Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial.

BACKGROUND: Clinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial. METHODS: The ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint. RESULTS: The 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112-2.8485]; p = 0.31). CONCLUSION: Hernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique. TRIAL REGISTRY: NCT01965249, registered on 18 October 2013.

Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial.

PURPOSE: The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material. METHODS: Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes. RESULTS: At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768-1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379-0.6617), p = 0.0115]. CONCLUSIONS: Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique. TRIAL REGISTRY: NCT01965249, registered October 18, 2013.

A calcium prerinse required to form calcium fluoride in plaque from a sodium fluoride rinse.

The purpose of this study is to determine whether a calcium (Ca) prerinse used before a 228 µg/g (ppm) fluoride (F) rinse would induce the formation of 'calcium fluoride-like' (CaF2-like) deposits in human dental plaque. Sixty minutes after the use of the Ca prerinse/F rinse, plaque samples were collected from 10 volunteers, homogenized, and split into 2 aliquots. The plaque mass from one aliquot was then extracted with a 'plaque-like' solution that extracted all the CaF2-like deposits. The total F in both aliquots was then determined and compared. The results demonstrated that, as in previous studies, the Ca prerinse induced large increases in plaque fluid and total plaque F. However, unlike previous results without the Ca prerinse, 30% of the plaque F deposits were CaF2 or CaF2-like. Given that maintaining an elevated F concentration in the vicinity of a developing lesion may play an important role in the cariostatic effect of this ion, and the potential advantages of CaF2-like deposits as an F source, these results suggest that a Ca prerinse may increase the cariostatic effect of topical agents.

Impact of pathologic complete response on disease-free survival in patients with esophagogastric adenocarcinoma receiving preoperative docetaxel-based chemotherapy.

BACKGROUND: The aim of this study was to evaluate the impact of pathologic complete response (pCR) on outcome in patients with gastric or esophagogastric junction (EGJ) adenocarcinoma after neoadjuvant docetaxel/platin/fluoropyrimidine-based chemotherapy. PATIENTS AND METHODS: Patients received at least one cycle of chemotherapy for potentially operable disease. Pretreatment clinicopathologic factors and pCR were investigated. Disease-free survival (DFS), overall survival (OS) and tumor-related death were correlated with pCR. RESULTS: One hundred twenty patients were included in this analysis. Eighteen patients (15%) achieved a pCR. Tumor localization in the EGJ was identified as the only significant predictor of pCR (P = 0.019). Median follow-up was 41.1 months. Median DFS and OS for all patients were 24.1 and 48.6 months, respectively. Median DFS for patients with a pCR was not reached versus 22.1 months non-pCR patients (hazard ratio, HR 0.38; 3-year DFS: 71.8% and 37.7%, respectively, P = 0.018). While OS was not significantly different, the risk for tumor-related death was significantly lower for pCR patients compared with non-pCR patients (3-year cumulative incidences of 6.4% and 45.4%, respectively, P = 0.009). CONCLUSION: A pCR following preoperative docetaxel/platin/fluoropyrimidine indicates favorable outcome in patients with gastric or EGJ adenocarcinoma. Tumor location in the EGJ is associated with a higher pCR rate.

[Creation of centres in high-volume hospitals -- promotor of communication]. / Zentrenbildung beim Maximalversorger - Katalysator der Kommunikation.

The number of patients with a diagnosis of cancer is alarming: according to new figures from the Robert Koch Institute about 435 000 patients are diagnosed annually in Germany. 210 000 patients die annually of this diagnosis. Even if no significant progress in prevention has been achieved, in 2020 about 25 % more cases will be diagnosed. In the last two decades it has become established that an interdisciplinary treatment of tumour patients is necessary because the variety of different treatment options depending on an individual person cannot be mastered by one physician. The goal of the centres and certification is to establish a very concentrated expertise in large case numbers and quality-assured transparent treatment. The central requirement of a maximum-care centre is thus to enable communication under appropriate conditions. Promoting not only the space requirements, centre must also develop a treatment corridor and is responsible for further education. Additionally an oncology centre has a goal in communications, namely, to offer a treatment option for all patients in each stage of the disease, and to incorporate cancer patients in clinical trials.

Perioperative chemotherapy with docetaxel, cisplatin and capecitabine (DCX) in gastro-oesophageal adenocarcinoma: a phase II study of the Arbeitsgemeinschaft Internistische Onkologie (AIO){dagger}.

BACKGROUND: This prospective multicentre phase II trial assessed the feasibility and efficacy of perioperative chemotherapy with docetaxel, cisplatin and capecitabine (DCX) in patients with gastro-oesophageal adenocarcinoma. METHODS: Patients with curatively resectable adenocarcinoma of the stomach, the gastro-oesophageal junction or the lower third of the oesophagus were enrolled. Patients received docetaxel 75 mg/m(2) plus cisplatin 60 mg/m(2) (day 1), followed by oral capecitabine 1875 mg/m(2) divided into two doses (days 1-14) every 3 weeks. There were three cycles preoperatively and three cycles postoperatively. The primary end point was the R0 resection rate. RESULTS: Fifty-one patients were recruited and assessed for feasibility and efficacy. 94.1% of patients received all three planned cycles preoperatively, and 52.9% received three cycles postoperatively. The R0 resection rate was 90.2%. 13.7% of patients showed complete pathological remission (pCR). Toxicity was acceptably tolerable. Without prophylactic granulocyte colony-stimulating factor administration, neutropenic fever developed in 21.5% of patients preoperatively (grade 3 or 4) and in 11.1% of patients postoperatively. CONCLUSIONS: DCX is a safe and feasible perioperative regimen in the treatment of gastro-oesophageal adenocarcinoma with a high percentage of cycles delivered pre- and postoperatively, compared with standard practice. The high efficacy in terms of R0 resection rate and pCR is very promising.

[Diagnosis and treatment of gastric cancer]. / Diagnostik und Therapie des Magenkarzinoms.

From a global perspective, gastric cancer including cancer of the esophago-gastric junction is the fourth most common malignant tumor and the second-most common cause of cancer-related death. Due to the lack of screening programs in Western countries, most gastric cancers are diagnosed in advanced stages. A sophisticated staging should include high-resolution computed tomography of the thorax, abdomen and pelvis and video-documented endoscopy and endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In the stages II and III perioperative chemotherapy has been established as a standard of care and should be applied. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can help to maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine regarded as standard. About 20 % of gastric cancers exhibit overexpression of the growth factor receptor family member Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and 5-fluorouracil or capecitabine.

No calcium-fluoride-like deposits detected in plaque shortly after a sodium fluoride mouthrinse.

Plaque 'calcium-fluoride-like' (CaF(2)-like) and fluoride deposits held by biological/bacterial calcium fluoride (Ca-F) bonds appear to be the source of cariostatic concentrations of fluoride in plaque fluid. The aim of this study was to quantify the amounts of plaque fluoride held in these reservoirs after a sodium fluoride rinse. 30 and 60 min after a 228 microg/g fluoride rinse, plaque samples were collected from 11 volunteers. Each sample was homogenized, split into 2 aliquots (aliquots 1 and 2), centrifuged, and the recovered plaque fluid combined and analyzed using microelectrodes. The plaque mass from aliquot 1 was retained. The plaque mass from aliquot 2 was extracted several times with a solution having the same fluoride, calcium and pH as the plaque fluid in order to extract the plaque CaF(2)-like deposits. The total fluoride in both aliquots was then determined. In a second experiment, the extraction completeness was examined by applying the above procedure to in vitro precipitates containing known amounts of CaF(2)-like deposits. Nearly identical fluoride concentrations were found in both plaque aliquots. The extraction of the CaF(2)-like precipitates formed in vitro removed more than 80% of these deposits. The results suggest that either CaF(2)-like deposits were not formed in plaque or, if these deposits had been formed, they were rapidly lost. The inability to form persistent amounts of CaF(2)-like deposits in plaque may account for the relatively rapid loss of plaque fluid fluoride after the use of conventional fluoride dentifrices or rinses.

Results of liver resection in combination with radiofrequency ablation for hepatic malignancies.

INTRODUCTION: Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC). PATIENTS AND METHODS: RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection. RESULTS: Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1-26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2-18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%. CONCLUSION: RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.

The impact of carbon dioxide pneumoperitoneum on liver regeneration after liver resection in a rat model.

BACKGROUND: In recent years, laparoscopic hepatic resection is performed by an increasing number of surgeons. Despite many advantages of the laparoscopic procedure, it is unclear whether the pneumoperitoneum affects the postoperative liver regeneration after liver resection. The current study aimed to investigate the influence of a carbon dioxide (CO(2)) pneumoperitoneum on liver regeneration in a rat model. METHODS: In this study, 60 male Wistar rats were subjected to 70% partial hepatic resection. Of these 60 animals, 30 underwent preoperative pneumoperitoneum at 9 mmHg for 60 min. After hepatic resection, the rats were killed at 12, 24, and 48 h, and on days 4 and 7. The outcome parameters were hepatocellular injury (plasma aminotransferases), oxidative stress (plasma malondialdehyde), interleukin-6 (IL-6), and liver regeneration (mitotic index, KI-67; regenerating liver mass). RESULTS: The mitotic index was significantly lower in the pneumoperitoneum group than in the group without pneumoperitoneum at all time points (p < 0.05). In the pneumoperitoneum group, KI-67 was significantly lower on day 4 (p < 0.05). The liver regeneration rate was significantly lower for the animals with pneumoperitoneum on days 2 and 4 (p < 0.05). The postoperative hepatocellular injury was significantly greater after pneumoperitoneum at 12, 24, and 48 h (p < 0.05). Plasma malondialdehyde and IL-6 were significantly higher in the pneumoperitoneum group at 24 h and on day 4 (p < 0.05). CONCLUSION: This study showed that pneumoperitoneum before extended liver resection impaired postoperative liver regeneration. Oxidative stress reaction and hepatocellular damage was markedly higher after pneumoperitoneum. Further investigations, especially with patients that have impaired liver function, are necessary for clinical consequences to be drawn from these results.

[Clinical and pathological prognostic factors for cancers of the esophagogastric junction]. / Klinisch-pathologische Prognosefaktoren des Adenokarzinoms des gastroösophagealen Ubergangs.

INTRODUCTION: Adenocarcinoma of the esophagogastric junction (AEG) is a particular tumour entity because two substantially different surgical procedures are required according to the location. There is no difference in long-term prognosis between the tumour types in spite of the different surgical procedures. We were interested to evaluate the clinical and pathological prognostic factors of the AEGs which were operated in our department. PATIENTS AND METHODS: 108 patients were operated for AEG between 1.1.2000 and 1.4.2006 in our institution. 32 (29.6 %) patients with distal esophageal cancer (type I according to Siewert) underwent a transthoracic esophagectomy with gastric pull-up and two-field lymphadenectomy. 57 (52.8 %) patients with type II and 19 (17.6 %) patients with type III cancers received an extended gastrectomy with D2 lymphadenectomy. The retrospective analysis was focused on clinical and pathological parameters. Possible differences between the tumour types were also evaluated. Median follow-up was 11.4 months (range: 1-57 months). RESULTS: Follow-up data were complete for 107 patients. A median survival of 17.4 +/- 3.25 months and a cumulative survival of 30 % were independent of the tumour location and the surgical procedure. Overall hospital mortality was 3.7 %. The univariate analysis showed that survival was significantly associated with the T category, lymph node status, lymphangio- and angioinvasion and tumour grading. In the multivariate analysis, only lymph node status was identified as an independent prognosis factor for survival. Where-as the R status was not a prognostic factor per se, how-ever, patients with an R0 situation without lymphangio- and angioinvasion had a significantly better survival compared to all other patients (p = 0.001). An increased angioinvasion rate was observed in type III tumours (52.6 %) in comparison to type I (21.9 %) and type II (21.1 %) tumours. CONCLUSION: The prognostic factors of our patients determined substantially the prognosis of the patients. Patients with lymph- or haemangioinvasion should regarded as high-risk patients independent of the R status. Close oncological follow-up including potential adjuvant treatment in these patients is recommended.

AMORPHOUS CALCIUM PHOSPHATE COMPOSITES AND THEIR EFFECT ON COMPOSITE-ADHESIVE-DENTIN BONDING.

This study evaluates the bond strength and related properties of photo-polymerizable, remineralizing amorphous calcium phosphate (ACP) polymeric composite-adhesive systems to dentin after various periods of aqueous aging at 37 °C. An experimental ACP base and lining composite was made from a photo-activated resin comprising 2,2-bis[p-(2'-hydroxy-3'-methacryloxypropoxy)phenyl]propane (Bis-GMA), triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) and zirconyl dimethacrylate (ZrDMA); designated BTHZ. An experimental orthodontic composite was formulated from a photo-activated resin comprising ethoxylated bisphenol A dimethacrylate (EBPADMA), TEGDMA, HEMA and methacryloxyethyl phthalate (MEP); designated ETHM. In both composite series three fillers were compared: 1) freshly precipitated zirconium-modified ACP freshly precipitated (as-prepared Zr-ACP), 2) milled Zr-ACP and 3) an ion-leachable fluoride glass. In addition to the shear bond strength (SBS), work to fracture and failure modes of the orthodontic composites were determined. The SBS of the base and lining ACP composites appeared unaffected by filler type or immersion time. In the orthodontic ACP composite series, milled ACP composites showed initial mechanical advantages over as-prepared ACP composites, and produced higher incidence of a failure mode consistent with stronger adhesion. After six months of aqueous exposure, 80 % of specimens failed at the dentin-primer interface, with a 42 % overall reduction in bond strength. BTHZ and ETHM based ACP composites are potentially effective anti-demineralizing-remineralizing agents with possible clinical utility as protective base-liners and orthodontic cements, respectively. The analysis of the bond strength and failure modalities suggests that milled ACP composites may offer greater potential in clinical applications.

Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI.

The aim of this study was to identify suitable interactive (dynamic) magnetic resonance (MR) sequences for real-time MR-guided liver dissection in a 1.0-T high field open MRI system. Four dynamic sequences encompassing balanced steady state free precession (bSSFP), T1W gradient echo (GRE), T2W GRE and T2W fast spin echo (FSE) were analysed regarding the image quality, artefact susceptibility and the performance of SNR and CNR. The T2W FSE sequence (1.5 s/image) was considered superior because of an intraoperative SNR of 6.9 (+/-0.7) and CNR (vessel to parenchyma) of 5.6 (+/-1.7) in the interventional setting. As a proof of concept, MR-guided laparoscopic liver resection was performed in two healthy domestic pigs by using the T2W FSE sequence. The additional MR images offered simultaneous multiplanar real-time visualisation of the liver vessels during the intervention and thereby increased the anatomical orientation of the surgeon.

Hepatic artery calcification in a liver transplant recipient.

The abdominal aorta and the renal, mesenteric, and splenic arteries are frequently affected with arterial wall calcification upon increasing age; the hepatic artery is far less often found to be calcified. We report the case of a liver transplant recipient who presented with a calcified hepatic artery in the liver graft 13 years after transplantation for primary sclerosing cholangitis. Although the etiology of hepatic artery calcification was unknown, underlying causes for calcification may include chronic hemodialysis for renal insufficiency and subsequent secondary hyperparathyroidism, as well as a calcified aneurysms. However, it remained unclear whether hepatic artery calcification had to be considered an epiphenomenon or an original pathology of the liver. It thus seems unlikely that hepatic artery calcification as a single finding is to be considered a serious pathologic entity, even for a liver graft.

Surgical results of patients after esophageal resection or extended gastrectomy for cancer of the esophagogastric junction.

Precise classification of cancers of the esophagogastric junction according to Siewert may be difficult for the presence of Barrett's esophagus or hiatal hernia, which subsequently leads to a difficult choice of the surgical procedure of esophagectomy or gastrectomy. Ninety-six patients with such cancers were operated on in our department in 7 years. Twenty-nine patients (30.2%), classified as type I (group 1), underwent a transthoracic esophagectomy with gastric pull up. Sixty-seven patients (69.8%) classified as type II or III (group 2) underwent an extended gastrectomy. We compared the patients of both groups retrospectively for disease-free survival and postoperative complications. The general performance status of most patients was comparable in both groups and was assigned to the American Society of Anesthesiologists class II or III. Statistically significant differences between the groups were seen for the postoperative reintubation rate [group 1: 31.0% vs. group 2: 9.0% (P = 0.009)], median time for surgery [group 1: 6 (3.5-8.5) hours vs. group 2: 4.7 (2.2-11.5) hours (P = 0.001)], time in the intensive care unit [group 1: 6 (3-85) days vs. group 2: 3 (1-54) days (P = 0.001)], median hospitalization time [group 1: 23 (14-105) days vs. group 2: 18 (10-63) days (P = 0.018)]. No statistical difference was observed for the recurrence-free survival of 40% after 3 years (P = 0.311), the mortality rate, the morbidity rate (P = 0.108), surgical and respiratory complications, and the incidence of anastomotic leakage (P = 0.645). We conclude that in selected cases it may be possible to perform an extended gastrectomy for small type I cancers.

[Impact of the body mass index on the prognosis and complication rate after surgical resection of cancers at the oesophagogastric junction]. / Einfluss des Body-Mass-Index auf die Prognose und Komplikationsrate nach Resektion beim Kardiakarzinom.

BACKGROUND: An elevated body mass index (BMI) is associated with an increased incidence of cancer at the gastro-oesophageal junction. Less is known about the postoperative complication rate and prognosis in relation to the BMI. PATIENTS AND METHODS: We investigated 108 patients with cancer of the cardia and a BMI below (group 1, n = 56) or above (group 2, n = 52) 25 kg / m (2), who were operated from 2000 to 2006 in our department. According to the Siewert classification, the tumours were subdivided into 3 types. Patients with type I cancers (n = 26) received a transthoracic oesophageal resection with gastric pull up. Patients with type II (n = 61) or type III (n = 21) cancers underwent an extended gastrectomy. The complication rates and survival were analysed. RESULTS: The complications were pulmonary (respiratory insufficiency n = 12, pneumonia n = 12, bronchitis n = 7, pulmonary embolism n = 2), surgical (anastomotic leakage n = 7, abscesses n = 8, bleeding n = 2, chylus fistula n = 1), or functional (dysphagia n = 5, nausea n = 5, heart burn n = 4, delayed enteral passage n = 6, vomiting n = 9). Patients of group 2 showed more delayed enteral passages (5 vs. 1) and more vomiting (7 vs. 2) than those of group 1. The median stay in the intensive care unit was shorter in group 1 than in group 2 (3 vs. 5 days) (p = 0.021). Overall hospitalisation was 14 days in the mean in both groups. We found no significant difference in the postoperative mortality of 6.5 % (n = 7) between the two groups. Overall survival after a follow-up of 42 months was 34 % (group 1) and 25 % (group 2). The difference did not reach statistical significance (p = 0.961). Patients with an elevated BMI show slightly more complications than those with a lower BMI. CONCLUSIONS: Our data show that patients with elevated BMI have slightly more complications and an identical long term survival as patients with normal body weight.

Swift heavy ion irradiation of Cu-Zn-Al and Cu-Al-Ni alloys.

The effects produced by swift heavy ions in the martensitic (18R) and austenitic phase (ß) of Cu based shape memory alloys were characterized. Single crystal samples with a surface normal close to [210](18R) and [001](ß) were irradiated with 200 MeV of Kr(15+), 230 MeV of Xe(15+), 350 and 600 MeV of Au(26+) and Au(29+). Changes in the microstructure were studied with transmission electron microscopy (TEM) and high resolution transmission electron microscopy (HRTEM). It was found that swift heavy ion irradiation induced nanometer sized defects in the 18R martensitic phase. In contrast, a hexagonal close-packed phase formed on the irradiated surface of ß phase samples. HRTEM images of the nanometer sized defects observed in the 18R martensitic phase were compared with computer simulated images in order to interpret the origin of the observed contrast. The best agreement was obtained when the defects were assumed to consist of local composition modulations.

Methylprednisolone therapy in deceased donors reduces inflammation in the donor liver and improves outcome after liver transplantation: a prospective randomized controlled trial.

OBJECTIVE: To investigate potential beneficial effects of donor treatment with methylprednisolone on organ function and outcome after liver transplantation. SUMMARY BACKGROUND DATA: It is proven experimentally and clinically that the brain death of the donor leads to increased levels of inflammatory cytokines and is followed by an intensified ischemia/reperfusion injury after organ transplantation. In experiments, donor treatment with steroids successfully diminished these effects and led to better organ function after transplantation. METHODS: To investigate whether methylprednisolone treatment of the deceased donor is applicable to attenuate brain death-associated damage in clinical liver transplantation we conducted a prospective randomized treatment-versus-control study in 100 deceased donors. Donor treatment (n = 50) consisted of 250 mg methylprednisolone at the time of consent for organ donation and a subsequent infusion of 100 mg/h until recovery of organs. A liver biopsy was taken immediately after laparotomy and blood samples were obtained after brain death diagnosis and before organ recovery. Cytokines were assessed by real-time reverse transcriptase-polymerase chain reaction. Soluble serum cytokines were measured by cytometric bead array system. RESULTS: After methylprednisolone treatment, steroid plasma levels were significantly higher (P < 0.05), and a significant decrease in soluble interleukins, monocyte chemotactic protein-1, interleukin-2, interleukin-6, tumor necrosis factor-alpha, and inducible protein-10 was observed. Methylprednisolone treatment resulted in a significant downregulation of intercellular adhesion molecule-1, tumor necrosis factor-alpha, major histocompatibility complex class II, Fas-ligand, inducible protein-10, and CD68 intragraft mRNA expression. Significantly ameliorated ischemia/reperfusion injury in the posttransplant course was accompanied by a decreased incidence of acute rejection. CONCLUSIONS: Our present study verifies the protective effect of methylprednisolone treatment in deceased donor liver transplantation, suggesting it as a potential therapeutical approach.

Influence of vaccination and surgery on HLA-DR expression in patients with upper aerodigestive tract cancer.

Major surgery is associated with an increased risk of post-operative immunosuppression and infections. We investigated the influence of influenza vaccination on cell-mediated immune responses in cancer patients undergoing either surgical or conservative therapy. Forty patients with an upper aerodigestive tract tumour were allocated to either a surgical or non-surgical treatment course. Patients within each group were randomized to the vaccination or non-vaccination group. Vaccination was performed twice before surgery or conservative treatment. Human leucocyte antigen receptor (HLA-DR) expression on monocytes was analysed by flow cytometry. In the surgical patients, HLA-DR expression on day 1 after surgery decreased in both the vaccinated and non-vaccinated groups. Vaccinated non-surgical patients showed significantly increased HLA-DR expression levels compared with the non-vaccinated patients. This pilot study demonstrated that vaccination increased monocyte HLA-DR expression in conservatively-treated cancer patients whereas surgery abrogated this response. Vaccination before surgery, therefore, might not help to maintain immune reactivity after surgery.

Ca pre-rinse greatly increases plaque and plaque fluid F.

Previous studies demonstrated that a Ca pre-treatment greatly increases salivary F from a subsequent NaF rinse. This study examines if these increases are found in plaque and plaque fluid F. Thirteen individuals accumulated plaque before rinsing with: (1) 12 mmol/L NaF (228 microg/g F), (2) 150 mmol/L Ca rinse, or (3) the Ca rinse followed by the F rinse. One hr later, plaque samples were collected, the plaque fluid was recovered, and the plaque residues were extracted 5 times with pH 6.8 or pH 4.8 buffers, and then by acid. The F in each extract after the Ca rinse/F rinse greatly exceeded the corresponding F from the NaF rinse. Consequently, the Ca rinse/F rinse increased the total plaque F and the plaque fluid F by 12x and 5x, compared with the NaF rinse alone. These and the previous salivary results suggest that a Ca pre-treatment may increase the cariostatic effects of topical F agents.