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Baghaie L, Haxho F, Leroy F, Lewis B, Wawer A, Minhas S, Harless WW, Szewczuk MR. Contemporaneous Perioperative Inflammatory and Angiogenic Cytokine Profiles of Surgical Breast, Colorectal, and Prostate Cancer Patients: Clinical Implications. Cells 2023; 12:2767. [PMID: 38067195 PMCID: PMC10706122 DOI: 10.3390/cells12232767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Surgery-induced tumor growth acceleration and synchronous metastatic growth promotion have been observed for decades. Surgery-induced wound healing, orchestrated through growth factors, chemokines, and cytokines, can negatively impact patients harboring residual or metastatic disease. We provide detailed clinical evidence of this process in surgical breast, prostate, and colorectal cancer patients. Plasma samples were analyzed from 68 cancer patients who had not received treatment before surgery or adjuvant therapy until at least four weeks post-surgery. The levels of plasma cytokines, chemokines, and growth factors were simultaneously quantified and profiled using multiplexed immunoassays for eight time points sampled per patient. The immunologic processes are induced immediately after surgery in patients, characterized by a drastic short-term shift in the expression levels of pro-inflammatory and angiogenic molecules and cytokines. A rapid and significant spike in circulating plasma levels of hepatocyte growth factor (HGF), interleukin-6 (IL-6), placental growth factor (PLGF), and matrix metalloproteinase-9 (MMP-9) after surgery was noted. The rise in these molecules was concomitant with a significant drop in transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF-AB/BB), insulin-like growth factor-1 (IGF-1), and monocyte chemoattractant protein-2 (MCP-2). If not earlier, each plasma analyte was normalized to baseline levels within 1-2 weeks after surgery, suggesting that surgical intervention alone was responsible for these effects. The effects of surgical tumor removal on disrupting the pro-inflammatory and angiogenic plasma profiles of cancer patients provide evidence for potentiating malignant progression. Our findings indicate a narrow therapeutic window of opportunity after surgery to prevent disease recurrence.
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Affiliation(s)
- Leili Baghaie
- Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (L.B.); (F.H.); (F.L.)
| | - Fiona Haxho
- Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (L.B.); (F.H.); (F.L.)
- Dermatology Residency Program, the Cumming School of Medicine, University of Calgary, Calgary, AB T2T 5C7, Canada
| | - Fleur Leroy
- Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (L.B.); (F.H.); (F.L.)
- Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, F-67000 Strasbourg, France
| | - Beth Lewis
- ENCYT Technologies Inc., Membertou, NS B1S 0H1, Canada; (B.L.); (A.W.); (S.M.)
| | - Alexander Wawer
- ENCYT Technologies Inc., Membertou, NS B1S 0H1, Canada; (B.L.); (A.W.); (S.M.)
| | - Shamano Minhas
- ENCYT Technologies Inc., Membertou, NS B1S 0H1, Canada; (B.L.); (A.W.); (S.M.)
| | - William W. Harless
- ENCYT Technologies Inc., Membertou, NS B1S 0H1, Canada; (B.L.); (A.W.); (S.M.)
| | - Myron R. Szewczuk
- Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (L.B.); (F.H.); (F.L.)
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Truant S, Baillet C, Deshorgue AC, El Amrani M, Huglo D, Pruvot FR. Contribution of hepatobiliary scintigraphy in assessing ALPPS most suited timing. Updates Surg 2017; 69:411-419. [PMID: 28795384 DOI: 10.1007/s13304-017-0481-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 07/12/2017] [Indexed: 12/12/2022]
Abstract
To reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future remnant liver (FRL). Nevertheless, high morbi-mortality rates have been reported . The current study aimed to analyze the kinetics of FRL function in patients who were offered ALPPS. Serial SPECT (99 m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) was performed in all patients before and after surgery as well as at inter-stage to quantitatively assess hepatic function [total liver (TL) and FRL]. Patients were offered ALPPS for colorectal liver metastases (CLMs) (n = 6) and gallbladder carcinoma (n = 1). The data of delta of function or volume, expressed as (postoperative FRL - preoperative FRL/preoperative FRL) were compared to those derived from HBS of patients referred to the university hospital of Lille for one-stage major hepatectomy (n = 93). Additionally, the intrinsic liver function (i.e. function per unit of volume) was used to assess the regeneration rate. All but one patient had an anticipated FRL to body weight ratio (FRLBWR) ≤0.5%. Inter-stages HBS showed a progressive attenuation of the functional value of the excluded hepatic segments in favour of the FRL for all patients. Overall, there was a drop of total liver function contrasting with subnormal passive biochemical tests. Notably, the increase in FRL function between ALPPS stages [+12.5% (4.2-28.6%)] was lower than the volumetric gain [+42.6% (18.3-110.2%)] and inferior to that observed after one-stage major hepatectomy [+41.7% (-38.6 to +158.33%)]. This resulted in a drop of the FRL intrinsic liver function in ALPPS patients, of whom one died from PHLF. Our study enhances the importance of assessing liver function along with volume during ALPPS procedure and supports HBS as a suitable and reliable method, including a valuable contribution to determine most appropriate stage 2 surgical timing.
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Affiliation(s)
- Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000, Lille, France.
| | - Clio Baillet
- Department of Nuclear Medicine, Hôpital HURIEZ, Lille, France
| | - Anne Claire Deshorgue
- Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000, Lille, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000, Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, Hôpital HURIEZ, Lille, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000, Lille, France
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Zhang Y, Kuchimanchi M, Zhu M, Doshi S, Hoang T, Kasichayanula S. Assessment of pharmacokinetic interaction between rilotumumab and epirubicin, cisplatin and capecitabine (ECX) in a Phase 3 study in gastric cancer. Br J Clin Pharmacol 2016; 83:1048-1055. [PMID: 27966237 DOI: 10.1111/bcp.13179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/20/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIMS Rilotumumab is a fully human monoclonal antibody investigated for the treatment of MET-positive gastric cancer. The aim of this study was to evaluate the potential pharmacokinetic (PK)-based drug-drug interaction (DDI) between rilotumumab and epirubicin (E), cisplatin(C) and capecitabine (X). METHODS This was a Phase 3 double-blind, placebo-controlled study, in which rilotumumab, epirubicin and cisplatin were administered intravenously at 15 mg kg-1 , 50 mg m-2 , and 60 mg m-2 Q3W, respectively, while capecitabine was given orally at 625 mg m-2 twice daily. Rilotumumab PK samples were taken at pre-dose and at the end-of-infusion from all patients in cycles 1, 3, 5 and 7. ECX PK samples were taken in cycle 3 from patients who participated in the intensive PK assessment. ECX PK was assessed by non-compartmental (NCA) analyses and PK parameters were compared between two arms. Rilotumumab PK was assessed by comparing the observed rilotumumab serum concentrations with model-predicted concentrations using a population PK model developed from previous Phase 1 and Phase 2 studies. RESULTS The study enrolled 609 patients. ECX plasma concentrations in the presence and absence of rilotumumab were similar, as demonstrated by the geometric mean ratios for Cmax and AUC, which were close to 1.0, suggesting ECX PK was not affected by co-administration of rilotumumab. The observed rilotumumab serum concentrations were similar to the values predicted by population PK modelling on the basis of a prediction-corrected visual predictive check, indicating rilotumumab exposure was not affected by co-administration of ECX. CONCLUSIONS The results suggest lack of PK-based DDI between rilotumumab and ECX.
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Affiliation(s)
- Yilong Zhang
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., Thousand Oaks, California, 91320
| | - Mita Kuchimanchi
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., Thousand Oaks, California, 91320
| | - Min Zhu
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., Thousand Oaks, California, 91320
| | - Sameer Doshi
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., Thousand Oaks, California, 91320
| | - Tien Hoang
- Clinical Development, Amgen Inc., Thousand Oaks, California, 91320
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Jalkanen J, Maksimow M, Jalkanen S, Hakovirta H. Hypoxia-induced inflammation and purinergic signaling in cross clamping the human aorta. SPRINGERPLUS 2016; 5:2. [PMID: 26759741 PMCID: PMC4700025 DOI: 10.1186/s40064-015-1651-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/21/2015] [Indexed: 12/20/2022]
Abstract
Open aortic surgery evokes a systemic inflammatory response and is associated with high morbidity and mortality. Purinergic signaling has been shown to be crucial for maintaining vascular integrity and attenuating inflammation related to hypoxia. The involvement of purinergic signaling in cross clamping of major human arteries is unknown. Our aim was to compare systemic inflammatory responses and hypoxia-induced purinergic signaling in patients undergoing either open infra-renal abdominal aortic repair or infra-inguinal revascularization. Pre- and 24 h post-operative blood samples were gathered from 6 patients undergoing aortic clamping and 6 similar patients undergoing common femoral artery cross-clamping. Using Biorad Multipex™ 21- and 27-panels 48 different cytokines, chemokines and growth factors were analyzed, in addition to circulating levels of ATP, ADP, CD39, CD73 and HIF-1α, and compared between the groups. Several inflammatory cytokines were elevated from baseline levels after aortic clamping, but not after femoral cross clamping. Most pronoun rises were seen in IL-6 (667 %, P = 0.016) and HGF (760 %, P = 0.016). HIF-1α values showed a steady increase after clamping of either artery unless the subject underwent blood transfusion. Despite an adequate increase in HIF-1α CD39 and CD73 activity decreased significantly after aortic clamping (P = 0.047 and P = 0.016, respectively). Aortic clamping is associated with a clear and strong systemic inflammatory response and impaired repair mechanisms in terms of purinergic signaling. Patients undergoing open aorta repair could benefit from pre-operative medical therapy, which enhances CD73 expression.
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Affiliation(s)
- Juho Jalkanen
- Department of Vascular Surgery, Turku University and Turku University Hospital, Hämeenkatu 11, 20521 Turku, Finland
| | - Mikael Maksimow
- MediCity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Tykistönkatu 6A, 20520 Turku, Finland
| | - Sirpa Jalkanen
- MediCity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Tykistönkatu 6A, 20520 Turku, Finland
| | - Harri Hakovirta
- Department of Vascular Surgery, Turku University and Turku University Hospital, Hämeenkatu 11, 20521 Turku, Finland
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The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome. Am J Surg 2013; 205:457-65. [DOI: 10.1016/j.amjsurg.2012.07.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/06/2012] [Accepted: 07/17/2012] [Indexed: 12/17/2022]
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Efron PA, Matsumoto T, McAuliffe PF, Scumpia P, Ungaro R, Fujita S, Moldawer LL, Foley D, Hemming AW. Major hepatectomy induces phenotypic changes in circulating dendritic cells and monocytes. J Clin Immunol 2009; 29:568-81. [PMID: 19387804 DOI: 10.1007/s10875-009-9291-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 03/24/2009] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients undergoing major hepatectomy are at increased risk for post-operative morbidity and mortality, and changes in the phenotype of effector cells may predispose these patients to infectious sequelae. METHODS To better understand post-hepatectomy immune responses, peripheral blood from 15 hepatectomy patients was drawn immediately before and after liver resection and on post-operative days 1, 3, and 5. Circulating monocytes and dendritic cells were analyzed by flow cytometry for quantity, phenotype, activation status, human leukocyte antigen DR (HLA-DR) expression, and toll-like receptor-2 and -4 expression. RESULTS Major hepatectomy increased the numbers of activated CD16(bright) blood monocytes and the percentage of activated dendritic cells, although monocyte HLA-DR expression was reduced. These results may represent both dysfunctional antigen presentation and pending anergy, as well as cellular priming of immune effector cells. Better understanding of the alterations in innate immunity induced by hepatectomy may identify strategies to reduce infectious outcomes.
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Affiliation(s)
- Philip A Efron
- Department of Surgery, University of Florida College of Medicine, Shands Hospital, Box 100286, Gainesville, FL 32610-0286, USA.
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Absood A, Hu B, Bassily N, Colletti L. VIP inhibits human HepG2 cell proliferation in vitro. ACTA ACUST UNITED AC 2007; 146:285-92. [PMID: 18077011 DOI: 10.1016/j.regpep.2007.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 10/18/2007] [Accepted: 11/01/2007] [Indexed: 12/20/2022]
Abstract
Hepatocellular carcinoma (HCC) is an aggressive and often fatal neoplasm. HepG2 cells are a cell line derived from HCC. This investigation shows that vasoactive intestinal peptide (VIP) inhibits HepG2 cell proliferation in vitro. In addition, VIP decreases the expression of signal transducers and activators of transcription-3 (STAT-3) and phosphorylated STAT-3 (pSTAT-3). Transfection of HepG2 cells with STAT-3 siRNA also dose-dependently inhibits proliferation. These findings suggest that VIP-mediated inhibition of HepG2 proliferation may be mediated by STAT-3. Further studies demonstrate that VIP increases HepG2 cAMP levels and 8-cl-cAMP inhibits HepG2 proliferation as well as pSTAT-3 and STAT-3 levels, suggesting that cAMP is also involved in the inhibition of HepG2 proliferation. VIP also attenuates the proliferative effects of hepatocyte growth factor (HGF) and interleukin-6 (IL-6) on HepG2 cells. These preliminary studies suggest that the antiproliferative actions of VIP may offer a new and promising means of suppressing HCC.
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Affiliation(s)
- Afaf Absood
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Nakashima S, Katano Y, Nakano I, Hirooka Y, Ito A, Ishigami M, Hayashi K, Honda T, Goto H. Changes in circulating cytokine levels and lymphocyte subsets in healthy liver donors after partial hepatectomy. Hepatol Res 2007; 37:878-84. [PMID: 17584192 DOI: 10.1111/j.1872-034x.2007.00136.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Studies of animal models have determined that liver regeneration after partial hepatectomy is mediated by a various cytokines. The aim of the present study was to evaluate the levels of these cytokines and subsets of circulating lymphocytes in healthy humans after partial hepatectomy. METHODS Four individuals underwent partial hepatectomy for living-related donor liver transplantation. We also evaluated for comparison, three patients with myoma uteri who underwent hysterectomy. Blood samples were obtained before surgery and on postoperative days (PD) 1, 3, and 7. Serum levels of hepatocyte growth factor, interleukin (IL)-6, -10, and plasma levels of transforming growth factor beta were measured. RESULTS Increased circulating levels of hepatocyte growth factor and transforming growth factor beta were observedafter hepatectomy. The levels of IL-6 and IL-10 peaked on PD 1. Circulating white blood cell counts increased remarkably, whereas lymphocyte count decreased particularly on PD 1 and 3. CD4/CD8 and T-helper cell (Th)1/Th2 ratios were still decreased on PD 7. The percentage of natural killer cells was increased on PD 1. Partial hepatectomy in healthy humans leads not only to decreased lymphocyte counts, but also to remarkable changes in lymphocyte subsets. CONCLUSION These findings suggest that immune suppression after partial hepatectomy involves decreases in CD4(+) helper T cells, particularly Th1 cells.
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Affiliation(s)
- Sayori Nakashima
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ng KK, Lam CM, Poon RT, Shek TW, To JY, Wo YH, Ho DW, Fan ST. Comparison of systemic responses of radiofrequency ablation, cryotherapy, and surgical resection in a porcine liver model. Ann Surg Oncol 2005; 11:650-7. [PMID: 15231521 DOI: 10.1245/aso.2004.10.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The degree of systemic response after hepatic radiofrequency ablation (RFA) has not been well investigated. METHODS An in vivo study was conducted on 23 domestic swine. Different hepatic procedures (RFA, cryotherapy, hepatic pedicle ligation, and hepatectomy) were performed on the medial lobe of the liver (30% of the liver volume). Systemic responses in terms of systemic inflammatory marker changes and end-organ functions were determined. RESULTS During the early postoperative period, the systemic inflammatory marker concentrations (tumor necrosis factor-alpha and interleukin-1beta) in the RFA group were significantly lower than in the cryotherapy group but significantly higher than in the control group. The corresponding concentrations in the hepatectomy group remained similar to those in the control group. The pattern of changes of serum inflammatory marker concentrations in the pedicle ligation group followed the pattern in the RFA group. The serum intracellular content concentrations (lactate dehydrogenase and urate) of the cryotherapy group peaked at 6 hours after operation, which was significantly later than in the other groups. Liver function, renal function, and coagulation profiles remained normal in the RFA group. However, the renal function deteriorated in the cryotherapy group on day 1. Both platelet count and activated clotting time showed significant derangement in the cryotherapy group compared with the control group. There was more severe interstitial pneumonitic change of the porcine lung after cryotherapy than after RFA. CONCLUSIONS The systemic responses of RFA were significantly less severe than those of cryotherapy in this porcine model. However, the increase in serum inflammatory markers and pneumonitis after RFA was substantial when compared with hepatectomy.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Centre for the Study of Liver Disease, University of Hong Kong, Pokfulamad, Hong Kong, China. kcng66@yahoo. com
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Sekine K, Fujishima S, Aikawa N. Plasma hepatocyte growth factor is increased in early-phase sepsis. J Infect Chemother 2004; 10:110-4. [PMID: 15160305 DOI: 10.1007/s10156-004-0301-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2003] [Accepted: 01/09/2004] [Indexed: 10/26/2022]
Abstract
To elucidate the involvement of hepatocyte growth factor (HGF) in systemic inflammatory response syndrome (SIRS) and sepsis, we investigated the plasma levels of HGF, as well as those of various proinflammatory and anti-inflammatory cytokines, in 50 patients who visited our emergency department (ED). The patients were divided into four groups, depending on the existence of SIRS and infection: group 1 (G1), no infection and no SIRS; group 2 (G2), infection and no SIRS; group 3 (G3), no infection and SIRS; and group 4 (G4), infection and SIRS (e.g., sepsis). We found that plasma HGF levels in G4 were significantly higher than those in the groups without infection (G1 and G3). However, the correlations between HGF and other cytokines were comparatively low compared with those between any other pairs of cytokines, suggesting independent regulation of HGF production in vivo. High plasma HGF was significantly correlated with the presence of infection and with serum total bilirubin (TB) level on multivariate logistic regression analysis. Considering HGF's known functions, we speculated that high plasma HGF levels may indicate the occurrence or necessity for tissue protection and regeneration after acute systemic insults in sepsis.
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Affiliation(s)
- Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Lukomska B, Dluzniewska J, Polanski J, Zajac L. Expression of growth factors in colorectal carcinoma liver metastatic patients after partial hepatectomy: implications for a functional role in cell proliferation during liver regeneration. COMPARATIVE HEPATOLOGY 2004; 3 Suppl 1:S52. [PMID: 14960204 PMCID: PMC2410267 DOI: 10.1186/1476-5926-2-s1-s52] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Barbara Lukomska
- Surgical Research and Transplantology Department, Medical Research Institute, Polish Academy of Sciences, Poland
| | - Joanna Dluzniewska
- Department of Molecular Biology, Medical Research Institute, Polish Academy of Sciences, Poland
| | - Jerzy Polanski
- 2nd Department of Surgery, 2nd Medical Faculty, Medical University, Warsaw, Poland
| | - Leszek Zajac
- 2nd Department of Surgery, 2nd Medical Faculty, Medical University, Warsaw, Poland
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Heijnen BHM, Straatsburg IH, Gouma DJ, van Gulik TM. Decrease in core liver temperature with 10°C by in situ hypothermic perfusion under total hepatic vascular exclusion reduces liver ischemia and reperfusion injury during partial hepatectomy in pigs. Surgery 2003; 134:806-17. [PMID: 14639360 DOI: 10.1016/s0039-6060(03)00125-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We attempted to assess liver ischemia/reperfusion injury under a mild decrease in core liver temperature of 10 degrees C by in situ hypothermic perfusion during ischemia. METHODS Liver ischemia was induced in pigs by total hepatic vascular exclusion with concomitant in situ perfusion with hypothermic (4 degrees C) Ringer-glucose (cold perfused group, core liver temperature maintained at 28 degrees C), with normothermic (38 degrees C) Ringer-glucose (warm perfused group) or without in situ perfusion (control group). RESULTS In the cold perfused, warm perfused, and control groups, 24-hour survival was 5/5, 0/5, and 3/5, respectively. Hemodynamic parameters in the cold perfused group remained stable, whereas pigs in both other groups required circulatory support. Plasma AST and interleukin-6 levels were lower in the cold perfused group than in both other groups. Hepatocellular function was best preserved in the cold perfused group as indicated by complete recovery of bile production during reperfusion and no loss of indocyanine green clearance capacity. In both other groups, bile production and indocyanine green clearance capacity were reduced significantly. The hyaluronic acid uptake capacity of pigs in the cold perfused group or control group did not differ, indicating preserved sinusoidal endothelial cell function. Histopathologic injury scores during reperfusion were significantly lower in the cold perfused group when compared to both other groups. CONCLUSIONS A mild decrease in core liver temperature of 10 degrees C by in situ hypothermic liver perfusion during ischemia protects the liver from ischemia/reperfusion injury. This protection appears to be related to cooling of the liver rather than to the washout of blood during perfusion.
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Affiliation(s)
- Bob H M Heijnen
- Surgical laboratory, IWO 10151, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Tanaka S, Hirohashi K, Tanaka H, Shuto T, Lee SH, Kubo S, Takemura S, Yamamoto T, Uenishi T, Kinoshita H. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg 2002; 195:484-9. [PMID: 12375753 DOI: 10.1016/s1072-7515(02)01288-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile leakage is one of the frequent and disturbing complications of hepatic resection. STUDY DESIGN Clinical records of the 363 patients who underwent hepatic resections without biliary reconstruction for hepatic cancers between January 1994 and June 2001 were reviewed. Postoperative bile leakage was defined as continuous drainage with a bilirubin concentration of 20 mg/dL or 1,500 mg/d lasting 2 days. Leakage that continued longer than 2 weeks or that required surgical intervention was defined as uncontrollable. Differences in incidence and frequency of uncontrollable leakage for the different types of hepatic resection, tumors, and underlying liver disease were investigated. Outcomes after treatment for uncontrollable bile leakage were also reviewed. RESULTS Postoperative bile leakage occurred in 26 of 363 patients (7.2%). Although the incidence in patients with cholangiocellular carcinoma (3/9 [33%]) was higher (p = 0.03) than in patients with hepatocellular carcinoma, rates of occurrence were similar among the different types of hepatic resection and underlying liver disease. Eight of the 26 patients (31%) had uncontrollable leakage. Two patients required reoperation to control leakage; one of these developed hepatic failure and died 2 months after surgery. Four patients underwent endoscopic nasobiliary drainage 21 to 34 days after hepatectomy, and the leakage resolved within 3 to 21 days. Fibrin glue sealing was effective in two patients whose leaking bile ducts were not connected to the common bile duct. CONCLUSIONS Although meticulous surgical technique can minimize the risk of postoperative bile leakage, some instances of leakage are unavoidable. Nonsurgical treatments, such as nasobiliary drainage or fibrin glue sealing, are preferable to reoperation.
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Affiliation(s)
- Shogo Tanaka
- Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Tsokos M, Reichelt U, Jung R, Nierhaus A, Püschel K. Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period. Forensic Sci Int 2001; 119:47-56. [PMID: 11348793 DOI: 10.1016/s0379-0738(00)00391-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postmortem interleukin-6 (IL-6) and C-reactive protein (CRP) serum levels were investigated prospectively in sepsis-related fatalities and non-septic fatalities by using a linear regression model. At least three blood samples were collected between 0.3 and 139 h postmortem from sepsis-related fatalities (n=8) and non-septic fatalities (n=16). In addition, one antemortem blood sample was collected shortly before death from the septic patients. Antemortem and postmortem IL-6 and CRP levels were highly elevated in all individuals included in the sepsis group. An excessive postmortem increase of IL-6 serum levels associated with progressive time after death was observed in five out of the eight septic patients. Both, IL-6 and CRP serum concentrations seem to be suitable biochemical postmortem markers of sepsis. The determination of IL-6 serum levels above 1500 pg/ml in peripheral venous blood obtained in the early postmortem interval can be considered as a diagnostic hint towards an underlying septic condition. A more precise postmortem discrimination between sepsis and non-septic underlying causes of death is provided by the postmortem measurement of serum CRP in peripheral venous blood: on condition that at least two postmortem CRP values have been determined at different time points postmortem, the CRP level of a deceased at the time of death can be calculated by using linear regression analysis. When assessing postmortem IL-6 and CRP concentrations as biochemical postmortem markers of sepsis, various clinical conditions, such as a preceding trauma or burn injury going along with elevated IL-6 and/or CRP levels prior to death as a result of the systemic inflammatory response syndrome (SIRS) should be taken into consideration, thus adding relevant information for the practical interpretation of the results.
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Affiliation(s)
- M Tsokos
- Institute of Legal Medicine, University of Hamburg, Butenfeld 34, D-22529, Hamburg, Germany.
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Matsuno S. DIGEST: surgery today. Br J Surg 2000; 87:1331-5. [PMID: 11044156 DOI: 10.1046/j.1365-2168.2000.01627.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Professor Seiki Matsuno, Chief Editor of Surgery Today (The Japanese Journal of Surgery), has selected from the April to June 2000 issues of the journal for this quater's digest. A digest of BJS for the same period written by Professor Pierre Guillou, Associate Editor, appears in the Japanese journal.
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Affiliation(s)
- S Matsuno
- Editor-in-Chief, Surgery Today (The Japanese Journal of Surgery)
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