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Augmenting apoptosis-mediated anticancer activity of lactoperoxidase and lactoferrin by nanocombination with copper and iron hybrid nanometals. Sci Rep 2022; 12:13153. [PMID: 35915221 PMCID: PMC9343395 DOI: 10.1038/s41598-022-17357-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
There is an urgent need in the medicinal fields to discover biocompatible nanoformulations with low cytotoxicity, which provide new strategies for promising therapies for several types of tumors. Bovine lactoperoxidase (LP) and lactoferrin (LF) have recently attracted attention in medicine for their antitumor activities with recognized safety pattern. Both LP and LF are suitable proteins to be coated or adsorbed to Cu and Fe nanometals for developing stable nanoformulations that boost immunity and strong anticancer effects. New nanometals of Cu and Fe NPs embedded in LP and LF forming novel nanocombinations of LP-CNPs and LF-FNPs had a spherical shape with an average nanosize of about 21 nm. The combination of LP-CNPs and LF-FNPs significantly exhibited the highest growth inhibitory efficacy, in terms of effectively lowering the half-maximal inhibitory concentration (IC50) values, against Caco-2, HepG2 and MCF7 cells comparing to nanometals, LP, LF and individual nanoproteins (LP-CNPs or LF-FNPs). The highest apoptotic effect of this nanocombination (LP-CNPs and LF-FNPs) was confirmed by the highest percentages of annexin-stained apoptotic cells and G0 population with the strongest alteration in the expression of two well-characterized apoptosis guards (p53 and Bcl-2) and the maximum suppression in the proliferation marker (Ki-67). Also, the in silico analysis predicted that LP-CNPs and LF-FNPs enhanced AMP-activated protein kinase (AMPK, p53 activator) activity and inhibited cancer migration-related proteases (cathepsin B and matrix metalloproteinase (MMP)-9). Our results offer for the first time that these novel nanocombinations of LP and LF were superior in their selectivity and apoptosis-mediating anticancer activity to Cu and Fe nanometals as well as the free form of these proteins or their individual nanoforms.
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Sawamura S, Koike Y, Yamamoto T, Terauchi M, Koyama S, Utsunomiya D. The use of viabahn VBX stent-grafts for the treatment of extrahepatic portal vein hemorrhage. MINIM INVASIV THER 2022; 31:1066-1069. [DOI: 10.1080/13645706.2022.2056706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shungo Sawamura
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuya Koike
- Department of Interventional Radiology, Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan
| | - Toh Yamamoto
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Miki Terauchi
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Shingo Koyama
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
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Ferral H, Alonzo MJ, Datri J, Hogg ME, Marsh R, Talamonti MS. Endovascular management of portal vein obstruction in hepatobiliary cancer patients. J Surg Oncol 2021; 125:392-398. [PMID: 34643276 DOI: 10.1002/jso.26713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this article is to describe the procedural safety, technical success, and clinical success of endovascular management of portal and mesenteric venous obstruction in patients with hepatobiliary neoplasms. METHODS Institutional Review Board (IRB)-approved HIPAA compliant retrospective review of 21 consecutive patients with hepatobiliary malignancies who underwent endovascular portal vein recanalization and stent placement between January 2012 and March 2020. Clinical diagnoses were pancreatic cancer (n = 19), colon cancer metastatic to the liver (n = 1), and cholangiocarcinoma (n = 1). Presenting signs and symptoms included: ascites, abdominal pain, abnormal liver function tests, diarrhea, and gastrointestinal bleeding. Stent patency and patient survival are presented with Kaplan-Meier method. RESULTS The technical success rate was 100%. A transhepatic approach was used in 20 cases (95.2%); trans-splenic access in one. Primary stent patency was 95.2%, 84%, and 68% at 1, 3, and 6 months, respectively. All stent occlusions were caused by tumor progression. A total of 80% of patients reported symptomatic improvement. Patient survival at 10 months was 40%. The early death rate was 4.76%. There were no bleeding complications from the percutaneous tracts. CONCLUSION Endovascular recanalization with stent placement is safe with high technical and clinical success.
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Affiliation(s)
- Hector Ferral
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSciences, Evanston, Illinois, USA
| | - Marc J Alonzo
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSciences, Evanston, Illinois, USA
| | - Jewel Datri
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Melissa E Hogg
- Department of Surgery, Hepatobiliary Surgery, NorthShore University HealthSciences, Evanston, Illinois, USA
| | - Robert Marsh
- Department of Medicine, Oncology, NorthShore University HealthSciences, Evanston, Illinois, USA
| | - Mark S Talamonti
- Department of Surgery, Hepatobiliary Surgery, NorthShore University HealthSciences, Evanston, Illinois, USA
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Kreso A, Yamada K, Irani Z, Kalva S, Fagenholz P. Novel techniques for management of portal system hemorrhage in acute pancreatitis. Pancreatology 2020; 20:1576-1581. [PMID: 33077381 DOI: 10.1016/j.pan.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/21/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
Current management of infected pancreatic necrosis is focused on a minimally invasive step-up approach. The step-up approach consists of initial percutaneous or endoscopic drainage of infected pancreatic necrosis, followed, if necessary, by minimally invasive surgical or endoscopic debridement. While there is reduced morbidity and mortality, vascular complications can be life-threatening. Reported vascular complications have been limited to arterial bleeding. Venous bleeding has not been previously reported. We present two cases of portal venous bleeding in patients who underwent treatment for infected pancreatic necrosis with a step-up approach. We discuss the clinical presentation, diagnosis, and initial management. Moreover, we present two different techniques that can be used to successfully manage venous bleeding in patients who have percutaneous drains in place as part of a step-up approach. These techniques involve tamponading the cavity or drain tract with topical hemostatics and direct embolization of the bleeding vein. These experiences can serve as a guide for managing portal venous bleeding in patients with infected pancreatic necrosis.
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Affiliation(s)
| | - Kei Yamada
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Zubin Irani
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva Kalva
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
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Tsukamoto T, Nobori C, Nishiyama T, Kunimoto T, Kaizaki R, Inoue T, Nishiguchi Y. Stent-graft placement for delayed extrahepatic portal hemorrhage after surgical treatment for perihilar cholangiocarcinoma: A case report. Int J Surg Case Rep 2020; 77:519-522. [PMID: 33395836 PMCID: PMC7704364 DOI: 10.1016/j.ijscr.2020.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022] Open
Abstract
Stent-graft placement is a viable option for treatment of portal vein hemorrhage. Postoperative hemorrhage was caused by extrahepatic portal vein pseudoaneurysm formation. Portal vein pseudoaneurysm occurred at the reconstructed portion.
Introduction Potential curative therapy for perihilar cholangiocarcinoma requires extensive surgical treatment, which can still be associated with significant morbidity and mortality. Postoperative hemorrhage from the portal vein is a rare but life-threatening complication. We herein report postoperative hemorrhage from an extrahepatic portal vein pseudoaneurysm successfully treated by stent graft placement late after surgical treatment for perihilar cholangiocarcinoma. Presentation of case An 83-year-old man was referred to our hospital with a chief complaint of jaundice. Based on radiological findings, we diagnosed the patient with hilar cholangiocarcinoma. After endoscopic retrograde biliary drainage, resection of the extrahepatic bile duct combined with extended left hemi-hepatectomy, including the caudate lobe, lymphadenectomy of the hepatoduodenal ligament, partial resection and reconstruction of the portal vein, and right hepaticojejunostomy was performed. Fourteen days postoperatively, bleeding through the abdominal drain around the portal vein was observed. Twenty days postoperatively, abdominal computed tomography revealed a portal vein pseudoaneurysm that had formed at the portion of reconstruction. Therefore, 24 days postoperatively, a stent graft placement of the pseudoaneurysm through the ileocolic vein was performed. Subsequently, the portal vein hemorrhage ceased. Discussion Our present postoperative extrahepatic portal vein hemorrhage case was caused by an extrahepatic portal vein pseudoaneurysm that had formed at the reconstructed portion by erosion due to the chemical effect of the leaking bile and mechanical irritation of the surgical drain adjacent to the portal vein. Conclusion Stent-graft placement is a minimally-invasive, safe, and effective treatment option for hemorrhage from postoperative portal vein pseudoaneurysm.
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Affiliation(s)
- Tadashi Tsukamoto
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan.
| | - Chihoko Nobori
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Tsuyoshi Nishiyama
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Tomohiro Kunimoto
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Ryoji Kaizaki
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Toru Inoue
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Yukio Nishiguchi
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
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Pescatori LC, Kobeiter H, Zaarour Y, Herin E, Vitellius M, Tacher V. Transhepatic endovascular repair for portal vein haemorrhage. CVIR Endovasc 2020; 3:56. [PMID: 33030649 PMCID: PMC7544788 DOI: 10.1186/s42155-020-00149-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Post-surgical bleeding of the main portal vein (PV) is a rare event but difficult to manage surgically. Among the different options of treatment, endovascular stenting of the PV can be considered. We reported two cases of stent-graft placement in PV with subsequent closure of the portal vein access with two percutaneous closure devices deployed simultaneously. CASES PRESENTATION The first patient was a 43 years-old woman affected with a pseudoaneurysm of the extrahepatic PV, occurred after a duodenocephalopancreasectomy performed for a neuroendocrine tumour of the pancreatic isthmus. The second patient was a 54 years-old man suffering from multiple episodes of bleeding after liver transplantation, due to a PV fissure. In both cases, a stent graft was placed into the portal system, between the PV and the superior mesenteric vein through a right trans-hepatic access to the portal system. In both cases, a final control showed patency of the mesenteric vein and PV and no endoleak detection. At the end of the procedure, two percutaneous closure devices were loaded, to close the transhepatic portal access. In one case, one of the devices did not work and the entry point was managed with a single device, without further complications. No bleeding was seen though the entry point nor at the US examination performed right after the procedure. After procedure, patients were prescribed with low-molecular weight heparin (LMWH) and kept under surveillance. For both patients, CT scan performed within 24h after the procedure, showed a patent stent-graft and no evidence of any venous portal ischemia. The first patient was then transferred to another hospital, to continue observation and medical management. The second one underwent 2 months of hospitalization, during which he developed a pancreatic fistula and mild renal insufficiency. Then, he left the hospital to its native Country to continue his medical. CONCLUSION PV stent-graft placement seems a feasible option to manage portal bleeding. Trans-hepatic access is an easy and fast approach. The trans-hepatic portal accesses may be successfully managed with the deployment of percutaneous closure devices.
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Affiliation(s)
- Lorenzo Carlo Pescatori
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France.
| | - Hicham Kobeiter
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France.,Université Paris-Est Créteil (UPEC), Créteil, France
| | - Youssef Zaarour
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France
| | - Edouard Herin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France
| | - Manuel Vitellius
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France
| | - Vania Tacher
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France.,Université Paris-Est Créteil (UPEC), Créteil, France
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Erdem H, Çetinkünar S, Aziret M, Reyhan E, Sözütek A, Sözen S, İrkorucu O. Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction? ULUSAL CERRAHI DERGISI 2017; 32:248-251. [PMID: 28149120 DOI: 10.5152/ucd.2016.3174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method. MATERIAL AND METHODS The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb. RESULTS 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group. CONCLUSION In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas.
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Affiliation(s)
- Hasan Erdem
- Clinic of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Süleyman Çetinkünar
- Clinic of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Aziret
- Clinic of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Enver Reyhan
- Clinic of Gastroenterology Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Alper Sözütek
- Clinic of Gastroenterology Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Selim Sözen
- Department of General Surgery, Tekirdağ University School of Medicine, Tekirdağ, Turkey
| | - Oktay İrkorucu
- Clinic of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
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Suzuki K, Igami T, Komada T, Mori Y, Yokoyama Y, Ebata T, Naganawa S, Nagino M. Stent-graft treatment for extrahepatic portal vein hemorrhage after pancreaticoduodenectomy. Acta Radiol Open 2015; 4:2058460115589338. [PMID: 26137314 PMCID: PMC4475512 DOI: 10.1177/2058460115589338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/10/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of intraperitoneal hemorrhage from the extrahepatic portal vein after pancreaticoduodenectomy for distal bile duct carcinoma. A stent-graft was deployed from the superior mesenteric vein to the main portal vein using a transhepatic approach. After the procedure, the patient remained free of intraperitoneal hemorrhage and was discharged 2 months later.
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Affiliation(s)
- Kojiro Suzuki
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomohiro Komada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshine Mori
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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