BioMed Research International: Surgery The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Normoxic and Hyperoxic Cardiopulmonary Bypass in Congenital Heart Disease Thu, 18 Sep 2014 09:08:39 +0000 Cyanotic congenital heart disease comprises a diverse spectrum of anatomical pathologies. Common to all, however, is chronic hypoxia before these lesions are operated upon when cardiopulmonary bypass is initiated. A range of functional and structural adaptations take place in the chronically hypoxic heart, which, whilst protective in the hypoxic state, are deleterious when the availability of oxygen to the myocardium is suddenly improved. Conventional cardiopulmonary bypass delivers hyperoxic perfusion to the myocardium and is associated with cardiac injury and systemic stress, whilst a normoxic perfusate protects against these insults. Amir Mokhtari and Martin Lewis Copyright © 2014 Amir Mokhtari and Martin Lewis. All rights reserved. Collagen-Glycosaminoglycan Matrix Implantation Promotes Angiogenesis following Surgical Brain Trauma Wed, 17 Sep 2014 06:02:11 +0000 Surgical brain injury (SBI) is unavoidable during many neurosurgical procedures intrinsically linked to postoperative neurological deficits. We have previously demonstrated that implantation of collagen glycosaminoglycan (CG) following surgical brain injury could significantly promote functional recovery and neurogenesis. In this study we further hypothesized that this scaffold may provide a microenvironment by promoting angiogenesis to favor neurogenesis and subsequent functional recovery. Using the rodent model of surgical brain injury as we previously established, we divided Sprague-Dawley male rats (weighting 300–350 g) into three groups: (1) sham (2) surgical injury with a lesion (L), and (3) L with CG matrix implantation (L + CG). Our results demonstrated that L + CG group showed a statistically significant increase in the density of vascular endothelial cells and blood vessels over time. In addition, tissue concentrations of angiogenic growth factors (such as VEGF, FGF2, and PDGF) significantly increased in L + CG group. These results suggest that implantation of a CG scaffold can promote vascularization accompanied by neurogenesis. This opens prospects for use of CG scaffolds in conditions such as brain injury including trauma and ischemia. Kuo-Feng Huang, Wei-Cherng Hsu, Jong-Kai Hsiao, Gunng-Shinng Chen, and Jia-Yi Wang Copyright © 2014 Kuo-Feng Huang et al. All rights reserved. Risk Factors for Chronic Subdural Hematoma after a Minor Head Injury in the Elderly: A Population-Based Study Thu, 11 Sep 2014 05:37:49 +0000 Chronic subdural hematoma (CSDH) is one of the major comorbidities in elderly resulting in disability and death. Early recognition of CSDH is important for early management. However, manifestations of CSDH are nonspecific and subtle. Therefore, identification of risk factors of CSDH can offer clinical follow-up strategies for patients after episodes of head injury. The purpose of the study aimed at identifying risk factors of CSDH of Taiwanese. Analysis of data from the National Health Insurance provides important information on predictive factors influencing the early diagnosis of CSDH in elderly patients following minor head injuries. The current study is the first nationwide population-based study in Taiwan, showing that old age (≥75 years), male gender, and coexisting hydrocephalus are significantly predictive factors, irrespective to their medical comorbidities. Jen-Ho Tseng, Ming-Yuan Tseng, Ann-Jeng Liu, Wen-Hsiung Lin, Hsiao-Yun Hu, and Sheng-Huang Hsiao Copyright © 2014 Jen-Ho Tseng et al. All rights reserved. Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective Mon, 08 Sep 2014 06:15:58 +0000 The idea of protecting the heart from ischemic insult during heart surgery to allow elective cardiac arrest is as old as the idea of cardiac surgery itself. The current gold standard in clinical routine is a high potassium regimen added either to crystalloid or blood cardioplegic solutions inducing depolarized arrest. Ongoing patient demographic changes with increasingly older, comorbidly ill patients and increasing case complexity with increasingly structurally abnormal hearts as morphological correlate paired with evolutions in pediatric cardiac surgery allowing more complex procedures than ever before redefine requirements for cardioprotection. Many, in part adversarial, regimens to protect the myocardium from ischemic insults have entered clinical routine; however, functional recovery of the heart is still often impaired due to perfusion injury. Myocardial reperfusion damage is a key determinant of postoperative organ functional recovery, morbidity, and mortality in adult and pediatric patients. There is a discrepancy between what current protective strategies are capable of and what they are expected to do in a rapidly changing cardiac surgery community. An increased understanding of the molecular players of ischemia reperfusion injury offers potential seeds for new cardioprotective regimens and may further displace boundaries of what is technically feasible. Andreas Habertheuer, Alfred Kocher, Günther Laufer, Martin Andreas, Wilson Y. Szeto, Peter Petzelbauer, Marek Ehrlich, and Dominik Wiedemann Copyright © 2014 Andreas Habertheuer et al. All rights reserved. Propofol Protects the Immature Rabbit Heart against Ischemia and Reperfusion Injury: Impact on Functional Recovery and Histopathological Changes Wed, 27 Aug 2014 05:58:58 +0000 The general anesthetic propofol protects the adult heart against ischemia and reperfusion injury; however, its efficacy has not been investigated in the immature heart. This work, for the first time, investigates the cardioprotective efficacy of propofol at clinically relevant concentrations in the immature heart. Langendorff perfused rabbit hearts (7–12 days old) were exposed to 30 minutes’ global normothermic ischemia followed by 40 minutes’ reperfusion. Left ventricular developed pressure (LVDP) and coronary flow were monitored throughout. Lactate release into coronary effluent was measured during reperfusion. Microscopic examinations of the myocardium were monitored at the end of reperfusion. Hearts were perfused with different propofol concentrations (1, 2, 4, and 10 μg/mL) or with cyclosporine A, prior to ischemic arrest and for 20 minutes during reperfusion. Propofol at 4 and 10 μg/mL caused a significant depression in LVDP prior to ischemia. Propofol at 2 μg/mL conferred significant and maximal protection with no protection at 10 μg/mL. This protection was associated with improved recovery in coronary flow, reduced lactate release, and preservation of cardiomyocyte ultrastructure. The efficacy of propofol at 2 μg/mL was similar to the effect of cyclosporine A. In conclusion, propofol at a clinically relevant concentration is cardioprotective in the immature heart. Makoto Shirakawa, Hajime Imura, and Takashi Nitta Copyright © 2014 Makoto Shirakawa et al. All rights reserved. Evaluation of the TMJ by means of Clinical TMD Examination and MRI Diagnostics in Patients with Rheumatoid Arthritis Tue, 26 Aug 2014 11:04:26 +0000 This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings. Silke Witulski, Thomas J. Vogl, Stefan Rehart, and Peter Ottl Copyright © 2014 Silke Witulski et al. All rights reserved. Adjuvant Cardioprotection in Cardiac Surgery: Update Tue, 19 Aug 2014 00:00:00 +0000 Cardiac surgery patients are now more risky in terms of age, comorbidities, and the need for complex procedures. It brings about reperfusion injury, which leads to dysfunction and/or loss of part of the myocardium. These groups of patients have a higher incidence of postoperative complications and mortality. One way of augmenting intraoperative myocardial protection is the phenomenon of myocardial conditioning, elicited with brief nonlethal episodes of ischaemia-reperfusion. In addition, drugs are being tested that mimic ischaemic conditioning. Such cardioprotective techniques are mainly focused on reperfusion injury, a complex response of the organism to the restoration of coronary blood flow in ischaemic tissue, which can lead to cell death. Extensive research over the last three decades has revealed the basic mechanisms of reperfusion injury and myocardial conditioning, suggesting its therapeutic potential. But despite the enormous efforts that have been expended in preclinical studies, almost all cardioprotective therapies have failed in the third phase of clinical trials. One reason is that evolutionary young cellular mechanisms of protection against oxygen handling are not very robust. Ischaemic conditioning, which is among these, is also limited by this. At present, the prevailing belief is that such options of treatment exist, but their full employment will not occur until subquestions and methodological issues with the transfer into clinical practice have been resolved. Robert Wagner, Pavel Piler, Zufar Gabbasov, Junko Maruyama, Kazuo Maruyama, Jiri Nicovsky, and Peter Kruzliak Copyright © 2014 Robert Wagner et al. All rights reserved. Insulin Preconditioning Elevates p-Akt and Cardiac Contractility after Reperfusion in the Isolated Ischemic Rat Heart Wed, 13 Aug 2014 12:14:50 +0000 Insulin induces cardioprotection partly via an antiapoptotic effect. However, the optimal timing of insulin administration for the best quality cardioprotection remains unclear. We tested the hypothesis that insulin administered prior to ischemia provides better cardioprotection than insulin administration after ischemia. Isolated rat hearts were prepared using Langendorff method and divided into three groups. The Pre-Ins group (Pre-Ins) received 0.5 U/L insulin prior to 15 min no-flow ischemia for 20 min followed by 20 min of reperfusion. The Post-Ins group (Post-Ins) received 0.5 U/L insulin during the reperfusion period only. The control group (Control) was perfused with KH buffer throughout. The maximum of left ventricular derivative of pressure development (dP/dt(max)) was recorded continuously. Measurements of TNF-α and p-Akt in each time point were assayed by ELISA. After reperfusion, dP/dt(max) in Pre-Ins was elevated, compared with Post-Ins at 10 minutes after reperfusion and Control at all-time points. TNF-α levels at 5 minutes after reperfusion in the Pre-Ins were lower than the others. After 5 minutes of reperfusion, p-Akt was elevated in Pre-Ins compared with the other groups. Insulin administration prior to ischemia provides better cardioprotection than insulin administration only at reperfusion. TNF-α suppression is possibly mediated via p-Akt leading to a reduction in contractile myocardial dysfunction. Tamaki Sato, Hiroaki Sato, Takeshi Oguchi, Hisashi Fukushima, George Carvalho, Ralph Lattermann, Takashi Matsukawa, and Thomas Schricker Copyright © 2014 Tamaki Sato et al. All rights reserved. Early Surgery Does Not Seem to Be a Pivotal Criterion to Improve Prognosis in Patients with Frontal Depressed Skull Fractures Tue, 12 Aug 2014 11:39:51 +0000 Introduction. There has been much debate about the ideal timing of surgery of frontal depressed skull fractures (DSF). In this paper, we assess whether timing of surgery may have influenced outcome. Methods. Retrospective cohort of 40 consecutive patients with frontal DSF who underwent surgical treatment over a 36-month period. The patients were divided into early surgery group (ESG) which were operated within 24 h and delayed surgery group (DSG). Results. The population comprised 39 (97.50%) men and the mean age was 27.9 years (range, 2–81 yr). There was no difference of age (), gender male (), presence of focal lesion on head CT (), hypotension (), and hypoxia (). Mean Glasgow Coma Scale (GCS) was significantly lower in patients of ESG than DSG (8.75 and 11.7, resp., ). There was no difference between the groups in relation to death (), unfavourable outcome (), late posttraumatic epilepsy (), and smell-and-taste disturbances (). Only one patient (3.5%) evolved meningitis during follow-up. Conclusion. We found no difference between the ESG and DSG in respect to death, unfavourable outcome, LPE, and STD. Iuri Santana Neville, Robson Luis Amorim, Wellingson Silva Paiva, Felipe Hada Sanders, Manoel Jacobsen Teixeira, and Almir Ferreira de Andrade Copyright © 2014 Iuri Santana Neville et al. All rights reserved. The Effect of Age, Gender, and Insertion Site on Marginal Bone Loss around Endosseous Implants: Results from a 3-Year Trial with Premium Implant System Tue, 12 Aug 2014 08:58:50 +0000 Objectives. The goal of this study was to evaluate bone changes around endosseous implants in partially edentulous patients. Materials and Methods. A total of 632 two-stage implants were placed in 252 patients. The implants had straight emergence profile, ZirTi surface, 3.3 to 5 mm diameter, and 8.5 to 13 mm length. Bone levels were assessed on orthopantomography immediately after surgery and after 36 months and marginal bone loss (MBL) was calculated from their difference. Results. Cumulative survival rate was 98.73%. Overall MBL was 0.8 mm ± 0.03 (mean ± SEM). Higher MBL was observed around implants in the maxilla than in the mandible (). A relation between implant diameter and MBL () was observed in male and, more limitedly, female patients. Older patients had higher MBL in the maxilla, but not in the mandible (). MBL progressively increased with age in male patients, but reached a peak already in the 50–60 years age group in the female subset (). Conclusions. The overall MBL is consistent with the available literature. Site difference and patient age and gender appear to significantly affect MBL, representing important factors to be considered during implant placement. Massimiliano Negri, Carlo Galli, Arianna Smerieri, Guido M. Macaluso, Edoardo Manfredi, Giulia Ghiacci, Andrea Toffoli, Mauro Bonanini, and Simone Lumetti Copyright © 2014 Massimiliano Negri et al. All rights reserved. Remote Effects of Lower Limb Ischemia-Reperfusion: Impaired Lung, Unchanged Liver, and Stimulated Kidney Oxidative Capacities Sun, 10 Aug 2014 06:28:07 +0000 Remote organ impairments are frequent and increase patient morbidity and mortality after lower limb ischemia-reperfusion (IR). We challenged the hypothesis that lower limb IR might also impair lung, renal, and liver mitochondrial respiration. Two-hour tourniquet-induced ischemia was performed on both hindlimbs, followed by a two-hour reperfusion period in C57BL6 mice. Lungs, liver and kidneys maximal mitochondrial respiration (), complexes II, III, and IV activity (), and complex IV activity () were analyzed on isolated mitochondria. Lower limb IR decreased significantly lung ( versus  μmol O2/min/g dry weight, resp.; ) and tended to reduce and . IR did not modify liver but increased kidneys mitochondrial respiration ( versus , , and versus  μmol O2/min/g dry weight for and , resp.). Kidneys mitochondrial coupling was increased after IR ( versus , ). There were no histological changes in liver and kidneys. Thus, lung mitochondrial dysfunction appears as a new early marker of hindlimb IR injuries in mice. Further studies will be useful to determine whether enhanced kidneys mitochondrial function allows postponing kidney impairment in lower limb IR setting. Z. Mansour, A. L. Charles, M. Kindo, J. Pottecher, T. N. Chamaraux-Tran, A. Lejay, J. Zoll, J. P. Mazzucotelli, and B. Geny Copyright © 2014 Z. Mansour et al. All rights reserved. The Effect of Alcohol Intoxication on Mortality of Blunt Head Injury Mon, 04 Aug 2014 00:00:00 +0000 Alcohol is found to have neuroprotection in recent studies in head injuries. We investigated the association of blood alcohol concentration (BAC) with mortality of patients with blunt head injury after traffic accident. All patients sustaining blunt head injury caused by traffic accident brought to our emergency department who had obtained a brain computed tomography scans and BAC were analyzed. Patients with unknown mechanisms, transfers from outside hospitals, and incomplete data were excluded. Logistic regression was used to identify independent predictors of mortality. During the study period, 3,628 patients with brain computed tomography (CT) were included. Of these, BAC was measured in 556 patients. Patients with the lowest BAC (less than 8 mg/dl) had lower mortality; intoxicated patients with BAC between 8 and less than 100 mg/dl were associated with significantly higher mortality than those patients in other intoxicated groups. Adjusted logistic regression demonstrated higher BAC group and Glasgow coma scale (GCS) scores, and lower ISS and age were identified as independent predictors of reduced mortality. In our study, we found that patients who had moderate alcohol intoxication had higher risk of mortality. However, higher GCS scores, lower ISS, and younger age were identified as independent predictors of reduced mortality in the study patients. Hsing-Lin Lin, Tsung-Ying Lin, Kwan-Ming Soo, Chao-Wen Chen, Liang-Chi Kuo, Yen-Ko Lin, Wei-Che Lee, and Chih-Lung Lin Copyright © 2014 Hsing-Lin Lin et al. All rights reserved. Innovations in Pancreatic Surgery Mon, 21 Jul 2014 10:28:48 +0000 Masahiko Hirota, Juhani Sand, Ralf Segersvärd, and Roberto Cirocchi Copyright © 2014 Masahiko Hirota et al. All rights reserved. Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery Tue, 15 Jul 2014 12:02:45 +0000 Prognosis of patients with pancreatic cancer is poor. Even the small minority that undergoes resection with curative intent has low 5-year survival rates. This may partly be explained by the high number of irradical resections, which results in local recurrence and impaired overall survival. Currently, ultrasonography is used during surgery for resectability assessment and frozen-section analysis is used for assessment of resection margins in order to decrease the number of irradical resections. The introduction of minimal invasive techniques in pancreatic surgery has deprived surgeons from direct tactile information. To improve intraoperative assessment of pancreatic tumor extension, enhanced or novel intraoperative imaging technologies accurately visualizing and delineating cancer cells are necessary. Emerging modalities are intraoperative near-infrared fluorescence imaging and freehand nuclear imaging using tumor-specific targeted contrast agents. In this review, we performed a meta-analysis of the literature on laparoscopic ultrasonography and we summarized and discussed current and future intraoperative imaging modalities and their potential for improved tumor demarcation during pancreatic surgery. Henricus J. M. Handgraaf, Martin C. Boonstra, Arian R. Van Erkel, Bert A. Bonsing, Hein Putter, Cornelis J. H. Van De Velde, Alexander L. Vahrmeijer, and J. Sven D. Mieog Copyright © 2014 Henricus J. M. Handgraaf et al. All rights reserved. Protection of Coronary Endothelial Function during Cardiac Surgery: Potential of Targeting Endothelial Ion Channels in Cardioprotection Sun, 13 Jul 2014 12:06:54 +0000 Vascular endothelium plays a critical role in the control of blood flow by producing vasoactive factors to regulate vascular tone. Ion channels, in particular, K+ channels and Ca2+-permeable channels in endothelial cells, are essential to the production and function of endothelium-derived vasoactive factors. Impairment of coronary endothelial function occurs in open heart surgery that may result in reduction of coronary blood flow and thus in an inadequate myocardial perfusion. Hyperkalemic exposure and concurrent ischemia-reperfusion during cardioplegic intervention compromise NO and EDHF-mediated function and the impairment involves alterations of K+ channels, that is, and , and Ca2+-permeable TRP channels in endothelial cells. Pharmacological modulation of these channels during ischemia-reperfusion and hyperkalemic exposure show promising results on the preservation of NO and EDHF-mediated endothelial function, which suggests the potential of targeting endothelial K+ and TRP channels for myocardial protection during cardiac surgery. Qin Yang, Cheuk-Man Yu, Guo-Wei He, and Malcolm John Underwood Copyright © 2014 Qin Yang et al. All rights reserved. Aesthetic Evaluation of the Nasolabial Region in Children with Unilateral Cleft Lip and Palate Comparing Expert versus Nonexperience Health Professionals Sun, 13 Jul 2014 07:01:07 +0000 Esthetic evaluation of cleft lip and palate rehabilitation outcomes may assist in the determination of new surgical interventions and aid in reevaluation of treatment protocols. Our objective was to compare esthetics assessments of the nasolabial region in children with a unilateral cleft lip and palate between healthcare professionals who were experienced in the treatment of cleft lip and palate and those who were inexperienced. The study group included 55 patients between 6 and 12 years of age who had already undergone primary reconstructive surgery for unilateral cleft lip. Standardized digital photographs were obtained, and the esthetic features of the nose, lip, and nasolabial region were evaluated. We used only cropped photographic images in the assessments of healthcare professionals with and without experience in cleft lip and palate. Interrater analysis revealed highly reliable assessments made by both the experienced and inexperienced professionals. There was no statistically significant difference in the esthetic attractiveness of the lip and nose between the experienced and inexperienced professionals. Compared with the inexperienced professionals, the experienced professional evaluators showed higher satisfaction with the esthetic appearance of the nasolabial region; however, no difference was observed in the analysis of the lip or nose alone. Tatiana Saito Paiva, Marcia Andre, Wellingson Silva Paiva, and Beatriz Silva Camara Mattos Copyright © 2014 Tatiana Saito Paiva et al. All rights reserved. Current Evidence regarding Prophylactic Antibiotics in Head and Neck and Maxillofacial Surgery Tue, 08 Jul 2014 06:50:56 +0000 Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base. Kilian Kreutzer, Katharina Storck, and Jochen Weitz Copyright © 2014 Kilian Kreutzer et al. All rights reserved. Preoperative Arrhythmias Such as Atrial Fibrillation: Cardiovascular Surgery Risk Factor Thu, 03 Jul 2014 10:12:21 +0000 Atrial fibrillation is still the most common arrhythmia that occurs in heart surgery. However, there is few literature data on the manner in which preoperative atrial fibrillation may influence the postoperative outcome of various heart surgery procedures. The purpose of our research is to assess the effects of preoperative atrial fibrillation on patients having undergone different heart surgery procedures. The results of our research are a review of clinical data which were collected prospectively, over a 10-year period, from all the patients who had undergone heart surgery in our Institute. The study group included 1119 heart surgery patients, who were divided as follows: the preoperative AFib group (, 20.19%) and the sinus rhythm group (, 79.80%). Major postoperative complications and hospital mortality rates were analyzed. According to our statistical analysis, preoperative atrial fibrillation significantly increased the mortality risk (), the patients’ mechanical ventilation needs (), the rate of occurrence of infectious complications (), the rate of occurrence of complications such as acute kidney failure (), and the time spent by the patients in the intensive care ward (). In conclusion, preoperative atrial fibrillation in heart surgery patients increases the mortality and major complication risk further to heart surgery. Diana Anghel, Radu Anghel, Flavia Corciova, Mihail Enache, and Grigore Tinica Copyright © 2014 Diana Anghel et al. All rights reserved. P-Selectin: An Unpredicted Factor for Deep Vein Thrombosis after Total Hip Arthroplasty Wed, 25 Jun 2014 09:25:30 +0000 Introduction. Deep vein thrombosis (DVT) is a severe complication after total hip arthroplasty (THA). It leads to acute pulmonary embolism, a life-threatening disease. P-selectin is a 140-kDa transmembrane glycoprotein. Elevated P-selectin was associated with 1.7-fold increase in the risk of venous thrombosis. Materials and Methods. To confirm the association, a total of 91 subjects who received primary total hip arthroplasty using lateral approach performed by one skilled orthopedic surgeon were studied. All the patients were consecutively enrolled at the Center of Diagnosis and Treatment for Joint Diseases, Drum Tower Hospital affiliated to the Medical School of Nanjing University from 2010 to 2012. All the subjects received venography 3–5 days after operation. We measured P-selectin by means of a highly sensitive sandwich ELISA technique and a commercially available test reagent set. Results. No significant association was detected between P-selectin and DVT (all   ). ΔsP-selectin was correlated with weight, APTT after operation, history of DVT, and diagnosis of primary disease ( values were 0.03, 0.03, 0.04, and 0.02, resp.). Conclusion. P-selectin may not be a predicted factor for deep vein thrombosis after total hip arthroplasty. Dongquan Shi, Xingquan Xu, Zhihong Xu, Takahiro Nakamura, Yong Pang, Chen Yao, Feng Wang, Dongyang Chen, Jin Dai, and Qing Jiang Copyright © 2014 Dongquan Shi et al. All rights reserved. Correlation between Density and Resorption of Fresh-Frozen and Autogenous Bone Grafts Tue, 24 Jun 2014 13:25:35 +0000 Trial Design. This analysis compared the outcome of fresh-frozen versus autologous bone block grafts for horizontal ridge augmentation in patients with Cawood and Howell class IV atrophies. Methods. Seventeen patients received autologous grafts and 21 patients received fresh-frozen bone grafts. Patients underwent CT scans 1 week and 6 months after surgery for graft volume and density analysis. Results. Two autologous and 3 fresh-frozen grafts failed. Autologous and fresh-frozen grafts lost, respectively, 28% and 46% of their initial volume . It is noteworthy that less dense fresh-frozen blocks lost more volume than denser grafts (61% versus 16%). Conclusions. According to these 6-month results, only denser fresh-frozen bone graft may be an acceptable alternative to autologous bone for horizontal ridge augmentation. Further studies are needed to investigate its behaviour at longer time points. Simone Lumetti, Carlo Galli, Edoardo Manfredi, Ugo Consolo, Claudio Marchetti, Giulia Ghiacci, Andrea Toffoli, Mauro Bonanini, Attilio Salgarelli, and Guido M. Macaluso Copyright © 2014 Simone Lumetti et al. All rights reserved. Biomarkers as Predictors of Recurrence following Curative Resection for Pancreatic Ductal Adenocarcinoma: A Review Tue, 24 Jun 2014 12:13:35 +0000 Pancreatic ductal adenocarcinoma (PDA) is the fourth most common cancer causing death in the United States. Early tumor recurrence is an important contributor to the dismal prognosis. The availability of an accurate prognostic biomarker for predicting disease recurrence following curative resection will be beneficial for patient care. Most of the currently studied biomarkers remain in the investigational phase, with CA 19-9 being the only biomarker currently approved by the FDA. Herein, we review the utility of CA 19-9 and other investigational cellular, gene, and molecular tumor markers for predicting PDA recurrence following curative surgical resection. Sylvester N. Osayi, Mark Bloomston, Carl M. Schmidt, E. Christopher Ellison, and Peter Muscarella Copyright © 2014 Sylvester N. Osayi et al. All rights reserved. Evaluation of Clinical Contributions Provided by Addition of the Brain, Calvarium, and Scalp to the Limited Whole Body Imaging Area in FDG-PET/CT Tumor Imaging Mon, 16 Jun 2014 05:36:25 +0000 Purpose. The aim of this study was to detect additional findings in whole body FDG-PET/CT scan including the brain, calvarium, and scalp (compared to starting from the base of the skull) in cancer patients and to determine contributions of these results to tumor staging and treatment protocols. Materials and Methods. We noted whether the findings related to the brain, calvarium, and scalp in 1359 patients had a potential to modify staging of the disease, chemotherapy protocol, radiotherapy protocol, and surgical management. We identified rates of metastatic findings on the brain, calvarium, and scalp according to the tumor types on FDG-PET/CT scanning. Results. We found FDG-PET/CT findings for malignancy above the base of the skull in 42 patients (3.1%), one of whom was a patient with an unknown primary tumor. Twenty-two of the metastatic findings were in the brain, 16 were in the calvarium, and two were in the scalp. Conclusion. This study has demonstrated that addition of the brain to the limited whole body FDG-PET/CT scanning may provide important contributions to the patient’s clinical management especially in patients with lung cancer, bladder cancer, malignant melanoma, breast cancer, stomach cancer, and unknown primary tumor. Bekir Tasdemir, Zeki Dostbil, Ali Inal, Kemal Unal, Sule Yildirim, and F. Selcuk Simsek Copyright © 2014 Bekir Tasdemir et al. All rights reserved. A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy Thu, 12 Jun 2014 13:13:04 +0000 For pancreatic ductal adenocarcinoma (PDAC) of the head and/or body invading the splenic artery (SA), we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR). We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD) for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD () and PD-SAR (). Most patients were treated by preoperative chemoradiotherapy (CRT). Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, ), despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL. Ryosuke Desaki, Shugo Mizuno, Akihiro Tanemura, Masashi Kishiwada, Yasuhiro Murata, Yoshinori Azumi, Naohisa Kuriyama, Masanobu Usui, Hiroyuki Sakurai, Masami Tabata, and Shuji Isaji Copyright © 2014 Ryosuke Desaki et al. All rights reserved. Is Roux-Y Binding Pancreaticojejunal Anastomosis Feasible for Patients Undergoing Left Pancreatectomy? Results from a Prospective Randomized Trial Wed, 11 Jun 2014 09:28:38 +0000 Background. After pancreaticoduodenectomy, the Finnish binding pancreaticojejunal anastomosis (FBPJ) seems to reduce the risk for pancreatic fistula (POPF). Our aim was to investigate whether FBPJ is feasible and prevents the risk for POPF even after left pancreatectomy (LP). Patients and Methods. 47 consecutive patients underwent LP. 27 patients were recruited on the basis of CT and, of these, 16 patients were randomized on the basis of findings during surgery (transection line must be left of portal vein, as 2-3 cm pancreatic mobilization is required for FBPJ) to receive either Roux-Y FBPJ or hand-sewn closure of the pancreatic remnant. Results. Only 34% (16/47) of the patients met the randomization criteria. Clinically significant POPF rate was higher in FBPJ group (60%) compared to thand-sewn closure group (13%; ). POPF rate in FBPJ group was higher even when compared to all patients with hand-sewn closure (60% versus 37%; ). Overall, FBPJ was technically feasible for only 28% of patients. Conclusion. FBPJ cannot be recommended for the routine closure of the pancreatic remnant after LP, as it was not technically achievable in 72% of the cases. Moreover, the technique does not seem to reduce the risk for POPF compared to the hand-sewn closure. Anne Antila, Juhani Sand, Isto Nordback, Sari Räty, and Johanna Laukkarinen Copyright © 2014 Anne Antila et al. All rights reserved. Translational Research of Telecare for the Treatment of Hepatitis C Tue, 10 Jun 2014 04:56:17 +0000 Objective. Chronic hepatitis C virus (HCV) infection is a serious health problem in Taiwan. The high dropout rate due to side effects limits the efficacy of treatment. The objective of this study is to investigate the effectiveness of telecare for the treatment of chronic hepatitis. Material and Methods. Two hundred and ninety-eight patients randomly chose either of the two support programs. Group 1 was offered public health nurse consultation at outpatient clinic. Group 2 was offered telecare program with 24 hours of consultation services via a health communication center. All patients were treated with standard therapy and followed up for 72 weeks. Results. Normalization of serum biochemistry was noted in both Group 1 (150 patients) and Group 2 (148 patients). The most common types of side effect in both groups were influenza-like symptoms. Patient compliance was 88% (Group 1) and 94.6% (Group 2). Total dropout cases were 18 (12%) in Group 1 and 8 (5.4%) in Group 2. The program costs were 232,632 USD (Group 1) and 112,500 USD (Group 2). Conclusion. Telecare system with health care communication center model is significant in reducing dropout rate and is more effective with easy access. Wan-Lin Chen, Wen-Ta Chiu, Ming-Shun Wu, Mei-Huang Hsu, and Shin-Han Tsai Copyright © 2014 Wan-Lin Chen et al. All rights reserved. Face Transplantation: On the Verge of Becoming Clinical Routine? Mon, 09 Jun 2014 09:12:33 +0000 Introduction. Face transplantation (FT) is an innovative achievement of modern reconstructive surgery and is on the verge of becoming a common surgical opportunity. This review article was compiled to provide an update on this surgical field, especially regarding clinical outcomes, benefits, and complications implied. Methods. We performed an extensive research on all English-language Medline articles, case reports, and reviews published online until September 15, 2013. Used search terms were “face transplantation,” “face transplant,” “facial transplantation,” “facial transplant,” “face allograft,” and “facial allograft.” Results. To date 27 FTs have been performed worldwide. 19 of these cases have been published in the Medline database. Long-term follow-up reports of FT cases are rare. Three deaths associated with the procedure have occurred to date. The clinical outcomes of FT are satisfying. Reinnervation of sensation has been faster than motor recovery. Extensive functional improvements have been observed. Due to strict immunosuppression protocols, no case of hyperacute or chronic rejection and no graft-versus-host disease have occurred to date. Conclusions. As studies on long-term outcomes are missing, particularly regarding immunosuppression-related complications, FT will stay experimental for the next years. Nevertheless, for a small group of patients, FT already is a feasible reconstructive option. Ralf Smeets, Carsten Rendenbach, Moritz Birkelbach, Ahmed Al-Dam, Alexander Gröbe, Henning Hanken, and Max Heiland Copyright © 2014 Ralf Smeets et al. All rights reserved. Evaluation of Human Amniotic Membrane as a Wound Dressing for Split-Thickness Skin-Graft Donor Sites Mon, 09 Jun 2014 07:27:56 +0000 Human amniotic membrane (HAM) has been used as a biomaterial in various surgical procedures and exceeds some qualities of common materials. We evaluated HAM as wound dressing for split-thickness skin-graft (STSG) donor sites in a swine model (Part A) and a clinical trial (Part B). Part A: STSG donor sites in 4 piglets were treated with HAM or a clinically used conventional polyurethane (PU) foil ( each). Biopsies were taken on days 5, 7, 10, 20, 40, and 60 and investigated immunohistochemically for alpha-smooth muscle actin (SMA: wound contraction marker), von Willebrand factor (vWF: angiogenesis), Ki-67 (cell proliferation), and laminin (basement membrane integrity). Part B: STSG donor sites in 45 adult patients (16 female/29 male) were treated with HAM covered by PU foam, solely by PU foam, or PU foil/paraffin gauze ( each). Part A revealed no difference in the rate of wound closure between groups. HAM showed improved esthetic results and inhibitory effects on cicatrization. Angioneogenesis was reduced, and basement membrane formation was accelerated in HAM group. Part B: no difference in re-epithelialization/infection rate was found. HAM caused less ichor exudation and less pruritus. HAM has no relevant advantage over conventional dressings but might be a cost-effective alternative. Denys J. Loeffelbein, Nils H. Rohleder, Matthias Eddicks, Claudia M. Baumann, Mechthild Stoeckelhuber, Klaus-D. Wolff, Enken Drecoll, Lars Steinstraesser, Simone Hennerbichler, and Marco R. Kesting Copyright © 2014 Denys J. Loeffelbein et al. All rights reserved. Pancreas-Preserving Approach to “Paraduodenal Pancreatitis” Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy Thu, 05 Jun 2014 08:45:04 +0000 Background. The term “paraduodenal pancreatitis” (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly. Objective. To assess the results of different types of treatment for PP. Method. Prospective analysis of 62 cases of PP (2004–2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded.  Results. Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. Conclusions. PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not “paraduodenal,” origin. V. I. Egorov, A. N. Vankovich, R. V. Petrov, N. S. Starostina, A. Ts. Butkevich, A. V. Sazhin, and E. A. Stepanova Copyright © 2014 V. I. Egorov et al. All rights reserved. Efficacy of Combined Endoscopic Lithotomy and Extracorporeal Shock Wave Lithotripsy, and Additional Electrohydraulic Lithotripsy Using the SpyGlass Direct Visualization System or X-Ray Guided EHL as Needed, for Pancreatic Lithiasis Thu, 05 Jun 2014 07:44:17 +0000 Introduction. To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis. Methods. For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options. Results. Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (). Conclusions. In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate. Ken Ito, Yoshinori Igarashi, Naoki Okano, Takahiko Mimura, Yui Kishimoto, Seiichi Hara, and Kensuke Takuma Copyright © 2014 Ken Ito et al. All rights reserved. Comparison of Venous Thromboembolism after Total Hip Arthroplasty between Ankylosing Spondylitis and Osteoarthritis Wed, 04 Jun 2014 08:34:40 +0000 Objective. Ankylosing spondylitis (AS), an inflammatory rheumatic disease, will gradually lead to severe hip joint dysfunction. Total hip arthroplasty is a useful method to improve patients’ quality of life. The aim of this study was to compare the incidence and risk factors of deep vein thrombosis (DVT) between AS and hip osteoarthritis. Methods. In a retrospective study, a total of 149 subjects who underwent cementless THA were studied. Clinical data, biochemical data, and surgery-related data were measured between AS and OA groups. Results. The incidence of DVT in AS group was lower than that of OA group, although no significant difference was detected (). The patients of AS group were much younger () and thinner () compared with those of OA group. AS patients had higher ejection fraction (EF) (), higher platelet counts (), and lower hypertension rate (). The values of APTT, PT, and INR in AS patients were higher than those in OA patients (all ). The values of D-dimer and APTT were both significantly higher in DVT subjects than those in non-DVT subjects. Conclusion. AS patients potentially had a lower incidence of DVT compared with OA patients. Dongquan Shi, Xingquan Xu, Kai Song, Zhihong Xu, Jin Dai, Dongyang Chen, and Qing Jiang Copyright © 2014 Dongquan Shi et al. All rights reserved. Surgical Technique in Distal Pancreatectomy: A Systematic Review of Randomized Trials Thu, 29 May 2014 13:10:06 +0000 Despite recent improvements in surgical technique, the morbidity of distal pancreatectomy remains high, with pancreatic fistula being the most significant postoperative complication. A systematic review of randomized controlled trials (RCTs) dealing with surgical techniques in distal pancreatectomy was carried out to summarize up-to-date knowledge on this topic. The Cochrane Central Registry of Controlled Trials, Embase, Web of Science, and Pubmed were searched for relevant articles published from 1990 to December 2013. Ten RCTs were identified and included in the systematic review, with a total of 1286 patients being randomized (samples ranging from 41 to 450). The reviewers were in agreement for application of the eligibility criteria for study selection. It was not possible to carry out meta-analysis of these studies because of the heterogeneity of surgical techniques and approaches, such as varying methods of pancreas transection, reinforcement of the stump with seromuscular patch or pancreaticoenteric anastomosis, sealing with fibrin sealants and pancreatic stent placement. Management of the pancreatic remnant after distal pancreatectomy is still a matter of debate. The results of this systematic review are possibly biased by methodological problems in some of the included studies. New well designed and carefully conducted RCTs must be performed to establish the optimal strategy for pancreatic remnant management after distal pancreatectomy. Filip Čečka, Bohumil Jon, Zdeněk Šubrt, and Alexander Ferko Copyright © 2014 Filip Čečka et al. All rights reserved. Hip Joint Replacement Using Monofilament Polypropylene Surgical Mesh: An Animal Model Thu, 29 May 2014 00:00:00 +0000 Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform. Jacek Białecki, Marian Majchrzycki, Antoni Szymczak, Małgorzata Dorota Klimowicz-Bodys, Edward Wierzchoś, and Krzysztof Kołomecki Copyright © 2014 Jacek Białecki et al. All rights reserved. The State of the Art of Robotic Pancreatectomy Wed, 28 May 2014 05:47:22 +0000 During the last decades an increasing number of minimally invasive pancreatic resections have been reported in the literature. With the development of robotic surgery a new enthusiasm has not only increased the number of centers approaching minimally invasive pancreatic surgery in general but also enabled the use of this technique for major pancreatic procedures, in particular in minimally invasive pancreatoduodenectomy. The aim of this review was to define the state of the art of pancreatic robotic surgery. No prospective randomized trials have been performed comparing robotic, laparoscopic, and open pancreatic procedures. From the literature one may conclude that robotic pancreatectomies seem to be as feasible and safe as open procedures. The general idea that the overall perioperative costs of robotic surgery would be higher than traditional procedures is not supported. With the current lack of evidence of any oncologic advantages, the cosmetic benefits offered by robotic surgery are not enough to justify extensive use in cancer patients. In contrast, the safety of these procedure can justify the use of the robotic technique in patient with benign/low grade malignant tumors of the pancreas. Marco Del Chiaro and Ralf Segersvärd Copyright © 2014 Marco Del Chiaro and Ralf Segersvärd. All rights reserved. Propeller Flaps: A Review of Indications, Technique, and Results Mon, 26 May 2014 11:10:48 +0000 In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors’ experience. Details about surgical technique are provided, together with tips to avoid and manage complications. Salvatore D'Arpa, Francesca Toia, Roberto Pirrello, Francesco Moschella, and Adriana Cordova Copyright © 2014 Salvatore D'Arpa et al. All rights reserved. Prognostic Significance of Sentinel Lymph Node Mapping in Merkel Cell Carcinoma: Systematic Review and Meta-Analysis of Prognostic Studies Mon, 26 May 2014 10:51:46 +0000 Aim. To assess through a systematic review and meta-analysis of the literature the prognostic implication of sentinel lymph node mapping in Merkel cell carcinoma (MCC). Materials and Methods. PubMed and SCOPUS databases were searched by using “Merkel AND sentinel” as keywords. All studies with prognostic information regarding SLN mapping in cN0 MCC patients were included. Hazard ratio (HR) for overall survival (OS) and disease free survival (DFS) was used as effect size. Results. SLN biopsy predicted better DFS and OS as compared to the nodal observation in cN0 MCC patients (pooled HR for DFS: 1.61 (95% CI: 1.05–2.46), ; pooled HR for OS: 1.08 (95% CI: 0.55–2.10), ). Pathologically negative SLN (SLN−) patients had better OS (pooled HR: 4.42 (95% CI: 1.82–10.7), ) and DFS (pooled HR: 2.58 (95% CI: 1.78–3.73)) as compared to SLN+ patients. Conclusion. SLN mapping can provide strong prognostic information regarding OS and DFS in cN0 MCC patients. More importantly, SLN mapping can improve DFS and possibly OS in cN0 MCC patients as compared to nodal observation. As MCC is a rare tumor, large multicenter prospective studies are still needed to validate the survival benefit of SLN mapping. Ramin Sadeghi, Zohreh Adinehpoor, Masoud Maleki, Babak Fallahi, Luca Giovanella, and Giorgio Treglia Copyright © 2014 Ramin Sadeghi et al. All rights reserved. Endoscopic Evacuation of Basal Ganglia Hemorrhage via Keyhole Approach Using an Adjustable Cannula in Comparison with Craniotomy Sun, 18 May 2014 08:52:15 +0000 Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate. Heng-Zhu Zhang, Yu-Ping Li, Zheng-cun Yan, Xing-dong Wang, Lei She, Xiao-dong Wang, and Lun Dong Copyright © 2014 Heng-Zhu Zhang et al. All rights reserved. Long Term Follow-Up in Inferior Alveolar Nerve Transposition: Our Experience Tue, 13 May 2014 07:47:45 +0000 Introduction. Inferior alveolar nerve transposition (IANT) is a surgical technique used in implantoprosthetic rehabilitation of the atrophic lower jaw which has not been well embraced because of the high risk of damage to the inferior alveolar nerve (IAN). There are cases in which this method is essential to obtain good morphologic and functional rebalancing of the jaw. In this paper, the authors present their experience with IANT, analyzing the various situations in which IANT is the only surgical preprosthetic option. Methods. Between 2003 and 2011, 35 patients underwent surgical IANT at our center. Thermal and physical sensitivity were evaluated in each patient during follow-up. The follow-up ranged from 14 to 101 months. Results and Conclusion. Based on our experience, absolute indications of IANT are as follows: (1) class IV, V, or VI of Cawood and Howell with extrusion of the antagonist tooth and reduced prosthetic free space; (2) class V or VI of Cawood and Howell with presence of interforaminal teeth; (3) class V or VI of Cawood and Howell if patient desires fast implantoprosthetic rehabilitation with predictable outcomes; (4) class VI of Cawood and Howell when mandibular height increase with inlay grafts is advisable. Giulio Gasparini, Roberto Boniello, Gianmarco Saponaro, Tito Matteo Marianetti, Enrico Foresta, Andrea Torroni, Giuliana Longo, Camillo Azzuni, Daniele Cervelli, and Sandro Pelo Copyright © 2014 Giulio Gasparini et al. All rights reserved. Morphohistological Features of Pancreatic Stump Are the Main Determinant of Pancreatic Fistula after Pancreatoduodenectomy Tue, 13 May 2014 00:00:00 +0000 Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management. Aim of the Study. Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy. Patients and Methods. Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue. Results. Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex (), (), prolonged surgery (), soft pancreatic texture (), small pancreatic duct (), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin (), large stump area (), and extended stump mobilization () were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF (). Discussion and Conclusions. Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy. Cristina Ridolfi, Maria Rachele Angiolini, Francesca Gavazzi, Paola Spaggiari, Maria Carla Tinti, Fara Uccelli, Marco Madonini, Marco Montorsi, and Alessandro Zerbi Copyright © 2014 Cristina Ridolfi et al. All rights reserved. Current Innovations in Endoscopic Therapy for the Management of Colorectal Cancer: From Endoscopic Submucosal Dissection to Endoscopic Full-Thickness Resection Wed, 30 Apr 2014 07:24:52 +0000 Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for colorectal cancer. However, due to technical difficulties and an increased rate of complications, ESD is not widely used in the colorectum. In some cases, endoscopic treatment alone is insufficient for disease control, and laparoscopic surgery is required. The combination of laparoscopic surgery and endoscopic resection represents a new frontier in cancer treatment. Recent developments in advanced polypectomy and minimally invasive surgical techniques will enable surgeons and endoscopists to challenge current practice in colorectal cancer treatment. Endoscopic full-thickness resection (EFTR) of the colon offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to current endoscopic techniques. However, closure is necessary after EFTR and natural transluminal endoscopic surgery (NOTES). Innovative methods and new devices for EFTR and suturing are being developed and may potentially change traditional paradigms to achieve minimally invasive surgery for colorectal cancer. The present paper aims to discuss the complementary role of ESD and the future development of EFTR. We focus on the possibility of achieving EFTR using the ESD method and closing devices. Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Asahiro Morishita, Kunihiko Izuishi, and Tsutomu Masaki Copyright © 2014 Shintaro Fujihara et al. All rights reserved. The Osteogenesis of Bone Marrow Stem Cells on mPEG-PCL-mPEG/Hydroxyapatite Composite Scaffold via Solid Freeform Fabrication Tue, 29 Apr 2014 14:18:32 +0000 The study described a novel bone tissue scaffold fabricated by computer-aided, air pressure-aided deposition system to control the macro- and microstructure precisely. The porcine bone marrow stem cells (PBMSCs) seeded on either mPEG-PCL-mPEG (PCL) or mPEG-PCL-mPEG/hydroxyapatite (PCL/HA) composite scaffold were cultured under osteogenic medium to test the ability of osteogenesis in vitro. The experimental outcomes indicated that both scaffolds possessed adequate pore size, porosity, and hydrophilicity for the attachment and proliferation of PBMSCs and the PBMSCs expressed upregulated genes of osteogensis and angiogenesis in similar manner on both scaffolds. The major differences between these two types of the scaffolds were the addition of HA leading to higher hardness of PCL/HA scaffold, cell proliferation, and VEGF gene expression in PCL/HA scaffold. However, the in vivo bone forming efficacy between PBMSCs seeded PCL and PCL/HA scaffold was different from the in vitro results. The outcome indicated that the PCL/HA scaffold which had bone-mimetic environment due to the addition of HA resulted in better bone regeneration and mechanical strength than those of PCL scaffold. Therefore, providing a bone-mimetic scaffold is another crucial factor for bone tissue engineering in addition to the biocompatibility, 3D architecture with high porosity, and interpored connection. Han-Tsung Liao, Yo-Yu Chen, Yu-Ting Lai, Ming-Fa Hsieh, and Cho-Pei Jiang Copyright © 2014 Han-Tsung Liao et al. All rights reserved. Stereotactic Ablative Radiotherapy for Oligometastatic Disease in Liver Tue, 29 Apr 2014 09:07:27 +0000 Liver metastasis in solid tumors, including colorectal cancer, is the most frequent and lethal complication. The development of systemic therapy has led to prolonged survival. However, in selected patients with a finite number of discrete lesions in liver, defined as oligometastatic state, additional local therapies such as surgical resection, radiofrequency ablation, cryotherapy, and radiotherapy can lead to permanent local disease control and improve survival. Among these, an advance in radiation therapy made it possible to deliver high dose radiation to the tumor more accurately, without impairing the liver function. In recent years, the introduction of stereotactic ablative radiotherapy (SABR) has offered even more intensive tumor dose escalation in a few fractions with reduced dose to the adjacent normal liver. Many studies have shown that SABR for oligometastases is effective and safe, with local control rates widely ranging from 50% to 100% at one or two years. And actuarial survival at one and two years has been reported ranging from 72% to 94% and from 30% to 62%, respectively, without severe toxicities. In this paper, we described the definition and technical aspects of SABR, clinical outcomes including efficacy and toxicity, and related parameters after SABR in liver oligometastases from colorectal cancer. Myungsoo Kim, Seok Hyun Son, Yong Kyun Won, and Chul Seung Kay Copyright © 2014 Myungsoo Kim et al. All rights reserved. Splanchnicectomy for Pancreatic Cancer Pain Sun, 27 Apr 2014 00:00:00 +0000 Persistent pain is a serious problem that often contributes to a poor quality of life in pancreatic cancer patients. Medical management by opioid analgesics is often accompanied by side effects and incomplete pain relief. A celiac plexus block is a simple treatment which relieves pain, but the procedure demands a certain degree of proficiency and the duration of the effects obtained can be rather limited. Transhiatal bilateral splanchnicectomy achieves a certain denervation of splanchnic nerves, but it requires a laparotomy. Unilateral thoracoscopic splanchnicectomy is a minimally invasive procedure to cause definite denervation. Bilateral thoracoscopic splanchnicectomy is recommended for unsatisfactory cases or recurrent pain occurring after the initial unilateral splanchnicectomy. It is important to select the most suitable treatment depending on patients’ actual medical state and the predicted outcomes. Toshiro Masuda, Masafumi Kuramoto, Shinya Shimada, Satoshi Ikeshima, Kenichiro Yamamoto, Kenichi Nakamura, and Hideo Baba Copyright © 2014 Toshiro Masuda et al. All rights reserved. Immunohistochemical Detection of Cancer Stem Cell Related Markers CD44 and CD133 in Metastatic Colorectal Cancer Patients Tue, 22 Apr 2014 09:38:06 +0000 Aim. The goal of this study was to semiquantitatively detect presence of cancer stem cells markers CD44 and CD133 in immunohistochemically stained paired samples of colorectal cancer (CRC) and colorectal liver metastases (CLM). Level of staining intensity was compared to clinical and pathological characteristics of tumors with the aim to identify impact of CD44 or CD133 expression on tumor behavior. Patients and Methods. Formalin fixed paraffin embedded samples from 94 patients with colorectal tumor and liver metastases were collected at Sikl’s Department of Pathology. Samples were stained by antibodies against CD44 and CD133. Presence and intensity of staining was assessed semiquantitatively by three trained researchers. Results. Patients with higher level of CD133 staining in CRC had longer disease free interval (Cox-Mantel ), whereas we found no relation between CD44 expression and overall survival or disease free interval. CD133 expression in CRC and CLM differed based on CRC grading; in case of CD44 we found differences in staining intensity in individual stages of tumor lymph node invasion. Conclusion. Effect of cancer stem cell markers on prognosis of colorectal cancer can vary depending on pathological classification of tumor, and we have shown that CD133, generally considered to be a negative marker, can bear also clinically positive prognostic information in group of patients with colorectal liver metastases. Pavel Pitule, Miroslava Cedikova, Ondrej Daum, Jan Vojtisek, Ondrej Vycital, Petr Hosek, Vladislav Treska, Ondrej Hes, Milena Kralickova, and Vaclav Liska Copyright © 2014 Pavel Pitule et al. All rights reserved. Laparoscopic Resection for Rectal Cancer: What Is the Evidence? Wed, 16 Apr 2014 13:54:00 +0000 Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients’ quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer. Dedrick Kok-Hong Chan, Choon-Seng Chong, Bettina Lieske, and Ker-Kan Tan Copyright © 2014 Dedrick Kok-Hong Chan et al. All rights reserved. Total Reconstruction of the Auricle: Our Experiences on Indications and Recent Techniques Mon, 14 Apr 2014 00:00:00 +0000 Introduction. Auricular reconstruction is a great challenge in facial plastic surgery. With the advances in surgical techniques and biotechnology, different options are available for consideration. The aim of this paper is to review the knowledge about the various techniques for total auricular reconstruction based on the literature and our experience. Methods. Approximately 179 articles published from 1980 to 2013 were identified, and 59 articles were included. We have focused on the current status of total auricular reconstruction based on our personal experience and on papers of particular interest, published within the period of review. We have also included a prospective view on the tissue engineering of cartilage. Results. Most surgeons still practice total auricular reconstruction by employing techniques developed by Brent, Nagata, and Firmin with autologous rib cartilage. Within the last years, alloplastic frameworks for reconstruction have become well established. Choosing the reconstruction techniques depends mainly on the surgeon’s preference and experience. Prosthetic reconstruction is still reserved for special conditions, even though the material is constantly improving. Tissue engineering has a growing potential for clinical applicability. Conclusion. Auricular reconstruction still receives attention of plastic/maxillofacial surgeons and otolaryngologists. Even though clinical applicability lags behind initial expectations, the development of tissue-engineered constructs continues its potential development. K. Storck, R. Staudenmaier, M. Buchberger, T. Strenger, K. Kreutzer, A. von Bomhard, and T. Stark Copyright © 2014 K. Storck et al. All rights reserved. Technical Development of a New Semispherical Radiofrequency Bipolar Device (RONJA): Ex Vivo and In Vivo Studies Wed, 09 Apr 2014 14:23:29 +0000 The aim of this study is to inform about the development of a new semispherical surgical instrument for the bipolar multielectrode radiofrequency liver ablation. Present tools are universal; however they have several disadvantages such as ablation of healthy tissue, numerous needle punctures, and, therefore, longer operating procedure. Our newly designed and tested semispherical surgical tool can solve some of these disadvantages. By conducting an in vivo study on a set of 12 pigs, randomly divided into two groups, we have compared efficiency of the newly developed instrument with the commonly used device. Statistical analysis showed that there were no significant differences between the groups. On average, the tested instrument RONJA had shorter ablation time in both liver lobes and reduced the total operating time. The depth of the thermal alteration was on average 4 mm larger using the newly tested instrument. The new radiofrequency method described in this study could be used in open liver surgery for the treatment of small liver malignancies (up to 2 cm) in a single application with the aim of saving healthy liver parenchyma. Further experimental studies are needed to confirm these results before clinical application of the method in the treatment of human liver malignancies. Petr Vavra, Marek Penhaker, Jan Grepl, Jana Jurcikova, Jiri Palecek, Michal Crha, Jana Nowakova, Martin Hasal, Martina Skrobankova, Petr Ostruszka, Peter Ihnat, Patricie Delongova, Dana Salounova, Nagy A. Habib, and Pavel Zonca Copyright © 2014 Petr Vavra et al. All rights reserved. Patterns in the Parathyroid Response to Sodium Bicarbonate Infusion Test in Healthy Volunteers Tue, 08 Apr 2014 07:42:58 +0000 Background. The sodium bicarbonate infusion test evaluates the function of the parathyroid glands. The present study aims to evaluate the range of parathyroid response in healthy individuals and the potential influence of various factors. Methods. Fifty healthy volunteers were subjected to the test. Levels of vitamin D, calcium, albumin, and PTH were measured before infusion. PTH was measured at 3, 5, 10, 30, and 60 minutes after infusion. Results. A curve describing the response of parathyroids to the test was drawn. Twenty percent of the subjects had blunted PTH response. No significant difference was observed between normal and blunted responders concerning age, BMI, baseline PTH, or calcium levels. Nonetheless, there was a significant difference in vitamin D levels (). Interpretation. The test is easy to perform and may be used for everyday screening. It has to be clarified whether our observations are, at least partly, produced due to the presence of individuals with a constitutively blunted response or if low levels of vitamin D decrease the ability of the parathyroids to respond. Whichever the case, PTH response of normal individuals to sodium bicarbonate infusion test is more varied than previously thought and vitamin D levels influence it. Theodossis S. Papavramidis, Olympia E. Anastasiou, Ioannis Pliakos, Nick Michalopoulos, Mike Polyzonis, Konstantina Triantafyllopoulou, Georgia Kokaraki, and Spiros Papavramidis Copyright © 2014 Theodossis S. Papavramidis et al. All rights reserved. The Use of the Phrenic Nerve Communicating Branch to the Fifth Cervical Root for Nerve Transfer to the Suprascapular Nerve in Infants with Obstetric Brachial Plexus Palsy Mon, 31 Mar 2014 10:11:29 +0000 Traditionally, suprascapular nerve reconstruction in obstetric brachial plexus palsy is done using either the proximal C5 root stump or the spinal accessory nerve. This paper introduces another potential donor nerve for neurotizing the suprascapular nerve: the phrenic nerve communicating branch to the C5 root. The prevalence of this communicating branch ranges from 23% to 62% in various anatomical dissections. Over the last two decades, the phrenic communicating branch was used to reconstruct the suprascapular nerve in 15 infants. Another 15 infants in whom the accessory nerve was used to reconstruct the suprascapular nerve were selected to match the former 15 cases with regard to age at the time of surgery, type of palsy, and number of avulsed roots. The results showed that there is no significant difference between the two groups with regard to recovery of external rotation of the shoulder. It was concluded that the phrenic nerve communicating branch may be considered as another option to neurotize the suprascapular nerve. M. M. Al-Qattan and A. A. F. El-Sayed Copyright © 2014 M. M. Al-Qattan and A. A. F. El-Sayed. All rights reserved. Recombinant nAG (a Salamander-Derived Protein) Decreases the Formation of Hypertrophic Scarring in the Rabbit Ear Model Sun, 30 Mar 2014 10:04:30 +0000 nAG (newt-Anterrior Gradient) protein is the key mediator of regrowth of amputated limbs in salamanders. In a previous work in our lab, a new nAG gene (suitable for humans) was designed and cloned. The cloned vector was transfected into primary human fibroblasts. The expression of nAG in human primary fibroblasts was found to suppress collagen expression. The current study shows that local injection of recombinant nAG reduces scar hypertrophy in the rabbit ear model. This is associated with lower scar elevation index (SEI), lower levels of collagen I & III, higher levels of MMP1, and a higher degree of scar maturation in experimental wounds compared to controls. Mohammad M. Al-Qattan, Mervat M. Abd-Al Wahed, Khalid Hawary, Ahmed A. Alhumidi, and Medhat K. Shier Copyright © 2014 Mohammad M. Al-Qattan et al. All rights reserved. Colorectal Cancer: Prevention and Management of Metastatic Disease Mon, 24 Mar 2014 07:50:13 +0000 This paper compared the similarities and differences of the two most common types of colorectal cancer metastases. The treatment of liver metastases by surgery combined with systemic chemotherapy was explained. The different natural history of liver metastases as compared to peritoneal metastases and the possibility for prevention of peritoneal metastases were emphasized. Perioperative cancer chemotherapy or second-look surgery must be considered as individualized treatments of selected patients who have small volume peritoneal metastases or who are known to be at risk for subsequent disease progression on peritoneal surfaces. However, the fact that peritoneal metastases, when diagnosed in the follow-up of colorectal cancer patients, can be cured with a combination of cytoreductive surgery and hyperthermic perioperative chemotherapy cannot be ignored. Careful follow-up and timely intervention in colorectal cancer patients with progressive disease are a necessary part of the management strategies recommended by the multidisciplinary team. After a critical evaluation of the data currently available, these strategies for prevention and management of colorectal metastases are presented as the author’s recommendations for a high standard of care. As more information becomes available, modifications may be necessary. Paul H. Sugarbaker Copyright © 2014 Paul H. Sugarbaker. All rights reserved. TFIIB-Related Factor 2 Is Associated with Poor Prognosis of Nonsmall Cell Lung Cancer Patients through Promoting Tumor Epithelial-Mesenchymal Transition Mon, 17 Mar 2014 07:05:19 +0000 In this study, we found that increased BRF2 protein expression was prevalent in NSCLC. Overexpression of BRF2 correlated with abnormal expression of E-cadherin, N-cadherin, and snail. Additionally, expression of BRF2 was found to be an independent prognostic factor in NSCLC patients. Furthermore, we showed that targeted knockdown of BRF2 expression could inhibit the migratory and invasive abilities of NSCLC cells and induced loss of the epithelial-mesenchymal transition of NSCLC cells. These results suggested that BRF2 overexpression in tumor tissues is significantly associated with the poor prognosis of NSCLC patients through promoting epithelial-mesenchymal transition (EMT) program. Yu Tian, Ming Lu, Weiming Yue, Lin Li, Shuhai Li, Cun Gao, Libo Si, Lei Qi, Wensi Hu, and Hui Tian Copyright © 2014 Yu Tian et al. All rights reserved. Does Intraoperative Ulinastatin Improve Postoperative Clinical Outcomes in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials Sun, 09 Mar 2014 07:14:47 +0000 Introduction. The systematic meta-analysis of randomized controlled trials (RCTs) evaluated the effects of intraoperative ulinastatin on early-postoperative recovery in patients undergoing cardiac surgery. Methods. RCTs comparing intraoperative ulinastatin with placebo in cardiac surgery were searched through PubMed, Cochrane databases, Medline, SinoMed, and the China National Knowledge Infrastructure (1966 to May 20th, 2013). The primary endpoints included hospital mortality, postoperative complication rate, length of stay in intensive care unit, and extubation time. The physiological and biochemical parameters illustrating postoperative cardiac and pulmonary function as well as inflammation response were considered as secondary endpoints. Results. Fifteen RCTs (509 patients) met the inclusion criteria. Ulinastatin did not affect hospital mortality, postoperative complication rate, or ICU length of stay but reduced extubation time. Ulinastatin also increased the oxygenation index on postoperative day 1 and reduced the plasma level of cardiac troponin-I. Additionally, ulinastatin inhibited the increased level of tumor necrosis factor-alpha, polymorphonuclear neutrophil elastase, interleukin-6, and interleukin-8 associated with cardiac surgery. Conclusion. Ulinastatin may be of value for the inhibition of postoperative increased inflammatory agents and most likely provided pulmonary protective effects in cardiac surgery. However, larger adequately powered RCTs are required to define the clinical effect of ulinastatin on postoperative outcomes in cardiac surgery. Qiu-Lan He, Fei Zhong, Fang Ye, Ming Wei, Wei-Feng Liu, Mei-Na Li, Qiao-Bo Li, Wen-Qi Huang, Lai-Bao Sun, and Hai-Hua Shu Copyright © 2014 Qiu-Lan He et al. All rights reserved. Study of the Association between ITPKC Genetic Polymorphisms and Calcium Nephrolithiasis Mon, 03 Mar 2014 12:33:13 +0000 Nephrolithiasis is a multifactorial disease caused by environmental, hormonal, and genetic factors. Genetic polymorphisms of ORAI1, which codes for the main subunit of the store-operated calcium (SOC) channel, were reported to be associated with the risk and recurrence of calcium nephrolithiasis. Inositol 1,4,5-trisphosphate (IP3) 3-kinase C (ITPKC) is a negative regulator of the SOC channel-mediated signaling pathway. We investigated the association between calcium containing nephrolithiasis and genetic variants of ITPKC gene in Taiwanese patients. 365 patients were recruited in this study. Eight tagging single nucleotide polymorphisms of ITPKC were selected for genotyping. ITPKC genotypes were determined by TaqMan assay. ITPKC plasmids were transfected into cells to evaluate the intracellular calcium mobilization. Our results indicated that rs2607420 CC genotype in the intron region of the ITPKC gene is associated with a lower eGFR by both Modification of Diet in Renal Diseases () and Cockcroft-Gault () equations in patients with calcium nephrolithiasis. Our results identify a novel polymorphism for renal function and highlight the importance of ITPKC as a key molecule to regulate calcium signaling. Wei-Chih Kan, Yii-Her Chou, Siou-Jin Chiu, Yu-Wen Hsu, Hsing-Fang Lu, Wenli Hsu, and Wei-Chiao Chang Copyright © 2014 Wei-Chih Kan et al. All rights reserved. Tissue Factor and Tissue Factor Pathway Inhibitor in Chronically Inflamed Gallbladder Mucosa Thu, 27 Feb 2014 15:52:02 +0000 We characterised a tissue factor (TF) and tissue factor pathway inhibitor (TFPI) expression in relation to severity of inflammatory infiltration of the gallbladder mucosa in a chronic cholecystitis. We prospectively studied the gallbladder specimens obtained from 54 patients who had undergone cholecystectomy due to chronic calculous cholecystitis and 16 calculosis-free gallbladder specimens obtained from patients who underwent cholecystectomy due to the polyp/polyps as well as in cases of gallbladder injury. To assess TF and TFPI immunoreactivity by immunohistochemistry, the monoclonal anti-human TF and TFPI antibodies were used. The inflammatory infiltration of the gallbladder mucosa was reflected by the number of CD3 and CD68 positive cells. The expression of TF and TFPI differed significantly between the cholecystitis and the control group. Most capillary endothelial cells of the cholecystitis group presented weak expression for TFPI. The mean number of CD3 positive lymphocytes in the cholecystitis group was 18.6 ± 12.2, but the mean number of CD68 positive cells was 29.7 ± 13.9. In the control sections, it was 3.1 ± 1.9 and 8.8 ± 3.9, respectively (). The results of the current study suggest that the tissue procoagulant state found may be engaged in the etiopathogenesis of the cholecystitis. Jacek Liczko, Tomasz Stawski, Małgorzata Żaba, Józef Kurek, Daniel Sabat, Grzegorz Wyrobiec, Dorota Domal-Kwiatkowska, Damian Dudek, Marek Kucharzewski, and Krzysztof Helewski Copyright © 2014 Jacek Liczko et al. All rights reserved. Cone Beam Computed Tomographic Analyses of the Position and Course of the Mandibular Canal: Relevance to the Sagittal Split Ramus Osteotomy Thu, 27 Feb 2014 07:54:09 +0000 Purpose. The aim of this study was to document the position and course of the mandibular canal through the region of the mandibular angle and body in dental patients, using cone beam computed tomographic imaging. Methods. The position and course of the mandibular canal from the region of the third molar to the first molar were measured at five specific locations in the same plane: at three different positions just between the first and second molars; between the second and third molars; and just distal to the third molar. Results. The study sample was composed of 500 hemimandibles from 250 dental patients with a mean age of 26.32. Significant differences were found between genders, distances, and positions. B decreased significantly from the anterior positions to the posterior positions in both females and males. The mean values of S and CB increased significantly from the posterior positions to the anterior positions in both females and males. Conclusion. Because the sagittal split ramus osteotomy is a technically difficult procedure, we hope that the findings of the present study will help the surgeon in choosing the safest surgical technique for the treatment of mandibular deformities. Ahmet Ercan Sekerci and Halil Sahman Copyright © 2014 Ahmet Ercan Sekerci and Halil Sahman. All rights reserved. Relative Contribution of Haptic Technology to Assessment and Training in Implantology Thu, 20 Feb 2014 13:22:55 +0000 Background. The teaching of implant surgery, as in other medical disciplines, is currently undergoing a particular evolution. Aim of the Study. To assess the usefulness of haptic device, a simulator for learning and training to accomplish basic acts in implant surgery. Materials and Methods. A total of 60 people including 40 third-year dental students without knowledge in implantology (divided into 2 groups: 20 beginners and 20 experiencing a simulator training course) and 20 experienced practitioners (experience in implantology >15 implants) participated in this study. A basic exercise drill was proposed to the three groups to assess their gestural abilities. Results. The results of the group training with the simulator tended to be significantly close to those of the experienced operators. Conclusion. Haptic simulator brings a real benefit in training for implant surgery. Long-term benefit and more complex exercises should be evaluated. David Joseph, Jean-Philippe Jehl, Pablo Maureira, Cyril Perrenot, Neal Miller, Pierre Bravetti, Pascal Ambrosini, and Nguyen Tran Copyright © 2014 David Joseph et al. All rights reserved. Clinical Outcomes after Treatment of Periodontal Intrabony Defects with Nanocrystalline Hydroxyapatite (Ostim) or Enamel Matrix Derivatives (Emdogain): A Randomized Controlled Clinical Trial Sun, 09 Feb 2014 13:13:08 +0000 Introduction. Periodontitis is an inflammatory process in response to dental biofilm and leads to periodontal tissue destruction. The aim of this study was the comparison of outcomes using either an enamel matrix derivative (EMD) or a nanocrystalline hydroxyapatite (NHA) in regenerative periodontal therapy after 6 and 12 months. Methods. Using a parallel group, prospective randomized study design, we enrolled 19 patients in each group. The primary outcome was bone fill after 12 months. Attachment gain, probing pocket depth (PPD) reduction, and recession were secondary variables. Additionally, early wound healing and adverse events were assessed. Data analysis included test of noninferiority of NHA group (test) compared to EMD group (reference) in bone fill. Differences in means of secondary variables were compared by paired t-test, frequency data by exact χ2 test. Results. Both groups showed significant bone fill, reduction of PPD, increase in recession, and gain of attachment after 6 and 12 months. No significant differences between groups were found at any time point. Adverse events were comparable between both groups with a tendency of more complaints in the NHA group. Conclusion. The clinical outcomes were similar in both groups. EMD could have some advantage compared to NHA regarding patients comfort and adverse events. The trial is registered with NCT00757159. Elyan Al Machot, Thomas Hoffmann, Katrin Lorenz, Ihssan Khalili, and Barbara Noack Copyright © 2014 Elyan Al Machot et al. All rights reserved. Transverse Skin Crease versus Vertical Midline Incision versus Laparoscopy for Right Hemicolectomy: A Systematic Review—Current Status of Right Hemicolectomy Thu, 30 Jan 2014 09:59:00 +0000 Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy. Alberto Santoro, Carlo Boselli, Claudio Renzi, Francesca Gubbiotti, Veronica Grassi, Giorgio Di Rocco, Roberto Cirocchi, and Adriano Redler Copyright © 2014 Alberto Santoro et al. All rights reserved. Long-Term Use of Probiotics Lactobacillus and Bifidobacterium Has a Prophylactic Effect on the Occurrence and Severity of Pouchitis: A Randomized Prospective Study Tue, 21 Jan 2014 13:55:58 +0000 Aim. The aim of the study was to assess the impact of the long-term use of the composite probiotics in patients after restorative proctocolectomy. Method. Forty-three patients (20 females and 23 males, aged 21 to 68 years) after restorative proctocolectomy were included in the study. After randomization patients were divided into placebo group and treatment group with oral intake of probiotic containing Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Bifidobacterium bifidus. Patients were investigated during initial visit and during final visit after 9 months. All patients were subjected to standard clinical and endoscopic examination with microscopic study of the specimens. Concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK were determined in all cases. Results. The average severity of pouchitis and the number of patients with pouchitis significantly decrease after 9 months of the probiotic taking. The concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK significantly decreased after the therapy. Conclusions. Nine months of the probiotic treatment (Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Bifidobacterium bifidus) reduced the number of patients with pouchitis, decreased the PDAI score, and also decreased the fecal pyruvate kinase and calprotectin. The long-term probiotics use is safe and well accepted and can be an effective method of the pouchitis prevention. Banasiewicz Tomasz, Stojcev Zoran, Walkowiak Jarosław, Marciniak Ryszard, Grochowalski Marcin, Burdyński Robert, Krokowicz Piotr, Krokowicz Lukasz, Paszkowski Jacek, Gronek Piotr, Pyda Przemysław, and Drews Michał Copyright © 2014 Banasiewicz Tomasz et al. All rights reserved. The Evidence for Nerve Repair in Obstetric Brachial Plexus Palsy Revisited Thu, 16 Jan 2014 08:29:25 +0000 Strong scientific validation for nerve reconstructive surgery in infants with Obstetric Brachial Plexus Palsy is lacking, as no randomized trial comparing surgical reconstruction versus conservative treatment has been performed. A systematic review of the literature was performed to identify studies that compare nerve reconstruction to conservative treatment, including neurolysis. Nine papers were identified that directly compared the two treatment modalities. Eight of these were classified as level 4 evidence and one as level 5 evidence. All nine papers were evaluated in detail to describe strong and weak points in the methodology, and the outcomes from all studies were presented. Pooling of data was not possible due to differences in patient selection for surgery and outcome measures. The general consensus is that nerve reconstruction is indicated when the result of nerve surgery is assumedly better than the expected natural recovery, when spontaneous recovery is absent or severely delayed. The papers differed in methodology on how the cut-off point to select infants for nerve reconstructive surgical therapy should be determined. The justification for nerve reconstruction is further discussed. Willem Pondaag and Martijn J. A. Malessy Copyright © 2014 Willem Pondaag and Martijn J. A. Malessy. All rights reserved. Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy Sun, 12 Jan 2014 16:45:08 +0000 Purpose. This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery. Methods. Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data. Results. This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation. Discussion. The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery. Stuart A. Bade, Jenny C. Lin, Christine G. Curtis, and Howard M. Clarke Copyright © 2014 Stuart A. Bade et al. All rights reserved. Median Nerve to Biceps Nerve Transfer to Restore Elbow Flexion in Obstetric Brachial Plexus Palsy Thu, 09 Jan 2014 09:53:39 +0000 Median nerve to biceps nerve transfer in the arm has been reported only in adults. The following paper reports on 10 cases of this transfer in obstetric brachial plexus palsy. All patients had upper palsy (ERb’s or extended ERb’s palsy) and presented to the author late (13–19 months of age) with poor or no recovery of elbow flexion. Following the nerve transfer, nine children recovered elbow flexion (a score of 6 in one child and a score of 7 in eight children by the Toronto scale). The remaining child did not recover elbow flexion. M. M. Al-Qattan and T. M. Al-Kharfy Copyright © 2014 M. M. Al-Qattan and T. M. Al-Kharfy. All rights reserved. Obstetric Brachial Plexus Palsy: The Mallet Grading System for Shoulder Function—Revisited Sun, 05 Jan 2014 11:57:17 +0000 The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The aim of the current study is to investigate the percentage of children in which the Mallet score could not be applied because of a discrepancy between the deficiency of shoulder abduction and shoulder external rotation. The study group included 50 consecutive unoperated older children (over 5 years of age) with Erb’s palsy and deficits in shoulder movements. The Mallet score could be applied in 40 cases (80%). In the remaining 10 cases (20%), the Mallet score could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation () or vice versa (). It was concluded that documenting the deficits in shoulder abduction and external rotation are best done separately and this can be accomplished by using other grading systems. M. M. Al-Qattan and A. A. F. El-Sayed Copyright © 2014 M. M. Al-Qattan and A. A. F. El-Sayed. All rights reserved. Triceps Innervation Pattern: Implications for Triceps Nerve to Deltoid Nerve Transfer Mon, 30 Dec 2013 07:42:17 +0000 There are multiple nerve branches supplying the triceps. Traditionally, the nerve to the long head of triceps is utilized for nerve transfer to neurotize the deltoid muscle in patients with brachial plexus injuries. However, no anatomical studies were done to investigate which triceps nerve would be preferred for nerve transfer. This anatomical study was carried out to describe the innervation pattern of the triceps muscle to investigate the preferred triceps nerve for nerve transfer. Twenty-five cadaveric arms were dissected. The long head of the triceps received a single branch in 23 cases (92%) and double branches in 2 cases (8%) only. The medial head had a single branch in 22 cases (88%) and double branches in 3 cases (12%). The lateral head was the most bulky one and received more than one branch in all cases (100%), ranging from 2 to 5 branches. The transfer of the most proximal branch to the lateral head of the triceps seems to be the most preferred choice for deltoid muscle innervation. Obaid Al-Meshal and Alain Gilbert Copyright © 2013 Obaid Al-Meshal and Alain Gilbert. All rights reserved. Bilateral Single-Port Sympathectomy: Long-Term Results and Quality of Life Sat, 07 Dec 2013 16:04:56 +0000 Object. Video-assisted thoracoscopic sympathectomy is a safe, effective, and minimally invasive procedure for primary hyperhidrosis. This study aims to evaluate long-term results and patients’ quality of life and investigate potential variables responsible for compensatory sweating after one-stage bilateral single-port thoracoscopic sympathectomy. Methods. Between 2005 and 2011, 260 consecutive bilateral thoracoscopic sympathectomies were performed in 130 patients for primary palmar and axillary hyperidrosis through one-port access. Residual pain, postoperative complications, recurrence of symptoms, heart rate adjustment, and quality of life were analyzed. Multivariate analysis was performed. Results. No operative mortality and conversion to open surgery were recorded. Mean operative time was 38 ± 5 minutes. Mean hospital stay was 1.1 ± 0.6 days. Eight patients (6%) had unilateral pneumothorax. Twenty-five cases (19%) were complicated by compensatory sweating. Winter and fall were identified as protective factors for compensatory sweating occurrence. Decreased heart rate was observed 1 year after surgery and permanently over the time. No recurrence during the follow-up period (31.5 months) was observed and 90% of patients showed improved quality of life. Conclusions. One-stage bilateral miniuniportal thoracoscopic sympathectomy is a valid and safe treatment for primary hyperhidrosis, achieving definitive and esthetic results, with excellent patients’ satisfaction. Compensatory sweating may potentially occur in a season-dependent manner. Mohsen Ibrahim, Cecilia Menna, Claudio Andreetti, Anna Maria Ciccone, Antonio D'Andrilli, Giulio Maurizi, Leda Marina Pomes, Francesco Cassiano, Federico Venuta, and Erino A. Rendina Copyright © 2013 Mohsen Ibrahim et al. All rights reserved. Rotational Transport of Islets: The Best Way for Islets to Get around? Wed, 13 Nov 2013 08:47:37 +0000 Islet transplantation is a valid treatment option for patients suffering from type 1 diabetes mellitus. To assure optimal islet cell quality, specialized islet isolation facilities have been developed. Utilization of such facilities necessitates transportation of islet cells to distant institutions for transplantation. Despite its importance, a clinically feasible solution for the transport of islets has still not been established. We here compare the functionality of isolated islets from C57BL/6 mice directly after the isolation procedure as well as after two simulated transport conditions, static versus rotation. Islet cell quality was assessed using real-time live confocal microscopy. In vivo islet function after syngeneic transplantation was determined by weight and blood sugar measurements as well as by intraperitoneal glucose tolerance tests. Vascularization of islets was documented by fluorescence microscopy and immunohistochemistry. All viability parameters documented comparable cell viability in the rotary group and the group transplanted immediately after isolation. Functional parameters assessed in vivo displayed no significant difference between these two groups. Moreover, vascularization of islets was similar in both groups. In conclusion, rotary culture conditions allows the maintenance of highest islet quality for at least 15 h, which is comparable to that of freshly isolated islets. Rupert Oberhuber, Christof Mittermair, Bettina Zelger, Daniela Pirkebner, Anna Draxl, Annemarie Weissenbacher, Thomas Resch, Christian Margreiter, Robert Sucher, Raimund Margreiter, Johann Pratschke, Paul Hengster, and Martin Hermann Copyright © 2013 Rupert Oberhuber et al. All rights reserved. Comparison of New Technology Integrated and Nonintegrated Arterial Filters Used in Cardiopulmonary Bypass Surgery: A Randomized, Prospective, and Single Blind Study Mon, 11 Nov 2013 14:10:12 +0000 Background. Innovative cardiopulmonary bypass (CPB) settings have been developed in order to integrate the concepts of “surface-coating,” “blood-filtration,” and “miniaturization.” Objectives. To compare integrated and nonintegrated arterial line filters in terms of peri- and postoperative clinical variables, inflammatory response, and transfusion needs. Material and Methods. Thirty-six patients who underwent coronary bypass surgery were randomized into integrated (Group In) and nonintegrated arterial line filter (Group NIn) groups. Arterial blood samples for the assessments of complete hemogram, biochemical screening, interleukin-6, interleukin-2R, and C-reactive protein were analyzed before and after surgery. Need for postoperative dialysis, inotropic therapy and transfusion, in addition to extubation time, total amount of drainage (mL), length of intensive care unit, and hospital stay, and mortality rates was also recorded for each patient. Results. Prime volume was significantly higher and mean intraoperative hematocrit value was lower in Group NIn, but need for erythrocyte transfusion was significantly higher in Group NIn. C-reactive protein values did not differ significantly except for postoperative second day's results, which were found significantly lower in Group In than in Group NIn. Conclusion. Intraoperative hematocrit levels were higher and need for postoperative erythrocyte transfusion was decreased in Group In. Özgür Gürsu, Selim Isbir, Koray Ak, Fethullah Gerin, and Sinan Arsan Copyright © 2013 Özgür Gürsu et al. All rights reserved. Gastric Stump Cancer: More Than Just Another Proximal Gastric Cancer and Demanding a More Suitable TNM Staging System Mon, 16 Sep 2013 13:21:45 +0000 Background. Considerable controversy persists about the biological behavior of gastric stump cancer (GSC). The aim of this study is to clarify if this cancer is just another proximal gastric cancer or if it emerges as a distinctive clinicopathologic entity. Methods. This review of a prospectively collected gastric cancer database identified 73 patients with GSC in a single institution between January 1980 and June 2012 and compared them with 328 patients with proximal gastric cancer (PGC) and 291 patients with esophagogastric junction cancer (EGJC). Results. Patients with GSC were predominantly males. Eighty-three percent of GSC penetrated the subserosal or the serosal layers. The median number of lymph nodes retrieved in GSC patients was significantly lower than in PGC patients or in EGJC patients. Cumulative survival curves were not different between GSC, PGC, or EGJC patients. Unlike that observed in PGC and in EGJC, no significant differences in cumulative survival according to the TNM staging system were observed in GSC cases. Conclusions. The outcome of patients with GSC displayed significant differences when compared to those with other proximal gastric cancers concerning the lack of survival association with the TNM staging system. Therefore a more suitable staging system should be designed for these unique cancers. André Costa-Pinho, J. Pinto-de-Sousa, José Barbosa, and J. Costa-Maia Copyright © 2013 André Costa-Pinho et al. All rights reserved. 3D-Culture System for Heart Regeneration and Cardiac Medicine Sun, 08 Sep 2013 10:24:05 +0000 3D cultures have gained attention in the field of regenerative medicine for their usefulness as in vitro model of solid tissues. Bottom-up technology to generate artificial tissues or organs is prospective and an attractive approach that will expand as the field of regenerative medicine becomes more translational. We have characterized c-kit positive cardiac stem cells after long-term cultures and established a 3D-nanoculture system using collagen scaffolds. By combining informatics-based studies, including proteomic analyses and microarrays, we sought to generate methods that modeled cardiac regeneration which can ultimately be used to build artificial hearts. Here, we describe the use of biodegradable beads or 3D cultures to study cardiac regeneration. We summarize recent work that demonstrates that, by using a combination of molecular analyses with 3D cultures, it is possible to evaluate concise mechanisms of solid tissue stem cell biology. Nanako Kawaguchi, Kota Hatta, and Toshio Nakanishi Copyright © 2013 Nanako Kawaguchi et al. All rights reserved. Preliminary Results of Implantation in Animal Model and Osteoblast Culture Evaluation of Prototypes of Biomimetic Multispiked Connecting Scaffold for Noncemented Stemless Resurfacing Hip Arthroplasty Endoprostheses Mon, 29 Jul 2013 13:57:29 +0000 We present the new fixation method for RHA (resurfacing hip arthroplasty) endoprostheses by means of the biomimetic multispiked connecting scaffold (MSC-Scaffold). Such connecting scaffold can generate new type of RHA endoprostheses, that is stemless and fixed entirely without cement. The preprototypes of this MSC-Scaffold were manufactured with modern additive laser additive technology (SLM). The pilot surgical implantations in animal model (two laboratory swine) of MSC-Scaffold preprototypes have showed after two months neither implant loosening, migration, and nor other early complications. From the results of performed histopathological evaluation of the periscaffold spikes bone tissue and 10-day culture of human osteoblasts (NHOst) we can conclude that (1) the scaffolding effect was obtained and (2) to improve the osseointegration of the scaffold spikes, their material surface should be physicochemically modified (e.g., with hydroxyapatite). Some histopathological findings in the periscaffold domain near the MSC-Scaffold spikes bases (fibrous connective tissue and metallic particles near the MSC-Scaffold spikes bases edges) prompt considering the necessity to optimize the design of the MSC-Scaffold in the regions of its interspike space near the spikes bases edges, to provide more room for new bone formation in this region and for indispensable post-processing (glass pearl blasting) after the SLM manufacturing. Ryszard Uklejewski, Piotr Rogala, Mariusz Winiecki, Andrzej Kędzia, and Piotr Ruszkowski Copyright © 2013 Ryszard Uklejewski et al. All rights reserved. Growth Factors Serum Levels in Coronary Artery Disease Patients Scheduled for Bypass Surgery: Perioperative Dynamics and Comparisons with Healthy Volunteers Mon, 29 Jul 2013 08:39:37 +0000 Background. Vascular endothelial growth factors are important mediators for neovascularization of chronically ischemic adult heart, but their elevated values have also been connected with acute ischemia. Coronary artery bypass grafting (CABG) is associated with activation of inflammatory processes. We aimed to clarify whether the latter is also accompanied with acute changes in concentrations of vascular growth factors. Methods. Concentrations of growth factors VEGF and EGF, monocyte chemoattractant protein-1 (MCP-1), and a set of cytokines of 39 patients with stable coronary artery disease (CAD) were evaluated before and after CABG. Preoperative values were compared with data of healthy volunteers. Results. In comparison with CAD patients, healthy controls had significantly higher values of VEGF (15.5 (10.05–35.3) and 119.4 (55.7–136.9) pg/mL, resp.), EGF (1.70 (1.14–3.18) and 37.3 (27.1–51.9) pg/mL, resp.), and MCP-1 (111.6 (81.75–171.9) and 156.9 (134.7–241.3) pg/mL, resp.). MCP-1, but not others, demonstrated a significant rise throughout the postoperative period. Proinflammatory interleukin-6 was significantly higher and anti-inflammatory IL-4 and IL-10 lower in patients with CAD. Conclusions. Patients with stable CAD have lower serum levels of growth factors than healthy volunteers. MCP-1, but not VEGF and EGF, becomes elevated immediately after CABG. Inflammatory status of CAD patients was drifted towards proinflammatory state. Inga Karu, Joel Starkopf, Kersti Zilmer, and Mihkel Zilmer Copyright © 2013 Inga Karu et al. All rights reserved. The Investigation of Laparoscopic Instrument Movement Control and Learning Effect Wed, 24 Jul 2013 09:06:30 +0000 Laparoscopic surgery avoids large incisions for intra-abdominal operations as required in conventional open surgery. Whereas the patient benefits from laparoscopic techniques, the surgeon encounters new difficulties that were not present during open surgery procedures. However, limited literature has been published in the essential movement characteristics such as magnification, amplitude, and angle. For this reason, the present study aims to investigate the essential movement characteristics of instrument manipulation via Fitts' task and to develop an instrument movement time predicting model. Ten right-handed subjects made discrete Fitts' pointing tasks using a laparoscopic trainer. The experimental results showed that there were significant differences between the three factors in movement time and in throughput. However, no significant differences were observed in the improvement rate for movement time and throughput between these three factors. As expected, the movement time was rather variable and affected markedly by direction to target. The conventional Fitts' law model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional model. These findings pointed to a design direction for the laparoscopic surgery training program, and the predictive model can be used to establish standards in the training procedure. Chiuhsiang Joe Lin and Hung-Jen Chen Copyright © 2013 Chiuhsiang Joe Lin and Hung-Jen Chen. All rights reserved. Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience Thu, 30 May 2013 09:01:56 +0000 Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan’s experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan. Yu-Kai Huang, Chieh Chou, Chung-Liang Li, Hui-Gin Chiu, and Yu-Tang Chang Copyright © 2013 Yu-Kai Huang et al. All rights reserved. Soft Tissue Response to the Presence of Polypropylene-G-Poly(ethylene glycol) Comb-Type Graft Copolymers Containing Gold Nanoparticles Sun, 25 Dec 2011 13:01:09 +0000 The aim of this study is to evaluate the soft tissue response of the pure and Au-embedded PPg-PEG. PP-g-PEG2000, PP-g-PEG4000, Au-PP-g-PEG2000, and AuPP-g-PEG4000 were obtained via chlorination of polypropylene and polyethylene glycol in the presence of a base with a “grafting onto” technique. Solvent cast films of these four copolymers with PP as a control group were embedded into five different rats. After 30 days of implantation, microscopic evaluation of inflammation and SEM analysis were done. PP had the most intense inflammatory reaction among the other polymers. PP-PEG block copolymers with high molecular weight and gold-nanoparticles-embedded ones revealed mild inflammatory reaction independently. SEM assessment revealed punched hole-like defects on the surface of all polymer samples except for PP. Graft copolymers with PEG, especially Au-attached ones, have favorable soft tissue response, and inflammatory reaction becomes milder as the number of PEG side chains increases. Derya Burcu Hazer, Baki Hazer, and Nazmiye Dinçer Copyright © 2011 Derya Burcu Hazer et al. All rights reserved. Relative Quantification of Several Plasma Proteins during Liver Transplantation Surgery Sat, 10 Dec 2011 13:34:49 +0000 Plasma proteome is widely used in studying changes occurring in human body during disease or other disturbances. Immunological methods are commonly used in such studies. In recent years, mass spectrometry has gained popularity in high-throughput analysis of plasma proteins. In this study, we tested whether mass spectrometry and iTRAQ-based protein quantification might be used in proteomic analysis of human plasma during liver transplantation surgery to characterize changes in protein abundances occurring during early graft reperfusion. We sampled blood from systemic circulation as well as blood entering and exiting the liver. After immunodepletion of six high-abundant plasma proteins, trypsin digestion, iTRAQ labeling, and cation-exchange fractionation, the peptides were analyzed by reverse phase nano-LC-MS/MS. In total, 72 proteins were identified of which 31 could be quantified in all patient specimens collected. Of these 31 proteins, ten, mostly medium-to-high abundance plasma proteins with a concentration range of 50–2000 mg/L, displayed relative abundance change of more than 10%. The changes in protein abundance observed in this study allow further research on the role of several proteins in ischemia-reperfusion injury during liver transplantation and possibly in other surgery. Ville Parviainen, Sakari Joenväärä, Eija Tukiainen, Minna Ilmakunnas, Helena Isoniemi, and Risto Renkonen Copyright © 2011 Ville Parviainen et al. All rights reserved. Preparation and Characterization of a Novel Skin Substitute Wed, 22 Sep 2010 16:09:22 +0000 Autologous epidermal cell cultures (CEA) represent a possibility to treat extensive burn lesions, since they allow a significative surface expansion which cannot be achieved with other surgical techniques based on autologous grafting. Moreover currently available CEA preparations are difficult to handle and their take rate is unpredictable. This study aimed at producing and evaluating a new cutaneous biosubstitute made up of alloplastic acellular glycerolized dermis (AAGD) and CEA to overcome these difficulties. A procedure that maintained an intact basement membrane was developed, so as to promote adhesion and growth of CEA on AAGD. Keratinocytes were seeded onto AAGD and cultured up to 21 days. Viability tests and immunohistochemical analysis with specific markers were carried out at 7, 14, and 21 days, to evaluate keratinocyte adhesion, growth, and maturation. Our results support the hypothesis that this newly formed skin substitute could allow its permanent engraftment in clinical application. Carlotta Castagnoli, Mara Fumagalli, Daniela Alotto, Irene Cambieri, Stefania Casarin, Alessia Ostorero, Raffaella Casimiri, Patrizia Germano, Carla Pezzuto, and Maurizio Stella Copyright © 2010 Carlotta Castagnoli et al. All rights reserved.