Enhancing medial layer recellularization of tissue-engineered blood vessels using radial microchannels.

Aim: Cell repopulation of tissue-engineered vascular grafts (TEVGs) from decellularized arterial scaffolds is limited by dense concentric tunica media layers which impede cells migrating radially between the layers. We aimed to develop and validate a new microneedle device to modify decellularized carotid arteries with radial microchannels to enhance medial layer repopulation. Material & methods: Modified decellularized porcine arteries were seeded with rat mesenchymal stem cells using either standard longitudinal injection, or a dual vacuum-perfusion bioreactor. Mechanical tests were used to assess the arterial integrity following modification. Results & conclusion: The method herein achieved radial recellularization of arteries in vitro without significant loss of mechanical integrity, Thus, we report a novel method for successful radial repopulation of decellularized carotid artery-based tissue-engineered vascular grafts.

Initial Approach to Childhood Obesity in Spain. A Multisociety Expert Panel Assessment.

PURPOSE: In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain. METHODS: The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed. RESULTS: The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40. CONCLUSIONS: Spanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.

[Influence of the surgeon as a factor in the surgical treatment of rectal cancer with preoperative radiochemotherapy. A comparative study]. / Influencia del factor cirujano en el tratamiento quirúrgico del cáncer de recto con radioquimioterapia preoperatoria. Estudio comparativo.

INTRODUCTION: In the last few years, changes have been introduced in rectal cancer surgery that have improved its results. These changes include autosuture devices, total mesorectal excision, and neoadjuvant treatment. The aim of the present study was to determine whether the surgeon influences the results of surgical treatment for rectal cancer. PATIENTS AND METHODS: A comparative, retrospective study was performed in 194 consecutive patients with rectal cancer who underwent preoperative radiotherapy. The patients were divided into two groups according to the type of surgeon performing the intervention: group I: 3 surgeons with 101 patients; group II: 16 surgeons with 93 patients. RESULTS: Sphincter-preserving surgery was performed in 77% of patients in group I and in 52% of those in group II (p < 0.001). In group I anterior resection was performed in 100%, 100% and 58% when the tumor was between 11-15 cm, 6-10 cm and 1-5 cm, respectively, compared with 100%, 69% and 23.5% in group II. Complications occurred in 41% of patients in group I and in 48% of those in group II (p = 0.037). Length of hospital stay was 9.9 days in group I and 13.9 days in group II (p < 0.001). Local recurrence occurred in 3.5% of patients in group I and in 11.3% of those in group II (p = 0.054). Survival was similar in both groups. CONCLUSIONS: The surgeon is a key factor in rectal cancer, despite the introduction of autosuture devices, neoadjuvant treatment, and total mesorectal excision. These patients should be operated on by experts in this type of surgery and not by surgeons who perform these interventions only occasionally.