Increased metastatic potential in human prostate carcinoma cells by overexpression of arachidonate 12-lipoxygenase.

Arachidonate 12-lipoxygenase (LOX) converts arachidonic acid to 12(S)-hydroxyeicosatetraenoic acid (HETE), a bioactive lipid implicated in tumor angiogenesis, growth, and metastasis. Alteration in 12-LOX expression or activity has been reported in various carcinomas including prostate carcinoma. However, little is known about the impact of the altered expression or activity of 12-LOX on tumor metastasis. In the present study, we examined whether or not an increase in 12-LOX expression in human prostate carcinoma cells can modulate their metastatic potential. We report that increased expression of 12-LOX in PC-3 cells caused a significant change in cell adhesiveness, spreading, motility, and invasiveness. Specifically 12-LOX transfected PC-3 cells were more adhesive toward vitronectin, type I and IV collagen, but not to fibronectin or laminin, than cells transfected with control vector. Increased spreading on vitronectin, fibronectin, collagen type I and IV also was observed in 12-LOX transfected PC-3 cells when compared to control PC-3 cells. The increased spreading of 12-LOX transfected PC-3 cells was blocked by treatment with 12-LOX inhibitors, baicalein and CDC. 12-LOX transfected PC-3 cells were more invasive through Matrigel than cells transfected with control vector. In vivo, tumor cell invasion to surrounding muscle or fat tissues was more frequent in nude mice bearing s.c. tumors from 12-LOX transfected PC-3 cells than in those from control vector transfected cells. When injected via the tail vein into SCID mice with implanted human bone fragments, there was an increase in tumor metastasis to human bone by 12-LOX transfected PC-3 cells in comparison to control vector transfected cells. Taken together, our data suggest that an increase in 12-LOX expression enhances the metastatic potential of human prostate cancer cells.

Shorter circular staple is height associated with lower anastomotic stricture rate in laparoscopic gastric bypass.

BACKGROUND: Anastomotic stenosis, leak, and hemorrhage are common stapler-related complications of laparoscopic Roux-en-Y gastric bypass. In May 2007, we transitioned from a 25-mm diameter, 4.8-mm-height circular stapler to a 25-mm, 3.5-mm-height circular stapler. We hypothesized that the staple height would be associated with a decreased incidence of perioperative complications. METHODS: The records of 360 consecutive patients who had undergone laparoscopic Roux-en-Y gastric bypass from May 1, 2006 to March 31, 2008 were retrospectively abstracted. The National Surgical Quality Improvement Project and Michigan Bariatric Surgery Collaborative databases were used to collect the patient demographics and track complications of laparoscopic Roux-en-Y gastric bypass. Data were collected on the rates of anastomotic stenosis requiring dilation of the gastrojejunostomy, anastomotic leak, hemorrhage requiring transfusion, and wound infection. Patients with a 4.8-mm staple height gastrojejunostomy were compared with those with a 3.5-mm staple height gastrojejunostomy for differences in complications. RESULTS: The groups were similar with respect to age, gender, body mass index, hypertension, hyperlipidemia, diabetes, sleep apnea, and surgery duration. In the 4.8- and 3.5-mm staple height groups, 15% and 6.1% required gastrojejunal dilation, respectively (P = .01). A trend was seen toward a decrease in postoperative hemorrhage (5% versus 2.8%) with the shorter staple height. No anastomotic leaks occurred, and the incidence of wound infection (1.7% versus 2.2%) was similar between the 2 groups. CONCLUSION: In the present study, the use of a 25-mm, 3.5-mm staple height circular stapler was associated with a decreased rate of anastomotic stenosis.

A wireless and battery-less miniature intracardiac pressure sensor: early implantation studies.

Permanently implantable hemodynamic monitors show great promise in providing personalized and cost-efficient care to heart failure patients by providing timely intracardiac pressure data under ambulatory conditions. The data may be used to titrate maintenance therapies and to monitor health status so that more intensive interventions can be planned and performed under optimal conditions. In this pilot study, we present the results of the implantation of a novel wireless, battery-less pressure sensor into the apex of the left ventricle of four dogs for a period of 8 weeks. All animals recovered to a normal state and did not show any clinical signs of cardiac insufficiency or any complications suggestive of thromboembolism. All sensors functioned throughout the implantation period and provided detailed waveforms of ventricular pressure.

Airway pressure release ventilation and successful lung donation.

HYPOTHESIS: Donor management with airway pressure release ventilation (APRV) improves oxygenation and increases lung donation while maintaining equivalent graft survival. DESIGN: Retrospective case series. SETTING: Private, tertiary care, level I trauma center. PATIENTS: Forty-five consecutive organ donors. INTERVENTIONS: Management with assist/control ventilation (ACV) or APRV. MAIN OUTCOME MEASURES: Demographic characteristics, medical history, mode of brain death, and partial pressure of arterial oxygen (Pao(2))/fraction of inspired oxygen (Fio(2)) ratios on admission and after 100% oxygen challenge, percentage of lungs transplanted, and graft survival. RESULTS: Twenty potential donors were managed with ACV and 25 were managed with APRV during the study period. The APRV patients were younger than the ACV patients (mean [SD] age, 34 [11] vs 41 [12] years, respectively; P = .05). Otherwise, there was no difference between the ACV and APRV groups with respect to demographic characteristics, medical history, or mode of brain death. Although the ACV and APRV groups had similar Pao(2)/Fio(2) ratios on admission and the mean time on the ventilator was the same, the APRV group had a higher Pao(2)/Fio(2) ratio than the ACV group (mean [SD], 498 [43] vs 334 [104] mm Hg, respectively; P < .001) after 100% oxygen challenge. The ACV group ultimately donated 7 of 40 potential lungs (18%) compared with 42 of 50 potential lungs (84%) in the APRV group (P < .001). There was no difference in the number of other organs per donor procured from the 2 groups. Survival of grafts managed with both APRV and ACV compared favorably with national averages. CONCLUSION: The use of APRV prior to procurement may increase the rate of successful lung donation.

The safe transition from open to thoracoscopic lobectomy: a 5-year experience.

BACKGROUND: We hypothesized that established thoracic surgeons without formal minimally invasive training can learn thoracoscopic lobectomy without compromising patient safety or outcome. METHODS: Data were retrospectively collected on patients who underwent pulmonary lobectomy at a single health system between August 1, 2003, and April 1, 2008. Age, sex, pulmonary function tests, preoperative and postoperative stages, pathologic diagnosis, anatomic resection, extent of lymph node sampling, surgical technique and duration, complications, blood loss, transfusion requirement, chest tube duration, length of hospital stay, 30-day readmission, and mortality rate were examined. The percentage of patients who underwent thoracoscopic lobectomy and their outcomes were then compared among three chronologic cohorts. RESULTS: Three hundred sixty-four patients underwent pulmonary lobectomy (239 open; 99 thoracoscopic; 26 thoracoscopic converted to open). Baseline characteristics, staging, pathologic diagnosis, and anatomic resections were similar in the early, middle, and late cohorts. The percentage of thoracoscopic lobectomies increased from 16% to 49%, whereas open lobectomy decreased from 81% to 42% (p < 0.0001). The complication rate remained constant with the exception of air leaks lasting more than 7 days (9% versus 10% versus 2%; p = 0.02). Hospital length of stay (6 versus 5 versus 4 days; p < 0.0001) and chest tube duration (4 versus 3 versus 3 days; p < 0.0001) decreased and operative duration increased as more thoracoscopic lobectomies were performed. Blood loss, transfusion requirement, 30-day readmission, and 1-year survival were not significantly different among chronologic cohorts. CONCLUSIONS: Established thoracic surgeons can safely incorporate thoracoscopic lobectomy with no increase in morbidity or mortality.