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Robotic technology: Optimizing the outcomes in rectal cancer?

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World Journal of clinical Oncology 2015年第3期6卷 22-24页

作者： Nicolas C Buchs clinic for Visceral and Transplantation surgery Department of SurgeryUniversity Hospital of Geneva

Minimally invasive rectal resection remains a challenging procedure, even in experienced hands. Technical limitations explain at least in part the reasons of a relatively poor adoption of laparoscopy for rectal resection, in particular for low tumors in a deep and narrow *** is intended to overcome these *** better short-term outcomes have beenpublished: reduced conversion rates, better functional outcomes, shorter learning curve, reduction of positive margins, better specimen… However, robotic surgery has not yet taken over as the gold standard approach for low anterior resection. Several drawbacks might indeed discourage the most fervent surgeon: the size of the robot, the lack of tactile feedback, the risk and difficulties during multiquadrant surgery, and, of course, costs. Whilst new systems might overcome most of these drawbacks, it seems obvious that the development of robotic surgery is underway. Robotics is not just another interesting technical tool, but more a new concept, which should play a role in the future.

关键词： Robot Laparoscopy Total mesorectal excision Transanal total mesorectal excision Transanal endoscopic microsurgery Outcomes Rectal cancer

Superior mesenteric venous thrombosis: Endovascular management and outcomes

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World Journal of clinical Cases 2022年第1期10卷 217-226页

作者： Khaled Alnahhal Beau B Toskich Samuel Nussbaum Zhuo Li Young Erben Albert G Hakaim Houssam Farres Department of surgery Division of Vascular SurgeryMayo Clinic FloridaJacksonvilleFL 32224United States Department of Radiology Mayo Clinic FloridaJacksonvilleFL 32224United States Department of Biostatistics Mayo Clinic FloridaJacksonvilleFL 32224United States

BACKGROUND Superior mesenteric venous thrombosis(SMVT)is a rare but fatal condition that is typically treated initially with anticoagulation therapy,and if this fails,with endovascular ***,due to its rarity,there are not many studies that have explored the effectiveness of anticoagulation and endovascular therapies in treating *** To evaluate patients diagnosed with SMVT who received endovascular therapy in addition to anticoagulation and report technical and clinical *** A retrospective analysis of the patients who underwent endovascular treatment for SMVT at Mayo clinic from 2000-2019 was *** success was defined as angiographic improvement in SMV flow after *** patency was defined as the interval from reestablishing mesenteric venous flow until the first repeat thrombotic event or need for additional *** patency was defined as successful restoration of flow after repeat intervention until rethrombosis or last *** adverse events were reported through Clavien-Dindo *** Twenty-four patients were included for *** median age at intervention was 60 years(35-74 years)and 16(67%)were *** patients presented with acute thrombosis(79.2%)and 5 with chronic thrombosis with acute manifestations(20.8%).The most commonly used endovascular modalities were thrombectomy in 12 patients(50.0%)and catheter-directed thrombolysis in 10 patients(41.7%).Technical success was achieved in 18 patients(75%).The 14-d and 30-d primary patency rates were 88.9%and 83.3%,*** events were reported in two patients(8.3%),one marked as grade IIIB,and 1 death marked as grade ***-year overall survival rate was 82%(58%-100%).CONCLUSION Endovascular intervention with anticoagulation appears to be effective for managing *** treatment combination may be considered as first-line therapy for SMVT management in select patients.

关键词： Superior mesenteric venous thrombosis Endovascular Anticoagulation Retrospective Thrombectomy Mesenteric Thrombolysis

Extended criteria donors in liver transplantation—from marginality to mainstream

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Hepatobiliary surgery and Nutrition 2018年第5期7卷 386-388页

作者： Amit Nair Koji Hashimoto Department of General surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA

Further to refinements in immunosuppression and the significant gains witnessed in outcomes over recent decades, liver transplantation has firmly established itself as the definitive treatment for end stage liver disease and selected instances of hepatic malignancy. However, there exists a constant divide between organ supply and demand, with the numbers of new entrants to liver transplant waiting lists consistently and significantly outstripping that of transplants performed annually, as exemplified by United Network for Organ Sharing (UNOS) data from the United States (1).

关键词： annually stripping lists

Levels of biological markers of nitric oxide in serum of patients with squamous cell carcinoma of the oral cavity

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International Journal of Oral Science 2013年第3期5卷 141-145页

作者： Wioletta Ratajczak-Wrona Ewa Jablonska Bozena Antonowicz Dorota Dziemianczyk Stanislawa Zyta Grabowska Department of Immunology Medical University of Bialystok Department of Oral surgery Medical University of Bialystok Maxillofacial and Plastic surgery clinic Medical University of Bialystok

The aim of the study was a determination of the levels of nitric oxide（NO）and its biological markers such as malonyldialdehyde（MDA）and nitrotyrosine in the serum of patients with squamous cell carcinoma（SCC）of the oral cavity and identification of the relationships between NO and those *** studies were performed on patients with SCC of the oral cavity before and after *** reaction was used for the estimation of the total concentration of NO in *** nitrotyrosine level in serum was assessed with an enzyme-linked immunosorbent assay（ELISA）kit,and MDA level using a spectrophotometric *** concentrations of NO in blood serum were determined in patients with stage IV of the disease before treatment in comparison to the control group and patients with stages II and III of the ***,higher concentrations of MDA and nitrotyrosine were determined in the serum of patients in all stages of the disease in comparison to healthy *** treatment,lower concentrations of NO in the serum of patients with stage IV of the disease were observed in comparison to the amounts obtained prior to *** addition,lower levels of nitrotyrosine in the serum of patients with all stages of the disease were recorded,whereas higher concentrations of MDA were determined in these patients in comparison to results obtained before *** compounds formed with the contribution of NO,such as MDA and nitrotyrosine,may lead to cancer progression in patients with SCC of the oral cavity,and contribute to formation of resistance to therapy in these patients as ***,the lack of a relationship between concentrations of NO and MDA,and between NO and nitrotyrosine in serum suggests that the process of lipid peroxidation and nitration in patients with SCC does not just depend on NO.

关键词： malonyldialdehyde nitric oxide nitrotyrosine squamous cell carcinoma of the oral cavity

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

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Gastroenterology Report 2018年第2期6卷 114-121,I0002页

作者： Nan Lan Luca Stocchi Yi Li Bo Shen Center for Inflammatory Bowel Disease and Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Colorectal surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data *** aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP)***:All CD patients undergoing surgery between 2005 and 2013 were identified from *** were defined according to the ACS NSQIP *** primary outcome was infectious complications,including superficial,deep and organ/space surgical site infection,wound dehiscence,urinary tract infection,pneumonia,systemic sepsis and septic *** analyses were performed to assess the risk factors for post-operative ***:All 10100 eligible patients were included and 611(6.0%)received perioperative *** patients were older,lighter in weight and more likely to be functionally *** patients were more likely to have post-operative infectious complications than those without BT,including superficial surgical site infection(SSI)(10.8%vs 7.4%,p¼0.002),deep SSI(3.3%vs 1.6%,p¼0.003),organ/space SSI(14.2%vs 5.4%,p<0.001),pneumonia(3.8%vs 1.3%,p<0.001),urinary tract infection(3.9%vs 2.2%,p¼0.006),sepsis(11.5%vs 4.5%,p<0.001)and sepsis shock(3.1%vs 0.8%,p<0.001).Multivariate analysis showed that intra-and/or post-operative BT was an independent risk factor for post-operative infectious complications(odds ratio[OR]¼2.2;95%confidence interval[CI]:1.8–2.7;p<0.001)and the risk increased with each administered unit of red blood cell(OR¼1.3,95%CI:1.2–1.5).Other independent factors were history of smoking,chronic heart disease,diabetes,hypertension and the use of ***-operative BT,however,was not found to be a risk factor to post-operative ***:Intra-and/or post-operative,not p

关键词： blood transfusion Crohn’s disease infectious complications surgical outcomes

Gene expression profiles of human adipose-derived mesenchymal stem cells dynamically seeded on clinically available processed nerve allografts and collagen nerve guides

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Neural Regeneration Research 2021年第8期16卷 1613-1621页

作者： Femke Mathot Nadia Rbia Roman Thaler Allan B.Dietz Andre Jvan Wijnen Allen T.Bishop Alexander Y.Shin Department of Orthopedic surgery Mayo ClinicRochesterMNUSA Department of Plastic surgery RadboudumcNijmegenThe Netherlands Department of Dermatology Erasmus Medical CenterRotterdamThe Netherlands Department of Biochemistry and Molecular Biology Mayo ClinicRochesterMNUSA Department of Laboratory Medicine and Pathology Mayo ClinicRochesterMNUSA

It was hypothesized that mesenchymal stem cells(MSCs) could provide necessary trophic factors when seeded onto the surfaces of commonly used nerve graft substitutes. We aimed to determine the gene expression of MSCs when influenced by Avance■ Nerve Grafts or Neura Gen■ Nerve Guides. Human adipose-derived MSCs were cultured and dynamically seeded onto 30 Avance■ Nerve Grafts and 30 Neura Gen■ Nerve Guides for 12 hours. At six time points after seeding, quantitative polymerase chain reaction analyses were performed for five samples per group. Neurotrophic [nerve growth factor(NGF), glial cell line-derived neurotrophic factor(GDNF), pleiotrophin(PTN), growth associated protein 43(GAP43) and brain-derived neurotrophic factor(BDNF)], myelination [peripheral myelin protein 22(PMP22) and myelin protein zero(MPZ)], angiogenic [platelet endothelial cell adhesion molecule 1(PECAM1/CD31) and vascular endothelial cell growth factor alpha(VEGFA)], extracellular matrix(ECM) [collagen type alpha I(COL1A1), collagen type alpha III(COL3A1), Fibulin 1(FBLN1) and laminin subunit beta 2(LAMB2)] and cell surface marker cluster of differentiation 96(CD96) gene expression was quantified. Unseeded Avance■ Nerve Grafts and Neura Gen■ Nerve Guides were used to evaluate the baseline gene expression, and unseeded MSCs provided the baseline gene expression of MSCs. The interaction of MSCs with the Avance■ Nerve Grafts led to a short-term upregulation of neurotrophic(NGF, GDNF and BDNF), myelination(PMP22 and MPZ) and angiogenic genes(CD31 and VEGFA) and a long-term upregulation of BDNF, VEGFA and COL1A1. The interaction between MSCs and the Neura Gen■ Nerve Guide led to short term upregulation of neurotrophic(NGF, GDNF and BDNF) myelination(PMP22 and MPZ), angiogenic(CD31 and VEGFA), ECM(COL1A1) and cell surface(CD96) genes and long-term upregulation of neurotrophic(GDNF and BDNF), angiogenic(CD31 and VEGFA), ECM genes(COL1A1, COL3A1, and FBLN1) and cell surface(CD96) genes. Analysis demonstrat

关键词： Avance■Nerve Grafts dynamic seeding mesenchymal stem cell NeuraGen■Nerve Guides peripheral nerve repair qPCR

Current management of fecal incontinence:Choosing amongst treatment options to optimize outcomes

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World Journal of Gastroenterology 2013年第48期19卷 9216-9230页

作者： Julie Ann M Van Koughnett Steven D Wexner Departmen of Colorectal surgery Cleveland Clinic Florida Weston FL 33331 United States

The severity of fecal incontinence widely varies and can have dramatic devastating impacts on a person’s *** incontinence is common,though it is often underreported by *** addition to standard treatment options,new treatments have been developed during the past decade to attempt to effectively treat fecal incontinence with minimal ***-operative treatments include dietary modifications,medications,and biofeedback *** used surgical treatments include repair(sphincteroplasty),stimulation(sacral nerve stimulation or posterior tibial nerve stimulation),replacement(artificial bowel sphincter or muscle transposition)and diversion(stoma formation).Newer augmentation treatments such as radiofrequency energy delivery and injectable materials,are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal *** general,more invasive surgical treatments are now reserved for moderate to severe fecal *** and quality of life related outcomes,as well as potential complications of the treatment must be considered and the treatment of fecal incontinence must be individualized to the *** indications,techniques,and outcomes profiles for the various treatments of fecal incontinence are discussed in *** the most effective treatment for the individual patient is essential to achieve optimal outcomes in the treatment of fecal incontinence.

关键词： Fecal incontinence Treatment Sacral nerve stimulation Sphincteroplasty Artificial bowel Sphincter Biofeedback

Current indications and role of surgery in the management of sigmoid diverticulitis

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World Journal of Gastroenterology 2010年第7期16卷 804-817页

作者： Luca Stocchi Department of Colorectal surgery Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic *** review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical ***-spectrum antibiotics are the standard of care for uncomplicated *** published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously ***,a more individualized approach,taking into account frequency,severity of the attacks and their impact on quality of life,should guide the indication for *** the other hand,complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal *** surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized *** is not sufficient evidence supporting any changes in the approach to management in younger ***,the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised *** clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.

关键词： Sigmoid diverticulitis Diverticulitis management Diverticulitis surgery Acute diverticulitis Complicated diverticulitis Perforated diverticulitis Laparoscopic colectomy

Adynamic and dynamic muscle transposition techniques for anal incontinence

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Gastroenterology Report 2014年第2期2卷 98-105页

作者： Goran Barišic Zoran Krivokapic clinic for Digestive surgery First Surgical ClinicBelgrade School of MedicineUniversity of BelgradeSerbia

Gracilis muscle transposition is well established in general surgery and has been the main muscle transposition technique for anal ***,through a schedule of continuous electrical stimulation,converts the fatigue-prone muscle fibres to a tonic fatigue-resistant morphology with acceptable results in those cases where there is limited sphincter muscle *** differences between gluteoplasty and graciloplasty,as well as the techniques and complications of both procedures,are outlined in this ***,these techniques are rarely carried out in specialized units with experience,as there is a high revision and explantation rate.

关键词： anal incontinence muscle transposition gluteoplasty graciloplasty dynamization