Gastrointestinal regeneration using collagen scaffolds loaded with human collagen-binding bFGF in a porcine model

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Surgical Forum Abstracts

neuronal PGP9.5 colocalized. In mice, hemopoietic GFR-alpha3 deficiency did not induce a phenotype switch. CONCLUSIONS: The sympathetic nervous system is injured during early POI and regulates recovery from POI via the neuronal artemin/GFR-alpha3 axis independent from the local inflammatory response. Intestinal alkaline phosphatase is an endogenous regulator of host microbiota Omeed Moaven, MD, Konstantinos P Economopoulos, MD, Sayeda N Alam, MD, Nur Muhammad, MD, Kanakaraju Kaliannan, MD, Madhury Ray, MD, Mussa M Rafat Mohamed, MD, Angela K Moss, MD, Madhu S Malo, MD, Richard A Hodin, MD, FACS Massachusetts General Hospital, Boston, MA INTRODUCTION: Dysregulation of the intestinal microbiota has been implicated in the pathogenesis of various disease conditions. Here, we examine the role of the brush border enzyme, intestinal alkaline phosphatase (IAP), in maintaining the commensal flora. METHODS: We established an intestinal loop model and bacteria were instilled for 2 hours, then withdrawn and plated. A variety of in vivo environments with low vs high IAP levels were compared for their impact on the bacteria. RESULTS: E coli growth was higher with high endogenous IAP levels i.e. WT vs IAP-KO mice (2.54
0.09 vs 1.54
0.05 foldincrease, p<0.001), and fed vs fasting (low IAP) (3.09
0.09 vs 1.93
0.16 fold-increase; p<0.001). Growth was further enhanced by adding exogenous IAP to the KO-loop (2.61
0.12 vs 1.63
0.07 fold-increase, p<0.001), whereas, it was decreased by adding phenylalanine (IAP inhibitor) to the WT-loop (1.53
0.12 vs 2.61
0.10 fold-increase, p<0.001). IAP also promoted the growth. M. morganii (2.62
0.13 vs 1.65
0.06 fold-increase, p<0.001) and E. faecalis (2.23
0.14 vs 1.32
0.06 fold-increase, p¼0.002). We observed a dose-dependent inhibition of bacterial growth when ATP was added to the loop (1.12
0.05 vs 1.57
0.07, p<0.001), whereas the ATP hydrolysis inhibitor ARL-67156 also decreased bacterial growth (1.68
0.06 vs 2.71
0.10, p<0.001). ATP levels were higher in the IAP-KO (150.0
19.1 vs 35.0
11.2, p¼0.013), whereas adding IAP decreased ATP levels (138.8
18.4 vs 27.2
10.4, p¼0.006). CONCLUSIONS: These data suggest a novel model for hostmicrobial homeostasis based upon the levels of endogenous IAP. We believe that IAP could be developed as a novel supplement to promote the healthy, commensal gut flora. Gastrointestinal regeneration using collagen scaffolds loaded with human collagen-binding bFGF in a porcine model Bo Zhou, MD, Jianan Ren, MD, PhD, FACS, Jianwu Dai, Gefei Wang, MD, PhD, Guosheng Gu, MD, PhD, Gang Han, MD Medical School of Nanjing University, Nanjing, China

J Am Coll Surg

INTRODUCTION: Complex duodenal injuries and their complications, which requires complex enteric reconstruction and drainage procedures, are often associated with poor, albeit benign, outcomes. Thus, it is very important to promote in situ duodenal regeneration. In the present study, two collagen membrane patches was developed to bridge the gaps to evaluate the efficacy in the repair of a complex (>50%) injury and if it could induce intestinal regeneration at the graft site. METHODS: Thirty-six China experimental hybrid pigs of either sex, weighing 20-25 kg were randomly divided into 3 groups, including collagen/CBD-bFGF group, collagen/PBS group and non-operated group. A 3.5-cm long by 2-cm wide defect was created in the second portion of the duodenum, approximately 4 cm distal to the pylorus. After 30 minutes of peritoneal soilage, a bioprosthetic repair was performed. Animals were recovered and resumed a normal diet on day 4. Blood test, imaging examination and operative re-exploration was performed at 1-, 4-, and 12-week intervals. All specimens was evaluated by histological analysis. RESULTS: All animals in experimental groups survived after the operation and appeared healthy, with progressive weight gain and normal bowel function. No animal had evidence of liver dysfunction, duodenal stenosis, proximal dilation, or abscess formation. Histological analysis demonstrated collagen/CBD-bFGF promoted more vascularization and smooth muscle cell ingrowth and induced complete intestinal structures. CONCLUSIONS: The collagen/CBD-bFGF composite biomaterial was promising for the treatment of complex duodenal defect by promoting intestinal regeneration.

Comparison of complications following laparoscopic versus open gastrostomy Rachel Van Dusen, MD, Michal Radomski, MD, Khashayar Vaziri, MD, FACS, Richard Amdur, PhD, Stephanie Knapp, BS, Babak Sarani, MD, FACS, FCCM George Washington University, Washington, DC INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is the standard of care for prolonged enteral access. When PEG is not feasible, surgeons have a choice of open (OG) or laparoscopic gastrostomy (LG). There are no studies to date comparing these three approaches in adults. We hypothesize that the LG is associated with fewer complications than OG in adults who cannot undergo PEG. METHODS: CPT codes were used to identify all cases receiving PEG, OG, or LG in the National Surgical Quality Improvement (NSQIP) database for 2005-2010. Stepwise logistic regression was used to examine independent associations of procedure with wound, pulmonary, renal, cardiac, and thromboembolic outcomes, after controlling for: race, sex age, diabetes, general anesthesia, independent functional status, alcohol use, ascites, COPD, previous surgery within 30 days, CHF, previous cardiac surgery, peripheral vascular disease, stroke, disseminated cancer, steroid use, weight-loss, chemotherapy use, bleeding disorder,