Our results suggest that single-incision laparoscopic cholecystectomy is a safe and effective alternative to four-port laparoscopic cholecystectomy that provides surgeons with an alternative minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus.
The significant improvement in operative times after the first quintile followed by consistent results without subsequent variability suggests that the learning curve for the single-port cholecystectomy, in the hands of a fellowship-trained laparoscopic surgeon, is approximately ten cases.
There is a well-established link between inflammation and cancer of various organs, but little data are available on inflammation-associated markers of diagnostic and prognostic clinical utility in pulmonary malignancy. Blood samples were prospectively collected from 75 resectable lung cancer patients before surgery and in a cohort of 1,358 high-risk subjects. Serum levels of long pentraxin 3 (PTX3) were determined by high-sensitivity ELISA. PTX3 immunostaining was evaluated by immunohistochemistry in cancer tissue. Serum PTX3 levels in the high-risk population were not predictive of developing subsequent lung cancer or any other malignancy; however, serum PTX3 values in patients with lung cancer were significantly higher compared with cancer-free heavy smokers. With a cutoff of 4.5 ng/ml, specificity was 0.80, sensitivity 0.69, positive predictive value 0.15 and negative predictive value 0.98. The receiver operating curve (ROC) for serum PTX3 had an area under the curve (AUC) of 83.52%. Preoperative serum PTX3 levels in lung cancer patients did not correlate with patient outcome, but high interstitial expression of PTX3 in resected tumor specimens was a significant independent prognostic factor associated with shorter survival (p < 0.001). These results support the potential of serum PTX3 as a lung cancer biomarker in high-risk subjects. Furthermore, PTX3 immunohistochemistry findings support the role of local inflammatory mechanisms in determining clinical outcome and suggest that local expression of PTX3 may be of prognostic utility in lung cancer patients.Despite advancements in surgery, anesthesiology and the improvement of chemotherapy and radiotherapy regimens, the prognosis for clinically detected lung cancer remains dismal, with overall 5-year survival rates of 5-15%. Even with early-stage disease 30-40% of the patients ultimately relapse and die, 1 suggesting that sophisticated biological mechanisms affect their outcome that are not reflected by pathological stage alone. For such a reason, prognostic markers independent of stage are actively sought.In the last few years, leukocyte counts and blood levels of several inflammation markers have been correlated with lung cancer prognosis 2 or investigated as lung cancer risk predictors. 3,4 The role of inflammation in cancer pathogenesis and progression-that has long been investigated-includes the generation of reactive oxygen/nitrogen species and the secretion of cytokines, chemokines and proangiogenic factors. [5][6][7][8] In lung cancer, in addition to smoking-the predominant risk factor-inflammatory conditions such as chronic obstructive pulmonary disease, 9 pulmonary fibrosis and chronic lung infections 10,11 as well as polymorphisms of inflammatory genes 12 are all associated with an increased risk.
The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues or organs in order to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate.
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