The 50th Congress of the European Society for Surgical Research June 10-13, 2015, Liverpool, United Kingdom
Guest Editors Thomas Theologou, Liverpool KlaireExarchou, Liverpool Helen Bermingham, Liverpool Benjamin Chan, Liverpool Dion Morton, Birmingham John A. Hunt, Liverpool
Contents
3
Oral Presentations Abstracts O-1_O-195
91
Short Presentations Abstracts SP-1_SP-40
Poster Presentations 108 Abstracts PP-1_PP-150
Basel Freiburg Paris London New York New Delhi Bangkok Beijing Tokyo Kuala Lumpur Singapore Sydney •
•
•
•
•
•
•
•
•
•
•
Downloaded by: San Diego State University 198.143.33.17 - 1/27/2016 3:58:29 AM
The abstracts are available online, free of charge, under http://www.karger.com/esr_55_s1_2015
Basel · Freiburg · Paris · London · New York · New Delhi · Bangkok · Beijing · Tokyo · Kuala Lumpur · Singapore · Sydney
Disclaimer The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
E-Mail [email protected] www.karger.com
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center (see ‘General Information’). © Copyright 2015 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) e-ISBN 978–3–318 05495-8
Downloaded by: San Diego State University 198.143.33.17 - 1/27/2016 3:58:29 AM
S. Karger Medical and Scientific Publishers
Eur Surg Res 2015;55(suppl 1):1-167
3
DOI: 10. 1159/381839 Published online: June 10, 2015
© 2015 S. Karger AG, Basel 0014-312X/15/0555-0001$39.50/0 www.karger.com/esr
Abstracts
OP-1
R1 Rectal Cancer: An Analysis of Survival 1
2
N. M. Ormsby ,*, H. Joshi 1, S. Kelly , K. Whitmarsh 3 1 1 1 1 , M. Chadwick , A. Samad , D. Maitra , M. Scott , 1 R. Rajaganeshan 1
2
Colorectal Surgery, Department of Histopathology, Department of Oncology, St Helens and Knowsley TeachingHospitals NHS Foundation Trust, Liverpool, United Kingdom 3
Background: Evidence has shown that a positive resection
margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes of patients with R1 resection of rectal cancer. Method: Retrospective study of all patients operatively managed within our institution between April 2008-April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival(OS), disease free survival(DFS) and recurrence were the primary outcome measures. Results: Overall there were 306 primary rectal cancers. 76% were grade T3/4 tumours. OS of 30 months.R1 rate was 16% (48 patients). 31 patients underwent APR, and 17 AR. 32 patients underwent neo-adjuvant treatment. In responders, overall survival was 55 months, with no EMV. In nonresponders OS was 29 months, with EMV in 48%. In patients who did not receive NAC, OS was 23 months, with EMV in 74%. EMV is the strongest predictor for poor survival following R1 (p=0. 001). We found a correlation between number of positive nodes, and OS/DFS(p=0. 004). Conclusion: R1 rectal cancer is not an automatic death sentence. We have demonstrated relatively positive OS in this cohort. In particular, those who respond to NAC have the potential for very good OS and DFS, with the potential for remission. We have shown EMV to be the strongest predictor for poor survival. Perhaps these patients could benefit from intraoperative frozen section histo-pathological analysis and intraoperative radiotherapy to improve survival and reduce recurrence rate. ___________________ OP-2
Plasma microRNA to monitor treatment response in patients with colorectal neoplasia J. Carter MBChB, J. Rice MD, M. McClain BS, R. Farmer MD, S. Galandiuk MD Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Price Institute of Surgical Research and the Section of Colorectal Surgery, Louisville, KY, USA
Background and Aims: MicroRNAs (miRNAs) are small, nonprotein-encoding RNAs that play an important role in oncogenesis by regulating gene expression. Plasma miRNAs are promising biomarkers for colorectal neoplasia. We believe miRNA can be used to prospectively monitor patients with colorectal advanced adenoma (CAA) as well as colorectal cancer (CRC). The ideal plasma-based biomarkers for neoplasia would revert to normal levels after treatment to enable prospective therapy monitoring. Methods: Plasma was isolated from 5 patients with CAA >0. 6cm, before and after polypectomy, and 4 patients with CRC without metastasis, before and after surgery.Each sample was screened for 380 plasma-miRNAs using microfluidic array technology (Applied BioSystems®) and pre and posttreatment miRNA expression was compared. Statistical analysis was performed using SPSS® and dysregulated miRNAs were identified. Results: In CAA, 269/380 miRNA were consistently expressed in pre- and post-treatment samples, as compared to 276/380 miRNA in CRC patients. Eighty-nine percent of these miRNA were present in both CAA and CRC samples. Notably several miRNA showed significant changes in expression in post-treatment compared to pre-treatment samples. Of these, miRNA-302a and miRNA-490 are of particular interest. They have been shown to function as tumour suppressor and inhibitors of cell proliferation in cancer. In line with this, expression of these miRNA were higher in post-treatment samples. Conclusions: Plasma miRNA may provide a non-invasive method of determining response to treatment. This has significant implications particularly in the era of watchful waiting following neoadjuvant therapy for rectal cancer. Clearly much more work in field is needed.
___________________ OP-3
Neutrophil Extracellular Trap Formation is Increased in Patients with Colorectal Cancer In-vivo. 1,2
1
2
Richardson , Charles Hendrickse , Fang Gao-Smith , 2 David Thickett 1
Department of General Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom 2 Centre of Experimental Medicine, University of Birmingham, Birmingham, United Kingdom Background: Emerging evidence suggests that neutrophils, which function as the first line of defence during infections and have been shown to have a multitude of additional roles in immunity, facilitate cancer progression. Neutrophil Extracellular Traps (NETs) are extra-cellular neutrophil derived DNA webs that trap and kill invading pathogens. NETs have been implicated in the promotion of cancer progression and to the development of metastases by sequestering circulating tumour cells. Although NETs have
Downloaded by: San Diego State University 198.143.33.17 - 1/27/2016 3:58:29 AM
___________________
Eur Surg Res 2015;55(suppl 1):1-167 DOI: 10. 1159/381839 Published online: June 10, 2015
been detected in infection their role in-vivo is unclear. Objectives: This study was performed to evaluate any differences in NET formation in patients with Colorectal Cancer compared to healthy individuals. Patients and Methods: Systemic neutrophils were isolated from consecutive consenting patients with a confirmed diagnosis of Colorectal Cancer and from consenting age-matched Healthy Controls (in the absence of infection). NETs were measured in response to No-Stimulant, IL-8, LPS and f-MLP by fluorescence video-microscopy. Results: 41 patients with a confirmed diagnosis of Colorectal Cancer were evaluated (mean 68. 6years, 95%CI 65. 2–71. 5) and compared to 20 Healthy Controls (mean 69. 9years, 95%CI 66. 3-73. 5).Increases in NET formation were demonstrated in patients with Colorectal Cancer compared with Healthy Controls: No-Stimulant (12,440AFU vs. 9,251AFU, p=0. 0264), IL-8 (13,210AFU vs. 8,620AFU, p=0. 0014), LPS (13,850AFU vs. 11,650AFU, p=0. 0275), f-MLP (12,810AFU vs. 10,790AFU, p=0. 3293). Conclusions: Significant increases in NET formation have been demonstrated in patients with Colorectal Cancer. These findings suggest that NETs are implicated in cancer development and progression. NETs could represent potential therapeutic targets and merit further investigation in the context of Colorectal Cancer. ___________________
4 © 2015 S. Karger AG, Basel 0014-312X/15/0555-0001$39.50/0 www.karger.com/esr
(12,440AFU vs. 8683AFU, p=0. 0005), IL-8 (13,210AFU vs. 9,589AFU, p=0. 0002), LPS (13,850AFU vs. 9,661AFU, p 0.05 for all).Mean aortic cross clamp and cardio-pulmonary bypass times were 71(45-133) and 98(58-218) vs 76(52118) and 105(68-158) minutes for Group I and II respectively(p>0.05 for all).No heart block or paravalvular and valvular leak were observed.Conclusion: Although, it is not statistically significant, the patients with sutureless aortic bioprostheses had shorter operative times and better hemodynamic performance postoperatively, without an increase in heart block or paravalvular leaks.This new technology may help make the operation simpler, faster and less traumatic. Background:
1
2
1
3
N. Iflazoglu , O. Ureyen , M. K. Atahan , U. M. Meral , 4 1 G. Sezgin , E. Tarcan 1
Department of General Surgery, Ataturk Training and Research Hospital, Katip Celebi University, Izmir/Turkey 2 Department of General Surgery, Bozyaka Training and Research Hospital. Izmir/Turkey 3 Department of General Surgery, Izmir Military Hospital.Izmir/Turkey 4 Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir/Turkey Background and Aim: The use of mammography(MM) in breast cancer screening programs has been increasing in recent years. Thus, increasing the number of detected nonpalpable breast cancer patients, through early diagnosis and treatment also increased survival rates. In our study, we wanted to share the factors about imaging-guided exicional biopsies for non-palpable breast lesions in postoperative proven breast carcinoma patients. Material and Methods: The surgical data were reviewed for 83 patients (age range 32-80 years) with non-palpabl high-riski breast lesions undergoing imaging-guided surgery in our department between January, 2006 and May, 2011. Age, localization of lesion, ultrasound(US) and MM image results, BI-RADS categorization, histopathologic results were assessed retrospectively in patients with US/MM guided wire or radio-guided occult lesion localization(ROLL) technique. Results: Mean age was 53,5(32-80). 29(34,9%) of patients were malign in histopathologic results. In four patient, reexcision performed because of positive surgical margins. Axillary examination results were normal in 24(82,7%) of malignant patients. In MM examination; microcalcifications and nodular opasity were diagnosed in 74,6% of patients before surgery. There were no differance about malignity in these groups after surgery(p: 0,428). 59% and 32,7% of patients were BI-RADS 4 and 3,respectively. Postoperative diagnosed malignancies in BI-RADS 4 group were significantly higher than BI-RADS 3 group(p: 30% Macro-steatotic Livers; A New Means to Expand the Donor Pool?
Modulating TLR-4 mucosal expression via postconditioning the small intestine following mesenteric occlusion
1
1
1
Background: The current drastic shortage of donor organs has led to increased acceptance of marginal liversfor transplantation, despite higher risk of primary non-function (PNF). Here we report the impact of subnormothermic machine perfusion (SMP) preservation of >30% macrosteatotic livers, compared with the gold standard, cold storage (CS). Methods: Dietary hepatic steatosis was induced in Wistar rats by 2-day fasting and subsequent 3-day refeeding with fat-free, carbohydrate-rich diet. This protocol induces 50-60% macrovesicular steatosis, which should be discarded when preserved by CS. Fatty livers were retrieved, flushed and preserved for 4 hours either by CS (HTK) or by SMP (modified-Polysol). In SMP, the livers were perfused both from the portal vein (1ml/g-liver/minute) and from the hepatic artery (0. 1ml/g-liver/minute) at room temperature. Functional integrity of the grafts was evaluated by isolated reperfusion at 37°C for 2 hours. Results: SMP resulted in significant reduction of not only parenchymal (ALT: p 300 mg/dL), MG (200 to 300 mg/dL), and NG (100 to 150 mg/dL) groups. HI group received the same glucose infusion as HG group with insulin infusion of 6 U/kg/h, to maintain blood glucose for 200 to 300 mg/dL. Sham group underwent a sham operation and received the same glucose infusion as HG. All rats were sacrificed 9 hours after surgery to measure plasma interleukin-6 (IL-6), AGEs, plasma and hepatic RAGE levels. Results: Nine hours after CLP, plasma IL-6 levels of HG were three times higher than the other septic groups. There was no significant difference between MG, NG and HI. Plasma AGEs levels were significantly higher in HG than HI. Among septic groups, plasma AGEs levels showed moderate correlation with blood glucose levels (r = 0. 57). There was no significant difference in plasma and hepatic RAGE levels. Conclusion: We demonstrated the deleterious effect of acute severe hyperglycemia on inflammatory response. The underlying mechanism might be associated with AGEs.
© 2015 S. Karger AG, Basel 0014-312X/15/0555-0001$39.50/0 www.karger.com/esr
however, patients with cancer and some other diseases are assigned a special score. Objetives: The goal of this study was to assess the fairness of organ distribution by the MELD system among different groups of diseases. Patients and Methods: Retrospective study with patients over 12 years of age, between January 2009 and September 2013. Demographics, indication for transplantation and MELD scores were compared with the incidence of transplant or death, patient origin and disease groups. Differences were significant when p
Guest Editors Thomas Theologou, Liverpool KlaireExarchou, Liverpool Helen Bermingham, Liverpool Benjamin Chan, Liverpool Dion Morton, Birmingham John A. Hunt, Liverpool
Contents
3
Oral Presentations Abstracts O-1_O-195
91
Short Presentations Abstracts SP-1_SP-40
Poster Presentations 108 Abstracts PP-1_PP-150
Basel Freiburg Paris London New York New Delhi Bangkok Beijing Tokyo Kuala Lumpur Singapore Sydney •
•
•
•
•
•
•
•
•
•
•
Downloaded by: San Diego State University 198.143.33.17 - 1/27/2016 3:58:29 AM
The abstracts are available online, free of charge, under http://www.karger.com/esr_55_s1_2015
Basel · Freiburg · Paris · London · New York · New Delhi · Bangkok · Beijing · Tokyo · Kuala Lumpur · Singapore · Sydney
Disclaimer The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
E-Mail [email protected] www.karger.com
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center (see ‘General Information’). © Copyright 2015 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) e-ISBN 978–3–318 05495-8
Downloaded by: San Diego State University 198.143.33.17 - 1/27/2016 3:58:29 AM
S. Karger Medical and Scientific Publishers
Eur Surg Res 2015;55(suppl 1):1-167
3
DOI: 10. 1159/381839 Published online: June 10, 2015
© 2015 S. Karger AG, Basel 0014-312X/15/0555-0001$39.50/0 www.karger.com/esr
Abstracts
OP-1
R1 Rectal Cancer: An Analysis of Survival 1
2
N. M. Ormsby ,*, H. Joshi 1, S. Kelly , K. Whitmarsh 3 1 1 1 1 , M. Chadwick , A. Samad , D. Maitra , M. Scott , 1 R. Rajaganeshan 1
2
Colorectal Surgery, Department of Histopathology, Department of Oncology, St Helens and Knowsley TeachingHospitals NHS Foundation Trust, Liverpool, United Kingdom 3
Background: Evidence has shown that a positive resection
margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes of patients with R1 resection of rectal cancer. Method: Retrospective study of all patients operatively managed within our institution between April 2008-April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival(OS), disease free survival(DFS) and recurrence were the primary outcome measures. Results: Overall there were 306 primary rectal cancers. 76% were grade T3/4 tumours. OS of 30 months.R1 rate was 16% (48 patients). 31 patients underwent APR, and 17 AR. 32 patients underwent neo-adjuvant treatment. In responders, overall survival was 55 months, with no EMV. In nonresponders OS was 29 months, with EMV in 48%. In patients who did not receive NAC, OS was 23 months, with EMV in 74%. EMV is the strongest predictor for poor survival following R1 (p=0. 001). We found a correlation between number of positive nodes, and OS/DFS(p=0. 004). Conclusion: R1 rectal cancer is not an automatic death sentence. We have demonstrated relatively positive OS in this cohort. In particular, those who respond to NAC have the potential for very good OS and DFS, with the potential for remission. We have shown EMV to be the strongest predictor for poor survival. Perhaps these patients could benefit from intraoperative frozen section histo-pathological analysis and intraoperative radiotherapy to improve survival and reduce recurrence rate. ___________________ OP-2
Plasma microRNA to monitor treatment response in patients with colorectal neoplasia J. Carter MBChB, J. Rice MD, M. McClain BS, R. Farmer MD, S. Galandiuk MD Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Price Institute of Surgical Research and the Section of Colorectal Surgery, Louisville, KY, USA
Background and Aims: MicroRNAs (miRNAs) are small, nonprotein-encoding RNAs that play an important role in oncogenesis by regulating gene expression. Plasma miRNAs are promising biomarkers for colorectal neoplasia. We believe miRNA can be used to prospectively monitor patients with colorectal advanced adenoma (CAA) as well as colorectal cancer (CRC). The ideal plasma-based biomarkers for neoplasia would revert to normal levels after treatment to enable prospective therapy monitoring. Methods: Plasma was isolated from 5 patients with CAA >0. 6cm, before and after polypectomy, and 4 patients with CRC without metastasis, before and after surgery.Each sample was screened for 380 plasma-miRNAs using microfluidic array technology (Applied BioSystems®) and pre and posttreatment miRNA expression was compared. Statistical analysis was performed using SPSS® and dysregulated miRNAs were identified. Results: In CAA, 269/380 miRNA were consistently expressed in pre- and post-treatment samples, as compared to 276/380 miRNA in CRC patients. Eighty-nine percent of these miRNA were present in both CAA and CRC samples. Notably several miRNA showed significant changes in expression in post-treatment compared to pre-treatment samples. Of these, miRNA-302a and miRNA-490 are of particular interest. They have been shown to function as tumour suppressor and inhibitors of cell proliferation in cancer. In line with this, expression of these miRNA were higher in post-treatment samples. Conclusions: Plasma miRNA may provide a non-invasive method of determining response to treatment. This has significant implications particularly in the era of watchful waiting following neoadjuvant therapy for rectal cancer. Clearly much more work in field is needed.
___________________ OP-3
Neutrophil Extracellular Trap Formation is Increased in Patients with Colorectal Cancer In-vivo. 1,2
1
2
Richardson , Charles Hendrickse , Fang Gao-Smith , 2 David Thickett 1
Department of General Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom 2 Centre of Experimental Medicine, University of Birmingham, Birmingham, United Kingdom Background: Emerging evidence suggests that neutrophils, which function as the first line of defence during infections and have been shown to have a multitude of additional roles in immunity, facilitate cancer progression. Neutrophil Extracellular Traps (NETs) are extra-cellular neutrophil derived DNA webs that trap and kill invading pathogens. NETs have been implicated in the promotion of cancer progression and to the development of metastases by sequestering circulating tumour cells. Although NETs have
Downloaded by: San Diego State University 198.143.33.17 - 1/27/2016 3:58:29 AM
___________________
Eur Surg Res 2015;55(suppl 1):1-167 DOI: 10. 1159/381839 Published online: June 10, 2015
been detected in infection their role in-vivo is unclear. Objectives: This study was performed to evaluate any differences in NET formation in patients with Colorectal Cancer compared to healthy individuals. Patients and Methods: Systemic neutrophils were isolated from consecutive consenting patients with a confirmed diagnosis of Colorectal Cancer and from consenting age-matched Healthy Controls (in the absence of infection). NETs were measured in response to No-Stimulant, IL-8, LPS and f-MLP by fluorescence video-microscopy. Results: 41 patients with a confirmed diagnosis of Colorectal Cancer were evaluated (mean 68. 6years, 95%CI 65. 2–71. 5) and compared to 20 Healthy Controls (mean 69. 9years, 95%CI 66. 3-73. 5).Increases in NET formation were demonstrated in patients with Colorectal Cancer compared with Healthy Controls: No-Stimulant (12,440AFU vs. 9,251AFU, p=0. 0264), IL-8 (13,210AFU vs. 8,620AFU, p=0. 0014), LPS (13,850AFU vs. 11,650AFU, p=0. 0275), f-MLP (12,810AFU vs. 10,790AFU, p=0. 3293). Conclusions: Significant increases in NET formation have been demonstrated in patients with Colorectal Cancer. These findings suggest that NETs are implicated in cancer development and progression. NETs could represent potential therapeutic targets and merit further investigation in the context of Colorectal Cancer. ___________________
4 © 2015 S. Karger AG, Basel 0014-312X/15/0555-0001$39.50/0 www.karger.com/esr
(12,440AFU vs. 8683AFU, p=0. 0005), IL-8 (13,210AFU vs. 9,589AFU, p=0. 0002), LPS (13,850AFU vs. 9,661AFU, p 0.05 for all).Mean aortic cross clamp and cardio-pulmonary bypass times were 71(45-133) and 98(58-218) vs 76(52118) and 105(68-158) minutes for Group I and II respectively(p>0.05 for all).No heart block or paravalvular and valvular leak were observed.Conclusion: Although, it is not statistically significant, the patients with sutureless aortic bioprostheses had shorter operative times and better hemodynamic performance postoperatively, without an increase in heart block or paravalvular leaks.This new technology may help make the operation simpler, faster and less traumatic. Background:
1
2
1
3
N. Iflazoglu , O. Ureyen , M. K. Atahan , U. M. Meral , 4 1 G. Sezgin , E. Tarcan 1
Department of General Surgery, Ataturk Training and Research Hospital, Katip Celebi University, Izmir/Turkey 2 Department of General Surgery, Bozyaka Training and Research Hospital. Izmir/Turkey 3 Department of General Surgery, Izmir Military Hospital.Izmir/Turkey 4 Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir/Turkey Background and Aim: The use of mammography(MM) in breast cancer screening programs has been increasing in recent years. Thus, increasing the number of detected nonpalpable breast cancer patients, through early diagnosis and treatment also increased survival rates. In our study, we wanted to share the factors about imaging-guided exicional biopsies for non-palpable breast lesions in postoperative proven breast carcinoma patients. Material and Methods: The surgical data were reviewed for 83 patients (age range 32-80 years) with non-palpabl high-riski breast lesions undergoing imaging-guided surgery in our department between January, 2006 and May, 2011. Age, localization of lesion, ultrasound(US) and MM image results, BI-RADS categorization, histopathologic results were assessed retrospectively in patients with US/MM guided wire or radio-guided occult lesion localization(ROLL) technique. Results: Mean age was 53,5(32-80). 29(34,9%) of patients were malign in histopathologic results. In four patient, reexcision performed because of positive surgical margins. Axillary examination results were normal in 24(82,7%) of malignant patients. In MM examination; microcalcifications and nodular opasity were diagnosed in 74,6% of patients before surgery. There were no differance about malignity in these groups after surgery(p: 0,428). 59% and 32,7% of patients were BI-RADS 4 and 3,respectively. Postoperative diagnosed malignancies in BI-RADS 4 group were significantly higher than BI-RADS 3 group(p: 30% Macro-steatotic Livers; A New Means to Expand the Donor Pool?
Modulating TLR-4 mucosal expression via postconditioning the small intestine following mesenteric occlusion
1
1
1
Background: The current drastic shortage of donor organs has led to increased acceptance of marginal liversfor transplantation, despite higher risk of primary non-function (PNF). Here we report the impact of subnormothermic machine perfusion (SMP) preservation of >30% macrosteatotic livers, compared with the gold standard, cold storage (CS). Methods: Dietary hepatic steatosis was induced in Wistar rats by 2-day fasting and subsequent 3-day refeeding with fat-free, carbohydrate-rich diet. This protocol induces 50-60% macrovesicular steatosis, which should be discarded when preserved by CS. Fatty livers were retrieved, flushed and preserved for 4 hours either by CS (HTK) or by SMP (modified-Polysol). In SMP, the livers were perfused both from the portal vein (1ml/g-liver/minute) and from the hepatic artery (0. 1ml/g-liver/minute) at room temperature. Functional integrity of the grafts was evaluated by isolated reperfusion at 37°C for 2 hours. Results: SMP resulted in significant reduction of not only parenchymal (ALT: p 300 mg/dL), MG (200 to 300 mg/dL), and NG (100 to 150 mg/dL) groups. HI group received the same glucose infusion as HG group with insulin infusion of 6 U/kg/h, to maintain blood glucose for 200 to 300 mg/dL. Sham group underwent a sham operation and received the same glucose infusion as HG. All rats were sacrificed 9 hours after surgery to measure plasma interleukin-6 (IL-6), AGEs, plasma and hepatic RAGE levels. Results: Nine hours after CLP, plasma IL-6 levels of HG were three times higher than the other septic groups. There was no significant difference between MG, NG and HI. Plasma AGEs levels were significantly higher in HG than HI. Among septic groups, plasma AGEs levels showed moderate correlation with blood glucose levels (r = 0. 57). There was no significant difference in plasma and hepatic RAGE levels. Conclusion: We demonstrated the deleterious effect of acute severe hyperglycemia on inflammatory response. The underlying mechanism might be associated with AGEs.
© 2015 S. Karger AG, Basel 0014-312X/15/0555-0001$39.50/0 www.karger.com/esr
however, patients with cancer and some other diseases are assigned a special score. Objetives: The goal of this study was to assess the fairness of organ distribution by the MELD system among different groups of diseases. Patients and Methods: Retrospective study with patients over 12 years of age, between January 2009 and September 2013. Demographics, indication for transplantation and MELD scores were compared with the incidence of transplant or death, patient origin and disease groups. Differences were significant when p
