Combination therapy with checkpoint inhibitors blocks inhibitory immune cell signaling and improves clinical responses to anticancer treatments. However, continued development of innovative and controllable delivery systems for immune-stimulating agents is necessary to optimize clinical responses. Herein, we engineered Salmonella to deliver recombinant granulocyte macrophage colony stimulating factor (GM-CSF) in a controllable manner for combination treatment with a programmed death-ligand 1 (PD-L1) inhibitor. The engineered Salmonella enabled delivery of recombinant GM-CSF into mouse tumors, activating recruitment of immune cells, such as M1-polarized macrophages, dendritic cells, and CD8⁺ T cells. Combination treatment with the PD-L1 inhibitor and engineered Salmonella increased the survival rate of tumor-bearing mice by 25%. New tumor growth was strongly suppressed, and visible tumors disappeared at 120 days post-infection (dpi) in mice rechallenged with additional tumor implantation at 100 dpi. The number of memory T cells increased >2-fold in tumor-rechallenged mice. Our findings demonstrate superiority of the engineered Salmonella as a cancer therapeutic agent with precise targeting ability, immune-boosting activity, and ease of combination with other therapeutics.

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.
Abdominal Abscess ; Appendectomy ; Appendicitis ; Child ; Humans ; Ileus ; Incidence ; Length of Stay ; Wound Infection

PURPOSE: Laparoscopic hernioplasty is a standard procedure used for the repair of inguinal hernia. However, due to the technical and anatomical complexities associated with this treatment and the requirement for long surgery time as compared to other methods, the use of laparoscopic hernioplasty remains questionable. This study compared the results of two surgical repair methods: totally extraperitoneal (TEP) hernia repair and the Prolene hernia system (PHS). METHODS: A retrospective review was conducted of all patients who underwent TEP (154 cases) and PHS (126 cases) from January 2008 to December 2010 as performed by a surgeon at our hospital. Operating time, length of hospital stay, recurrence rate, surgical site infection rate, wound hematoma rate and scrotum swelling rate were all compared. RESULTS: For the TEP treatment cases the mean operating time was 59.5 min, mean hospital stay was 4.9 days, there were 2 cases (1.3%) of recurrence, one case (0.6%) of surgical site infection, 20 cases (12.9%) of wound hematoma and 8 cases (5.2%) of scrotum swelling. In the case including treatment by PHS the mean operating time was 39.6 min, mean hospital stay was 5.4 days, there were no cases of recurrence, there were 2 cases (1.7%) of surgical site infection, 11 cases (9.5%) of wound hematoma and 12 cases (10.3%) of scrotum swelling. There were no cases involving neurogenic pain or chronic pain. CONCLUSION: Both PHS and TEP are safe and effective procedures for repairing inguinal hernia. Thus, with consideration of variable patient conditions and other factors, either PHS or TEP are recommended as viable procedures for treating inguinal hernia.
Hematoma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Polypropylenes ; Pyrazines ; Recurrence ; Retrospective Studies ; Scrotum

PURPOSE: Laparoscopic totally extraperitoneal (TEP) repair has been increasingly used for the treatment of inguinal hernias. This procedure is a very difficult technically and it requires a great deal of experience. However, there are only few studies on the learning curve (LC) of this procedure in the Korea literature. The aim of this study is to determine the number of case that are needed to overcome the learning curve of TEP hernia repairs and to document the surgical and clinical differences before and after overcoming the LC. METHODS: This study retrospectively reviewed 96 TEP hernia repairs that were performed by a single surgeon. The time required to overcome the LC was determined by examining the operation time. The preoperative and postoperative clinical data, such as incidental intraoperative findings, the rate of operative morbidity, the rate of conversion to an open procedure and the length of the postoperative hospital stay, were compared between the before and after groups with overcoming the LC. RESULTS: The 40th case was determined to be the transition point of overcoming the LC according to the operation time. The time before overcoming the LC averaged 73.0 minutes compared to 55.6 minutes after overcoming the LC. The postoperative hospital stay and the conversion rate were all significant (p<0.05). However, the other postoperative outcomes did not show significant differences. CONCLUSION: Based on the plateau of the operative time, this study shows that the downward slope of LC for TEP repair is at the 40th operation.
Conversion to Open Surgery ; Hernia, Inguinal ; Herniorrhaphy ; Korea ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Operative Time ; Pyrazines ; Retrospective Studies

PURPOSE: Laparoscopic appendectomy has many benefits compared to the open technique, such as easy localization of the appendix, less scarring for cosmetic reasons and less reported wound infection. However, for patients with complicated appendicitis, controversy exists as to whether laparoscopic appendectomy is a safe procedure. Some recent studies have reported no significant difference of the complication rate compared to that of the open procedure, suggesting that laparoscopic appendectomy could be used as an alternative procedure. This study was performed to evaluate the safety and benefits of laparoscopic appendectomy as compared to that of the open technique for treating complicated and uncomplicated appendicitis. METHODS: We studied the patients who underwent appendectomy by either the laparoscopic or open technique at Bundang Jaesaeang General Hospital between January 2005 and September 2008. Of the total 2,226 patients, there were 168 patients in the laparoscopic appendectomy (LA) group and 2,058 patients in the open appendectomy (OA) group. We compared the patient demographic data and perioperative outcomes of the two groups. RESULTS: Both patient groups were comparable in terms of age. The mean operative time was 91.8 minutes in the LA group and 47.2 minutes in the OA group (p<0.00). There were no significant differences between the two groups in terms of the mean hospital stay. The noncomplicated appendicitis LA group showed a quicker time to start an oral diet (p=0.03) & wound infection (p=0.032). For complicated appendicitis, there were no differences of wound infection & intestinal obstruction between the two groups. CONCLUSION: Although laparoscopic appendectomies requires a longer operation time, it did not lengthen the hospital stay nor delay the start of a soft oral diet. Appendiceal abscess in complicated appendicitis did not occur in the laparoscopic or open appendectomy groups. Therefore, laparoscopic appendectomy is a safe procedure for both complicated and uncomplicated appendicitis. To reach a final consensus on the scope of this study, a prospective randomized controlled study is needed in the near future.
Abscess ; Appendectomy ; Appendicitis ; Appendix ; Cicatrix ; Consensus ; Cosmetics ; Diet ; Hospitals, General ; Humans ; Intestinal Obstruction ; Length of Stay ; Operative Time ; Postoperative Complications ; Wound Infection