Treatment of chronic pancreatitis (CP) is a challenging disease for surgeons. During the last several decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and development of sophisticated diagnostic methods in clinical practice have resulted in significant changes in surgery for CP. Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy and pathophysiology, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. Even though available results from randomized controlled trials were published, new studies are needed to determine which procedure is the most effective for the management of patients with CP.
Drainage ; Duodenum ; Head ; Humans ; Pain, Intractable ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Pancreatitis, Chronic ; Quality of Life

In a popular sense, Jehovah's Witnesses (JW) have their creeds, one of which is refusal of blood transfusion. Such refusal may impinge on their proper management, especially in critical situations. We present a case of successful bloodless multimodality therapy, which was performed for a JW. The patient was a 49-year-old woman and JW who had general weakness 7 days before admission. She was diagnosed with a pancreatic neuroendocrine tumor (PNET) with hepatic metastases. Transcatheter arterial chemoembolization and Sandostatin LAR injection were performed, and then she was given a transfusion-free Radical antegrade modular pancreatosplenectomy sequentially. We gave recombinant human erythropoietin and iron hydroxide sucrose complex daily for five days after surgery. She was discharged at postoperative day 12 without any surgical complications. Multimodality therapy is very important for optimal treatment of PNET. Along with intimate interdepartmental cooperation, careful patient selection and appropriate perioperative management could possibly enhance the surgical outcome.
Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Disulfiram ; Erythropoietin ; Female ; Humans ; Iron ; Jehovah's Witnesses ; Middle Aged ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors* ; Octreotide ; Pancreas* ; Pancreatectomy ; Patient Selection ; Sucrose

Research is one of the available methods by which scientists can obtain results from various and complex events. Especially, experimental research is a fundamental method from which we are able to find clues from changes in materials. This experimental research is important not only for surgeons, but also for the general human being. The first step for an experiment is close observation. Second, a scientific question is needed for the establishment of a hypothesis. Finally, the scientist must proceed to the experiment to prove the raised hypothesis. And then, the proven hypothesis can be published as a journal and other people can share the valuable results. This is the normal scientific pathway for us to get high quality scientific evidence for natural daily events. In this paper, the author is willing to show experiments on himself and present how it is related to the surgeon and how important it is for the surgeon's practice.
Animal Experimentation ; Animals ; Humans ; Resin Cements

No abstract available.
Organ Transplantation* ; Transplants*

The direct reprogramming of a terminally differentiated cell into another lineage using defined combinations of factors has fundamentally changed traditional concepts of the inalterability of differentiated cells. Many studies have achieved direct conversion into various cell types in recent years, and this strategy is considered to be a promising approach for inducing functional cells. Here, we review work on direct reprogramming, from the early pioneering studies to the most recent, including the discovery of novel reprogramming factors, molecular mechanisms, and strategies. We also discuss the applications of direct reprogramming and the perspectives and challenges of this novel technology.
Cell Differentiation ; Regenerative Medicine ; Transcription Factors

No abstract available.
Stem Cell Research* ; Stem Cells*

No abstract available.
Humans

The microbiome, which has been defined as ‘the ecological community of commensal, symbiotic and pathogenic microorganisms that share our body space, may be distinguished from the microbiota as it includes the collective genomes. An increasing level of evidence reveals that the human microbiome plays a major role in health. For this reason, it is often referred to as the ‘forgotten organ.’ All surfaces of the human body that are exposed to the environment are colonized, including skin, respiratory system, urogenital tract and gastrointestinal (GI) tract, totaling at least 100 trillion microbial cells. The known roles of the GI microbiome include metabolic functions, synthesis functions, and immune roles. Recent studies indicate that the human gut microbiome plays a significant role in health and disease. Dysbiosis, defined as a pathological imbalance in a microbial community, is becoming increasingly appreciated as a ‘central environmental factor’ that is both associated with complex phenotypes and affected by host genetics, diet, and antibiotic use. More recently, a link has been established between the dysmetabolism of bile acids (BAs) in the gut and the gut-liver axis, and this relationship with the microbiome has been highlighted. This review summarizes the microbiome of the hepatobiliary system and how microbiome is related to diseases of the liver and biliary tract.
Bile Acids and Salts ; Biliary Tract ; Biota ; Colon ; Diet ; Dysbiosis ; Gallbladder ; Gastrointestinal Microbiome ; Genetics ; Genome ; Human Body ; Humans ; Liver ; Microbiota* ; Pancreas ; Phenotype ; Respiratory System ; Skin

BACKGROUND: Immunosuppression after kidney transplantation is associated with increased risk of malignancy, which has become the second most common cause of death among kidney transplant recipients. In this review, we report the incidence of malignancies after kidney transplantation in a single center and evaluate the incidence, characteristics, relationship to immunosuppressive drugs and discuss what clinicians must consider during a follow-up of patients after kidney transplantation. METHODS: Between May 1978 and September 2013, a total of 748 kidney transplant patients who were able to undergo a follow-up process through electronic medical records were enrolled in this retrospective cohort study to determine the potential incidence and types of malignancy that may occur after kidney transplantation and the associated impact on patients and graft survival. RESULTS: Among 748 patients, 63 cases of malignancy appeared in 54 patients (7.2%). Gastrointestinal cancer (12 cases, 19%) and post-transplant lymphoproliferative disorder (12 cases, 19%) were the two most common types of malignancy. The second most common type of malignancy was urinary tract malignancy in 10 patients. Two different types of malignancy were diagnosed in nine patients during our follow-up. The overall graft survival in malignancy patients was better, which may mean that malignancy did not affect the overall graft loss. CONCLUSIONS: Clinicians should be aware of the incidence of malignancy in transplant patients and perform routine examinations for early detection of malignancy.
Cause of Death ; Cohort Studies ; Electronic Health Records ; Follow-Up Studies ; Gastrointestinal Neoplasms ; Graft Survival ; Humans ; Immunosuppression ; Incidence* ; Kidney ; Kidney Transplantation* ; Lymphoproliferative Disorders ; Retrospective Studies ; Transplantation ; Transplants ; Urinary Tract

PURPOSE: Primary mammalian hepatocytes largely retain their liver-specific functions when they are freshly derived from donors. However, long-term cultures of functional hepatocytes are difficult to establish. To increase the longevity and maintain the differentiated functions of hepatocytes in primary culture, cells can be cultured in a sandwich configuration of collagen. In such a configuration, hepatocytes can be cultured for longer periods compared with cultures on single layers of collagen. However, research regarding mouse hepatocytes in sandwich culture is lacking. METHODS: Primary mouse hepatocytes were sandwiched between two layers of collagen to maintain the stability of their liver-specific functions. After gelation, 2 mL of hepatocyte culture medium was applied. RESULTS: After 24 hours, 5, 10 days of culture, the collagen gel sandwich maintained the cellular border and numbers of bile canaliculi more efficiently than a single collagen coating in both high and low density culture dishes. Reverse transcription-polymerase chain reaction analysis of alpha-1-antitrypsin (AAT), hepatocyte nuclear factor 4 alpha (HNF4A), alphafetoprotein, albumin, tryptophan oxygenase (TO), the tyrosine aminotransferase gene, glucose-6-phosphatase, glyceraldehyde-3-phosphate dehydrogenase for mouse primary hepatocytes cultured on collagen coated dishes and collagen gels showed superior hepatocyte-related gene expression in cells grown using the collagen gel sandwich culture system. AAT, HNF4A, albumin, TO were found to be expressed in mouse hepatocytes cultured on collagen gels for 5 and 10 days. In contrast, mouse hepatocytes grown on collagen-coated dishes did not express these genes after 5 and 10 days of culture. CONCLUSION: The collagen gel sandwich method is suitable for primary culture system of adult mouse hepatocytes.
Adult ; Animals ; Bile Canaliculi ; Collagen ; Gels ; Gene Expression ; Glucose-6-Phosphatase ; Hepatocyte Nuclear Factor 4 ; Hepatocytes ; Humans ; Longevity ; Mice ; Oxidoreductases ; Tissue Donors ; Tryptophan Oxygenase ; Tyrosine Transaminase