groups. For normokalemia, ketone oxidation was reduced in the presence of insulin and the combination of metformin and insulin reduced fatty acid oxidation. Metformin reduced fatty acid and ketone oxidation during cardioplegia. Fatty acid oxidation was increased in the bypass group compared with all other conditions.Conclusion
Metformin and insulin affect substrate utilization and reduce fatty acid oxidation before reperfusion. These alterations in substrate oxidation did not affect myocardial function in otherwise normal hearts. 相似文献13.
Pretreatment with intravenous fish oil reduces hepatic ischemia reperfusion injury in a murine model
Meredith A. Baker Prathima Nandivada Paul D. Mitchell Gillian L. Fell Amy Pan Lorenzo Anez-Bustillos Duy T. Dao Kathleen M. Gura Vania Nosé Mark Puder 《Surgery》2018,163(5):1035-1039
Background
Ischemia reperfusion injury is a barrier to liver surgery and transplantation, particularly for steatotic livers. The purpose of this study was to determine if pretreatment with a single dose of intravenous fish oil decreases hepatic ischemia reperfusion injury and improves recovery of injured livers.Methods
Sixty adult male C57BL/6 mice received 1?g/kg intravenous fish oil (Omegaven, Fresenius Kabi) or isovolumetric 0.9% NaCl (saline) via tail vein 1 hour before 30 minutes of 70% hepatic ischemia. Animals were killed 4, 8, or 24 hours postreperfusion, and livers were harvested for histologic analysis.Results
Four hours postreperfusion, saline-treated livers demonstrated marked ischemia diffusely around the central veins, while intravenous fish oil–treated livers demonstrated only patchy necrosis with intervening normal parenchyma. Eight hours postreperfusion, all livers demonstrated pale areas of cell loss with surrounding regenerating hepatocytes. Ki67 staining confirmed 14.4/10 high-powered field (95% confidence interval, 3.2–25.6) more regenerating hepatocytes around areas of necrosis in intravenous fish oil–treated livers. Twenty-four hours postreperfusion, all livers demonstrated patchy areas of necrosis, with an 89% (95% confidence interval, 85–92) decrease in the area of necrosis in intravenous fish oil–treated livers.Conclusion
Intravenous fish oil treatment prior to hepatic ischemia reperfusion injury decreased the area of hepatic necrosis and increased hepatocyte regeneration compared to saline treatment in a mouse model. 相似文献14.
Diana R. Hernandez Adriana Artiles Juan C. Duque Laisel Martinez Mariana T. Pinto Keith A. Webster Omaida C. Velazquez Roberto I. Vazquez-Padron Roberta M. Lassance-Soares 《Surgery》2018,163(4):877-882
Background
Arteriogenesis is a process whereby collateral vessels remodel usually in response to increased blood flow and/or wall stress. Remodeling of collaterals can function as a natural bypass to alleviate ischemia during arterial occlusion. Here we used a genetic approach to investigate possible roles of tyrosine receptor c-Kit in arteriogenesis.Methods
Mutant mice with loss of c-Kit function (KitW/W-v), and controls were subjected to hindlimb ischemia. Blood flow recovery was evaluated pre-, post-, and weekly after ischemia. Foot ischemic damage and function were assessed between days 1 to 14 post-ischemia while collaterals remodeling were measured 28 days post-ischemia. Both groups of mice also were subjected to wild type bone marrow cells transplantation 3 weeks before hindlimb ischemia to evaluate possible contributions of defective bone marrow c-Kit expression on vascular recovery.Results
KitW/W-v mice displayed impaired blood flow recovery, greater ischemic damage and foot dysfunction after ischemia compared to controls. KitW/W-v mice also demonstrated impaired collateral remodeling consistent with flow recovery findings. Because arteriogenesis is a biological process that involves bone marrow-derived cells, we investigated which source of c-Kit signaling (bone marrow or vascular) plays a major role in arteriogenesis. KitW/W-v mice transplanted with bone marrow wild type cells exhibited similar phenotype of impaired blood flow recovery, greater tissue ischemic damage and foot dysfunction as nontransplanted KitW/W-v mice.Conclusion
This study provides evidence that c-Kit signaling is required during arteriogenesis. Also, it strongly suggests a vascular role for c-Kit signaling because rescue of systemic c-Kit activity by bone marrow transplantation did not augment the functional recovery of KitW/W-v mouse hindlimbs. 相似文献15.
Background
Diabetic patients are at increased risk of complications from severe peripheral arterial disease. Mesenchymal stem cells (MSC) may be useful in limiting these complications. Our objective is to test the angiogenic potential of diabetic versus healthy MSCs.Methods
MSCs' angiogenic potential was tested by endothelial cell (EC) proliferation, migration, and 3-dimensional sprouting. Diabetic conditions were simulated with 5.5, 20, or 40 mM glucose. MSC secretome was quantified by enzyme-linked immunosorbent assay.Results
Human aortic ECs were most sensitive to glucose conditions and were used for all MSC experiments. Diabetic MSCs had greater 3-dimensional invasion than healthy MSCs (P?<?.05), but EC sprouting was decreased in high glucose conditions in both diabetic and healthy MSCs. Secretome analysis demonstrated that 20mM glucose stimulated epidermal growth factor (EGF) expression in diabetic and healthy MSCs, but that diabetic MSCs had a unique secretome with increased levels of chemokine (C-X-C motif) ligand 1 (CXCL-1), interleukin six (IL-6), and monocyte chemoattractant protein 1 (MCP-1) (P?<?.05).Conclusion
Despite having similar in vitro angiogenic activity, diabetic MSCs secrete a unique and inflammatory angiogenic signature that may influence MSC survival and function after transplantation in cell therapy applications. Strategies that normalize secretome in diabetic patients may improve the utility of autologous MSCs in this population of patients. 相似文献16.
Daniel Saltzman Lance Augustin Arnold Leonard Michael Mertensotto Janet Schottel 《Surgery》2018,163(3):509-514
Background
Immunotherapies for cancer treatment have demonstrated substantial promise even though toxicities and development of tumor resistance limit their effectiveness. A combinatorial approach using immunotherapy with other treatment modalities may decrease side effects while maintaining maximal therapeutic effect. We aimed to determine if bacterial immunotherapy in combination with a chemotherapeutic would be efficacious and less toxic than conventional chemotherapy in an established, preclinical, autochthonous tumor model.Methods
BALB-neuT mice develop autochthonous mammary neoplasms that resemble closely the aggressive Her2-driven cancer found in human patients. Virulence-attenuated S. Typhimurium was used for bacterial immunotherapy. Doxorubicin was the chemotherapeutic agent used at the maximum tolerated dose (5?mg/kg) and low dose (1.25?mg/kg). S. Typhimurium was administered intravenously on day 0 and doxorubicin on days 0, 7, and 14. Experiments concluded on day 35. Mammary pad tumors were measured weekly to ascertain efficacy, and mice were weighed weekly to evaluate toxicity.Results
Mice administered maximum tolerated dose doxorubicin (5?mg/kg) demonstrated a 1.4-fold increase in tumor size by day 35 and showed a nearly 25% weight loss by day 14 revealing severe toxicity. When mice were administered a single dose of S. Typhimurium combined with a low dose of doxorubicin (1.25?mg/kg), tumors increased <3-fold by day 35, and mice showed only 5% weight loss, indicating no clinically relevant toxicity.Conclusion
Bacterial immunotherapy combined with low dose chemotherapy decreased the tumor burden when compared with low dose chemotherapy alone and was less toxic than maximum tolerated dose chemotherapy in an established, autochthonous murine model of breast cancer. 相似文献17.
Background
Microwave thermosphere ablation is a new treatment modality that creates spherical ablation zones using a single antenna. This study aims to analyze local recurrence associated with this new treatment modality in patients with malignant liver tumors.Methods
This is a prospective clinical study of patients who underwent microwave thermosphere ablation of malignant liver tumors between September 2014 and March 2017. Clinical, operative, and oncologic parameters were analyzed using Kaplan-Meier survival and Cox proportional hazards model.Results
One hundred patients underwent 301 ablations. Ablations were performed laparoscopically in 87 and open in 13 patients. Pathology included neuroendocrine liver metastasis (n = 115), colorectal liver metastasis (n = 100), hepatocellular cancer (n = 21), and other tumor types (n = 65). Ninety-day morbidity was 7% with one not procedure-related mortality. Median follow-up was 16 months with 65% of patients completing at least 12 months of follow-up. The rate of local tumor recurrence rate per lesion was 6.6% (20/301). Local tumor, new hepatic, and extrahepatic recurrences were detected in 15%, 40%, and 40% of patients, respectively. Local recurrence rate per pathology was 12% for both colorectal liver metastasis (12/100) and other metastatic tumors (8/65). No local recurrence was observed to date in the neuroendocrine liver metastasis and in the limited number of patients with hepatocellular cancers. Tumor size >3?cm and tumor type were independent predictors of local recurrence.Conclusion
This is the first study to analyze local recurrence after microwave thermosphere ablation of malignant liver tumors. Short-term local tumor control rate compares favorably with that reported for radiofrequency and other microwave technologies in the literature. 相似文献18.
Takahiro Nishio Kojiro Taura Naohiko Nakamura Satoru Seo Kentaro Yasuchika Toshimi Kaido Hideaki Okajima Etsuro Hatano Shinji Uemoto 《Surgery》2018,163(2):264-269
Background
Statins have been reported to reduce the risk of hepatocellular carcinoma (HCC). The effect of perioperative statin use on the prognosis of HCC patients undergoing liver resection remains unclear.Methods
We retrospectively analyzed 643 patients who underwent curative liver resection for HCC. Patients negative for hepatitis B surface antigen and hepatitis C antibody were classified as the non-B non-C HCC subgroup (n?=?204). Perioperative statin users were defined as patients preoperatively receiving statin medications and maintaining?>?28 cumulative defined daily doses after liver resection. The recurrence-free survival (RFS) and overall survival (OS) according to statin use were analyzed in the overall HCC cohort or in the non-B non-C HCC subgroup.Results
Among a total of 643 (HCC) patients, 43 patients (6.7%) received perioperative statin medications. In statin users, the proportion of non-B non-C HCC patients was significantly higher than in nonstatin users. Statin users had a high prevalence of obesity and diabetes, as well as dyslipidemia. The liver function of statin users was better than that of nonstatin users. The multivariate survival analysis revealed that use of statins was significantly associated with improvement of RFS (hazard ratio [HR], .42; 95% confidence interval [CI], 0.25–0.71; P?=?.001), but not with OS (HR, 0.62; 95% CI, 0.30–1.27; P?=?.19). In the subgroup analysis of the non-B non-C HCC cohort, statin use was significantly associated with improvement of RFS (HR, 0.47; 95% CI, 0.22–0.99; P?=?.04).Conclusion
Perioperative statin use was associated with an improvement of RFS in HCC patients undergoing curative liver resection. 相似文献19.
Adalbert Raimann Alireza Javanmardi Monika Egerbacher Gabriele Haeusler 《The spine journal》2017,17(11):1674-1684
Background Context
The process of linear growth is driven by axial elongation of both long bones and vertebral bodies and is accomplished by enchondral ossification. Differences in regulation between the two skeletal sites are mirrored clinically by the age course in body proportions. Whereas long bone growth plates (GPs) can easily be discriminated, vertebral GPs are part of the cartilaginous end plate, which typically shows important species differences.Purpose
The objective of this study was to describe and compare histologic, histomorphometric, and regulatory characteristics in the GPs of the spine and the long bones in a porcine model.Materials and Methods
Two- and six-week-old piglet GPs of three vertebral segments (cervical, thoracic, and lumbar) and eight long bones (proximal and distal radius, humerus, tibia, and femur) were analyzed morphometrically. Further, estrogen receptors, proliferation markers, and growth factor expressions were examined by immunohistochemistry.Results
Individual vertebral GPs were smaller in width and contained fewer chondrocytes than long bone GPs, although their proliferation activity was similar. Whereas the expression pattern of growth hormone-associated factors such as insulin-like growth factor (IGF)-1 and IGF-1 receptor (IGF-1R) was similar, estrogen receptor (ER)-ß and IGF-2 were distinctly expressed in the vertebral samples.Conclusions
Vertebral GPs display differential growth, with measurements similar to the slowest-growing GPs of long bones. Further investigation is needed to decipher the molecular basis of the differential growth of the spine and the long bones. Knowledge on the distinct mechanism will ultimately improve the assessment of clinically essential characteristics of spinal growth, such as vertebral elongation potential and GP fusion. 相似文献20.
Ivy N. Haskins Julietta Chang Zubaidah Nor Hanipah Tavankit Singh Neal Mehta Arthur J. McCullough Stacy A. Brethauer Philip R. Schauer Ali Aminian 《Surgery for obesity and related diseases》2018,14(3):342-346