Validation of comprehensive complication index in the general surgery department of a small-volume hospital: A prospective observational study.

BACKGROUND/OBJECTIVE: The comprehensive complication index (CCI) was developed following the Clavien-Dindo classification (CDC) to more properly reflect various complications that occur in one patient. In this study, we performed a prospective observational study to validate the usefulness of CCI in a small-volume hospital. METHODS: From March 2017 to February 2018, among the patients who had scheduled surgery with general anesthesia in the Department of Surgery in St. Paul hospital in Korea, 240 patients were enrolled after informed consent. A minor-risk surgery, such as appendectomy, and surgery for inguinal hernia were excluded. The complications were estimated in both CDC and CCI in each patient. Patients were investigated with the EORCT-C30 quality of life questionnaire before and after surgery, and the relationship between CCI score and change in the quality of life was evaluated. RESULTS: There were 26 (10.83%), 41 (17.08%), 8 (3.33%), 3 (1.25%), 4 (1.67%), and 2 (0.83%) patients who were classified as grades I, II, IIIa, IIIb, IVa, and IVb, respectively. The average CCI was 22.94 ± 12.79, and distribution ranged from 8.66 to 76.40. CCI was well distributed in patients with complications more than CDC grade. While there was no correlation between preoperative Charlson comorbidity index with CCI, pain scale, and cognitive scale were aggravated significantly when CCI increased. CONCLUSION: CCI reflected the complication status with a more detailed distribution compared with CDC. Moreover, CCI had a significant relation with pain and the cognitive function scale. CCI might be a useful complication grading system in a small-volume surgical department.

Potential of Allogeneic Adipose-Derived Stem Cell-Hydrogel Complex for Treating Diabetic Foot Ulcers.

Mesenchymal stem cells (MSCs) may hold great promise for treating diabetic wounds. However, it is difficult for a clinician to use MSCs because they have not been commercialized. Meanwhile, a new commercial drug that contains adipose-derived stem cells (ASCs) has been developed. The purpose of this study was to examine the potential of allogeneic ASC sheets for treating diabetic foot ulcers. Fifty-nine patients with diabetic foot ulcers were randomized to either the ASC treatment group (n = 30) or a control group treated with polyurethane film (n = 29). Either an allogeneic ASC sheet or polyurethane film was applied on diabetic wounds weekly. These wounds were evaluated for a maximum of 12 weeks. Complete wound closure was achieved for 73% in the treatment group and 47% in the control group at week 8. Complete wound closure was achieved for 82% in the treatment group and 53% in the control group at week 12. The Kaplan-Meier median times to complete closure were 28.5 and 63.0 days for the treatment group and the control group, respectively. There were no serious adverse events related to allogeneic ASC treatment. Thus, allogeneic ASCs might be effective and safe to treat diabetic foot ulcers.

Inhibitory effects of luteolin on titanium particle-induced osteolysis in a mouse model.

Wear particles liberated from the surfaces of an implanted prosthesis are associated with peri-implant osteolysis and subsequent aseptic loosening. In the latter wear particle-induced inflammation and osteoclastogenesis have been identified as critical factors, and their inhibition as important steps in the treatment of affected patients, such as those undergoing total hip replacement. In this study the ability of luteolin to inhibit both titanium (Ti) particle-induced osteoclastogenesis in vitro and osteolysis in a murine calvaria Ti particle-induced model of osteolysis was examined. The results showed that luteolin, a highly potent and efficient inhibitor of tumor necrosis factor α (TNF-α) and interleukin-6 expression, inhibited Ti particle-induced inflammatory cytokine release, osteoclastogenesis, and bone resorption in bone marrow macrophages. Microcomputed tomography and histological analyses showed that the Ti particles caused significant bone resorption and increased TRAP(+) multinuclear osteoclasts in the murine calvarial model of osteolysis, whereas this was not the case in the luteolin treatment group, in which osteolytic suppression was accompanied by a decrease in both TNF-α production and serum levels of the osteoclast marker the C-terminal telopeptide fragment of type I collagen. These results support the use of luteolin as a natural compound in the prevention and treatment of aseptic loosening after total replacement arthroplasty.

Adipose-derived stem cells improve renal function in a mouse model of IgA nephropathy.

T-cell dysregulation plays an important role in the pathogenesis of immunoglobulin A nephropathy (IgAN). Adipose-derived stem cells (ASCs) have been reported to be able to prevent tissue damage through immune-modulating effects. To evaluate the effects of ASCs in high IgA ddY (HIGA) mice, ASCs were isolated from HIGA mice with different stages of IgAN before and after disease onset. ASCs were injected at a dose of 5×10(6) cells/kg body weight through the tail vein every 2 weeks for 3 months. Although the administered ASCs were rarely detected in the glomeruli, 24-h proteinuria was markedly decreased in all ASC-treated groups. Although glomerular deposition of IgA was not significantly different among groups, mesangial proliferation and glomerulosclerosis were dramatically decreased in most ASC treatment groups. In addition, levels of fibrotic and inflammatory molecules were markedly decreased by ASC treatment. Interestingly, ASC therapy significantly decreased Th1 cytokine activity in the kidney and caused a shift to Th2 responses in spleen T-cells as determined by FACS analysis. Furthermore, conditioned media from ASCs abrogated aggregated IgA-induced Th1 cytokine production in cultured HIGA mesangial cells. These results suggest that the beneficial effects of ASC treatment in IgAN occur via paracrine mechanisms that modulate the Th1/Th2 cytokine balance. ASCs are therefore a promising new therapeutic agent for the treatment of IgAN.

Pre-treatment of mesenchymal stem cells with a combination of growth factors enhances gap junction formation, cytoprotective effect on cardiomyocytes, and therapeutic efficacy for myocardial infarction.

OBJECTIVES: The goal of this study was to investigate the effect of pre-treatment of mesenchymal stem cells (MSCs) with growth factors (GFs) on cardiomyogenic differentiation, cytoprotective action on cardiomyocytes (CMCs), and their therapeutic efficacy in myocardial infarction. BACKGROUND: Mechanisms of myocardial repair with MSC transplantation have not been fully elucidated, and therapeutic efficacy needs to be enhanced. METHODS: The MSCs obtained from the bone marrow of Fisher344 rats were treated with fibroblast growth factor-2, insulin-like growth factor-1, and bone morphogenetic protein-2. The expression of cardiac specific markers and the cytoprotective effect of MSCs with its mechanism were evaluated. Efficacy of MSCs transplantation was studied in rat myocardial infarction model. RESULTS: Treatment of MSCs with cocktails of GFs enhanced expression of cardiac transcription factors and survival. Induction of cardiac specific markers by coculture with CMCs and gap junctional communication with CMCs was more active in GF-treated MSCs than untreated MSCs. The GF-treated MSCs reduced apoptosis of neighboring CMCs in a hypoxic condition and enhanced the phosphorylated Akt and phosphorylated c-AMP response element binding protein expression of CMCs, which was markedly reduced by gap junction blockade. In a rat myocardial infarction model, transplantation of GF-treated MSCs resulted in smaller infarct size and better cardiac function than transplantation of untreated MSCs. Additionally, GF treatment enhanced gap junction formation of transplanted MSCs, which did not aggravate arrhythmia. CONCLUSIONS: Pre-treatment of MSCs with GFs enhanced cytoprotective effects on neighboring CMCs through gap junction and improved the therapeutic efficacy of MSC transplantation for myocardial repair. "Priming of MSCs with GFs" before transplantation might improve the therapeutic efficacy of cell therapy.

The TGF-beta-induced gene product, betaig-h3: its biological implications in peritoneal dialysis.

BACKGROUND: TGF-beta is involved in peritoneal changes during long-term peritoneal dialysis (PD). TGF-beta induces betaig-h3 in several cell lines, and betaig-h3 may be a marker for biologically active TGF-beta. However, no study has reported induction of betaig-h3 in human peritoneal mesothelial cells (HPMCs) or its involvement in PD-related peritoneal membrane changes. METHODS: We used cultured HPMCs to investigate the biological roles of betaig-h3 during mesothelial cell injury and repair, employing the adhesion, spreading, scratching and cell migration assays. Changes in betaig-h3 expression after high glucose exposure in vivo were also evaluated using an animal chronic PD model. RESULTS: In vitro, TGF-beta1 induced betaig-h3 in cultured HPMCs, and betaig-h3-mediated mesothelial cell adhesion occurred via alphavbeta3 integrin. betaig-h3 enhanced mesothelial cell adhesion and migration and, in part, wound healing during mesothelial cell injury. The animal study demonstrated that compared to the control group, betaig-h3 concentrations in the dialysate effluent increased in the dialysis group with alterations in peritoneal structure and function during PD, and betaig-h3 positively correlated with peritoneal solute transport. Immunohistochemical and immunoblotting results showed that betaig-h3 localizes in the mesothelium and submesothelial matrix of the parietal peritoneum, and in the vascular endothelium of omentum. betaig-h3 protein expression was higher in the dialysis group. CONCLUSION: In vitro, betaig-h3 induced by TGF-beta1 in HPMCs improved adhesion and migration of HPMCs during wound healing. In the chronic infusion model of PD, betaig-h3 played a role in the functional deterioration of the peritoneal membrane, which is associated with fibrosis.

Characterization of NOM in the Han River and evaluation of treatability using UF-NF membrane.

Chlorine reacts with the natural organic matter (NOM) that remains in waters and forms halogenated by-products. Some of these products such as trihalomethanes (THMs) and haloacetic acids (HAAs) have been known to cause cancer and other toxic effects to human beings. Disinfection is a process for the inactivation of pathogenic microorganisms and prevention of waterborne diseases. Despite these advantages, disinfection needs to be evaluated and is of concern because of the serious risks to human health. Therefore, this study characterized NOM, which is a disinfection by-product (DBP) precursor, in the water treatment processes from the Han River and evaluated the removal efficiencies of NOM fractions by conventional and advanced processes. The raw water from the Han River contained higher hydrophilic fraction than the hydrophobic fraction. The hydrophilic NOM constituted still 55-70% of NOM in waters after each process. Since the hydrophilic NOM exhibited higher HAAFP than hydrophobic NOM, chlorination of the Han River water produced higher haloacetic acid formation potential (HAAFP) than trihalomethane formation potential (THMFP). When the fractions of DBPFP are expressed as percentage of total organic halide formation potential (TOXFP), THMFP, HAAFP, and others are 26%, 43%, and 31% of the TOXFP, respectively. UF membrane could replace conventional processes showing a little higher removal efficiency of NOM and DBPFP, but advanced processes will be required to meet future requirements. The ultrafiltration (UF)-nanofiltration (NF) combined membrane process had better removal efficiency of NOM compared to other processes. Therefore, the results of this study suggest that the UF-NF membrane process is one of the best available ways for removing NOM.