Journal of Surgical Research

Changing Epidemiology of Acute Appendicitis in the United States: Study Period 1993–2008

2011-08-10

Background: Addis et al. [5] described the epidemiology of appendicitis in the United States from 1970 to 1984. He reported that while overall incidence decreased, the highest incidence of appendicitis occurred in 10- to 19-y-olds. This study examines if the incidence of appendicitis and mean age of diagnosis has changed, and whether demographics are related to the frequency of admissions and incidence rate of acute appendicitis (AA).Materials and Methods: Study questions were assessed using the Nationwide Inpatient Sample (NIS) discharge data and US Census data from 1993–2008. Operatively managed, uncomplicated, and complex cases of AA were included. Incidental appendectomy and right hemicolectomy were excluded. Descriptive, ANOVA, χ2, and test of proportion statistics were used to evaluate frequency of admissions, incidence rate, and demographic changes in appendicitis.Results: The annual rate of AA increased from 7.62 to 9.38 per 10,000 between 1993 and 2008. The highest frequency of AA was found in the 10–19 y age group, however occurrence in this group decreased by 4.6%. Persons between ages 30 and 69 y old experienced an increase of AA by 6.3%. AA rates remained higher in males. Hispanics, Asians, and Native Americans saw a rise in the frequency of AA, while the frequencies among Whites and Blacks decreased.Conclusions: While AA is most common in persons 10- to 19-y old, the mean age at diagnosis has increased over time. Minorities are experiencing an increase in the frequency of appendicitis. The changing demographics of the US plays a role in the current epidemiology of appendicitis, but is not solely responsible for the change observed.

“Pulling the plug”—Management of meconium plug syndrome in neonates

Alex G. Cuenca, Anam S. Ali, David W. Kays, Saleem Islam — 2012-03-14

Abstract: Background: The significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung’s disease and magnesium tocolysis. We reviewed our experience to attempt to identify any potential association with these conditions and to review our outcomes.Methods: Using the International Classification of Diseases, Ninth revision, code for meconium obstruction, patient charts were identified during the 1998–2008 period. A total of 61 cases of MPS were found, after excluding 7 of meconium ileus. Data regarding the hospital course and outcomes were collected and analyzed.Results: Approximately 30% of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97% success. Only 2 patients required surgical intervention owing to worsening distension and subsequent peritonitis. When we stratified the patients according to gestational age of >36 and <36 wk, contrast barium enemas were performed 2.2 ± 1.8 versus 8.6 ± 7.8 d after birth (P = 0.003), respectively, and the lower gestational age patients had a longer length of stay. Contrast barium enema was still successful in 94% of patients with a gestational age of <36 wk. Magnesium tocolysis was noted in 16% of the cases, and Hirschsprung’s disease was only found in 3.2% of patients.Conclusions: Patients with MPS have excellent outcomes, independent of gestational age. Contrast barium enema remains the initial diagnostic and treatment of choice for patients with MPS. Also, although previous reports have shown a link between magnesium tocolysis and Hirschsprung’s disease with MPS, our experience suggests otherwise.

Real-Time Monitoring for Detection of Retained Surgical Sponges and Team Motion in the Surgical Operation Room Using Radio-Frequency-Identification (RFID) Technology: A Preclinical Evaluation

2011-04-14

Background: Technical progress in the surgical operating room (OR) increases constantly, facilitating the development of intelligent OR systems functioning as “safety backup” in the background of surgery. Precondition is comprehensive data retrieval to identify imminent risky situations and inaugurate adequate security mechanisms. Radio-frequency-identification (RFID) technology may have the potential to meet these demands.Methods: We set up a pilot study investigating feasibility and appliance reliability of a stationary RFID system for real-time surgical sponge monitoring (passive tagged sponges, position monitoring: mayo-stand/abdominal situs/waste bucket) and OR team tracking (active transponders, position monitoring: right/left side of OR table).Results: In vitro: 20/20 sponges (100%) were detected on the mayo-stand and within the OR-phantom, however, real-time detection accuracy declined to 7/20 (33%) when the tags were moved simultaneously. All retained sponges were detected correctly. In vivo (animal): 7–10/10 sterilized sponges (70%–100%) were detected correctly within the abdominal cavity. OR-team: detection accuracy within the OR (surveillance antenna) and on both sides of the OR table (sector antenna) was 100%. Mean detection time for position change (left to right side and contrariwise) was 30–60 s. No transponder failure was noted.Conclusion: This is the first combined RFID system that has been developed for stationary use in the surgical OR. Preclinical evaluation revealed a reliable sponge tracking and correct detection of retained textiles (passive RFID) but also demonstrated feasibility of comprehensive data acquisition of team motion (active RFID). However, detection accuracy needs to be further improved before implementation into the surgical OR.

Modified Map-Seeking Circuit: Use of Computer-Aided Detection in Locating Postoperative Retained Foreign Bodies1

Bolanle Asiyanbola, Chao Cheng-Wu, Jonathan S. Lewin, Ralph Etienne-Cummings — 2011-12-15

Background: More than 98% of intra-operative X-rays taken to search for postoperative retained foreign bodies (RFBs) have negative findings; in over 30% of cases of such X-rays, the finding is a false negative. Newer technologies created to find RFBs must not only reduce the false-negative rate, but also must not increase the burden of detecting RFBs. We have introduced the use of computer-aided detection (CAD) to facilitate the detection of RFBs on X-rays utilizing a modified version of map-seeking circuit (MSC) algorithm the referenced map-seeking circuit (RMSC), for our proof-of-concept study for detection of needles in plain abdominal X-rays.Methods: Images were obtained by using a portable cassette-based X-ray machine and a C-arm (digital) machine, both of which are commonly used in the operating room. The images obtained using these machines were divided into subimages of approximately 250 × 250 pixels each, for a total of 455 subimages from the cassette-based machine (A) and 365 from the digital machine (B) for use as test samples. Images obtained from A and B were analyzed separately using our modified MSC algorithm with a minimum (τ = 0) and a maximum threshold (τ = 0.5).Results: The automated detection rate (positive predictive value) was 86%, with a false positive/negative rate of 10% to 15% when τ was zero.Conclusion: The CAD-based RMSC algorithm has the potential to improve the accuracy with which RFBs can be found in X-rays. Further research is needed to optimize the detection rate and to identify a wider range of RFBs.

Effective Oncolytic Vaccinia Therapy for Human Sarcomas

2011-12-16

Background: Approximately one fourth of bone and soft-tissue sarcomas recur after prior treatment. GLV-1h68 is a recombinant, replication-competent vaccinia virus that has been shown to have oncolytic effects against many human cancer types. We sought to determine whether GLV-1h68 could selectively target and lyse a panel of human bone and soft-tissue sarcoma cell lines in vitro and in vivo.Methods: GLV-1h68 was tested in a panel of four cell lines including: fibrosarcoma HT-1080, osteosarcoma U-2OS, fibrohistiocytoma M-805, and rhabdomyosarcoma HTB-82. Gene expression, infectivity, viral proliferation, and cytotoxicity were characterized in vitro. HT-1080 xenograft flank tumors grown in vivo were injected intratumorally with a single dose of GLV-1h68.Results: All four cell lines supported robust viral transgene expression in vitro. At a multiplicity of infection (MOI) of five, GLV-1h68 was cytotoxic to three cell lines, resulting in >80% cytotoxicity over 7 d. In vivo, a single injection of GLV-1h68 into HT-1080 xenografts exhibited localized intratumoral luciferase activity peaking at d 2–4, with gradual resolution over 8 d and no evidence of spread to normal tissues. Treated animals exhibited near-complete tumor regression over a 28-d period without observed toxicity.Conclusion: GLV-1h68 has potent direct oncolytic effects against human sarcoma in vitro and in vivo. Recombinant vaccinia oncolytic virotherapy could provide a new platform for the treatment of patients with bone and soft tissue sarcomas. Future clinical trials investigating oncolytic vaccinia as a therapy for sarcomas are warranted.

Tracheal Replacement with Fresh and Cryopreserved Aortic Allograft in Adult Dog

2011-04-20

Background: Many reports have described tracheal replacement using aortic allografts, with varying results and minimal understanding of the mechanism of tracheal regeneration. The present study attempted tracheal regeneration in adult dogs using fresh aortic allografts (FAA) and cryopreserved aortic allografts (CAA).Materials and Methods: Twelve adult beagles underwent tracheal resection and were transplanted with FAA (n = 5) or CAA (n = 7). Animals were followed-up with serial radiography and magnetic resonance imaging, and were euthanized at predetermined times up to 16 mo post-surgery.Results: There were no procedural deaths, but two animals died due to stent migration. Stent migration occurred in seven of the 12 animals. Evidence of regeneration of tracheal epithelium was observed in the surviving animals, with the transformation of squamous metaplasia to mucociliary epithelium being time-dependent. Islet of cartilage were observed in animals after 6 mo, but ring-like cartilage structures were absent, even after 16 mo. During autopsy, axial graft contractions up to 68% were observed. Serial radiographs show that most of the contraction occurred within 1 mo. The results of the MRI showed that the graft area was strongly enhanced for up to 2 mo, but was clearly reduced after 3 mo.Conclusions: Tracheal replacement in adult dogs using FAA or CAA is feasible. However, immaturity of the neotracheal cartilage did not allow the tissue to function as native tracheal tissue. Prolonged stenting should be considered in adult if the procedure is to be clinically contemplated.

Feasibility of Endoscopic Transoral Thoracic Surgical Lung Biopsy and Pericardial Window Creation

2011-04-08

Background: The thoracic cavity approach for natural orifice transluminal endoscopic surgery (NOTES) is technically challenging. The aim of this study was to evaluate the feasibility of a transoral endoscopic technique for a surgical lung biopsy and pericardial window creationMethods: Under general anesthesia, a 12 mm incision was made over the vestibulum oris region. Under video guidance, a homemade metallic tube was introduced through the incision, extending along the pre-tracheal space to the substernal space with blunt dissection technique, and used as the entrance into the thoracic cavity. A surgical lung biopsy and a pericardial window creation were performed in 12 canines, using the transoral NOTES technique.Results: The transoral endoscopic surgical lung biopsy and pericardial window creation were successfully completed in 11 of the 12 canines. Intraoperative bleeding and death from an injury to the pulmonary hilum developed in one animal during the electrosurgical excision of lung tissue.Conclusions: Transoral surgical lung biopsy and pericardial window creation in canine models is technically feasible and can be used as a novel experimental platform for studies of NOTES for intra-thoracic surgery.

Total Knee and Hip Arthroplasty Across BMI Categories: A Feasible Option for the Morbidly Obese Patient

Steven R. Allen — 2011-08-12

In the United States, obesity has grown to epidemic proportions over the past decade with a prevalence of up to 35% of adults being reported as obese . Obesity in the adult population increases the rates of musculoskeletal diseases, in particular osteoarthritis, which represents a major source of disability in the United States . The development of osteoarthritis increases by 36% for every 5 kg increase in body weight . Osteoarthritis negatively impacts quality of life. Total knee (TKA) and hip (THA) arthroplasties are known to reduce pain, improve physical function and improve quality of life in patients affected by osteoarthritis . Despite the benefits of TKA and THA, data from recent studies has been conflicting , with some studies reporting increases in perioperative complications with increased BMI . These data have led to some reluctance in the orthopedic surgery community to proceed with elective joint replacement in patients with BMI >35, fearing increased perioperative complications.

Computerized Rounding Reports: Individualized Solutions Might Work Better

Andreas H. Meier — 2011-05-19

The paper by Drs. Wohlauer, Rove, and colleagues covers a very important problem that healthcare systems and providers are increasingly faced with today. Well-conducted patient sign-outs and handovers are critical for patient safety, but if done poorly, these care transition points can lead to significant breaks in communication. There is strong evidence that flaws in provider-to-provider hand-offs can directly lead to patient harm . Opportunities for such communication breaks unfortunately will increase even further as we embark on ever-tighter restrictions of work hours. These affect especially the more junior residents, who often represent the primary provider group engaged in hand-over activities.

Minimally Invasive Thoracic Surgery

Danny Chu — 2011-06-23

Minimally invasive surgery is rapidly gaining popularity due to the small-size incision and the potential for rapid postoperative recovery. Patients often demand this approach for even the most complex surgical diseases. In order to stay competitive in the field of thoracic surgery, one must embrace new innovations and technology for the ultimate goal of improving patient care.

Assessment of Colon Cancer Literacy in Screening Colonoscopy Patients: A Validation Study

Rajesh Pendlimari, Stefan D. Holubar, James P. Hassinger, Robert R. Cima — 2011-05-19

Background: Few, if any, instruments assess disease-specific health literacy in colon cancer patients. We aimed to validate the Assessment of Colon Cancer Literacy (ACCL) compared with a standard health literacy test, the Newest Vital Sign (NVS).Materials and Methods: A convenience sample of screening colonoscopy patients was surveyed. General health literacy was assessed with the NVS and colon cancer literacy with the ACCL. Contingency table analysis was performed. Results are frequency (proportion) or mean.Results: Sixty-one subjects completed our survey, mean age 64 ± 9 y, 33 (54%) were women, 28 (46%) had a college degree, 38 (62%) had prior colonoscopy, and 19 (31%) worked in healthcare. The sensitivity and specificity of NVS to identify limited colon cancer literacy was 45.7% and 86.7%, respectively, while the sensitivity and specificity of ACCL to identify limited general health literacy was 91.3% and 34.2%, respectively.Conclusions: The ACCL is a valid, sensitive measure of health literacy. Furthermore, given its focus on clinically relevant content, this instrument may facilitate discussion of diagnosis, treatment, and prognosis with colon cancer patients. ACCL is a novel, valid health literacy instrument that may aid gastroenterologists, colorectal surgeons, and medical oncologists in optimizing patient education.

The Impact of iMedConsent on Patient Decision-Making Regarding Cholecystectomy and Inguinal Herniorrhaphy1

2011-05-25

Background: The Veterans Affairs Healthcare System implemented a computer-based tool (iMedConsent) to improve the quality of informed consent in 2004. The impact of this tool on the process of informed consent remains unknown. Our aim was to determine the impact of iMedConsent on patient information preference, anxiety, trust in the surgeon, ambivalence about the surgical decision, and comprehension of procedure-specific risk, benefits, and alternatives.Materials and Methods: We prospectively enrolled a consecutive cohort of patients presenting to a general surgery clinic for possible cholecystectomy or inguinal herniorrhaphy from October 2009 to August 2010. We administered questionnaires before and after the clinic visit.Results: Seventy-five patients completed pre-visit questionnaires. After evaluation by the surgeon, 42 patients were offered surgery and documented their informed consent using iMedConsent, of whom 38 (90%) also completed a post-visit questionnaire. Among the participants who completed both pre- and post-visit questionnaires, participant comprehension of procedure-specific risks benefits and alternatives improved from 50% at baseline to 60% after the clinic visit (P < 0.001). No differences were noted in ambivalence, trust, or anxiety. After the clinic visit, significantly more patients expressed a preference for participating in decision making with their surgeon (98% versus 71%, P = 0.008). However, significantly fewer expressed a preference for knowing all possible details about their illness (25% to 83%, P ≤ 0.001).Conclusions: The informed consent process using iMedConsent improves patient comprehension of procedure-specific risks, benefits, and alternatives. It also increases patient preferences for participating more actively in the decision-making process. However, the process may provide more detail than patients want regarding their illness.

Hydrogen Sulfide Modulates Contractile Function in Rat Jejunum

Michael S. Kasparek, David R. Linden, Gianrico Farrugia, Michael G. Sarr — 2011-04-25

Background: Effects of hydrogen sulfide (H2S), a third gasotransmitter of the gut, are not well understood. The aim of this study was to determine effects/mechanisms of H2S action on contractile function in rat jejunal muscle.Methods: Transmural strips of longitudinal muscle were evaluated. Response to sodium hydrosulfide (NaHS, H2S donor; 10−5–10−3M) was studied on spontaneous contractile activity and after precontraction (bethanechol, 3 × 10−6M). Atropine, propranolol, phentolamine, tetrodotoxin, capsaicin, L-NG-nitro arginine (L-NNA), and glibenclamide were used to determine mechanisms. L-cysteine (10−4–10−2M; substrate for H2S production) and aminooxyacetic acid and DL-propargylglycine (inhibitors of enzymes generating H2S endogenously) were used to study endogenous production. Aminooxyacetic acid, DL-propargylglycine, L-NNA, and vasoactive intestinal polypeptide (VIP) antagonist [D-p-Cl-Phe6,Leu17]-VIP were used to study H2S release during electrical field stimulation (EFS) and interaction with VIP and nitric oxide. Immunohistofluorescence of jejunal whole mounts was performed for endogenous H2S-producing enzymes.Results: Cystathionine-β-synthase and cystathionine-γ-lyase were expressed only in myenteric plexus. NaHS suppressed spontaneous and stimulated contractile activity (P < 0.01). Glibenclamide prevented some suppression by NaHS (P = 0.01) of stimulated contractile activity but did not prevent suppression of spontaneous contractile activity. Other drugs had no effect on spontaneous contractile activity but increased inhibitory effects of NaHS on spontaneous and stimulated contractile activity (P < 0.05). L-cysteine had no effects on contractile activity. Inhibitors altered basal and stimulated activity suggesting endogenous release of H2S.Conclusions: H2S presumably suppresses contractile activity in jejunum by direct effects on smooth muscle. Mechanism(s) of inhibition remains unclear, because blocking known neurotransmitters enhanced H2S-induced suppression, while blocking adenosine triphosphate (ATP)-sensitive K+-channels did not block H2S-induced inhibition.

Clinicopathologic Characteristics and Surgical Outcomes of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

2011-04-25

Background: Hepatocellular carcinoma (HCC) has a high predilection for portal vein invasion. Furthermore, the treatment of HCC with portal vein tumor thrombosis (PVTT) is controversial. The objective of this study was to investigate clinicopathologic characteristics and surgical outcomes of HCC patients with PVTT.Methods: The clinicopathologic data and surgical outcomes of 88 patients HCC with PVTT and 211 patients without PVTT who underwent surgery were retrospectively reviewed. The risk factors and the prognosis of HCC patients with PVTT were determined.Results: Cirrhosis, serum alkaline phosphatase (ALP) > 100 IU/L, tumor size > 8 cm, incomplete tumor capsule, and adjacent organ invasion were risk factors for PVTT in HCC on multivariate analysis. Furthermore, HCC patients with PVTT received more major hepatectomies, had more intraoperative blood loss and greater blood transfusion requirements, and higher incidence of postoperative mortality compared with HCC patients without PVTT. The median overall survival of HCC patients with PVTT after surgery was 9 mo, with the 1-, 2-, and 3-y overall survival rates of 31.1%, 18.3%, and 15.2 %, respectively. AFP level, adjacent organ invasion, and PVTT location predicted overall survival of HCC patients with PVTT.Conclusions: High serum ALP level, cirrhosis, large tumor, incomplete tumor capsule and adjacent organ invasion are predictors of PVTT in HCC. Surgery is a valid therapy for selected HCC patients with PVTT.

Peritrocal and Intraperitoneal Ropivacaine for Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind Controlled Trial1

2011-05-18

Background: The goal of this study was to evaluate the effect of peritrocal, intraperitoneal, or combined peritrocal-intraperitoneal ropivacaine on the parietal, visceral, and shoulder tip pain after laparoscopic cholecystectomy.Methods: Eighty patients were randomly assigned to four groups. Group A received peritrocal and intraperitoneal saline. Group B received peritrocal saline and intraperitoneal ropivacaine. Group C received peritrocal ropivacaine and intraperitoneal saline. Group D received peritrocal and intraperitoneal ropivacaine. The parietal, visceral, and shoulder tip pain were assessed at 2, 4, 8, 12, 24, and 48 h postoperatively using a visual analog scale (VAS). The frequency of the patient pushing the button of the PCA and fentanyl use were also recorded.Results: In visceral pain, significantly lower VAS scores were observed in Group B from 2 to 4 h and in Group D from 2 to 8 h. In parietal pain, significantly lower VAS scores were observed in Group C from 4 to 24 h and in Group D from 2 to 12 h. In shoulder tip pain, significantly lower VAS scores were observed in Group B from 4 to 48 h and in Group D from 2 to 12 h. The fentanyl use and the frequency to push the button of the PCA were the highest in Group A and the lowest in Group D at every time point.Conclusions: We conclude that peritrocal infiltration of ropivacaine significantly decreases parietal pain and intraperitoneal instillation of ropivacaine significantly decreases the visceral and shoulder tip pain. Their effects are additive with respect to the total pain.

The Oxidative Effect of Prolonged CO2 Pneumoperitoneum A Comparative Study in Rats

2011-10-14

Background: The current study evaluated the effect of time in the severity of the oxidative stress due to pneumoperitoneum.Methods: Forty Wistar rats were allocated randomly into 2 groups. The 1 h pneumoperitoneum (Pp) group, which was subjected to 60 min of pneumoperitoneum, and the 3 h Pp, to pneumoperitoneum for 180 min. The animals were divided in half. One half of the rats were left resting for 30 min after abdominal desufflation and the other for 8 h. After these two time periods, blood, liver, kidney, lung and small intestine were obtained for biochemical analysis and histopathological examination.Results: In the 3 h Pp, the associated oxidative stress was increased. There was an overt increase in blood and tissue MDA and blood PAB values. The MPO values were significantly higher in the 3 h Pp group in serum, kidneys, and intestine during the early phase of reperfusion and in liver after 8 h of reperfusion. These changes occurred in the presence of light microscopic evidence of greater tissue damage for the 3 h Pp, which were consistent with the fluctuation of the MPO values.Conclusion: In our experimental model, we proved biochemically and histologically that time of maintenance of pneumoperitoneum is an additive factor that could cause increased oxidative stress in laparoscopic procedures.

Phenacetin O-Deethylation is a Useful Tool for Evaluation of Hepatic Functional Reserve in Rats with CCl4-Induced Chronic Liver Injury

2011-12-21

Background: Mortality of liver resection is as high as 3.1% to 25% in patients with chronic liver disease. Evaluation of hepatic functional reserve is critical for the prediction of risk of postoperation death. Phenacetin O-deethylation is a marker reaction of cytochrome P4501A2 (CYP1A2) activity. In this study, our aim is to investigate whether phenacetin O-deethylation is a useful tool for the evaluation of hepatic functional reserve in rats with chronic liver injury.Materials and Methods: Rat model for chronic liver injury was established by subcutaneous administration of 50% CCl4, 1 mL/kg twice per week for 12 wk. Hepatic CYP1A2 activity, content, and mRNA expression were determined (n = 10). Effects of 15%, 30%, and 45% hepatectomy on phenacetin O-deethylation were evaluated in the rats (n = 5 in each group). Additionally, the correlation of risk of death after 70% hepatectomy with phenacetin O-deethylation was studied in 27 rats with chronic liver injury.Results: Compared with normal controls, CYP1A2 activity, content, and mRNA expression decreased 33%, 60%, and 50% in the rats with chronic liver injury (P < 0.05), respectively. Following the increasing of liver-resected size, CYP1A2 activity decreased proportionally (rs = −0.877, P < 0.05). Six of 27 rats with chronic liver injury died within 7 d after 70% hepatectomy. Phenacetin metabolism was impaired more severely in 6 rats that died than in 21 living rats (P < 0.05).Conclusions: Phenacetin O-deethylation is a useful tool for the evaluation of hepatic functional reserve in the rats with CCl4-induced chronic liver injury.

New Anthranilic Acid Derivative, EAntS-GS, Attenuates Freund’s Complete Adjuvant-Induced Acute Pain in Rats

2011-04-29

Background: Acute and chronic pain commonly accompany various clinical conditions such as contusion, fracture, osteoarthritis, peripheral neuropathy, and postherpetic neuralgia. Recent studies have found that antioxidative drugs can have analgesic effects. The present study tested the hypothesis that a new anthranilic acid derivative, EAntS-GS, exerts antinociceptive effects on inflammatory pain in a rat model.Methods: We induced subacute pain with a plantar injection of Freund’s complete adjuvant (FCA) in Sprague-Dawley rats. EAntS-GS (1 mg/kg subcutaneous injection or 1% application) was administered every 12 h beginning 24 h after FCA administration, and the plantar test was used to determine its effect on pain. Levels of myeloperoxidase, inducible nitric oxide synthase (iNOS), and protease activated receptor 2 (PAR2) were measured to elucidate the mechanism of action of EAntS-GS.Results: EAntS-GS significantly reduced FCA-induced pain and myeloperoxidase, iNOS, and PAR2 levels. Our findings suggest that the new anthranilic acid derivative, EAntS-GS, exerts antinociceptive effects, and that the mechanism involves iNOS and PAR2.Conclusion: We conclude that EAntS-GS should be considered a new therapeutic tool to treat acute and chronic pain.

Increased Osteoblast and Osteoclast Activity in Female Senescence-Accelerated, Osteoporotic SAMP6 Mice During Fracture Healing

2011-04-20

Background: Previous studies have shown that fracture healing depends on gender and that in females, ovariectomy-induced osteoporosis impairs the healing process. There is no information, however, whether the alteration of fracture healing in osteoporosis also depends on gender.Materials and Methods: Therefore, we herein studied fracture healing in female and male senescence-accelerated osteoporotic mice, strain P6 (SAMP6), including biomechanical, histomorphometric, and protein biochemical analysis.Results: Bending stiffness was reduced in male and female SAMP6 mice compared with senescence-resistant strain 1 (SAMR1) controls. This was associated with elevated serum concentrations of tartrate-resistent acid phosphatase form 5b (TRAP) in both female and male SAMP6 mice. Callus size, however, was significantly larger in female SAMP6 mice compared with male SAMP6 mice and female SAMR1 controls. This indicates a delayed remodeling process in female SAMP6 mice. The delay of callus remodeling in female SAMP6 mice was associated with a significantly higher osteoprotegerin (OPG) callus tissue expression and increased serum concentrations of osteocalcin (OC) and deoxypyridinoline (DPD), indicating elevated osteoblast and osteoclast activities.Conclusion: The present study shows that remodeling during fracture healing in female, but not in male, SAMP6 mice is delayed, most probably due to an increased osteoblast and osteoclast activity.

CD133(−) Cells, Derived From a Single Human Colon Cancer Cell Line, Are More Resistant to 5-Fluorouracil (FU) Than CD133(+) Cells, Dependent on the β1-Integrin Signaling

2011-04-25

Background and Aim: Recently, the cancer stem cells (CSCs) theory has been proposed, and CD133 has been suggested as a potential marker of CSCs in various cancer types. In the present study, we aimed evaluate CD133 as a potential marker of colorectal CSCs and, for this purpose, isolated CD133(+) and CD133(−) cells from a single colorectal cancer cell line, and compared their features, especially related to the tumor-forming and differentiation abilities, and the sensitivity to chemotherapy.Methods and Results: CD133(+) cells had higher in vivo tumor-forming ability than CD133(−) cells, and in culture, they progressively differentiated into CD133(−) cells, but not vice-versa. On the other hand, CD133(−) cells were more resistant to 5-fluorouracil (FU) treatment than CD133(+) cells, and it was found to be dependent on the higher expression of ß1-integrins, and consequently, higher ability to bind collagen. Disruption of the ß1-integrin function abrogated the chemoresistance.Conclusion: From the present results, we concluded that colorectal cancer CD133(+) cells, although showing some features of CSCs, are not more resistant to 5-FU than CD133(−) cells. Therefore, definite conclusions can not be drawn yet, but it is strongly suggestive that CD133 should not be used as a single CSC marker of colorectal cancer.

Clinical Significance of Serum Soluble E-cadherin in Colorectal Carcinoma1

2011-12-02

Background: E-cadherin expression has been associated with an outcome in patients with colorectal cancer, and serum levels of soluble E-cadherin (sE-cadherin) are significantly elevated in patients with malignant disease. However, the prognostic value of serum sE-cadherin level has not been demonstrated in colorectal cancer.Methods: Serum samples were collected from 186 patients with colorectal cancer and 21 normal volunteers. Serum sE-cadherin levels were measured using an enzyme-linked immunosorbent assay kit. We investigated the relationship between serum sE-cadherin level and clinicopathologic findings.Results: Mean serum sE-cadherin levels were significantly higher in CRC patients than in controls. Mean sE-cadherin levels were significantly correlated with hepatic metastasis, UICC classification, and poor prognosis. Elevated serum sE-cadherin level was an independent risk factor for predicting poor prognosis, and was an independent marker for predicting hepatic metastasis. Among patients with synchronous hepatic metastases, the prognosis was significantly worse in patients with elevated serum sE-cadherin levels than in those with lower levels.Conclusions: Preoperative elevated sE-cadherin level is associated with poor prognosis in colorectal cancer. Measuring serum sE-cadherin may provide valuable information for predicting prognosis in patients with hepatic metastasis.

Macrophage Genetic Reprogramming During Chronic Peritonitis is Augmented by LPS Pretreatment

2011-05-20

Background: Persistent and tertiary chronic peritonitis is a clinically challenging problem especially in those who are critically ill. This could be attributed to a state of immune-paralysis, known as microbial tolerance. Microbial tolerance is the diminished pro-inflammatory protein response following repeated stimulation by numerous pathogen-associated molecular patterns (PAMPs) of varying origins, which we have shown in this novel model of chronic peritonitis. We aimed in this study to investigate the molecular mechanisms behind microbial tolerance and the early innate immune response resolution in this model.Methods: C57BL/6 mice were pretreated intra-peritoneally (IP) with saline or endotoxin LPS 10 mg/kg (LPS 10). Following pretreatment, peritonitis was induced 24 h later injecting 103 Klebsiella pneumonia CFU IP. Gentamicin was administered 4 h prior to infection and BID thereafter. Peritoneal exudate cells (PEC) were obtained through peritoneal lavage and RNA was isolated (n = 3) at 4, 24, and 48 h following infection. SA Biosciences© RT2-Profiler PCR array mouse Toll-like receptor signaling pathway (PAMM_018A) data were further analyzed by Ingenuity Pathway Inc. analysis (IPA).Results: Of the 89 genes studied, 26 were significantly up-regulated (fold change > 1.2 and P value < 0.05) in the saline pretreated group at 4, 24, and 48 h after infection. There were no down-regulated genes. In the LPS-pretreated group, 35 genes were significantly up-regulated; of these genes, 13 were not increased in the saline pretreated infected mice. This left 22 up-regulated genes in both infected groups. At 4 h, 6 of these 22 genes (CHUK, HMGB1, HSPD1, IRAK2, LY96, and TLR4) were further 2-fold increased in the LPS pretreatment group compared with the saline pretreatment group. Only IRAK2 was 2-fold increased at 24 h. By 48 h, no LPS effect was seen. When applying IPA analysis, six main canonical pathways were constantly dysregulated in the same significance order in both the saline and LPS group at 4, 24, and 48 h. These were: Toll-like receptor and NF-κB signaling, hepatic cholestasis, interleukin-6, and LPS-mediated MAPK signaling pathways, and pattern recognition receptors of bacterial pathway.Conclusion: Peritonitis increased PEC gene expression associated with sepsis and a pro-inflammatory response, which was further augmented by LPS pretreatment over 24 h only. Prior exposure to LPS did not induce PEC gene tolerance to subsequent infection with Klebsiella at the mRNA level. Post-transcriptional modification as microRNA down-regulation of inflammatory cytokines could possibly explain such phenomena.

Injury-Induced Changes in Liver Specific Transcription Factors HNF-1α and HNF-4α

2011-05-25

Background: The hepatic acute phase response(APR) is an organ-specific response to a diverse array of insults and is largely under transcriptional control. Liver-specific transcription factors, hepatic nuclear factors (HNFs)-1α and 4α play important roles in maintenance of liver phenotype and function and their binding activity changes early after injury. However, their roles in modulation of the liver’s response over time are not defined.Materials and Methods: C57/BL6 mice were anesthetized and exposed to 95°C water for 10 s to create a 15% body surface area full-thickness burn. At specific time points, the mice were sacrificed. An ELISA for IL-6 was performed on serum and hepatic mRNA levels for fibrinogen-γ and serum amyloid A(SAA)-3 were obtained through polymerase chain reaction (PCR). Transcriptional factor binding activity was assessed with electrophoretic mobility shift assays.Results: Serum IL-6 levels peaked at 3 h and fibrinogen-γ and SAA mRNA levels increased more than 6-fold at 12 h before returning to control levels at 48 h. The binding activity of HNF-4α and HNF-1α rapidly declined after injury (1.5 h) but recovered to near control level at 24 and 6 h, respectively.Conclusions: Changes in HNF-4α and HNF-1α binding occurred before changes in acute phase protein mRNA levels and were preceded by the peak in IL-6 levels. The rapid suppression and reconstitution of liver-specific transcription factor binding after injury may represent a mechanism that allows the normal liver phenotype to change and an injury-response phenotype to prevail. This mechanism in the liver’s adaptive response to injury suggests a central role for both HNF-4α and HNF-1α in transcriptional regulation of the hepatic APR.

Magnolol Attenuates the Lung Injury in Hypertonic Saline Treatment from Mesenteric Ischemia Reperfusion through Diminishing iNOS

Hsin-Chin Shih, Mu-Shun Huang, Chen-Hsen Lee — 2011-05-27

Background: Hypertonic saline (HTS) administration can decrease the inflammation following ischemia reperfusion. Magnolol is a potent antioxidant. The present study investigated whether combined treatment of magnolol and HTS could provide further protection in mesenteric ischemia reperfusion injury.Methods: Male C3H/HeOuJ mice were randomly segregated into the following groups: sham-operated (sham), vehicle treatment and mesenteric ischemia reperfusion (MSIR) (vehicle-treated), magnolol treatment and MSIR (magnolol-treated), HTS treatment and MSIR (HTS-treated), as well as co-administration of magnolol plus HTS and MSIR (combined-treated). In MSIR, mice were subjected to mesenteric ischemia for 60 min followed by reperfusion for 30 min. Lung injury was evaluated by lung edema (water ratio) and myeloperoxide (MPO) activity; RNA expression of inducible nitric oxide synthetase (iNOS), TNF-α, and IL-6 were assayed by real time RT-PCR. The formation of peroxynitrite in plasma was assayed by the peroxynitrite-dependent oxidation of dihydrorhodamine 123 (DHR 123) to rhodamine.Results: Compared with those in the sham-treated group, lung edema and MPO activity, expressions of iNOS, TNF-α and IL-6, and plasma peroxynitrite were significantly increased in the vehicle-treated group. Significant attenuations of these parameters were found in the magnolol-treated or HTS-treated animals. Combined treatment of magnolol and HTS further suppressed the lung edema, iNOS, and TNF-α expressions, and plasma peroxynitrite, compared with the results of a single treatment of magnolol or HTS.Conclusions: Compared with single-agent use, co-administration of magnolol and HTS further decreases iNOS expression and plasma peroxynitrite as well as the degree of lung injury from MISR. These results may provide another treatment measure for post-injury immunomodulation.

N-acetylcysteine (NAC) Protects Against Acute Kidney Injury (AKI) Following Prolonged Pneumoperitoneum in the Rat

Antonio Carlos Seguro, Luiz F. Poli de Figueiredo, Maria Heloisa M. Shimizu — 2011-06-24

Background: Acute kidney injury (AKI) following prolonged laparoscopy is a documented phenomenon. Carbon dioxide pneumoperitoneum induces oxidative stress. Previous experimental studies have shown that the antioxidant, N-acetylcysteine, protects the rat from AKI following ischemia-reperfusion. The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) on rat renal function after prolonged pneumoperitoneum.Methods: Normal rats treated or not with NAC were submitted to abdominal CO2 insufflation of 10 mmHg, at short and long periods of time of 1 and 3 h, respectively, and evaluated at 24, 72 h, and 1 wk after deinsufflation. Glomerular filtration rate (GFR) was measured by inulin clearance and oxidative stress was evaluated by serum thiobarbituric acid reactive substances (TBARS)Results: No significant alterations in GFR were observed in normal animals submitted to the pneumoperitoneum of 1 h and evaluated after 24 h desufflation. With 3 h of pneumoperitoneum, a significant and progressive decrease in GFR occurred 24 and 72 h after desufflation with an increase in serum TBARS. GFR returned to normal levels a week later. In the NAC-treated rats, a complete protection against GFR drops was observed 24 and 72 h following 3 h of pneumoperitoneum associated with a decrease in TBARS.Conclusion: These results suggest that NAC protects against acute kidney injury following prolonged pneumoperitoneum. These findings have significant clinical implications.

Damage Control Resuscitation Decreases Systemic Inflammation After Hemorrhage

2011-12-19

Background: Severe hemorrhagic shock and resuscitation initiates a dysfunctional systemic inflammatory response leading to end-organ injury. Clinical evidence supports the transfusion of high ratios of plasma and packed red blood cells (pRBCs) in the treatment of hemorrhagic shock. The effects of resuscitation with different ratios of fresh blood products on inflammation and organ injury have not yet been characterized.Materials and Methods: Mice underwent femoral artery cannulation and pressure-controlled hemorrhage for 60 min, then resuscitation with fresh plasma and pRBCs collected from donor mice. Plasma alone, pRBCs alone, and ratios of 2:1, 1:1, and 1:2 plasma:pRBCs were used for resuscitation strategies. Mice were sacrificed to determine biochemical and hematologic parameters, serum cytokine concentrations, tissue myeloperoxidase levels, and vascular permeability.Results: Compared with other resuscitation strategies, mice resuscitated with pRBCs alone exhibited increased hemoglobin levels, while other hematologic and biochemical parameters were not significantly different among groups. Compared with 1:1, mice resuscitated with varying ratios of plasma:pRBCs exhibited increased cytokine concentrations of KC, MIP-1α, and MIP-2, and increased intestinal and lung myeloperoxidase levels. Mice resuscitated with 1:1 had decreased vascular permeability in the intestine and lung as compared with other groups.Conclusions: Resuscitation with a 1:1 ratio of fresh plasma:pRBCs results in decreased systemic inflammation and attenuated organ injury. These findings support the potential advantage of transfusing blood products in physiologic ratios to improve the treatment of severe hemorrhagic shock.

The Postoperative Serum Interleukin-15 Concentration Correlates with Organ Dysfunction and the Prognosis of Septic Patients Following Emergency Gastrointestinal Surgery

2011-12-23

Objective: To clarify the time course of changes in the serum interleukin-15 (IL-15) concentrations in septic patients undergoing emergency surgery for abdominal infection and to investigate whether the serum IL-15 levels correlate with the postoperative clinical course of septic patients.Methods: Twenty-four septic patients who had intra-abdominal infection and who underwent an emergency operation were enrolled in this study. The serum IL-15 levels were measured before surgery, and on postoperative d 1 (POD1), POD3, and POD5, and the relationship between the serum IL-15 levels and the postoperative clinical course estimated by the Systemic Inflammatory Response Syndrome (SIRS) criteria, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, the parameters of organ function, and the 30-d mortality were evaluated.Results: The time course of changes of the serum IL-15 levels were significantly different between survivors and non-survivors (P < 0.05, by repeated measures analysis of variance [ANOVA]). There was a statistically significant relationship between the serum IL-15 levels on POD1 or POD3 and the duration of SIRS (R = 0.50, P < 0.05, R = 0.65, P < 0.01, respectively). Furthermore, a significant positive correlation was observed between the serum IL-15 levels on POD1 and the creatinine levels on POD1 or POD3 (R = 0.48, P < 0.05, R = 0.50, P < 0.05, respectively), and a significant negative correlation between the serum IL-15 levels on POD1 or POD 3 and the PaO2/FiO2 on POD3 (R = –0.51, P < 0.05, R = –0.69, P < 0.01, respectively).Conclusions: The measurement of postoperative serum level of IL-15 might be useful for predicting the severity of SIRS and organ dysfunction, especially renal and pulmonary dysfunction.

A Biphasic Response to Nitric Oxide Donation in an Ex Vivo Model of Donation After Cardiac Death Renal Transplantation

Phillip J. Yates, Sarah A. Hosgood, Michael L. Nicholson — 2011-04-25

Background: Donation after cardiac death (DCD) donors are vital to maximize the organ donor pool. Reperfusion injury (RI) is an important sequela in DCD organs due to warm and cold ischemia. RI manifests clinically as a high incidence of delayed graft function (DGF) and primary non-function (PNF) compared with donation after brain death organs. The importance of nitric oxide (NO) in the generation of reperfusion injury is pivotal.Methods: Using an ex vivo porcine model of kidney transplantation the effects of reperfusion with and without NO supplementation on initial renal blood flow and function were compared. Real-time hemodynamic measurements were recorded and biochemical samples taken at set time-points. Molecular markers of reperfusion injury were also measured. Sodium nitroprusside was chosen as the NO donor.Results: Results showed that NO donation initially improved renal blood flow significantly over controls; at the end of reperfusion this benefit was lost. In addition, there was an improvement in creatinine clearance, fractional excretion of sodium and renal oxygen consumption. There were observed to be higher levels of urinary nitrite/nitrate excretion, but no difference in isoprostane levels.Conclusion: This study represents a good model for the initial reperfusion period in large animal renal transplantation. The improvement in renal blood flow observed in the NO supplemented groups represents NO mediated vasodilatation. Later in reperfusion, accumulation of nitrogenous free radicals impairs renal blood flow. Clinically, NO supplementation during initial reperfusion of DCD kidneys improves renal blood flow but should be considered with caution due to potential deleterious effects of nitrogenous compound accumulation.

Prolonged Cold Ischemia Does Not Trigger Lethal Rejection or Accelerate the Acute Rejection in Two Allogeneic Rat Liver Transplantation Models

Hao Jin, Uta Dahmen, Anding Liu, Hai Huang, Yanli Gu, Olaf Dirsch — 2011-04-29

Background: Prolonged cold ischemia (CI) might induce lethal liver graft rejection and/or accelerate the course of lethal rejection in BN-Lew and ACI-Lew liver transplantation (LT) models, which have been successfully challenged by liver-size reduction.Materials and Methods: Survival rate of recipients and body weight development after subjecting the grafts to prolonged CI in saline were assessed. Severity of rejection was assessed based on histology and the size of portal infiltration. Hepatic expression of CD25, CD28, CD38, granzyme B, and perforin were assessed to further judge the severity of allogeneic immune response.Results: An enhancement of allogeneic immune response after prolonged CI was observed, indicated by up-regulated mRNA expression of CD25, CD28, CD38, granzyme B, and perforin. However, the enhancement of allogeneic immune response did not reverse the BN-Lew spontaneous liver graft acceptance to lethal rejection. Eight-hour CI led to 100% 4 wk survival rate and graft acceptance and did not impair postoperative body weight recovery. Nine-hour CI caused the death of 2/6 rats due to primary non-function (PNF) of the graft within 48 h. Ten-hour CI caused lethal PNF in all rats within 96 h. Histology of surviving recipients revealed an expansion of the portal tract due to an inflammatory infiltrate. In rats dying from PNF, extended centrilobular necrosis was observed, but no sign of rejection. In the ACI-Lew full-size LT model, 8 h CI did not accelerate the course of lethal rejection.Conclusion: Prolonged CI was associated with an discrete enhancement of allogeneic immune response, but did not trigger lethal rejection in BN-LEW spontaneous liver graft acceptance model and did not accelerate acute rejection in ACI-Lew rejection model.

Cyclosporin-A Does Not Prevent Cold Ischemia/Reperfusion Injury of Rat Livers

2011-05-09

Cyclosporin–A (CsA) has been reported to protect livers from warm ischemia/reperfusion (I/R) injury. To study if CsA has also a protective effect on cold I/R injury, two models were used: the isolated perfused rat liver (IPRL) and the orthotopic rat liver transplantation (ORLT). (1) IPRL: Livers were preserved for 24 h (5°C) in University of Wisconsin (UW) solution alone (group 1), with CsA (400 nM) dissolved in dimethylsulfoxide (50 μM) (group 2), and with dimethylsulfoxide (DMSO) alone (group 3). Livers were reperfused for 60 min (37°C) (n = 8/group). Cell necrosis was evaluated by trypan blue uptake and apoptosis by laddering and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and by caspase-3 activation. Marked and similar sinusoidal endothelial cell necrosis was found in the three groups while apoptosis was found similarly deceased in groups 2 and 3 compared with group 1. (2) ORLT: Donors received either CsA (5 mg/kg) or corn oil 24 h before transplantation. Recipients were sacrificed after 240 min; cell necrosis and apoptosis were then evaluated. No difference was found between treated and control groups. The current data strongly suggest that CsA has no protective effect on hepatic cold I/R injury. Hepatocyte apoptosis can be reduced by antioxidants, as occurred with DMSO, but introduction of CsA does not provide additional protective effect.

MMP-3 (5A/6A) Polymorphism Does Not Influence Human Smooth Muscle Cell Invasion

2011-04-19

Background: Stromelysin (MMP-3) is an important regulator of vascular smooth muscle cell (SMC) invasion, a key contributor to saphenous vein (SV) bypass graft failure. The 5A allele of the common -1612 MMP-3 5A/6A promoter polymorphism reportedly confers increased promoter activity, MMP-3 tissue expression, and susceptibility to a number of vascular pathologies. The aim of this study was to determine whether the MMP-3 5A/6A polymorphism directly influences endogenous MMP-3 expression levels and, consequently, cell invasion, in SV-derived SMC cultured from patients with different genotypes.Material and Methods: Genotyping of 226 patients revealed -1612 MMP-3 5A/6A genotype frequencies of 20.8% 5A/5A, 52.7% 5A/6A, and 26.5% 6A/6A. Using a standardized, controlled protocol, we investigated cytokine- and growth factor-induced MMP-3 expression (real-time polymerase chain reaction [RT-PCR], ELISA) and SV-SMC invasion (Boyden chamber with Matrigel barrier) using cultured SV-SMC from patients with different MMP-3 genotypes.Results: Despite observing a strong correlation between MMP-3 mRNA levels and MMP-3 protein secretion, no significant differences were apparent in MMP-3 expression levels or cell invasion between cells with different MMP-3 5A/6A genotypes.Conclusions: Our data suggest that the MMP-3 5A/6A promoter polymorphism in isolation does not influence levels of MMP-3 secretion or cellular invasion in human SV-SMC.

A Somatostatin Analogue, Octreotide, Ameliorates Intestinal Ischemia-Reperfusion Injury Through the Early Induction of Heme Oxygenase-1

2011-04-20

Background: Intestinal damage after ischemia followed by revascularization, referred to as “ischemia-reperfusion (I/R) injury,” is a devastating complication that can occur after acute superior mesenteric obstruction, or after both elective and emergent abdominal aortic surgery. Once an entire layer of intestine is involved in severe ischemia, the mortality rate reaches 90%; no effective medical treatment has been reported to date. Here, we demonstrate that a somatostatin analogue, octreotide, but not a free-radical scavenger, MCI-186, prevented death due to surgically induced intestinal I/R injury in rats.Methods: Superior mesenteric artery (SMA) of Male Sprague-Dawley rats, that received MCI-186 or octreotide, was surgically clamped, and then the clips were removed and SMA blood flow restored. Survival was assessed, and blood and small intestine were subjected to cell count, enzyme-linked immunosorbent assay (ELISA), Western blotting, and immunohistochemistry.Results: Of interest, pretreatment with octreotide, but not with MCI-186, just before induced intestinal ischemia prompted the early expression of heme oxygenase-1 (HO-1) protein-associated accumulation of CD68-positive cells, a possible cellular source of HO-1. Inversely, the administration of tin protoporphyrin IX (SnPPN), a specific inhibitor of HO-1, completely abolished the therapeutic effects of octreotide, indicating that the favorable effects of octreotide against intestinal I/R injury is predominantly dependent on the early induction of HO-1.Conclusions: These results suggest that a somatostatin analogue may be useful in leading to an improvement of the prognosis of patients with intestinal I/R injury in the clinical setting.

Mechanical Evaluation of Decellularized Porcine Thoracic Aorta

Yu Zou, Yanhang Zhang — 2011-04-22

Background: Decellularized tissues are expected to have major cellular immunogenic components removed and in the meantime maintain similar mechanical strength and extracellular matrix (ECM) structure. However, the decellularization processes likely cause alterations of the ECM structure and thus influence the mechanical properties. In the present study, the effects of different decellularization protocols on the (passive) mechanical properties of the resulted porcine aortic ECM were evaluated.Methods: Decellularization methods using anionic detergent (sodium dodecyl sulfate), enzymatic detergent (Trypsin), and non-ionic detergent [tert-octylphenylpolyoxyethylen (Triton X-100)] were adopted to obtain decellularized porcine aortic ECM. Histologic studies and scanning electron microscopy were performed to confirm the removal of cells and to examine the structure of ECM. Biaxial tensile testing was used to characterize both the elastic and viscoelastic mechanical behaviors of decellularized ECM.Results: All three decellularization protocols remove the cells effectively. The major ECM structure is preserved under sodium dodecyle sulfate (SDS) and Triton X-100 treatments. However, the structure of Trypsin treated ECM is severely disrupted. SDS and Triton X-100 decellularized ECM exhibits similar elastic properties as intact aorta tissues. Decellularized ECM shows less stress relaxation than intact aorta due to the removal of cells. Creep behavior is negligible for both decellularized ECM and intact aortas.Conclusion: SDS and Triton X-100 decellularized ECM tissue appeared to maintain the critical mechanical and structural properties and might work as a potential material for further vascular tissue engineering.

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2012-06-15

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2012-06-15

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2012-06-15

Journal of Surgical Research

Changing Epidemiology of Acute Appendicitis in the United States: Study Period 1993–2008

“Pulling the plug”—Management of meconium plug syndrome in neonates

Real-Time Monitoring for Detection of Retained Surgical Sponges and Team Motion in the Surgical Operation Room Using Radio-Frequency-Identification (RFID) Technology: A Preclinical Evaluation

Modified Map-Seeking Circuit: Use of Computer-Aided Detection in Locating Postoperative Retained Foreign Bodies1

Effective Oncolytic Vaccinia Therapy for Human Sarcomas

Tracheal Replacement with Fresh and Cryopreserved Aortic Allograft in Adult Dog

Feasibility of Endoscopic Transoral Thoracic Surgical Lung Biopsy and Pericardial Window Creation

Total Knee and Hip Arthroplasty Across BMI Categories: A Feasible Option for the Morbidly Obese Patient

Computerized Rounding Reports: Individualized Solutions Might Work Better

Minimally Invasive Thoracic Surgery

Assessment of Colon Cancer Literacy in Screening Colonoscopy Patients: A Validation Study

The Impact of iMedConsent on Patient Decision-Making Regarding Cholecystectomy and Inguinal Herniorrhaphy1

Hydrogen Sulfide Modulates Contractile Function in Rat Jejunum

Clinicopathologic Characteristics and Surgical Outcomes of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Peritrocal and Intraperitoneal Ropivacaine for Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind Controlled Trial1

The Oxidative Effect of Prolonged CO2 Pneumoperitoneum A Comparative Study in Rats

Phenacetin O-Deethylation is a Useful Tool for Evaluation of Hepatic Functional Reserve in Rats with CCl4-Induced Chronic Liver Injury

New Anthranilic Acid Derivative, EAntS-GS, Attenuates Freund’s Complete Adjuvant-Induced Acute Pain in Rats

Increased Osteoblast and Osteoclast Activity in Female Senescence-Accelerated, Osteoporotic SAMP6 Mice During Fracture Healing

CD133(−) Cells, Derived From a Single Human Colon Cancer Cell Line, Are More Resistant to 5-Fluorouracil (FU) Than CD133(+) Cells, Dependent on the β1-Integrin Signaling

Clinical Significance of Serum Soluble E-cadherin in Colorectal Carcinoma1

Macrophage Genetic Reprogramming During Chronic Peritonitis is Augmented by LPS Pretreatment

Injury-Induced Changes in Liver Specific Transcription Factors HNF-1α and HNF-4α

Magnolol Attenuates the Lung Injury in Hypertonic Saline Treatment from Mesenteric Ischemia Reperfusion through Diminishing iNOS

N-acetylcysteine (NAC) Protects Against Acute Kidney Injury (AKI) Following Prolonged Pneumoperitoneum in the Rat

Damage Control Resuscitation Decreases Systemic Inflammation After Hemorrhage

The Postoperative Serum Interleukin-15 Concentration Correlates with Organ Dysfunction and the Prognosis of Septic Patients Following Emergency Gastrointestinal Surgery

A Biphasic Response to Nitric Oxide Donation in an Ex Vivo Model of Donation After Cardiac Death Renal Transplantation

Prolonged Cold Ischemia Does Not Trigger Lethal Rejection or Accelerate the Acute Rejection in Two Allogeneic Rat Liver Transplantation Models

Cyclosporin-A Does Not Prevent Cold Ischemia/Reperfusion Injury of Rat Livers

MMP-3 (5A/6A) Polymorphism Does Not Influence Human Smooth Muscle Cell Invasion

A Somatostatin Analogue, Octreotide, Ameliorates Intestinal Ischemia-Reperfusion Injury Through the Early Induction of Heme Oxygenase-1

Mechanical Evaluation of Decellularized Porcine Thoracic Aorta

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