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Su Y, Zhu C, Wang B, Zheng H, McAlister V, Lacefield JC, Quan D, Mele T, Greasley A, Liu K, Zheng X. Circular RNA Foxo3 in cardiac ischemia-reperfusion injury in heart transplantation: A new regulator and target. Am J Transplant 2021; 21:2992-3004. [PMID: 33382168 DOI: 10.1111/ajt.16475] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2020] [Accepted: 12/23/2020] [Indexed: 01/25/2023]
Abstract
Ischemia-reperfusion (I/R) injury occurring in heart transplantation (HT) remains as a leading cause of transplant heart graft failure. Circular RNAs (circRNAs) play important roles in gene regulation and diseases. However, the impact of circRNAs on I/R injury during HT remains unknown. This study aims to investigate the role of circular RNA Foxo3 (circFoxo3) in I/R injury in HT. Using an in vivo mouse HT model and an in vitro cardiomyocyte culture model, we demonstrated that circFoxo3 is significantly upregulated in I/R-injured hearts and hypoxia/reoxygenation (H/R)-damaged cardiomyocytes. Knockdown of circFoxo3 using siRNA not only reduces cell apoptosis and death, mitochondrial damage, and expression of apoptosis/death-related genes in vitro, but also protects heart grafts from prolonged cold I/R injury in HT. We also show that circFoxo3 interacts with Foxo3 proteins and inhibits the phosphorylation of Foxo3 and that it indirectly affects the expression of miR-433 and miR-136. In conclusion, circRNA is involved in I/R injury in HT and knockdown of circFoxo3 with siRNA can reduce I/R injury and improve heart graft function through interaction with Foxo3. This study highlights that circRNA is a new type of molecular regulator and a potential target for preventing I/R injury in HT.
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Affiliation(s)
- Yale Su
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China.,Department of Pathology, Western University, London, Ontario, Canada
| | - Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China.,Department of Pathology, Western University, London, Ontario, Canada
| | - Bowen Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China.,Department of Pathology, Western University, London, Ontario, Canada
| | - Hao Zheng
- Department of Pathology, Western University, London, Ontario, Canada
| | - Vivian McAlister
- Department of Surgery, Western University, London, Ontario, Canada.,London Health Sciences Centre, London, Ontario, Canada
| | - James C Lacefield
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Douglas Quan
- Department of Surgery, Western University, London, Ontario, Canada.,London Health Sciences Centre, London, Ontario, Canada
| | - Tina Mele
- Department of Surgery, Western University, London, Ontario, Canada.,London Health Sciences Centre, London, Ontario, Canada
| | - Adam Greasley
- Department of Pathology, Western University, London, Ontario, Canada
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Xiufen Zheng
- Department of Pathology, Western University, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Oncology, Western University, London, Canada
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2
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McAlister V. Lever effect and the optical illusion of safety in laparoscopic cholecystectomy. Can J Surg 2021; 64:E243. [PMID: 33829740 PMCID: PMC8064242 DOI: 10.1503/cjs.2164208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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3
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Abstract
Circular RNA (circRNA) is a highly abundant type of single-stranded non-coding RNA. Novel research has discovered many roles of circRNA in colorectal cancer (CRC) including proliferation, metastasis and apoptosis. Furthermore, circRNAs also play a role in the development of drug resistance and have unique associations with tumour size, staging and overall survival in CRC that lend circRNAs the potential to serve as diagnostic and prognostic biomarkers. Among cancers worldwide, CRC ranks second in mortality and third in incidence. In order to have a better understanding of the influence of circRNA on CRC development and progression, this review summarizes the role of specific circRNAs in CRC and evaluates their potential value as therapeutic targets and biomarkers for CRC. We aim to provide insight in the development of therapy and clinical decision-making.
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Affiliation(s)
- Anthony Li
- Department of Pathology and Laboratory MedicineWestern UniversityLondonCanada
- School of MedicineQueen’s UniversityKingstonCanada
| | - Wei Cen Wang
- Department of Microbiology & ImmunologyWestern UniversityLondonCanada
| | - Vivian McAlister
- Department of SurgeryWestern UniversityLondonCanada
- London Health Sciences CentreLondonCanada
| | - Qinfeng Zhou
- Department of Pathology and Laboratory MedicineWestern UniversityLondonCanada
- Department of Laboratory MedicineZhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese MedicineSuzhouChina
| | - Xiufen Zheng
- Department of Pathology and Laboratory MedicineWestern UniversityLondonCanada
- Department of SurgeryWestern UniversityLondonCanada
- Department of OncologyWestern UniversityLondonCanada
- Lawson Health Research InstituteLondonCanada
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4
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Zheng H, Su Y, Zhu C, Quan D, Skaro AI, McAlister V, Lacefield JC, Jiang J, Xue P, Wang Y, Zheng X. An Addition of U0126 Protecting Heart Grafts From Prolonged Cold Ischemia-Reperfusion Injury in Heart Transplantation: A New Preservation Strategy. Transplantation 2021; 105:308-317. [PMID: 32776778 DOI: 10.1097/tp.0000000000003402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury (IRI) is the major cause of primary graft dysfunction in organ transplantation. The mitogen-activated protein kinase/extracellular signal-regulated kinase (ERK) signaling pathway plays a crucial role in cell physiological and pathological processes including IRI. This study aims to investigate whether inhibition of ERK signaling with U0126 can prevent prolonged cold IRI in heart transplantation. METHODS Rat cardiac cell line H9c2 cells were treated with U0126 before exposure to hypothermic hypoxia/reoxygenation (H/R) conditions. The effect of U0126 on H9c2 cells in response to H/R stress was determined by measuring cell death, reactive oxygen species production, mitochondrial membrane potential, and ERK signaling activation. Mouse syngeneic heterotopic heart transplantation was conducted, where a donor heart was preserved in the University of Wisconsin (UW) solution supplemented with U0126 for 24 hours at 4°C before transplantation. Heart graft function, histopathologic changes, apoptosis, and fibrosis were measured to assess IRI. RESULTS Phosphorylated ERK was increased in both in vitro H/R-injured H9c2 cells and in vivo heart grafts with IRI. Pretreatment with U0126 inhibited ERK phosphorylation and prevented H9c2 cells from cell death, reactive oxygen species generation, and mitochondrial membrane potential loss in response to H/R. Preservation of donor hearts with U0126-supplemented solution improved graft function and reduced IRI by reductions in cell apoptosis/death, neutrophil infiltration, and fibrosis of the graft. CONCLUSIONS Addition of U0126 to UW solution reduces ERK signal activation and attenuates prolonged cold IRI in a heart transplantation model. ERK inhibition with U0126 may be a useful strategy to minimize IRI in organ transplantation.
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Affiliation(s)
- Hao Zheng
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
- College of Life Science, Wuhan University, Wuhan, China
| | - Yale Su
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Cuilin Zhu
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Douglas Quan
- Department of Surgery, Western University, London, ON, Canada
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Anton I Skaro
- Department of Surgery, Western University, London, ON, Canada
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Vivian McAlister
- Department of Surgery, Western University, London, ON, Canada
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - James C Lacefield
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Department of Oncology, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Jifu Jiang
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Peng Xue
- College of Life Science, Wuhan University, Wuhan, China
| | - Yefu Wang
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Xiufen Zheng
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
- Department of Surgery, Western University, London, ON, Canada
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
- Department of Oncology, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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5
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6
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MacDonald A, McAlister V. A tribute to Dr. Roger Keith (1940-2020). Can J Surg 2021; 64:E23-E24. [PMID: 33450147 PMCID: PMC7955825 DOI: 10.1503/cjs.000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dr. Roger Keith, a former co-editor of the Canadian Journal of Surgery who died recently in Saskatoon, was a Canadian ambassador for surgery and one of its leaders in North America. His career spans a period when surgery made the greatest progress in its history.
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Affiliation(s)
- Allan MacDonald
- From Cape Breton Regional Hospital, Sydney, NS (MacDonald); and the University Hospital, London, Ont. McAlister)
| | - Vivian McAlister
- From Cape Breton Regional Hospital, Sydney, NS (MacDonald); and the University Hospital, London, Ont. McAlister)
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7
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Zhou Q, Wang B, Koropatnick J, Min W, McAlister V, Greasley A, Zheng X. Circular RNA AEBP2 modulates dendritic cells by the hnRNP/pP65 signaling pathway. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.164.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Circular RNA (circRNA) has been the focus of research in recent years. However, circRNA is rarely reported in dendritic cells (DCs). In our study, Microarray analysis of circRNA showed that circular RNA AEBP2 (circAEBP2) is significantly up-regulated in mature DCs compared with immature DCs. Knockdown of circAEBP2 in DC with siRNA arrests DCs at immature status with lower expression of MHC class II, CD40, CD80, and CD83, as well as decreasing the expression of Phosphorylation of nuclear factor-kappa B p65. CircAEBP2 -silenced DCs failed to activate allogeneic CD4+ T cells and CD8+ T cells in vitro. RNA immunoprecipitation assays show heterogeneous nuclear ribonucleoproteins (hnRNP) are enriched by circAEBP2 probes which have complementary circAEBP2 sequence, indicating circAEBP2 interacts with hnRNP. The effect of circAEBP2 silenced DCs on induction of anti-tumor immunity is investigated in an ongoing murine melanoma model. In conclusion, our results demonstrate that circAEBP2 regulates the development and function of DCs through interacting the hnRNP/pP65 signaling pathway. CircAEBP2 will be a new potential target for DCs-based immunotherapy.
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Affiliation(s)
- Qinfeng Zhou
- 1university of Western Ontario, Canada
- 2Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, China
| | | | | | | | | | | | - Xiufen Zheng
- 1university of Western Ontario, Canada
- 3Lawson Health Research Institute, Canada
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8
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Serrano PE, Gu CS, Moulton CA, Husien M, Jalink D, Martel G, Tsang ME, Hallet J, McAlister V, Gallinger S, Levine M. Effect of PET-CT on disease recurrence and management in patients with potentially resectable colorectal cancer liver metastases. Long-term results of a randomized controlled trial. J Surg Oncol 2020; 121:1001-1006. [PMID: 32034769 DOI: 10.1002/jso.25864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Preoperative evaluation of resectable colorectal cancer liver metastases with positron emission tomography (PET) combined with computed tomography (PET-CT) is used extensively. The PETCAM trial evaluated the effect of PET-CT (intervention) vs no PET-CT (control) on surgical management. PET-CT resulted in 8% change in surgical management, therefore, we aimed to compare long-term outcomes (disease-free [DFS], overall survival [OS]). METHODS Trial recruitment (2005-2010) had prospective follow-up until 2013. Events from 2013 to 2017 were collected retrospectively. Survival was described by the Kaplan-Meier method and compared with log-rank test. Oncologic risk factors were calculated using Cox proportional hazard models. RESULTS Among 404 patients randomized, there were no differences in DFS (hazard ratio [HR] = 1.13; 95% confidence interval [CI], 0.89 to 1.43) or OS (HR, 1.02; 95% CI, 0.78-1.32) between groups. For all patients randomized, median DFS (PET-CT vs no PET-CT) was 16 months (95% CI, 13-18) and 15 months (95% CI, 11-22), P = .33. For patients who underwent liver resection (n = 368), DFS (17 vs 16 months, P = .51) and OS (58 months vs 52 months, P = .90) were similar between groups, respectively. Risk factors for DFS and OS were age, tumor size, node-positive disease, extrahepatic metastases and disease-free duration. CONCLUSION Preoperative PET-CT changes surgical management in a small percentage of cases, without effect on recurrence rates or long-term survival.
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Affiliation(s)
- Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario.,Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario.,Department of Oncology, McMaster University, Hamilton, Ontario
| | | | | | - Diederick Jalink
- Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario
| | | | | | - Julie Hallet
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
| | | | | | - Mark Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario.,Department of Oncology, McMaster University, Hamilton, Ontario
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9
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Smith S, McAlister V, Parry N, Power A, Vogt K. Vascular trauma: Does experience in the United States apply to a Canadian centre? Can J Surg 2019; 62:499-501. [PMID: 31782648 DOI: 10.1503/cjs.002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Summary Trauma care has evolved similarly in the United States and Canada over the last 3 decades. Like much of modern trauma care, management of vascular trauma has been influenced by combat surgery experiences in recent wars. The American Association for the Surgery of Trauma sponsored the Prospective Observational Vascular Injury Treatment (PROOVIT) registry to document changes in the treatment of vascular trauma and determine outcomes in the US. However, differences in trauma populations and trauma systems between Canada and the US need to be considered. Here we compare the vascular trauma experience at a Canadian level I trauma centre over a 5-year period to the data in the PROOVIT registry.
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Affiliation(s)
- Shane Smith
- From the Division of Vascular Surgery, Western University, London, Ont
| | - Vivian McAlister
- From the Division of Vascular Surgery, Western University, London, Ont
| | - Neil Parry
- From the Division of Vascular Surgery, Western University, London, Ont
| | - Adam Power
- From the Division of Vascular Surgery, Western University, London, Ont
| | - Kelly Vogt
- From the Division of Vascular Surgery, Western University, London, Ont
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10
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Serrano PE, Gu C, Husien M, Jalink D, Ritter A, Martel G, Tsang ME, Law CH, Hallet J, McAlister V, Sela N, Solomon H, Moulton C, Gallinger S, Levine M. Risk factors for survival following recurrence after first liver resection for colorectal cancer liver metastases. J Surg Oncol 2019; 120:1420-1426. [DOI: 10.1002/jso.25735] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Pablo E. Serrano
- Department of SurgeryMcMaster University Hamilton Ontario Canada
- Ontario Clinical Oncology GroupMcMaster University Hamilton Ontario Canada
| | - Chu‐Shu Gu
- Ontario Clinical Oncology GroupMcMaster University Hamilton Ontario Canada
- Department of OncologyMcMaster University Hamilton Ontario Canada
| | - Mohamed Husien
- Grand River Regional Cancer Centre Kitchener Ontario Canada
| | - Diederick Jalink
- Cancer Centre of Southeastern Ontario at Kingston General Hospital Kingston Ontario Canada
| | - Anne Ritter
- Cancer Centre of Southeastern Ontario at Kingston General Hospital Kingston Ontario Canada
| | | | | | - Calvin H. Law
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Julie Hallet
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | | | | | | | | | | | - Mark Levine
- Ontario Clinical Oncology GroupMcMaster University Hamilton Ontario Canada
- Department of OncologyMcMaster University Hamilton Ontario Canada
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11
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Akbari M, Saha MN, Telfer S, Ullah S, Mok A, McAlister V, Juriasingani S, Luke PP, Sener A. Reconstitution of T-Cell Subsets Following Thymoglobulin-Induced Depletion in High Immunologic Risk and Donation After Cardiac Death Renal Transplant Recipients. Transplant Proc 2019; 51:1744-1753. [PMID: 31399162 DOI: 10.1016/j.transproceed.2019.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/08/2019] [Accepted: 03/23/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Depletion therapy in high immunologic risk (HR) patients by antithymocyte globulin (rATG) induces lymphopenia and subsequent compartmental repopulation of T-cell subsets. rATG is also given to patients receiving kidneys from donations after cardiac death (DCDs) to mitigate innate immune activation associated with the DCD process. METHODS We compared the T-cell response with rATG in both HR and DCD kidney recipients. We examined the reconstitution of T-cell subsets after rATG treatment in HR and DCD recipients (n = 19 per group) by multicolor flow cytometry. RESULTS Following treatment, there was a rapid drop in the frequency of T cells in both groups, which persisted over 28 days. HR patients had an early surge in the frequency of CD4+ naïve, effector-memory, and regulatory T cells. Although we found a significant proliferation of the T cells in both groups, the DCD cohort had a blunted response as well as reduced CD4+ T-cell immune-reactivity compare with the HR group. CONCLUSIONS Our data suggest that there is a lack of significant homeostatic proliferative response in DCD recipients following rATG, and CD4+ T cells may be less reactive in the DCD group than previously thought, indicating that rATG treatment may not have to be considered a first-line induction therapy in DCD recipients.
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Affiliation(s)
- Masoud Akbari
- Department of Surgery, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, Western University, London, Ontario, Canada
| | - Manujendra N Saha
- Department of Surgery, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, Western University, London, Ontario, Canada
| | - Siobhan Telfer
- Department of Surgery, Western University, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Sha Ullah
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Amy Mok
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
| | - Vivian McAlister
- Department of Surgery, Western University, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Smriti Juriasingani
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
| | - Patrick P Luke
- Department of Surgery, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, Western University, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Alp Sener
- Department of Surgery, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, Western University, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Microbiology & Immunology, Western University, London, Ontario, Canada.
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12
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Abstract
The highly complex immuno-hematological system of the recipient has to rebalance itself when the liver is replaced with a graft that has its own system. This gives us an opportunity for observation. Here we consider the graft-to-recipient direction with passenger lymphocyte syndrome (PLS) as well as the recipient-to-graft direction with Factor VIII (FVIII) inhibitors, paroxysmal nocturnal hemoglobinuria (PNH) and graft endothelial replacement with liver transplantation. PLS extends beyond the ABO blood groups to any situation where the donor has been sensitized to a recipient antigen. PLS directed against ABO or minor blood group antigens is usually self limiting whereas Rhesus (Rh) PLS persists with life threatening immune hemolysis. Human platelet antigen (HPA) 1A PLS results in life threatening immune thrombocytopenia. Treatments of severe PLS may include reduction in immunosuppression, anti-B-cell therapy, plasmapheresis and splenectomy. Liver transplantation into recipients with FVIII inhibitors has been difficult. Donors with acquired hemophilia may transmit the capacity to make FVIII inhibitors by PLS and should be avoided. Patients with PNH have been transplanted successfully but a considerable cost in the continued use of high dose eculizumab. We speculate that combined bone marrow and liver transplantation would be a better option for recipients with FVIII inhibitors or PNH. Replacement of liver graft endothelium with recipient cells is common and may explain relative transplant tolerance that is believed to occur with liver transplantation.
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Affiliation(s)
- Hemant Sharma
- Department of Multiorgan Transplant Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | | | - Vivian McAlister
- Department of Surgery, University of Western Ontario, London, ON, Canada
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13
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Affiliation(s)
- Hemant Sharma
- Department of Multiorgan Transplant Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Vivian McAlister
- Department of Surgery, University of Western Ontario, London, ON, Canada
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14
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Lazo-Langner A, Ainsworth P, McAlister V. Long term follow-up after liver transplantation from a JAK2 mutation positive donor. Hepatobiliary Surg Nutr 2019; 8:189-191. [PMID: 31098378 DOI: 10.21037/hbsn.2019.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Peter Ainsworth
- Department of Pathology and Laboratory Medicine Western University, London, ON, Canada
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15
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McAlister V. Antibodies and liver transplantation. Hepatobiliary Surg Nutr 2019; 8:184-185. [PMID: 31098376 PMCID: PMC6503237 DOI: 10.21037/hbsn.2019.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vivian McAlister
- Department of Surgery, University of Western Ontario, London, ON, Canada
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16
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Doucet J, Haley G, McAlister V. Massacre of Canadian Army Medical Corps personnel after the sinking of HMHS Llandovery Castle and the evolution of modern war crime jurisprudence. Can J Surg 2018; 61:155-157. [PMID: 29806812 DOI: 10.1503/cjs.006518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
SUMMARY Events after the sinking of the hospital ship Llandovery Castle on June 27, 1918, by the German submarine U-86 outraged Canadians. Survivors aboard a single life raft gave evidence that many of the 234 souls lost had made it to lifeboats but were rammed and shot by the submarine. Many of those who died were nurses. Three German officers were charged with war crimes after the war. The submarine's captain evaded capture. The remaining two officers' defence that they were following the captain's orders failed and they were convicted. This ruling was used as a precedent to dismiss similar claims at the war crime trials after the Second World War. It is also the basis of the order given to members of modern militaries, including the Canadian Armed Forces, that it is illegal to carry out an illegal order.
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Affiliation(s)
- Jay Doucet
- From the Division of Trauma, Surgical Critical Care, Burns & Acute Care Surgery, University of California San Diego Health (Doucet); and the Canadian Forces Health Services, Ottawa, Ont. (Haley, McAlister)
| | - Gregory Haley
- From the Division of Trauma, Surgical Critical Care, Burns & Acute Care Surgery, University of California San Diego Health (Doucet); and the Canadian Forces Health Services, Ottawa, Ont. (Haley, McAlister)
| | - Vivian McAlister
- From the Division of Trauma, Surgical Critical Care, Burns & Acute Care Surgery, University of California San Diego Health (Doucet); and the Canadian Forces Health Services, Ottawa, Ont. (Haley, McAlister)
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18
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Mitrou N, Aquil S, Dion M, McAlister V, Sener A, Luke PP. Transplantation of pediatric renal allografts from donors less than 10 kg. Am J Transplant 2018; 18:2689-2694. [PMID: 29797654 DOI: 10.1111/ajt.14946] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 01/25/2023]
Abstract
Few transplant programs use kidneys from donors with body weight (BW) < 10 kg. We hypothesized that pediatric en bloc transplants from donors with BW < 10 kg would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N = 28). Data were stratified by smaller (donor BW < 10 kg; n = 11) or larger donors (BW > 10 kg; n = 17). Renal volume was assessed during follow-up with ultrasound. Demographic characteristics were similar between the 2 groups of recipients. After mean follow-up of 44 months (smaller donors) and 124 months (larger donors), graft and patient outcomes were similar between groups. Serum creatinine at 1, 3, and 5 years was no different between groups. At 1 day posttransplant, mean total renal volume in the smaller donors was 28 ± 9 mm3 vs 45 ± 12 mm3 (P < .01). By 3 weeks, it was 53 ± 19 mm3 (smaller donors) versus 73 ± 19 mm3 (larger donors) (P = NS). Complication rates were similar between both groups with 1 case of venous thrombosis in the smaller group. With experience, outcomes are equivalent to those from larger pediatric donors.
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Affiliation(s)
- Nicholas Mitrou
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Shahid Aquil
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Multi Organ Transplant Program, Western University, London, ON, Canada
| | - Marie Dion
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada
| | - Vivian McAlister
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Multi Organ Transplant Program, Western University, London, ON, Canada
| | - Alp Sener
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Multi Organ Transplant Program, Western University, London, ON, Canada
| | - Patrick P Luke
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Multi Organ Transplant Program, Western University, London, ON, Canada
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Zhang Y, Zhang G, Liu Y, Chen R, Zhao D, McAlister V, Mele T, Liu K, Zheng X. GDF15 Regulates Malat-1 Circular RNA and Inactivates NFκB Signaling Leading to Immune Tolerogenic DCs for Preventing Alloimmune Rejection in Heart Transplantation. Front Immunol 2018; 9:2407. [PMID: 30425709 PMCID: PMC6218625 DOI: 10.3389/fimmu.2018.02407] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Recombinant human growth differentiation factor 15 (rhGDF15) affects dendritic cell (DC) maturation. However, whether GDF15 is expressed in DCs and its roles and signaling in DCs remain largely unknown. It is unclear whether GDF15-DCs can induce immune tolerance in heart transplantation (HT). This study aims to understand the impact of endogenous GDF15 on DC's development, function, underlying molecular mechanism including circular RNA (circRNA). This study will also explore GDF15-DC-mediated immune modulation in HT. Bone marrow (BM) derived DCs were cultured and treated to up- or down regulate GDF15 expression. Phenotype and function of DCs were detected. Expression of genes and circRNAs was determined by qRT-PCR. The signaling pathways activated by GDF15 were examined. The impact of GDF15 treated DCs on preventing allograft immune rejection was assessed in a MHC full mismatch mouse HT model. Our results showed that GDF15 was expressed in DCs. Knockout of GDF15 promoted DC maturation, enhanced immune responsive functions, up-regulated malat-1 circular RNA (circ_Malat 1), and activated the nuclear factor kappa B (NFκB) pathway. Overexpression of GDF15 in DCs increased immunosuppressive/inhibitory molecules, enhanced DCs to induce T cell exhaustion, and promoted Treg generation through IDO signaling. GDF15 utilized transforming growth factor (TGF) β receptors I and II, not GFAL. Administration of GDF15 treated DCs prevented allograft rejection and induced immune tolerance in transplantation. In conclusion, GDF15 induces tolerogenic DCs (Tol-DCs) through inhibition of circ_Malat-1 and the NFκB signaling pathway and up-regulation of IDO. GDF15-DCs can prevent alloimmune rejection in HT.
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Affiliation(s)
- Yixin Zhang
- Departments of Cardiovascular Surgery, Jilin University, Changchun, China.,Department of Pathology, Western University, London, ON, Canada
| | - Guangfeng Zhang
- Department of Rheumatology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Yanling Liu
- Department of Pathology, Western University, London, ON, Canada
| | - Renqi Chen
- Department of Pathology, Western University, London, ON, Canada
| | - Duo Zhao
- Departments of Cardiovascular Surgery, Jilin University, Changchun, China.,Department of Pathology, Western University, London, ON, Canada
| | - Vivian McAlister
- Division of General Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Tina Mele
- Division of General Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Kexiang Liu
- Departments of Cardiovascular Surgery, Jilin University, Changchun, China
| | - Xiufen Zheng
- Departments of Cardiovascular Surgery, Jilin University, Changchun, China.,Department of Oncology, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,London Health Sciences Centre, London, ON, Canada
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Serrano Aybar PE, Gu CS, Husien M, Jalink D, Martel G, Tsang ME, Hallet JI, Gallinger S, Ritter A, McAlister V, Sela N, Solomon H, Beyfuss K, Li C, Lee E, Moulton CA, Levine MN. Effect of PET-CT on disease recurrence and its management in patients with potentially resectable colorectal cancer liver metastases. The long-term results of a randomized controlled trial (PET-CT Imaging prior to liver resection for colorectal adenocarcinoma metastases). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Mohamed Husien
- Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Erika Lee
- McMaster University, Hamilton, ON, Canada
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Serrano Aybar PE, Gu CS, Husien M, Jalink D, Martel G, Tsang ME, Hallet JI, Gallinger S, Ritter A, McAlister V, Sela N, Solomon H, Beyfuss K, Li C, Lee E, Moulton C, Levine MN. Effect of PET-CT on disease recurrence and its management in patients with potentially resectable colorectal cancer liver metastases: The long-term results of a randomized control trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
562 Background: The PETCAM randomized trial evaluated the effect of preoperative PET-CT (vs. no PET-CT) on surgical management in patients with colorectal cancer liver metastases. In this study, 8% of patients had a change in surgical management, including a higher proportion of major liver resections in the PET-CT arm. The current study compares the intervention groups for 5-year disease free (DFS) and overall survival (OS), and evaluated their long-term clinical course, i.e. sites of recurrence and management of disease recurrence. Methods: Recruitment to the trial occurred between 2005-2010, with last follow-up in 2013. Data on recurrence, management of recurrence and mortality from 2013-2017 was collected from patient’s charts. Recurrences according to site and management were described. Cox proportional Hazard Models were used to calculate the risk for recurrence and death. OS was calculated with Kaplan-Meir method and compared with log-rank test. Results: At 5 years, 157 of 404 (39%) patients were still alive and 19 patients were lost to follow-up. Median follow-up is 4.2 years. There were no differences in DFS (HR: 1.12, 95%CI: 0.88-1.42) or OS (HR: 0.97, 95%CI: 0.74-1.28) between groups. The median DFS for the 372 patients who had surgery was 17 months, 95%CI: 14.7-19.4. Risks factors for recurrence were: extrahepatic disease, liver tumour size, and nodal stage. The median OS for all patients was 50 months, 95%CI: 43.5-64.3. Risks factors for death also included age and prior use of chemotherapy. During the follow-up period, 287/404, 71% patients recurred (mostly liver and lung); 137 (48%) were treated solely with chemotherapy and 35% were treated with surgery with curative intent. Of these, the majority recurred (109/116, 94%). The median OS following first recurrence was 27.5 months, 95%CI: 23-30. Conclusions: PET-CT did not improve DFS or OS. Survival following liver resection is similar to previous reports, however most patients experience disease recurrence. A substantial proportion of patients who recur undergo surgery, however it is likely that they will recur again.
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Affiliation(s)
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Mohamed Husien
- Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Erika Lee
- McMaster University, Hamilton, ON, Canada
| | - Carolanne Moulton
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
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McAlister V. Author response to: Correction of place of practice: Brampton, not Brantford. Can J Surg 2018; 61:E2. [PMID: 29368683 DOI: 10.1503/cjs.1861014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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McAlister V. Le Dr Louis Kristal à 100 ans : témoin de l’évolution de la chirurgie au Canada. Can J Surg 2017. [DOI: 10.1503/cjs.016217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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24
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McAlister V. Vers un « mouvement de l’éducation nouvelle » de recherche en chirurgie. Can J Surg 2017. [DOI: 10.1503/cjs.009617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Pineda-Solís K, Xie WY, McAlister V, Sener A, Luke PP. Retroperitoneal Compartment Syndrome in Renal Transplantation: How to Salvage the Graft? Urology 2017; 107:268. [PMID: 28982622 DOI: 10.1016/j.urology.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/28/2017] [Accepted: 05/08/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Early allograft dysfunction may be caused by several technical factors including vascular complications such as thrombosis, kinking, or extrinsic compression. Renal allograft compartment syndrome (RACS) is an unrecognized cause of early allograft dysfunction. This complication is characterized by increased pressure of the iliac fossa that reduces the blood supply to the graft with a potentially devastating consequence. The main objective when recognizing this condition is to create a tension-free muscle closure. Many approaches have been proposed involving mesh such as the mesh hood fascial closure technique.1-4 PATIENT AND METHODS: We describe in the video an RACS during an operation. The recipient is a 23-year-old young man with a body mass index of 22, with renal failure secondary to chronic reflux. Past history of failure to peritoneal dialysis currently on hemodialysis. He received a living donor's kidney. After performing a standard anastomosis, his urine output was brisk. The fascia was then closed with no force, at which point he stopped making urine. A RACS was suspected; intraoperative examination and ultrasound showed no flow in the graft, with no signs of kinking. Immediately, reexploration was performed, showing the graft with abnormal color and turgor. After relieving the pressure, the graft returned to normal. The closure was redone with a large ellipsoid piece of polypropylene mesh draped loosely and without tension over the graft. RESULTS A Doppler ultrasound, after the skin closure was performed, showed good flow, and the postoperative course was unremarkable. There was minimal bulking in the right iliac area, making it cosmetically acceptable. CONCLUSION RACS could be associated with a lack of compliance in the retroperitoneal cavity.5 The RACS required a prompt intervention. The timely suspicion is a watershed in the prognosis of this rare pathology. We propose that mesh hood fascial closure is easy, effective, and a safe method to treat these complications.
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Affiliation(s)
- Karen Pineda-Solís
- Multi-organ Transplant Program, London Health Science Centre, London, Ontario, Canada.
| | - Wen Yan Xie
- Division of Urology, Department of Surgery, London Health Science Centre, London, Ontario, Canada
| | - Vivian McAlister
- Multi-organ Transplant Program, London Health Science Centre, London, Ontario, Canada
| | - Alp Sener
- Multi-organ Transplant Program, London Health Science Centre, London, Ontario, Canada; Division of Urology, Department of Surgery, London Health Science Centre, London, Ontario, Canada
| | - Patrick P Luke
- Multi-organ Transplant Program, London Health Science Centre, London, Ontario, Canada; Division of Urology, Department of Surgery, London Health Science Centre, London, Ontario, Canada
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McAlister V. Doceo ergo sum : le mentorat des chirurgiens. Can J Surg 2017. [DOI: 10.1503/cjs.003717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
SUMMARY In April 1917, medical units of the 4 divisions of the Canadian Corps combined for the first time in support of a single action, the assault upon Vimy Ridge. Detailed planning, infrastructure development, information dissemination and rehearsal were features of preparations by the combat arms and medical elements of the Canadian Forces. Extraordinary coordination resulted in the rapid rescue and evacuation by Canadian medical services of 8000 casualties over 4 days. Characteristics of today's military medical services are evident in the work of the Canadian Army Medical Corps 100 years ago.
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McAlister V. Festschrift in honour of Dr. Roger Keith. Can J Surg 2017. [DOI: 10.1503/cjs.016816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The festschrift in honour of Dr. Roger Keith, past editor of the Canadian Journal of Surgery, includes essays (available at canjsurg.ca), written from a personal perspective, on the development of specialty surgery in Canada (Richard Nason, Michael Marcaccio, Michael Kelly and Lissa Peeling), evolution of the certification examination (Ward Davies), building of a megahospital (Gerald Fried) and on the changes in surgical education (Grant Miller, Anees Chagpar, Christopher DeGara, E. Christopher Ellison, Richard Prinz and William Pollett), as well as personal reflections (Andrew Warshaw, Stewart Hamilton).
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Aboalsamh G, Anderson P, Al-Abbassi A, McAlister V, Luke PP, Sener A. Heparin infusion in simultaneous pancreas and kidney transplantation reduces graft thrombosis and improves graft survival. Clin Transplant 2016; 30:1002-9. [PMID: 27293140 DOI: 10.1111/ctr.12780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post-operative low-dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients. METHODS A total of 66 simultaneous pancreas kidney (SPK) transplants were performed at our institution from 2004 to 2014. Patients were divided into 2 retrospective cohort groups. Group 1 patients received only acetylsalicylic acid (ASA) 81 mg/d started on post-operative day 1. Group 2 patients received IV heparin infusion beginning in the recovery room at a rate of 500 IU/h for the first 24 hours, reduced by 100 IU/h every day to stop on day 5, and then received ASA 81 mg/d afterward. Outcome and complication rates were compared between the two groups for 5 years post-transplant. RESULTS We observed a significant reduction in graft thrombosis and graft loss with (0/29) patients in the heparin group vs (7/33) 25.7% from the non-heparin (P<.01) with no differences in complication rates. CONCLUSIONS We present a heparin infusion protocol which may help prevent graft thrombosis and graft loss in SPK transplantation.
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Affiliation(s)
- Ghaleb Aboalsamh
- Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada
| | - Patrick Anderson
- Division of Urology, Department of Surgery, Western University, London, Canada
| | - Amira Al-Abbassi
- Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada
| | - Vivian McAlister
- Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.,Division of General Surgery, Department of Surgery, Western University, London, Canada
| | - Patrick P Luke
- Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.,Division of Urology, Department of Surgery, Western University, London, Canada
| | - Alp Sener
- Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada. .,Division of Urology, Department of Surgery, Western University, London, Canada. .,Department of Microbiology and Immunology, Western University, London, Canada.
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Abstract
BACKGROUND Fluid excess may place people undergoing surgery at risk for various complications. Hypertonic salt solution (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. This review was published in 2010 and updated in 2016. OBJECTIVES To determine the benefits and harms of HS versus IS solutions administered for fluid resuscitation to people undergoing surgery. SEARCH METHODS In this updated review we have searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2016); MEDLINE (January 1966 to April 2016); EMBASE (January 1980 to April 2016); LILACS (January 1982 to April 2016) and CINAHL (January 1982 to April 2016) without language restrictions. We conducted the original search on April 30th, 2007, and reran it on April 8th, 2016. SELECTION CRITERIA We have included randomized clinical trials (RCTs) comparing HS to IS in people undergoing surgery, irrespective of blinding, language, and publication status. DATA COLLECTION AND ANALYSIS Two independent review authors read studies that met our selection criteria. We collected study information and data using a data collection sheet with predefined parameters. We have assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We have pooled the data using the mean difference (MD) for continuous outcomes. We evaluated heterogeneity between studies by I² percentage. We consider studies with an I² of 0% to 30% to have no or little heterogeneity, 30% to 60% as having moderate heterogeneity, and more than 60% as having high heterogeneity. In studies with low heterogeneity we have used a fixed-effect model, and a random-effects model for studies with moderate to high heterogeneity. MAIN RESULTS We have included 18 studies with 1087 participants of whom 545 received HS compared to 542 who received IS. All participants were over 18 years of age and all trials excluded high-risk patients (ASA IV). All trials assessed haematological parameters peri-operatively and up to three days post-operatively.There were three (< 1%) deaths reported in the IS group and four (< 1%) in the HS group, as assessed at 90 days in one study. There were no reports of serious adverse events. Most participants were in a positive fluid balance postoperatively (4.4 L IS and 2.5 L HS), with the excess significantly less in HS participants (MD -1.92 L, 95% confidence interval (CI) -2.61 to -1.22 L; P < 0.00001). IS participants received a mean volume of 2.4 L and HS participants received 1.49 L, significantly less fluid than IS-treated participants (MD -0.91 L, 95% CI -1.24 to -0.59 L; P < 0.00001). The maximum average serum sodium ranged between 138.5 and 159 in HS groups compared to between 136 and 143 meq/L in the IS groups. The maximum serum sodium was significantly higher in HS participants (MD 7.73, 95% CI 5.84 to 9.62; P < 0.00001), although the level remained within normal limits (136 to 146 meq/L).A high degree of heterogeneity appeared to be related to considerable differences in the dose of HS between studies. The quality of the evidence for the outcomes reported ranged from high to very low. The risk of bias for many of the studies could not be determined for performance and detection bias, criteria that we assess as likely to impact the study outcomes. AUTHORS' CONCLUSIONS HS reduces the volume of intravenous fluid required to maintain people undergoing surgery but transiently increases serum sodium. It is not known if HS affects survival and morbidity, but this should be examined in randomized controlled trials that are designed and powered to test these outcomes.
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Affiliation(s)
- Brad Shrum
- University Hospital London Health Sciences CentreGeneral Surgery Experimental LaboratoryDepartment of Surgery339 Windermere RoadLondonONCanadaN6A 5A5
| | - Brian Church
- Department of Anesthesia, University of Western Ontario1 Canadian Field Hospital, Canadian Forces Medical ServiceD2‐315 Victoria HospitalLondonONCanadaN6A 5A5
| | - Eric McArthur
- Victoria HospitalELL‐218800 Commissioners Rd ELondonONCanada
| | - Karen EA Burns
- Keenan Research Centre/Li Ka Shing Knowledge Institute, University of TorontoInterdepartmental Division of Critical Care30 Bond Street, Rm 4‐045 Queen WingTorontoONCanadaM5B 1WB
| | - Tammy Znajda
- Lakeshore General HospitalDepartments of General Surgery and Intensive Care Medicine160 Stillview AvePointe‐ClaireQCCanadaH9R 2Y2
| | - Vivian McAlister
- University of Western OntarioDepartment of SurgeryC4‐212, University HospitalLondonONCanadaN6A 5A5
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Pineda-Solis K, McAlister V. Wading through the noise of "multi-omics" to identify prognostic biomarkers in hepatocellular carcinoma. Hepatobiliary Surg Nutr 2015; 4:293-4. [PMID: 26312246 DOI: 10.3978/j.issn.2304-3881.2015.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 12/27/2022]
Abstract
Multi-omics, the molecular analysis of genes, transcriptional RNA and proteins, allows researchers document the mechanism of action of a target gene. However multi-omics may result in an avalanche of information when used to screen a population. It is very difficult to discern a pattern or signal related to a disease or its progression. Differential multi-omics exploits our ability to see differences between subjects who are similar in all respects except for the outcome being tested. Twin studies are an example of this. Miao and colleagues compared two patients who had diverse outcomes following treatment of multi-focal hepatocellular carcinoma (HCC) to identify seven candidates as the responsible genes. In a larger cohort of patients with HCC they narrowed the field down to a single target down. By looking at progression of HCC, they isolated TTK, a protein kinase which disrupts the interaction of the tumour suppressor p53 with the oncogene MDM2. TTK-high tumours recurred 3 times faster than TTK-low tumours.
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Affiliation(s)
- Karen Pineda-Solis
- Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Vivian McAlister
- Department of Surgery, University of Western Ontario, London, ON, Canada
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McAlister V. Élever les normes de production de rapports de recherche chirurgicale pour accroître leur impact. Can J Surg 2015. [DOI: 10.1503/cjs.010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Anderson P, Aboalsamh G, Al Abbassi A, McAlister V, Luke P, Sener A. MP79-13 POST-OPERATIVE INTRAVENOUS HEPARIN INFUSION IMPROVES SHORT AND LONG TERM SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANT OUTCOMES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McAlister V. La commémoration médicale. Can J Surg 2015. [DOI: 10.1503/cjs.003515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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McAlister V. Medical memorialization. Can J Surg 2015; 58:77-8, 78-9. [PMID: 25799241 DOI: 10.1503/cjs.003215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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McAlister V. Aucune spécialité n’est une île : la stratégie de Wilder Penfield. Can J Surg 2014. [DOI: 10.1503/cjs.008614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Stanford DA, Lee JM, Chandok N, McAlister V. A queuing model to address waiting time inconsistency in solid-organ transplantation. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.orhc.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McAlister V. Consensus ad idem : une démarche pour la formulation de déclarations de consensus. Can J Surg 2013. [DOI: 10.1503/cjs.028713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
INTRODUCTION Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in the event of traumatic disruption of the superficial femoral artery, to infuse protective agents or to place a stent to restore flow to the lower leg. METHODS Dissection of ten cadaveric lower limbs was performed to photograph the arterial anatomy from the inguinal ligament to the tibial tubercle. Anastomosis with branches of the popliteal artery was classified as: 'direct communication', 'approaching communication' or 'no evident communication'. RESULTS A constant descending artery in the lateral thigh (LDAT) was found to have five types of origin: Type 1 (2/10 limbs) involved the lateral circumflex femoral branch of the femoral artery, Type 2 (3/10 limbs) the lateral circumflex femoral branch of the profunda femoris artery, Type 3 (1/10 limbs) the femoral artery, Type 4 (3/10 limbs) the superficial femoral artery and Type 5 (2/10 limbs) the profunda femoris artery. In one limb, there were two descending arteries (Types 4 and 5). Collateral circulation at the knee was also variable: direct communicating vessels (3/10 limbs); approaching vessels with possible communication via capillaries (5/10 limbs); no evident communication (2/10 limbs). Communicating vessels, if present, are too small to provide immediate collateral circulation. CONCLUSIONS Modern representations of the genicular arterial anastomosis are inaccurate, derived commonly from an idealised image that first appeared Gray's Anatomy in 1910. The afferent vessel is not the DBLCFA. The majority of subjects have the potential to recruit collateral circulation via the LDAT following gradual obstruction to normal arterial flow, which may be important if the LDAT is removed for bypass or flap surgery. A direct communication is rarely present and is never as robust as generally depicted in textbooks.
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Affiliation(s)
- M Sabalbal
- Canadian Forces Medical Service and Western University Canada
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McAlister V. Contribution du Canada à l’ACS. Can J Surg 2013. [DOI: 10.1503/cjs.017213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
PURPOSE Although three or more liver transplantation (LT)s in the same patient arouse not only medical but also ethical issues in the context of organ shortage, it is a fact that additional liver retransplantation (reLT) is the only lifesaving treatment option for those with graft failure after a second LT. However, little is known regarding the risks and benefits associated with a third LT. METHODS We analyzed fifteen cases of third LT and 48 of second LT performed between January 2000 and December 2010. Clinical outcomes were compared with those of second LT cases performed during the same period. RESULTS Model for end-stage liver disease (MELD) scores at transplant was similar between the two groups. As for surgical aspects, there was no significant difference in operative time or number of units of red blood cells transfused during the transplant procedures between the groups. Patient and graft survival after the third LT at 1, 3, and 10 years were 66.7, 51.9, and 44.4 %, and 66.7, 51.9, and 29.6 %, respectively. There was no significant difference in patient or graft survival between the groups. However, graft loss within 3 months after the third LT was significantly higher than that of second LT patients. CONCLUSION Third LT cases showed acceptable short- and long-term outcomes that were not significantly inferior to those of a second LT. Careful patient care especially in the early phase after a third LT may be essential to improve the outcome.
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Affiliation(s)
- Hideya Kamei
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| | - Mamoun Al-Basheer
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Jeffrey Shum
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Michael Bloch
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Roberto Hernandez Alejandro
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Vivian McAlister
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - William Wall
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Douglas Quan
- Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada
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48
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McAlister V. La lente émergence d’un nouveau journalisme médical. Can J Surg 2013. [DOI: 10.1503/cjs.006113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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49
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Jiang A, McGregor T, Rowe N, McAlister V, Martin P, Sener A, Luke P. 2317 THE EFFECT OF SIMULTANEOUS PANCREAS KIDNEY TRANSPLANTATION ON THE 10-YEAR CARDIOVASCULAR DISEASE RISK OF TYPE 1 DIABETIC PATIENTS. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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McAlister V. Slow birth of new-wave medical journalism. Can J Surg 2013; 56:77. [PMID: 23517631 DOI: 10.1503/cjs.005513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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