1
|
Pencovich N, Smith BH, Attia ZI, Jimenez FL, Bentall AJ, Schinstock CA, Khamash HA, Jadlowiec CC, Jarmi T, Mao SA, Park WD, Diwan TS, Friedman PA, Stegall MD. Electrocardiography-based Artificial Intelligence Algorithms Aid in Prediction of Long-term Mortality After Kidney Transplantation. Transplantation 2024:00007890-990000000-00715. [PMID: 38557657 DOI: 10.1097/tp.0000000000005023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Predicting long-term mortality postkidney transplantation (KT) using baseline clinical data presents significant challenges. This study aims to evaluate the predictive power of artificial intelligence (AI)-enabled analysis of preoperative electrocardiograms (ECGs) in forecasting long-term mortality following KT. METHODS We analyzed preoperative ECGs from KT recipients at three Mayo Clinic sites (Minnesota, Florida, and Arizona) between January 1, 2006, and July 30, 2021. The study involved 6 validated AI algorithms, each trained to predict future development of atrial fibrillation, aortic stenosis, low ejection fraction, hypertrophic cardiomyopathy, amyloid heart disease, and biological age. These algorithms' outputs based on a single preoperative ECG were correlated with patient mortality data. RESULTS Among 6504 KT recipients included in the study, 1764 (27.1%) died within a median follow-up of 5.7 y (interquartile range: 3.00-9.29 y). All AI-ECG algorithms were independently associated with long-term all-cause mortality (P < 0.001). Notably, few patients had a clinical cardiac diagnosis at the time of transplant, indicating that AI-ECG scores were predictive even in asymptomatic patients. When adjusted for multiple clinical factors such as recipient age, diabetes, and pretransplant dialysis, AI algorithms for atrial fibrillation and aortic stenosis remained independently associated with long-term mortality. These algorithms also improved the C-statistic for predicting overall (C = 0.74) and cardiac-related deaths (C = 0.751). CONCLUSIONS The findings suggest that AI-enabled preoperative ECG analysis can be a valuable tool in predicting long-term mortality following KT and could aid in identifying patients who may benefit from enhanced cardiac monitoring because of increased risk.
Collapse
Affiliation(s)
- Niv Pencovich
- Departments of Surgery and Immunology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Byron H Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Andrew J Bentall
- Departments of Surgery and Immunology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Carrie A Schinstock
- Departments of Surgery and Immunology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | | | | | - Tambi Jarmi
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
| | - Shennen A Mao
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - Walter D Park
- Departments of Surgery and Immunology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Tayyab S Diwan
- Departments of Surgery and Immunology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Departments of Surgery and Immunology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| |
Collapse
|
2
|
Pencovich N, Pery R, Eshkenazy R, Nachmany I. Highly complex liver resections: Exploring the boundaries of feasibility and safety. J Surg Oncol 2024; 129:901-910. [PMID: 38164062 DOI: 10.1002/jso.27573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION In select clinical scenarios, advanced techniques for volume manipulation and vascular reconstruction are needed for complete hepatic tumor removal. These highly complex liver resections (HCLRs) entail a heightened risk of severe complications. Here, we describe the results of HCLR performed in a 3-year time period. MATERIALS AND METHODS We conducted a retrospective analysis encompassing patients who underwent hepatic resections between June 15, 2020, and June 15, 2023. HCLR was defined according to previously established criteria, and included associating liver partition and portal vein ligation for staged hepatectomy. The outcomes of HCLR were compared to all non-HCLR performed within the same time frame. RESULTS Among 167 hepatic resections, 26 were considered HCLR, and all were major resections. Five utilized total vascular exclusion, with venovenous bypass in three, and hypothermic liver perfusion in three. Five resections included vascular reconstructions, and one included hypothermic circulatory arrest for extraction of a tumor extending to the right atrium. Of the non-HCLR, 38 (26.9%) were major, and 49 (34.7%) were performed laparoscopically. The rates of overall major postoperative complications were comparable between those who underwent HCLR versus non-HCLR. HCLR was associated with increased rates of biliary complications, readmissions, and reoperation. However, no postoperative 90-day mortality was documented within patients that underwent HCLR compared to two in the non-HCLR group. CONCLUSIONS In expert hands, HCLR can be performed with acceptable complication profile, akin to that of major non-HCLR. Those with questionable resectability should be referred to tertiary hepato-pancreato-biliary centers.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Rony Eshkenazy
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
3
|
Nachmany I, Gudmundsdottir H, Meiri H, Eidelman P, Ziv O, Bear L, Nevo N, Jacoby H, Eshkenazy R, Pery R, Pencovich N. Perioperative Platelet Count Ratio Predicts Long-Term Survival after Left Pancreatectomy and Splenectomy for Pancreatic Adenocarcinoma. J Clin Med 2024; 13:1050. [PMID: 38398363 PMCID: PMC10888544 DOI: 10.3390/jcm13041050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The value of platelet characteristics as a prognostic factor in patients with pancreatic adenocarcinoma (PDAC) remains unclear. METHODS We assessed the prognostic ability of post-splenectomy thrombocytosis in patients who underwent left pancreatectomy for PDAC. Perioperative platelet count ratio (PPR), defined as the ratio between the maximum platelet count during the first five days following surgery and the preoperative level, was assessed in relation to long-term outcomes in patients who underwent left pancreatectomy for PDAC between November 2008 and October 2022. RESULTS A comparative cohort of 245 patients who underwent pancreaticoduodenectomy for PDAC was also evaluated. The median PPR among 106 patients who underwent left pancreatectomy was 1.4 (IQR1.1, 1.8). Forty-six had a PPR ≥ 1.5 (median 1.9, IQR1.7, 2.4) and 60 had a PPR < 1.5 (median 1.2, IQR1.0, 1.3). Patients with a PPR ≥ 1.5 had increased median overall survival (OS) compared to patients with a PPR < 1.5 (40 months vs. 20 months, p < 0.001). In multivariate analysis, PPR < 1.5 remained a strong predictor of worse OS (HR 2.24, p = 0.008). Among patients who underwent pancreaticoduodenectomy, the median PPR was 1.1 (IQR1.0, 1.3), which was significantly lower compared to patients who underwent left pancreatectomy (p > 0.001) and did not predict OS. CONCLUSION PPR is a biomarker for OS after left pancreatectomy for PDAC. Further studies are warranted to consolidate these findings.
Collapse
Affiliation(s)
- Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | | | - Hila Meiri
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Pavel Eidelman
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Ofir Ziv
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Lior Bear
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Nadav Nevo
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Harel Jacoby
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Rony Eshkenazy
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Ron Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
| | - Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv 52621, Israel; (I.N.); (H.M.); (P.E.); (O.Z.); (L.B.); (N.N.); (H.J.); (R.E.); (R.P.)
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
4
|
Pencovich N, Long JJ, Smith BH, Kinzelman-Vesely EA, Sudhindran V, Ryan RJ, Stegall MD, Kukla A, Diwan TS. Outcomes of Kidney Transplantation in Patients That Underwent Bariatric Surgery: A Systematic Review and Meta-analysis. Transplantation 2024; 108:346-356. [PMID: 37271882 DOI: 10.1097/tp.0000000000004680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The impact of bariatric surgery (BS) on kidney transplantation (KT) outcomes in patients with obesity remains controversial. We systematically searched MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials for studies reporting outcomes of KT recipients that underwent prior BS. Common/random effects meta-analyses were performed to obtain summary ratios of the postoperative outcomes. Eighteen eligible studies involving 315 patients were identified. Sleeve gastrectomy was the most common BS type (65.7%) followed by Roux-en-Y gastric bypass (27.6%) and gastric banding (4.4%). Across studies that provided the data, the %excess weight loss from BS to KT was 62.79% (95% confidence interval [CI], 52.01-73.56; range, 46.2%-80.3%). The rates of delayed graft function and acute rejection were 16% (95% CI, 7%-28%) and 16% (95% CI, 11%-23%) in 14 and 11 studies that provided this data, respectively. The rates of wound, urinary, and vascular complications following KT were 5% (95% CI, 0%-13%),19% (95% CI, 2%-42%), and 2% (95% CI, 0%-5%), in 12, 9, and 11 studies that provided this data, respectively. Follow-up time after KT was reported in 11 studies (61.1%) and ranged from 16 mo to >5 y. Graft loss was reported in 14 studies with an average of 3% (95% CI, 1%-6%). Four studies that included a comparator group of patients with obesity who did not undergo BS before KT showed comparable outcomes between the groups. We conclude that currently there is a paucity of robust evidence to suggest that pretransplant BS has a major effect on post-KT outcomes. High-quality studies are needed to fully evaluate the impact of BS on KT outcomes.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Jane J Long
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | | | - Vineeth Sudhindran
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Randi J Ryan
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Aleksandra Kukla
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Tayyab S Diwan
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
5
|
Goldstein AL, Nevo N, Nizri E, Shimonovich M, Maman Y, Pencovich N, Lahat G, Karin E. The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias. Am Surg 2023; 89:4616-4624. [PMID: 36069008 DOI: 10.1177/00031348221114027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique. METHODS A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study. RESULTS Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences. DISCUSSION The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.
Collapse
Affiliation(s)
| | - Nadav Nevo
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Eran Nizri
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Michal Shimonovich
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Yossi Maman
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Niv Pencovich
- Department of Surgery B, Tel Hashomer (Sheba) Hospital, Ramat Gan, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Eliad Karin
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| |
Collapse
|
6
|
Nevo N, Evola G, Sagnelli C, Pencovich N, Carbone G, Rispoli C. Severe Ketoacidosis After One Anastomosis Gastric Bypass Surgery. Am J Case Rep 2023; 24:e939581. [PMID: 37667468 PMCID: PMC10492420 DOI: 10.12659/ajcr.939581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/21/2023] [Accepted: 05/20/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Bariatric surgeries, such as one anastomosis gastric bypass (OAGB), has become a popular treatment option for managing obesity and associated comorbidities, including type-2 diabetes mellitus (T2DM). However, severe starvation ketoacidosis is a rare but potentially life-threatening complication that can occur postoperatively in patients with T2DM. Despite the increasing prevalence of these surgeries, the existing literature has limited information on severe starvation ketoacidosis as a postoperative complication. It is essential for healthcare professionals to be aware of this complication, its manifestations, and risk factors to ensure patient safety and improve outcomes. Therefore, this article aims to address the current gap in the literature and provide a comprehensive review of severe starvation ketoacidosis as a postoperative complication of bariatric surgeries, specifically OAGB, and its associated risk factors and manifestations. CASE REPORT A 38-year-old man with severe obesity and inadequately managed T2DM underwent OAGB surgery. On the second postoperative day, the patient experienced severe starvation ketoacidosis, exhibiting symptoms such as drowsiness, fatigue, weakness, and Kussmaul breathing. Blood gas analysis indicated significant metabolic acidosis. He was quickly transferred to the Intensive Care Unit (ICU) and given intravenous glucose and insulin therapy. Following this intervention, he showed rapid recovery and normalization of blood gases. He was discharged 6 days after surgery with normal clinical examination results and laboratory indices. CONCLUSIONS This case study emphasizes the significance of thorough preoperative glycemic control, comprehensive perioperative multidisciplinary management, and close postoperative monitoring for diabetic patients undergoing metabolic and bariatric surgeries. By implementing these strategies, healthcare professionals can reduce the risk of complications such as hypoglycemia or hyperglycemia/diabetic ketoacidosis (DKA) and enhance patient outcomes. The case also highlights the need for continuous education and training for healthcare providers to identify and manage such rare complications effectively.
Collapse
Affiliation(s)
- Nadav Nevo
- Bariatric Surgery Unit, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Giuseppe Evola
- General and Emergency Division, Garibaldi Hospital, Catania, Italy
| | - Carlo Sagnelli
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli “Monaldi Hospital”, Naples, Italy
| | - Niv Pencovich
- Bariatric Surgery Unit, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriele Carbone
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli “Monaldi Hospital”, Naples, Italy
| | - Corrado Rispoli
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli “Monaldi Hospital”, Naples, Italy
| |
Collapse
|
7
|
Pencovich N, Silverman JS, Horesh N, Nevo N, Eshkenazy R, Kent I, Ram E, Nachmany I. Readmission with acute kidney injury following ileostomy: patterns and predictors of a common phenomenon. Langenbecks Arch Surg 2023; 408:96. [PMID: 36805819 DOI: 10.1007/s00423-023-02842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Ileostomy is associated with various complications, often necessitating rehospitalization. High-output ileostomy is common and may lead to acute kidney injury (AKI). Here we describe the temporal pattern of readmission with AKI following ileostomy formation and identify risk factors. METHODS Patients that underwent formation of ileostomy between 2008 and 2021 were included in this study. Readmission with AKI with high output ileostomy was defined as readmission with serum creatinine > 1.5-fold compared to the level at discharge or latest baseline (at least stage-1 AKI according to Kidney Disease: Improving Global Outcome (KDIGO) criteria), accompanied by ileostomy output > 1000 ml in 24 h. Patient characteristics and perioperative course were assessed to identify predictors for readmission with AKI. RESULTS Of 1191 patients who underwent ileostomy, 198 (16.6%) were readmitted with a high output stoma and AKI. The mean time to readmission with AKI was 98.97 ± 156.36 days. Eighty-six patients (43.4%) had early readmission (within 30 days), and 66 (33%) were readmitted after more than 90 days. Over 90% of patients had more than one readmission, and 110 patients (55%) had 5 or more. Patient-related predictors for readmission with AKI were age > 65, body mass index > 30 kg/m2, and hypertension. Factors related to the postoperative course were AKI with creatinine > 2 mg/dl, postoperative hemoglobin < 8 g/dl or blood transfusion, albumin < 20 g/dl, high output stoma and need for loperamide, and length of hospital stay > 20 days. Factors related to early versus late readmissions and multiple readmissions were also analyzed. CONCLUSIONS Readmission with AKI following ileostomy formation is a consequential event with distinct risk factors. Acknowledging these risk factors is the foundation for designing interventions aiming to reduce frequency of AKI readmissions in predisposed patient populations.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel.
| | - Jacob Samuel Silverman
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of General Surgery, Faculty of Health Sciences, Assuta Medical Center, Ashdod, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rony Eshkenazy
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel
| | - Ilan Kent
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel
| | - Edward Ram
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Tel-Aviv, Israel
| |
Collapse
|
8
|
Barash Y, Klang E, Lux A, Konen E, Horesh N, Pery R, Zilka N, Eshkenazy R, Nachmany I, Pencovich N. Artificial intelligence for identification of focal lesions in intraoperative liver ultrasonography. Langenbecks Arch Surg 2022; 407:3553-3560. [PMID: 36068378 DOI: 10.1007/s00423-022-02674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Intraoperative ultrasonography (IOUS) of the liver is a crucial adjunct in every liver resection and may significantly impact intraoperative surgical decisions. However, IOUS is highly operator dependent and has a steep learning curve. We describe the design and assessment of an artificial intelligence (AI) system to identify focal liver lesions in IOUS. METHODS IOUS images were collected during liver resections performed between November 2020 and November 2021. The images were labeled by radiologists and surgeons as normal liver tissue versus images that contain liver lesions. A convolutional neural network (CNN) was trained and tested to classify images based on the labeling. Algorithm performance was tested in terms of area under the curves (AUCs), accuracy, sensitivity, specificity, F1 score, positive predictive value, and negative predictive value. RESULTS Overall, the dataset included 5043 IOUS images from 16 patients. Of these, 2576 were labeled as normal liver tissue and 2467 as containing focal liver lesions. Training and testing image sets were taken from different patients. Network performance area under the curve (AUC) was 80.2 ± 2.9%, and the overall classification accuracy was 74.6% ± 3.1%. For maximal sensitivity of 99%, the classification specificity is 36.4 ± 9.4%. CONCLUSIONS This study provides for the first time a proof of concept for the use of AI in IOUS and show that high accuracy can be achieved. Further studies using high volume data are warranted to increase accuracy and differentiate between lesion types.
Collapse
Affiliation(s)
- Yiftach Barash
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Klang
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adar Lux
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eli Konen
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadav Zilka
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rony Eshkenazy
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| |
Collapse
|
9
|
Wainer-Katsir K, Lavy-Shahaf G, Davidi S, Jacobovitch S, Voloshin T, Tzchori I, Porat Y, Ding L, Story M, Pencovich N, Volovitz I, Branter J, Smith SJ, Haber A, Giladi M, Weinberg U, Palti Y. Abstract 1866: Transcriptomics analysis for identification of pathways involved in the response to Tumor Treating Fields (TTFields). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Tumor Treating Fields (TTFields) are alternating electric fields that disrupt the function of polarized molecules within cancer cells. Initial data showed an anti-mitotic effect on cancerous cells whilst more recent findings confirmed additional effects such as downregulation of DNA double strand break repair, replication stress, upregulation of autophagy, and immunogenic cell death. Identification of TTFields-driven alterations in pan-cancer and tumor specific pathway is needed to aid selection of therapeutic modalities to be applied concomitant with TTFields for improved treatment outcomes. The aim of this study was to identify common pathways involved in the response to TTFields by comparing transcriptomics of various tumor type.
Methods: Control and TTFields-treated non-small cell lung carcinoma cell lines and animal model, glioblastoma (GBM) cell lines and patient-derived cell lines, and a hepatocellular carcinoma animal model were examined. Samples from GBM patients treated with concomitant TTFields and temozolomide (TMZ) were compared to samples from patients treated with TMZ alone. A list of differentially expressed genes (DEGs) was generated from transcriptomics analysis. Enrichment analysis was conducted according to the Gene Set Enrichment Analysis (GSEA) of MSigDB, Reactome, and Kegg pathway databases. Significantly overlapping pathways were identified using ActivePathways package according to the Reactome and Kegg gene sets, and an enrichment map was created according to the number of datasets supporting each pathway.
Results: DEGs in response to TTFields application included genes of the cytoskeleton, immune system, and some secretion proteins. Common pathways downregulated by TTFields (negative GSEA) included DNA repair, DNA and RNA synthesis, and cell cycle regulation, specifically the G2M checkpoint, E2F targets, and Myc targets. Common pathways upregulated by TTFields (positive GSEA) included the immune response, specifically complement cascades, coagulation, and lysosome activity. ActivePathways enrichment map results agreed with the gene set enrichment results, and revealed additional pathways involved in the response to TTFields, such as SUMOylation, metabolism of carbohydrates, unfolded protein response, and signaling by interleukins.
Conclusions: Transcriptomic analysis revealed common pathways involved in the responses to TTFields, regardless of the origin of the sample. Some identified pathways were in line with previously demonstrated effect of TTFields, such as mitotic interference, inhibition of DNA damage repair and upregulation of the innate immune response. New pathways revealed in this work support the examination of novel combination strategies with TTFields to increase the therapeutic effect in patients bearing various solid tumor types.
Citation Format: Kerem Wainer-Katsir, Gitit Lavy-Shahaf, Shiri Davidi, Sara Jacobovitch, Tali Voloshin, Itai Tzchori, Yaara Porat, Lianghao Ding, Michael Story, Niv Pencovich, Ilan Volovitz, Joshua Branter, Stuart J. Smith, Adi Haber, Moshe Giladi, Uri Weinberg, Yoram Palti. Transcriptomics analysis for identification of pathways involved in the response to Tumor Treating Fields (TTFields) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1866.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Lianghao Ding
- 2University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Story
- 2University of Texas Southwestern Medical Center, Dallas, TX
| | - Niv Pencovich
- 3Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Volovitz
- 4Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joshua Branter
- 5Children’s Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Stuart J. Smith
- 5Children’s Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | | | | | | | | |
Collapse
|
10
|
Younis M, Pencovich N, El-On R, Lubezky N, Goykhman Y, Phillips A, Nachmany I. Surgical Treatment for Choledocholithiasis Following Repeated Failed Endoscopic Retrograde Cholangiopancreatography. J Gastrointest Surg 2022; 26:1233-1240. [PMID: 35355173 DOI: 10.1007/s11605-022-05309-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment for choledocholithiasis. In many occasions, several attempts of ERCP are performed until failure is declared and surgical treatment is applied, in many times following procedure-related complications. We present the results of surgical management of patients with choledocholithiasis following repeated failures of ERCP due to impaction of multiple large stones. METHODS Patients that underwent surgical treatment for choledocholithiasis following repeated ERCP attempts between January 2006 and December 2018 were retrospectively assessed. Post-ERCP complications were evaluated and the surgical approach, technique, and outcomes were assessed. RESULTS One hundred and two patients were operated on for choledocholithiasis following repeated failed ERCP. All the patients had at least 2 failed attempts (mean = 3.2 ± 1.7), and 25 (23.5%) suffered major ERCP-related complications. Following choledochotomy and stone extraction, bilioenteric anastomosis was done in the vast majority of patients (90.2%), most commonly choledochoduodenostomy (62%). Thirty-eight (37%) patients had minimally invasive procedure (laparoscopic n = 26, robotic assisted n = 12). Major post-operative complications (Clavien-Dindo ≥ 3) occurred in 24 patients (23.5%). Nine patients (8.8%) were re-operated and 10 (9.8%) were readmitted within 30 days from surgery. Three patients died within 30 days from surgery. Older patients had significantly more ERCP attempts and suffered higher post-operative mortality. During a median follow-up of 70 months, the only biliary complication was an anastomotic stricture in one patient. CONCLUSION Surgery for CBDS after failure of ERCP is safe and provides a highly effective long-term solution.
Collapse
Affiliation(s)
- Muhammad Younis
- Division of General Surgery, Department of General Surgery B, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, 52621, Ramat-Gan, Israel.
| | - Reut El-On
- Division of General Surgery, Department of General Surgery B, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Lubezky
- Division of General Surgery, Department of General Surgery B, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Division of General Surgery, Department of General Surgery B, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Phillips
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, 52621, Ramat-Gan, Israel
| |
Collapse
|
11
|
Nevo N, Pencovich N, Lessing Y, Lasmanovich R, Barnes S, Lahat G, Nachmany I, Klausner JM. Preoperative biopsy for suspected adenocarcinoma of the pancreatic head: yield and complications. Minerva Surg 2022; 77:118-123. [PMID: 34338453 DOI: 10.23736/s2724-5691.21.08719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Histologic confirmation before pancreaticoduodenectomy (PD) for suspected pancreatic cancer is often performed. We assessed the yield of preoperative biopsy in these patients considering the associated complications. METHODS We retrospectively evaluated 216 patients that underwent PD for suspected carcinoma (CA) between 2012 and 2018. Post procedure complications and delay in surgery were assessed, as well as the postoperative diagnosis in relation to preoperative parameters. RESULTS Preoperative biopsy was performed in 142 patients (65.7%). Pathologic findings suggestive of CA were found in 106 (74.6%), while benign histology was found in 23 (16.1%), and non-diagnostic findings in 12 (8.4%). Seventy-four patients (34.3%) were operated without a preoperative biopsy. The time from diagnosis to surgery was significantly prolonged in those that underwent biopsy compared to patients that were taken straight to surgery (40±14 versus 18±15 days, P<0.001), and 18 patients (12.6%) suffered from clinically significant post procedure complications. Patients with a preoperative biopsy suggestive of CA, and those that were operated without a preoperative histologic confirmation had comparable rates of CA as a final pathological diagnosis (95.2% and 94.5%, respectively). Nevertheless, in patients with a benign or a non-diagnostic biopsy, the rates of pathologic diagnosis of CA were 69.6% and 73.6% respectively. Elevated levels of CA19-9 and a positive preoperative biopsy were associated with a final pathology of CA. CONCLUSIONS Preoperative histology is not uniformly required in patients with suspected pancreatic cancer. If preoperative biopsy is performed, benign histology does not rule out cancer but warrants additional evaluation prior to surgery.
Collapse
Affiliation(s)
- Nadav Nevo
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- Department of Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel -
| | - Yonatan Lessing
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rinat Lasmanovich
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sophie Barnes
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
Diamant G, Simchony Goldman H, Gasri Plotnitsky L, Roitman M, Shiloach T, Globerson-Levin A, Eshhar Z, Haim O, Pencovich N, Grossman R, Ram Z, Volovitz I. T Cells Retain Pivotal Antitumoral Functions under Tumor-Treating Electric Fields. J Immunol 2021; 207:709-719. [PMID: 34215656 DOI: 10.4049/jimmunol.2100100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
Tumor-treating fields (TTFields) are a localized, antitumoral therapy using alternating electric fields, which impair cell proliferation. Combining TTFields with tumor immunotherapy constitutes a rational approach; however, it is currently unknown whether TTFields' locoregional effects are compatible with T cell functionality. Healthy donor PBMCs and viably dissociated human glioblastoma samples were cultured under either standard or TTFields conditions. Select pivotal T cell functions were measured by multiparametric flow cytometry. Cytotoxicity was evaluated using a chimeric Ag receptor (CAR)-T-based assay. Glioblastoma patient samples were acquired before and after standard chemoradiation or standard chemoradiation + TTFields treatment and examined by immunohistochemistry and by RNA sequencing. TTFields reduced the viability of proliferating T cells, but had little or no effect on the viability of nonproliferating T cells. The functionality of T cells cultured under TTFields was retained: they exhibited similar IFN-γ secretion, cytotoxic degranulation, and PD1 upregulation as controls with similar polyfunctional patterns. Glioblastoma Ag-specific T cells exhibited unaltered viability and functionality under TTFields. CAR-T cells cultured under TTFields exhibited similar cytotoxicity as controls toward their CAR target. Transcriptomic analysis of patients' glioblastoma samples revealed a significant shift in the TTFields-treated versus the standard-treated samples, from a protumoral to an antitumoral immune signature. Immunohistochemistry of samples before and after TTFields treatment showed no reduction in T cell infiltration. T cells were found to retain key antitumoral functions under TTFields settings. Our data provide a mechanistic insight and a rationale for ongoing and future clinical trials that combine TTFields with immunotherapy.
Collapse
Affiliation(s)
- Gil Diamant
- The Cancer Immunotherapy Laboratory, Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel.,Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and
| | - Hadar Simchony Goldman
- The Cancer Immunotherapy Laboratory, Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Lital Gasri Plotnitsky
- The Cancer Immunotherapy Laboratory, Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Marina Roitman
- The Cancer Immunotherapy Laboratory, Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Tamar Shiloach
- Laboratory for Cancer Research and Immunotherapy, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Globerson-Levin
- Laboratory for Cancer Research and Immunotherapy, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zelig Eshhar
- Laboratory for Cancer Research and Immunotherapy, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oz Haim
- Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and
| | - Niv Pencovich
- Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and
| | - Rachel Grossman
- Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and
| | - Zvi Ram
- Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and
| | - Ilan Volovitz
- The Cancer Immunotherapy Laboratory, Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel; .,Neurosurgery Department, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and
| |
Collapse
|
13
|
Silverman J, Pencovich N, Mayer C, Volkov A, Eshkenazi R, Nachmany I. Giant leiomyosarcoma of the inferior vena cava necessitating extended liver resection: A case report and review of the literature. J Surg Case Rep 2021; 2021:rjab271. [PMID: 34168858 PMCID: PMC8219390 DOI: 10.1093/jscr/rjab271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 11/14/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour of smooth muscle origin. It commonly presents with non-specific symptoms including abdominal pain, distention, and lower extremity edema. Surgical resection with macroscopically clear margins is the only potential curative treatment for the disease. Here we present the case of a previously healthy 38-year-old woman with a subacute one-month increase of a four-year slowly progressive right sided abdominal pain and back pain. Imaging revealed a 14.5x12x15cm mass in the right hepatic lobe causing mass effect on adjacent abdominal and retroperitoneal organs, and involving the retrohepatic IVC. En-bloc resection of the right hemi-liver, most of segment four, the caudate lobe, and approximately a 10 cm section of the retrohepatic IVC, along with IVC reconstruction, was performed. Histologic examination revealed the diagnosis of a high grade leiomyosarcoma.
Collapse
Affiliation(s)
- Jacob Silverman
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Chen Mayer
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Alexander Volkov
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Rony Eshkenazi
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| |
Collapse
|
14
|
Pencovich N, Nevo N, Weiser R, Bonder E, Bogoch Y, Nachmany I. Postoperative Rise of Circulating Mitochondrial DNA Is Associated with Inflammatory Response in Patients following Pancreaticoduodenectomy. Eur Surg Res 2021; 62:18-24. [PMID: 33902043 DOI: 10.1159/000514661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Accumulation of plasma mitochondrial DNA (mtDNA) following severe trauma has been shown to correlate with the development of systemic inflammatory response syndrome (SIRS) and may predict mortality. Our objective was to investigate the relationship between levels of circulatory mtDNA following pancreaticoduodenectomy (PD) and the postoperative course. METHODS Levels of plasma mtDNA were assessed by real-time PCR of the mitochondrial genes ND1 and COX3 in 23 consecutive patients who underwent PD 1 day prior to surgery, within 8 h after surgery, and on postoperative day (POD)1 and POD5. The abundance of mtDNA was assessed relative to preoperative levels and in relation to parameters reflecting the postoperative clinical course. RESULTS When pooled for all patients, the circulating mtDNA levels were significantly increased after surgery. However, while a significant (at least >2-fold and up to >20-fold) rise was noted in 11 patients, no change in mtDNA levels was noted in the other 12 following surgery. Postoperative rise in circulating mtDNA was associated with an increased rate of postoperative fever until day 5, decreased hemoglobin and albumin levels, and increased white blood cell counts. These patients also suffered from increased rates of delayed gastric emptying. No significant differences were demonstrated in other postoperative parameters. CONCLUSION Circulating mtDNA surge is associated with an inflammatory response following PD and may potentially be used as an early marker for postoperative course. Studies of larger patient cohorts are warranted.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roi Weiser
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ekaterina Bonder
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoel Bogoch
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
15
|
Pencovich N, Orbach L, Lessing Y, Elazar A, Barnes S, Berman P, Blachar A, Nachmany I, Sagie B. Palliative bypass surgery for patients with advanced pancreatic adenocarcinoma: experience from a tertiary center. World J Surg Oncol 2020; 18:63. [PMID: 32238149 PMCID: PMC7114792 DOI: 10.1186/s12957-020-01828-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background As advances in oncological treatment continue to prolong the survival of patients with non-resectable pancreatic ductal adenocarcinoma (PDAC), decision-making regarding palliative surgical bypass in patients with a heavy disease burden turns challenging. Here we present the results of a pancreatic surgery referral center. Methods Patients that underwent palliative gastrojejunostomy and/or hepaticojejunostomy for advanced, non-resectable PDAC between January 2010 and November 2018 were retrospectively assessed. All patients were taken to a purely palliative surgery with no curative intent. The postoperative course as well as short and long-term outcomes was evaluated in relation to preoperative parameters. Results Forty-two patients (19 females) underwent palliative bypass. Thirty-one underwent only gastrojejunostomy (22 laparoscopic) and 11 underwent both gastrojejunostomy and hepaticojejunostomy (all by an open approach). Although 34 patients (80.9%) were able to return temporarily to oral intake during the index admission, 15 (35.7%) suffered from a major postoperative complication. Seven patients (16.6%) died from surgery and another seven within the following month. Nine patients (21.4%) never left the hospital following the surgery. Mean length of hospital stay was 18 ± 17 days (range 3–88 days). Mean overall survival was 172.8 ± 179.2 and median survival was 94.5 days. Age, preoperative hypoalbuminemia, sarcopenia, and disseminated disease were associated with palliation failure, defined as inability to regain oral intake, leave the hospital, or early mortality. Conclusions Although palliative gastrojejunostomy and hepaticojejunostomy may be beneficial for specific patients, severe postoperative morbidity and high mortality rates are still common. Patient selection remains crucial for achieving acceptable outcomes.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel.
| | - Lior Orbach
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Yonatan Lessing
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Amit Elazar
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Sophie Barnes
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Phillip Berman
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Arye Blachar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Boaz Sagie
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| |
Collapse
|
16
|
Diamant G, Simchony H, Shiloach T, Globerson-Levin A, Gasri Plotnitsky L, Eshhar Z, Pencovich N, Grossman R, Ram Z, Volovitz I. P12.05 Evaluating the compatibility of tumor treating electric fields with key antitumoral immune functions. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
TTFields has the ability to induce immunogenic cell death (ICD). As immunotherapy and TTFields have different mechanisms of action (MOA), combining these therapies is a rational approach. Contrarily, TTFields may interfere with immune functions critical for effective T cell function.
MATERIAL AND METHODS
We cultured T cells from healthy donors’ peripheral blood or from viably dissociated glioblastoma samples under normal or TTFields conditions, with or without superantigen-stimulation. In order to assess T cell responses we used eight-color flow cytometry by monitoring select pivotal antitumoral functions: proliferation (CFSE), IFNγ secretion, cytotoxic degranulation (CD107a), activation/exhaustion (PD1) and viability. Evaluation of direct cytotoxicity was done by using chimeric antigen receptor (CAR) T cells.
RESULTS
TTFields did not change T cell activation rates for all evaluated functions with the exception of reduced proliferation - in line with TTFields’ MOA. TTFields substantially reduced the viability of activated proliferating T cells, moderately affected activated nonproliferating T cells and had almost no effect on the viability of non-activated cells. Polyfunctionality analysis of T-cells, associated with effective antitumoral responses, demonstrated that under TTFields, the activated non-proliferating T cells retained polyfunctional capabilities. PD1-expressing TILs, a subset containing most of the tumor antigen-specific TILs, exhibited unaltered viability and functionality under TTFields. CAR T-cells, which utilize the same killing machinery as unmodified T cells, exhibited unaltered cytotoxic capability under TTFields. Immunohistochemical evaluation of GBM samples before TTFields treatment and after recurrence showed that some patients had accommodated large increases in their CD8 and CD4 counts. RNA-Seq performed on GBM samples from 6 standardly-treated and 6 TTFields-treated patients before treatment and after recurrence. The data shows differential increases in TTFields-treated patients to controls, in the expression of immune genes associated with favorable prognosis (e.g. t-bet, NKG2D, ICOS-L, CD70) and concurrent decreases in genes associated with poor prognosis (e.g. IL4, TSLP, various complement genes).
CONCLUSION
The preclinical data showed that all antitumoral T cell functions examined, but proliferation, were unhindered by TTFields. The clinical data showed that TTFields may shift treated tumors to a state more conducive of antitumoral immune responses. Our findings support the further preclinical and clinical investigation into combining TTFields with immunotherapy.
Collapse
Affiliation(s)
- G Diamant
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Simchony
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - T Shiloach
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Z Eshhar
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - N Pencovich
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Grossman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Ram
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I Volovitz
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
17
|
Diamant G, Simchony H, Shiloach T, Globerson-levin A, Plotnitsky LG, Eshhar Z, Pencovich N, Grossman R, Ram Z, Volovitz I. Abstract 3954: Evaluating the compatibility of tumor treating electric fields with key anti-tumoral immune functions. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Combining Tumor Treating electrical Fields (TTFields) with immunotherapy is a rational approach due to their different mechanisms of action (MOA) and to TTFields’ ability to induce immunogenic cell death (ICD). Conversely, TTFields may interfere with immune functions critical for effective T cell responses.
Methods: T cells from healthy donors’ peripheral blood or from viably dissociated glioblastoma samples were cultured under normal or TTFields conditions, with or without superantigen-stimulation. Eight-color flow cytometry was used to assess T cell responses by monitoring select pivotal antitumoral functions: proliferation (CFSE), IFNγ secretion, cytotoxic degranulation (CD107a), activation/exhaustion (PD1) and viability. Direct cytotoxicity was evaluated using chimeric antigen receptor (CAR) T cells.
Results: The viability of stimulated T cells that attempted to proliferate decreased under TTFields, in line with TTFields’ MOA. Small or no reductions in viability were found in activated T cells that did not attempt to proliferate and in unstimulated T cells.
The functionality of stimulated peripheral-blood T cells and tumor-infiltrating T cells (TILs) under TTFields was unhindered: T cells exhibited comparable PD1 upregulation, IFNγ secretion and CD107a expression as controls. T cell polyfunctionality, associated with effective antitumoral responses, was retained under TTFields conditions. PD1-expressing TILs, a subset containing most of the tumor antigen-specific TILs, exhibited unaltered viability and functionality under TTFields. CAR T-cells, which utilize the same killing machinery as unmodified T cells, exhibited unaltered cytotoxic capability under TTFields.
Immunohistochemical evaluation of GBM samples before TTFields treatment and after recurrence showed that some patients had accommodated large increases in their CD8 and CD4 counts. RNA-Seq performed on GBM samples from 6 standardly-treated and 6 TTFields-treated patients before treatment and after recurrence. The data shows differential increases in TTFields-treated patients to controls, in the expression of immune genes associated with favorable prognosis (e.g. t-bet, NKG2D, ICOS-L, CD70) and concurrent decreases in genes associated with poor prognosis (e.g. IL4, TSLP, various complement genes).
Conclusions: The preclinical data showed that all antitumoral T cell functions examined, but proliferation, were unhindered by TTFields. The clinical data showed that TTFields may shift treated tumors to a state more conducive of anti-tumoral immune responses. Our findings support the further preclinical and clinical investigation into combining TTFields with immunotherapy.
Citation Format: Gil Diamant, Hadar Simchony, Tamar Shiloach, Anat Globerson-levin, Lital Gasri Plotnitsky, Zelig Eshhar, Niv Pencovich, Rachel Grossman, Zvi Ram, Ilan Volovitz. Evaluating the compatibility of tumor treating electric fields with key anti-tumoral immune functions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3954.
Collapse
Affiliation(s)
- Gil Diamant
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | | | - Zelig Eshhar
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Zvi Ram
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | |
Collapse
|
18
|
Nachmany I, Bogoch Y, Friedlander-Malik G, Amar O, Bondar E, Zohar N, Hantisteanu S, Fainaru O, Lubezky N, Klausner JM, Pencovich N. The transcriptional profile of circulating myeloid derived suppressor cells correlates with tumor development and progression in mouse. Genes Immun 2019; 20:589-598. [PMID: 30880333 DOI: 10.1038/s41435-019-0062-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 12/27/2022]
Abstract
Myeloid derived suppressor cells (MDSCs) play key roles in cancer development. Accumulation of peripheral-blood MDSCs (PB-MDSCs) corresponds to the progression of various cancers, but provides only a crude indicator. We aimed toward identifying changes in the transcriptional profile of PB-MDSCs in response to tumor growth. CT26 colon cancer cells and B16 melanoma cells (106) were inoculated into peritoneal cavities of BALB/c mice and subcutaneously to C57-black mice, respectively. The circulating levels and global transcriptional patterns of PB CD11b+Ly6g+ MDSCs were assessed in control mice, and 4, 8, and 11 days following tumor cell inoculation. Although a significant accumulation of PB-MDSCs was demonstrated only 11 days following tumor induction, a pronounced transcriptional response was identified already on day 4 while the tumor was ~1 mm in size. Further transcriptional changes correlated with different stages of tumor growth. Key MDSC genes and canonical signaling pathways were activated along tumor progression. This phenomenon was demonstrated in both cancer models, and a consensus set of 817 genes, involved in myeloid cell recruitment and angiogenesis, was identified. The data suggest that the transcriptional signatures of PB-MDSC may serve as markers for tumor progression, as well as providing potential targets for future therapies.
Collapse
Affiliation(s)
- Ido Nachmany
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoel Bogoch
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilgi Friedlander-Malik
- Ilana and Pascal Mantoux Institute for Bioinformatics, Nancy and Stephen Grand Israel National Center for Personalized Medicine, The Weizmann Institute of Science, Rehovot, Israel
| | - Omer Amar
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ekaterina Bondar
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nitzan Zohar
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Hantisteanu
- Department of Molecular Genetics, The Weizmann Institute of Science, Rehovot, Israel
| | - Ofer Fainaru
- IVF Unit, Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Nir Lubezky
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- The Laboratory of Molecular Genetics, HPB Cancer Research, Department of Surgery B, the Surgical Division, Tel-Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| |
Collapse
|
19
|
Nachmany I, Bogoch Y, Sivan A, Amar O, Bondar E, Zohar N, Yakubovsky O, Fainaru O, Klausner JM, Pencovich N. CD11b +Ly6G + myeloid-derived suppressor cells promote liver regeneration in a murine model of major hepatectomy. FASEB J 2019; 33:5967-5978. [PMID: 30730772 DOI: 10.1096/fj.201801733r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Liver regeneration depends on sequential activation of pathways and cells involving the remaining organ in recovery of mass. Proliferation of parenchyma is dependent on angiogenesis. Understanding liver regeneration-associated neovascularization may be useful for development of clinical interventions. Myeloid-derived suppressor cells (MDSCs) promote tumor angiogenesis and play a role in developmental processes that necessitate rapid vascularization. We therefore hypothesized that the MDSCs could play a role in liver regeneration. Following partial hepatectomy, MDSCs were enriched within regenerating livers, and their depletion led to increased liver injury and postoperative mortality, reduced liver weights, decreased hepatic vascularization, reduced hepatocyte hypertrophy and proliferation, and aberrant liver function. Gene expression profiling of regenerating liver-derived MDSCs demonstrated a large-scale transcriptional response involving key pathways related to angiogenesis. Functionally, enhanced reactive oxygen species production and angiogenic capacities of regenerating liver-derived MDSCs were confirmed. A comparative analysis revealed that the transcriptional response of MDSCs during liver regeneration resembled that of peripheral blood MDSCs during progression of abdominal tumors, suggesting a common MDSC gene expression profile promoting angiogenesis. In summary, our study shows that MDSCs contribute to early stages of liver regeneration possibly by exerting proangiogenic functions using a unique transcriptional program.-Nachmany, I., Bogoch, Y., Sivan, A., Amar, O., Bondar, E., Zohar, N., Yakubovsky, O., Fainaru, O., Klausner, J. M., Pencovich, N. CD11b+Ly6G+ myeloid-derived suppressor cells promote liver regeneration in a murine model of major hepatectomy.
Collapse
Affiliation(s)
- Ido Nachmany
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoel Bogoch
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Sivan
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Amar
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ekaterina Bondar
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nitzan Zohar
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oran Yakubovsky
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Fainaru
- In Vitro Fertilization (IVF) Unit, Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Joseph M Klausner
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- The Surgical Division, Department of Surgery B, The Laboratory of Molecular Genetics, Hepato-Pancreato-Biliary (HPB) Cancer Research, Tel-Aviv Sourasky Medical Center-The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
20
|
Lessing Y, Pencovich N, Nevo N, Lubezky N, Goykhman Y, Nakache R, Lahat G, Klausner JM, Nachmany I. Early reoperation following pancreaticoduodenectomy: impact on morbidity, mortality, and long-term survival. World J Surg Oncol 2019; 17:26. [PMID: 30704497 PMCID: PMC6357503 DOI: 10.1186/s12957-019-1569-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background Reoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early reoperation following PD and analyze its effect on short- and long-term outcome. Methods Four hundred and thirty-three patients that underwent PD between August 2006 and June 2016 were retrospectively analyzed. Results Forty-eight patients (11%; ROp group) underwent 60 reoperations within 60 days from PD. Forty-two patients underwent 1 reoperation, and 6 had up to 6 reoperations. The average time to first reoperation was 10.1 ± 13.4 days. The most common indications were anastomotic leaks (22 operations in 18 patients; 37.5% of ROp), followed by post-pancreatectomy hemorrhage (PPH) (14 reoperations in 12 patients; 25%), and wound complications in 10 (20.8%). Patients with cholangiocarcinoma had the highest reoperation rate (25%) followed by ductal adenocarcinoma (12.3%). Reoperation was associated with increased length of hospital stay and a high post-operative mortality of 18.7%, compared to 2.6% for the non-reoperated group. For those who survived the post-operative period, the overall and disease-free survival were not affected by reoperation. Conclusions Early reoperations following PD carries a dramatically increased mortality rate, but has no impact on long-term survival.
Collapse
Affiliation(s)
- Yonatan Lessing
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel.
| | - Niv Pencovich
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Nir Lubezky
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Yaacov Goykhman
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Richard Nakache
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Guy Lahat
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| |
Collapse
|
21
|
Pencovich N, Houli R, Lubezky N, Goykhman Y, Nakache R, Klausner JM, Nachmany I. R1 resection of colorectal liver metastasis - What is the cost of marginal resection? J Surg Oncol 2018; 119:347-354. [PMID: 30548552 DOI: 10.1002/jso.25321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The impact of resection margins on the outcome of patients with colorectal liver metastasis (CRLM) remains controversial. We evaluated the short and long-term results of R1 resection. METHODS Between 2006 and 2016, 202 patients underwent liver resection for CRLM. R1 resection was defined as a distance of less than 1 mm between tumor cells and the transection plain. Patient and tumor characteristics, perioperative, and long-term outcomes were assessed. RESULTS In 161 (79.7%) and 41 (20.3%) patients, an R0 and R1 resections were achieved, respectively. Patients that underwent an R1 resection had higher rates of disease progression while on chemotherapy (12.1% vs 5.5%, P = 0.001), need for second-line chemotherapy (17% vs 6.2%, P < 0.001), increased use of preoperative volume manipulation (14.6% vs 5.5%, P = 0.001), and inferior vena-cava involvement (21.9% vs 8.7%, P < 0.001). These patients had higher rates of major postoperative complications (19.5% vs 6.8%, P < 0.001) and reoperations (7.3% vs 2.4%, P < 0.001). Multivariate analysis demonstrated that R1 resections were not associated with decreased recurrence-free survival or overall survival. CONCLUSIONS Although R1 resection is associated with worse disease behavior and postoperative complications, the long-term outcome of patients following an R1 resection is non-inferior to those who underwent an R0 resection.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rotem Houli
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Lubezky
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaacov Goykhman
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Richard Nakache
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
22
|
Pencovich N, Younis M, Lessing Y, Zac L, Lessing JB, Yogev Y, Kupferminc MJ, Nachmany I. Major liver resection in pregnancy: three cases with different etiologies and review of the literature. J Matern Fetal Neonatal Med 2017; 32:203-211. [DOI: 10.1080/14767058.2017.1376315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Niv Pencovich
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| | - Muhammad Younis
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| | - Yonatan Lessing
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| | - Lilach Zac
- Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv, Israel
| | - Joseph B. Lessing
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Michael J. Kupferminc
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| |
Collapse
|
23
|
Lessing Y, Pencovich N, Lahat G, Klausner JM, Abu-Abeid S, Meron Eldar S. Laparoscopic sleeve gastrectomy for diabetics - 5-year outcomes. Surg Obes Relat Dis 2017; 13:1658-1663. [PMID: 28843985 DOI: 10.1016/j.soard.2017.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although the laparoscopic sleeve gastrectomy (SG) is increasingly performed for morbid obesity, gastric bypass is still considered by many to be the gold standard procedure for obese diabetic patients. The aim of this study was to assess the long-term results of SG in morbidly obese patients with type 2 diabetes. METHODS Diabetic patients who underwent SG at a single center between 2009 and 2011 were included. Outcomes assessed included postoperative complications, weight loss, and resolution or improvement in co-morbidities with an emphasis on diabetes, including glycated hemoglobin (HbA1C) and medication status. RESULTS Fifty-one diabetic patients underwent SG, 35 females and 16 males, with a collective mean age of 49 years and a mean body mass index of 43.2 kg/m2. On average, patients had had diabetes for 5.4 ± 7.3 years before surgery. Mean HbA1C and fasting glucose levels were 7.9 ± 1.6% and 166.9 ± 63 mg/dL, respectively. Eleven patients (22%) were insulin dependent at the time of surgery. Average body mass index at a mean follow-up of 5 years after surgery was 34.4 ± 5.8 kg/m2, with an average HbA1C of 6.6 ± 1% and an average fasting glucose of 123 ± 60 mg/dL. Only 3 patients remained insulin dependent. CONCLUSION SG offers retainable weight loss results, accompanied by longstanding resolution or improvement of diabetes. Prospective, randomized controlled studies are warranted to better compare long-term outcomes between SG and gastric bypass.
Collapse
Affiliation(s)
- Yonatan Lessing
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Niv Pencovich
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Bariatric Surgery Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Bariatric Surgery Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Bariatric Surgery Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
24
|
Bogoch Y, Friedlander-Malik G, Lupu L, Bondar E, Zohar N, Langier S, Ram Z, Nachmany I, Klausner JM, Pencovich N. Augmented expression of RUNX1 deregulates the global gene expression of U87 glioblastoma multiforme cells and inhibits tumor growth in mice. Tumour Biol 2017; 39:1010428317698357. [PMID: 28443460 DOI: 10.1177/1010428317698357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Glioblastoma multiforme is the most common and aggressive primary brain tumor in adults. A mesenchymal phenotype was associated with tumor aggressiveness and poor prognosis in glioblastoma multiforme patients. Recently, the transcription factor RUNX1 was suggested as a driver of the glioblastoma multiforme mesenchymal gene expression signature; however, its independent role in this process is yet to be described. Here, we assessed the role of RUNX1 in U87 glioblastoma multiforme cells in correspondence to its mediated transcriptome and genome-wide occupancy pattern. Overexpression of RUNX1 led to diminished tumor growth in nude and severe combined immunodeficiency mouse xenograft tumor model. At the molecular level, RUNX1 occupied thousands of genomic regions and regulated the expression of hundreds of target genes, both directly and indirectly. RUNX1 occupied genomic regions that corresponded to genes that were shown to play a role in brain tumor progression and angiogenesis and upon overexpression led to a substantial down-regulation of their expression level. When overexpressed in U87 glioblastoma multiforme cells, RUNX1 down-regulated key pathways in glioblastoma multiforme progression including epithelial to mesenchymal transition, MTORC1 signaling, hypoxia-induced signaling, and TNFa signaling via NFkB. Moreover, master regulators of the glioblastoma multiforme mesenchymal phenotype including CEBPb, ZNF238, and FOSL2 were directly regulated by RUNX1. The data suggest a central role for RUNX1 as master regulator of gene expression in the U87 glioblastoma multiforme cell line and mark RUNX1 as a potential target for novel future therapies for glioblastoma multiforme.
Collapse
Affiliation(s)
- Yoel Bogoch
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilgi Friedlander-Malik
- 2 Bioinformatics Unit, Nancy and Stephen Grand Israel National Center for Personalized Medicine, The Weizmann Institute of Science, Rehovot, Israel
| | - Lior Lupu
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ekaterina Bondar
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Zohar
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sheila Langier
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Ram
- 3 Department of Neurosurgery, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph M Klausner
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Niv Pencovich
- 1 The Laboratory of Molecular Genetics, Hepatic-Bili-Pancreatic Cancer Research, Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
25
|
Nachmany I, Pencovich N, Ben-Yehuda A, Lahat G, Nakache R, Goykhman Y, Lubezky N, Klausner JM. Laparoscopic Distal Pancreatectomy: Learning Curve and Experience in a Tertiary Center. J Laparoendosc Adv Surg Tech A 2016; 26:470-4. [DOI: 10.1089/lap.2016.0098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ido Nachmany
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Ben-Yehuda
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Richard Nakache
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaacov Goykhman
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Lubezky
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M. Klausner
- Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
26
|
Nachmany I, Pencovich N, Zohar N, Goykhman Y, Lubezky N, Nakache R, Klausner JM. Resection of colorectal liver metastases in the elderly-Is it justified? J Surg Oncol 2016; 113:485-8. [DOI: 10.1002/jso.24188] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/17/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Ido Nachmany
- Division of General Surgery; Department of General Surgery B; Tel-Aviv Sourasky Medical Center; The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Niv Pencovich
- Division of General Surgery; Department of General Surgery B; Tel-Aviv Sourasky Medical Center; The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Nitzan Zohar
- Division of General Surgery; Department of General Surgery B; Tel-Aviv Sourasky Medical Center; The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Yaacov Goykhman
- Division of General Surgery; Department of General Surgery B; Tel-Aviv Sourasky Medical Center; The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Nir Lubezky
- Division of General Surgery; Department of General Surgery B; Tel-Aviv Sourasky Medical Center; The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Richard Nakache
- Division of General Surgery; Department of General Surgery B; Tel-Aviv Sourasky Medical Center; The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | | |
Collapse
|
27
|
Pencovich N, Haim O, Feldmesser E, Kanner A, Ram Z. ATCT-26TUMOR TREATING FIELDS-MEDIATED GENE EXPRESSION IN PATIENTS WITH GBM. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov206.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Nachmany I, Pencovich N, Zohar N, Ben-Yehuda A, Binyamin C, Goykhman Y, Lubezky N, Nakache R, Klausner JM. Laparoscopic versus open liver resection for metastatic colorectal cancer. Eur J Surg Oncol 2015; 41:1615-20. [PMID: 26454765 DOI: 10.1016/j.ejso.2015.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Application of minimally invasive surgery for oncologic liver resection is still limited to expert centers. We describe our experience in laparoscopic liver resection (LLR) for colorectal liver metastases (CLM). PATIENTS AND METHODS Between February 2010 and February 2015, 174 patients underwent resection of CLM. LLR was chosen according to surgeon's preferences. Data was retrieved from the institutes' electronic charts and retrospectively analyzed. RESULTS LLR was performed in 42 patients (24.5%) and OLR in 132. Increased number of metastases were found in OLR (2.82 ± 2.81 versus 1.78 ± 1.16, P = 0.02), with no difference in maximal lesion size (33.1 ± 22 versus 34.9 ± 27.5 cm, P = 0.7). Altogether 55 patients underwent major hepatectomy, and 50 of the OLR group (37.8%, 37 right hepatectomy and 7 left hepatectomy) (P = 0.02). In 5 patients (11.6%) a conversion to open surgery was indicated. Operative time was longer in LLR. Estimated blood loss was decreased in laparoscopic minor resections. One OLR patient died during the postoperative period (0.7%). Eight patients in the OLR group had major complications, versus 1 in the LLR group (P = 0.0016). Reoperation within 30 days was performed in 4 OLR patients and none in the LLR group. Patients in the LLR group had shorter length of stay (LOS) (6.78 ± 2.75 versus 8.39 ± 5.64 days, P = 0.038). R0 resection was 88% in both groups. CONCLUSIONS In selected patients with CLM, LLR is feasible, safe and may achieve shorter LOS without inferior oncologic outcome.
Collapse
Affiliation(s)
- I Nachmany
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - N Pencovich
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Zohar
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Ben-Yehuda
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - C Binyamin
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Goykhman
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Lubezky
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Nakache
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J M Klausner
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
29
|
Pencovich N, Hantisteanu S, Hallak M, Fainaru O. Gonadotropin stimulation in mice leads to ovarian accumulation of immature myeloid cells and altered expression of proangiogenic genes. Eur J Obstet Gynecol Reprod Biol 2014; 179:75-82. [PMID: 24965984 DOI: 10.1016/j.ejogrb.2014.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 03/25/2014] [Accepted: 05/22/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Ovarian hyperstimulation syndrome is associated with increased angiogenesis and vascular leakage. Immature myeloid cells (IMCs) and dendritic cells have been shown to be actively involved in angiogenesis in several disease models in mice and humans. Nevertheless, little is known about the role of these cells in the ovary. As such, this study sought to determine whether alterations in these ovarian myeloid cell populations are associated with gonadotropin stimulation in a mouse model. STUDY DESIGN Four-week-old pre-pubertal C57Bl/6 female mice were allocated into three groups: high-dose stimulation (n=4; pregnant mare serum gonadotropins (PMSG) 20U for 2 days), low-dose stimulation (n=5; PMSG 5U for 1 day) and sham-treated controls (n=4). Human chorionic gonadotropin 5U was injected on Day 3, and the mice were killed on Day 5. Ovaries were analysed by flow cytometry, confocal microscopy and quantitative polymerase chain reaction. RESULTS Gonadotropin stimulation increased the proportion of CD11b(+)Gr1(+) IMCs among the ovarian myeloid cells: 22.6±8.1% (high dose), 7.2±1.6% (low dose) and 4.1±0.3% (control) (p=0.02). Conversely, gonadotropin stimulation decreased the proportion of ovarian CD11c(+)MHCII(+) dendritic cells: 15.1±1.9% (high dose), 20.7±4.8% (low dose) and 27.3±8.2% (control) (p=0.02). IMCs, unlike dendritic cells, were localized adjacent to PECAM1(+) endothelial cells. Finally, gonadotropin stimulation was associated with increased expression of S100A8, S100A9, Vcan and Dmbt1, and decreased expression of MMP12. CONCLUSIONS Gonadotropin stimulation is associated with proangiogenic myeloid cell alterations, reflected by a dose-dependent increase in ovarian IMCs and a parallel decrease in dendritic cells. Recruited IMCs localize strategically at sites of angiogenesis. These changes are associated with differential expression of key proangiogenic genes.
Collapse
Affiliation(s)
- N Pencovich
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynaecology, Hillel Yaffe Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Hadera, Israel; Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel; Department of Surgery, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - S Hantisteanu
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynaecology, Hillel Yaffe Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Hadera, Israel; Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - M Hallak
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynaecology, Hillel Yaffe Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Hadera, Israel
| | - O Fainaru
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynaecology, Hillel Yaffe Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Hadera, Israel; Department of Surgery, Tel Aviv Souraski Medical Center, Tel Aviv, Israel; IVF Unit, Department of Obstetrics and Gynaecology, Hillel Yaffe Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Hadera, Israel.
| |
Collapse
|
30
|
Pencovich N, Bot G, Lidar Z, Korn A, Wostrack M, Meyer B, Bydon M, Jallo G, Constantini S. Spinal ependymoma with regional metastasis at presentation. Acta Neurochir (Wien) 2014; 156:1215-22. [PMID: 24604138 DOI: 10.1007/s00701-014-2048-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ependymomas are the most common glial neoplasms in the spinal cord. However, spinal cord ependymomas presenting with regional dissemination along the neuroaxis are rare, with a yet undetermined standard of care. We retrospectively evaluated the management and outcomes of patients who were diagnosed with spinal ependymoma with regional metastases at presentation (SERMP). METHODS Between 2002 and 2012, 16 patients with regionally metastatic spinal ependymomas were diagnosed and treated. The patients were retrospectively divided into two groups according to tumor grading and histological features. Nine patients were diagnosed with myxopapillary ependymomas (MPE), and seven patients were diagnosed with other low-grade ependymomas. RESULTS With a median follow-up of 46.4 months, 13 out of 16 patients had no postsurgical recurrence/progression of the disease. In three patients, the disease recurred/progressed, leading to death in one patient. There was no correlation between gross total removal (GTR) of the main tumor, or resection of the main lesion and the metastatic foci and increased progression free survival in patients of the MPE group. There was an advantage for patients diagnosed with other low-grade ependymomas. Adjuvant radiotherapy did not prove beneficial. CONCLUSIONS SERMP has a relatively benign course. Achieving GTR of both the main lesion and the metastases is preferable, but should not be achieved at any cost, especially in MPE interfering with the conus medullaris. The benefit of adjuvant radiotherapy remains unproven.
Collapse
|
31
|
Pencovich N, Luk J, Hantisteanu S, Hornstein MD, Fainaru O. The development of endometriosis in a murine model is dependent on the presence of dendritic cells. Reprod Biomed Online 2014; 28:515-21. [PMID: 24581985 DOI: 10.1016/j.rbmo.2013.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 01/09/2023]
Abstract
Endometriosis is a common condition associated with pelvic pain and infertility. This study group has previously shown that supplementation of dendritic cells led to enhancement of endometriosis lesion growth and angiogenesis. This study determined whether endometriosis is dependent on the presence of endogenous dendritic cells. Surgical induction of endometriosis was performed in CD11c⁺ DTR/GFP transgenic (Tg) female mice in which dendritic cells were ablated upon injection of diphtheria toxin (DT). Mice were allocated into four groups (n=5 each): group I, wild-type mice treated with vehicle; group II, wild-type mice treated with DT; group III, Tg mice treated with DT; and group IV, Tg mice treated with vehicle. After 10 days, mice were killed and endometriosis lesions were analysed by flow cytometry. DT treatment led to ablation of dendritic cells in spleens and endometriosis lesions in Tg mice while no ablation was observed in controls. Corresponding to dendritic cell ablation, endometriosis lesions in group III were ∼5-fold smaller than in the control groups (ANOVA P<0.0001). This study suggests that endometriosis development is dependent on the presence of endogenous dendritic cells. Therapies designed to inhibit dendritic cell infiltration as possible treatments for endometriosis warrant further study.
Collapse
Affiliation(s)
- Niv Pencovich
- Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Janelle Luk
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; Vascular Biology Program, Department of Surgery, Children's Hospital Boston, both at Harvard Medical School, Boston, MA 02115, USA
| | - Shay Hantisteanu
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, P.O. Box 169, Hadera 38100, Israel
| | - Mark D Hornstein
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Ofer Fainaru
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; Vascular Biology Program, Department of Surgery, Children's Hospital Boston, both at Harvard Medical School, Boston, MA 02115, USA; Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, P.O. Box 169, Hadera 38100, Israel; IVF Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, P.O. Box 169, Hadera 38100, Israel.
| |
Collapse
|
32
|
Ben-Ami O, Friedman D, Leshkowitz D, Goldenberg D, Orlovsky K, Pencovich N, Lotem J, Tanay A, Groner Y. Addiction of t(8;21) and inv(16) acute myeloid leukemia to native RUNX1. Cell Rep 2013; 4:1131-43. [PMID: 24055056 DOI: 10.1016/j.celrep.2013.08.020] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/03/2013] [Accepted: 08/08/2013] [Indexed: 12/11/2022] Open
Abstract
The t(8;21) and inv(16) chromosomal aberrations generate the oncoproteins AML1-ETO (A-E) and CBFβ-SMMHC (C-S). The role of these oncoproteins in acute myeloid leukemia (AML) etiology has been well studied. Conversely, the function of native RUNX1 in promoting A-E- and C-S-mediated leukemias has remained elusive. We show that wild-type RUNX1 is required for the survival of t(8;21)-Kasumi-1 and inv(16)-ME-1 leukemic cells. RUNX1 knockdown in Kasumi-1 cells (Kasumi-1(RX1-KD)) attenuates the cell-cycle mitotic checkpoint, leading to apoptosis, whereas knockdown of A-E in Kasumi-1(RX1-KD) rescues these cells. Mechanistically, a delicate RUNX1/A-E balance involving competition for common genomic sites that regulate RUNX1/A-E targets sustains the malignant cell phenotype. The broad medical significance of this leukemic cell addiction to native RUNX1 is underscored by clinical data showing that an active RUNX1 allele is usually preserved in both t(8;21) or inv(16) AML patients, whereas RUNX1 is frequently inactivated in other forms of leukemia. Thus, RUNX1 and its mitotic control targets are potential candidates for new therapeutic approaches.
Collapse
Affiliation(s)
- Oren Ben-Ami
- Department of Molecular Genetics, Weizmann Institute of Science, 76100 Rehovot, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Fainaru O, Pencovich N, Hantisteanu S, Barzilay I, Ellenbogen A, Hallak M. Gonadotropin stimulation in mice leads to ovarian accumulation of proangiogenic immature myeloid cells and to altered expression of key proangiogenic genes. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
34
|
Saad H, Khalil E, Bora SA, Parikh J, Abdalla H, Thum MY, Bina V, Roopa P, Shyamala S, Anupama A, Tournaye H, Polyzos NP, Guzman L, Nelson SM, Lourenco B, Sousa AP, Almeida-Santos T, Ramalho-Santos J, Okhowat J, Wirleitner B, Neyer T, Bach M, Murtinger M, Zech NH, Polyzos NP, Nwoye M, Corona R, Blockeel C, Stoop D, Camus M, Tournaye H, Rajikin MH, Kamsani YS, Chatterjee A, Nor-Ashikin MNK, Nuraliza AS, Scaravelli G, D'Aloja P, Bolli S, De Luca R, Spoletini R, Fiaccavento S, Speziale L, Vigiliano V, Farquhar C, Brown J, Arroll N, Gupta D, Boothroyd C, Al Bassam M, Moir J, Johnson N, Pantasri T, Robker RL, Wu LL, Norman RJ, Buzaglo K, Velez M, Shaulov T, Sylvestre C, Kadoch IJ, Krog M, Prior M, Carlsen E, Loft A, Pinborg A, Andersen AN, Dolleman M, Verschuren WMM, Eijkemans MJC, Dolle MET, Jansen EHJM, Broekmans FJM, Van der Schouw YT, Fainaru O, Pencovich N, Hantisteanu S, Barzilay I, Ellenbogen A, Hallak M, Cavagna M, Baruffi RLR, Petersen CG, Mauri AL, Massaro FC, Ricci J, Nascimento AM, Vagnini LD, Pontes A, Oliveira JBA, Franco JG, Canas MCT, Vagnini LD, Nascimento AM, Petersen CG, Mauri AL, Massaro FC, Nicoletti A, Martins AMVC, Cavagna M, Oliveira JBA, Baruffi RLR, Franco JG, Lichtblau I, Olivennes F, Aubriot FA, Junca AM, Belloc S, Cohen-Bacrie M, Cohen-Bacrie P, de Mouzon J, Nandy T, Caragia A, Balestrini S, Zosmer A, Sabatini L, Al-Shawaf T, Seshadri S, Khalaf Y, Sunkara SK, Joy J, Lambe M, Lutton D, Nicopoullos J, Bora SA, Parikh J, Faris R, Abdalla H, Thum MY, Behre HM, Howles CM, Longobardi S, Chimote N, Mehta B, Nath N, Chimote NM, Mehta B, Nath N, Chimote N, Chimote NM, Mine K, Yoshida A, Yonezawa M, Ono S, Abe T, Ichikawa T, Tomiyama R, Nishi Y, Kuwabara Y, Akira S, Takeshita T, Shin H, Song HS, Lim HJ, Hauzman E, Kohls G, Barrio A, Martinez-Salazar J, Iglesias C, Velasco JAG, Tejada MI, Maortua H, Mendoza R, Prieto B, Martinez-Bouzas C, Diez-Zapirain M, Martinez-Zilloniz N, Matorras R, Amaro A, Bianco B, Christofolini J, Mafra FA, Barbosa CP, Christofolini DM, Pesce R, Gogorza S, Ochoa C, Gil S, Saavedra A, Ciarmatori S, Perman G, Pagliardini L, Papaleo E, Corti L, Vanni VS, Ottolina J, de Michele F, Marca AL, Vigano P, Candiani M, Li L, Yin Q, Huang L, Huang J, He Z, Yang D, Parikh J, Bora SA, Abdalla H, Thum MY, Tiplady S, Ledger W, Godbert S, Hart S, Johnson S, Wong AWY, Kong GWS, Haines CJ, Franik S, Nelen W, Kremer J, Farquhar C, Gillett WR, Lamont JM, Peek JC, Herbison GP, Sung NY, Hwang YI, Choi MH, Song IO, Kang IS, Koong MK, Lee JS, Yang KM, Celtemen MB, Telli P, Karakaya C, Bozkurt N, Gursoy RH, Younis JS, Ben-Ami M, Pundir J, Pundir V, Omanwa K, Khalaf Y, El-Toukhy T. Female (in)fertility. Hum Reprod 2013. [DOI: 10.1093/humrep/det213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
35
|
Pencovich N, Jaschek R, Dicken J, Amit A, Lotem J, Tanay A, Groner Y. Cell-autonomous function of Runx1 transcriptionally regulates mouse megakaryocytic maturation. PLoS One 2013; 8:e64248. [PMID: 23717578 PMCID: PMC3662678 DOI: 10.1371/journal.pone.0064248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/10/2013] [Indexed: 01/18/2023] Open
Abstract
RUNX1 transcription factor (TF) is a key regulator of megakaryocytic development and when mutated is associated with familial platelet disorder and predisposition to acute myeloid leukemia (FPD-AML). We used mice lacking Runx1 specifically in megakaryocytes (MK) to characterized Runx1-mediated transcriptional program during advanced stages of MK differentiation. Gene expression and chromatin-immunoprecipitation-sequencing (ChIP-seq) of Runx1 and p300 identified functional Runx1 bound MK enhancers. Runx1/p300 co-bound regions showed significant enrichment in genes important for MK and platelet homeostasis. Runx1 occupied genomic regions were highly enriched in RUNX and ETS motifs and to a lesser extent in GATA motif. Megakaryocytic specificity of Runx1/P300 bound enhancers was validated by transfection mutagenesis and Runx1/P300 co-bound regions of two key megakaryocytic genes Nfe2 and Selp were tested by in vivo transgenesis. The data provides the first example of genome wide Runx1/p300 occupancy in maturating primary FL-MK, unravel the Runx1-regulated program controlling MK maturation in vivo and identify a subset of its bona fide regulated genes. It advances our understanding of the molecular events that upon RUNX1mutations in human lead to the predisposition to familial platelet disorders and FPD-AML.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of Molecular Genetics, The Weizmann Institute of Science, Rehovot, Israel
| | - Ram Jaschek
- Department of Computer Science and Applied Mathematics, The Weizmann Institute of Science, Rehovot, Israel
| | - Joseph Dicken
- Department of Molecular Genetics, The Weizmann Institute of Science, Rehovot, Israel
| | - Ayelet Amit
- Department of Molecular Genetics, The Weizmann Institute of Science, Rehovot, Israel
| | - Joseph Lotem
- Department of Molecular Genetics, The Weizmann Institute of Science, Rehovot, Israel
| | - Amos Tanay
- Department of Computer Science and Applied Mathematics, The Weizmann Institute of Science, Rehovot, Israel
| | - Yoram Groner
- Department of Molecular Genetics, The Weizmann Institute of Science, Rehovot, Israel
- * E-mail:
| |
Collapse
|
36
|
Pencovich N, Korn A, Constantini S. Intraoperative neurophysiologic monitoring during syringomyelia surgery: lessons from a series of 13 patients. Acta Neurochir (Wien) 2013; 155:785-91; discussion 791. [PMID: 23474772 DOI: 10.1007/s00701-013-1648-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/08/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Avoiding iatrogenic neurological injury during spinal cord surgery is crucially important. Intraoperative neurological monitoring (INM) has been widely used in a variety of spinal surgeries as a means of reducing the risk of intraoperative neurological insults. This study evaluates the benefits of INM specifically in spinal procedures for treatment of syringomyelia. METHODS Thirteen patients who underwent surgery for syrinx drainage with the assistance of INM were included in this study. In all patients both somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP) were monitored. INM data and perioperative neurological evaluations were both recorded and analyzed. RESULTS Eleven patients underwent syringo-subarachnoid shunt (SSAS) surgery. One patient underwent syrinx drainage and foramen magnum decompression (FMD). One patient underwent syringo-pleural shunt (SPA) surgery. Baseline MEP and SSEP were recordable at the beginning of surgery in 11 patients (>84 %). In the other two cases, baseline data from specific INM modalities were absent, correlating with the antecedent neurologic symptomotology. Two patients exhibited significant intraoperative changes in MEP data that influenced the course of surgery and prompted removal or re-insertion of the shunt. Mild and transient worsening of preoperative symptoms was reported in these instances. No new postoperative neurological deficits were reported in the other 11 patients in whom INM data were preserved throughout surgery. CONCLUSION These data support routine use of INM in syringomyelia surgery. INM can alert the surgeon to potential intraoperative threats to the functional integrity of the spinal cord, providing a useful adjunct to spinal cord surgeries for the treatment of syringomyelia.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of Pediatric Neurosurgery, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | | |
Collapse
|
37
|
Pencovich N, Margalit N, Constantini S. Atypical meningioma as a solitary malignancy in a patient with Rothmund-Thompson syndrome. Surg Neurol Int 2013; 3:148. [PMID: 23372965 PMCID: PMC3551513 DOI: 10.4103/2152-7806.104742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 06/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background: Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive disorder characterized by genomic instability and increased risk of various malignancies, especially osteosarcoma and squamous cell carcinoma. We report the first RTS patient who developed a central nervous system (CNS)-related neoplasm. Case description: A 28-year-old male, previously diagnosed with RTS , developed a massive parasagital lesion, detected by magnetic resonance imaging. The tumor was surgically removed and histologically diagnosed as atypical meningioma. Preoperative symptoms were dramatically improved. Conclusions: This is the first description of a CNS-related malignancy in RTS patients. Although rare, the genomic instability and additional risk factors of this syndrome should be considered in choosing the course of treatment.
Collapse
Affiliation(s)
- Niv Pencovich
- Department of Pediatric Neurosurgery, Dana-Dwek Children's Hospital, Tel-Aviv, Israel
| | | | | |
Collapse
|
38
|
Pencovich N, Ben-Sira L, Kesler A, Constantini S. Acquired and reversible Chiari-like descent following a single lumbar puncture: case report. Childs Nerv Syst 2012; 28:1269-71. [PMID: 22457165 DOI: 10.1007/s00381-012-1738-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Affiliation(s)
- N Pencovich
- Department of Pediatric Neurosurgery, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, Israel, 6 Weizman Street, Tel Aviv 64239, Israel
| | | | | | | |
Collapse
|