International Journal of Molecular Sciences accepted nominations for Junior Scientists Travel Awards 2016. Over 300 nominations were received and were evaluated by a panel of judges comprised of International Journal of Molecular Sciences editorial board members.With the goal of recognizing outstanding contributions to the field of molecular sciences by early-career investigators, including assistant professors, postdoctoral students and PhD students, and assisting them in attending international conferences in 2016, last year the We are excited to announce the following winners: Dr. Bert De Rybel, Dr. Jean Christopher Chamcheu, Dr. Jean-Marie Swiecicki, Mr. Pedro Rodrigues, and Dr. Renato Polimanti. They will be supported with up to 800 Swiss Francs each towards their travel expenses to attend international conferences in 2016.Dr. Bert De RybelScience, Nature, Nature Chemical Biology and Current Biology. He then moved to the laboratory of Professor Dolf Weijers in Wageningen (the Netherlands), funded by FEBS and Marie Curie post-doctoral fellowships, to work on embryo development and initiated work into vascular development. After five years of post-doctoral research in which he published his work in leading journals including Science and Developmental Cell, Dr. De Rybel received an FWO Odysseus return grant to set up his own line of research at the department of Plant Systems Biology in VIB-Ghent University, Belgium, where he currently works as a project leader on vascular development in plants. At the same time, he remains associated to Wageningen University, funded by an NWO VIDI grant. His current research focuses on understanding how plant vascular cells control the orientation of their cell divisions and how this has developed through evolution. When not in the lab, Dr. De Rybel enjoys Belgian beers, painting and hiking/camping.Dr. Bert De Rybel, Project Leader at VIB-Ghent University, Belgium. Dr. De Rybel completed his Ph.D. degree in the Department of Plant Systems Biology , supervised by Professor Tom Beeckman, focusing on early lateral root development. This resulted in publications in several leading journals such as Dr. Jean Christopher ChamcheuDr. Jean Christopher Chamcheu, Assistant Scientist at University of Wisconsin (UW)-Madison, Madison, WI, USA. Dr. Chamcheu earned his BS degree in Biochemistry with a minor in Biomedical Analyses and Pharmacology at the University of Dschang, Cameroon, and his MS degree in Biomedicine (2004), at Linkoping University in Sweden. He completed his Ph.D. degree in Dermatology and Venereology (2010) at Uppsala University in Sweden, working with Professors Hans Torma and Anders Vahlquist, to identify the underlying molecular genetic basis and develop new pharmacologic strategies for treating epidermolytic keratinopathic genodermatoses. On completion of his Ph.D., Dr. Chamcheu joined the Department of Dermatology at the UW-Madison as a Postdoctoral Research Associate, working with Professor Hasan Mukhtar for over 3.5 years. His initial research focused on defining the role of Caspase-14 in the pathogenesis of psoriasis, a chronic immune-mediated inflammatory skin disease, and in establishing the utility of delphinidin, a novel small molecule for treating psoriasis. In 2014, he was promoted to the scientist track, where he currently works as an Assistant Scientist, a position at UW-Madison . Dr. Chamcheu is now developing his research program in psoriasis with studies aimed at uncovering the underlying and regulatory mechanisms and contribution of PI3K/Akt/mTOR signaling to psoriasis pathogenesis, and its targeting, using natural small molecule inhibitors with the hope to identify novel prognostic markers and therapeutic targets for treating psoriasis and possibly other hyperproliferative and inflammatory skin disorders. Dr. Chamcheu has recently received a number of grants and awards as co-investigator or as principal investigator, including an American Skin Association Carson Research Scholar Award in Psoriasis. When Dr. Chamcheu is not in the lab, he enjoys outdoor activities, such as playing football soccer, and participates in community outreach organizations, such as the Powerman HOPE Foundation International.Dr. Jean-Marie SwiecickiN-linked protein glycosylation pathway of the human pathogen bacterium, Campylobacter jejuni. When not in the lab, Dr. Swiecicki enjoys baking at home, sailing on the Charles River and discussing politics.Dr. Jean-Marie Swiecicki, Post-Doctoral Research Associate at Massachusetts Institute of Technology, USA. Dr. Swiecicki completed his undergraduate studies in 2011 at the École Normale Supérieure in Paris with a major in Chemistry and a minor in Biology. He then obtained his Ph.D. degree from the University Pierre and Marie Curie in 2014 working under the guidance of Professor Solange Lavielle. His graduate research focused on the development of original strategies to interrogate cellular internalization mechanisms and the subsequent intracellular distribution of cell-penetrating peptides. His studies provided a comprehensive dynamic picture of the internalization processes, which he then used to rationally design a new delivery vector. Continuing on his academic path to decipher the elementary principles of membrane-associated processes, he is now working in Prof. Barbara Imperiali’s laboratory at MIT. As a post-doctoral associate, he is developing an integrated platform for characterizing molecular interactions among associated peripheral and integral membrane proteins, as well as the membrane lipids environment. He is currently applying this platform to the membrane-bound enzymes of the Mr. Pedro RodriguesMr. Pedro Rodrigues, Ph.D. Student at Research Institute for Medicines (iMed. ULisboa), Portugal. Pedro received his BS degree in Molecular and Cellular Biology from the New University of Lisbon in 2011 and a post-graduation in Biopharmaceutical Sciences in 2012. Since beginning his Ph.D. studies in 2013, Pedro has investigated the role of microRNAs and nuclear receptors in non-alcoholic fatty liver disease (NAFLD) pathogenesis, under the supervision of Dr. Rui Castro and Prof. Cecília Rodrigues. NAFLD can lead to cirrhosis and hepatocellular carcinoma which lack pharmacological therapeutic options. Studies performed by Pedro have already highlighted novel molecular therapeutic targets that may be useful in developing new drugs to treat NAFLD. He has presented his work in several national and international conferences and is the author of several scientific papers. Pedro has also received several grants and honors, including a National Scholar Award at UEG Week 2014, and his work has been distinguished at several conferences. Outside the lab, Pedro likes to play the clarinet and is a member of several bands and orchestras in Lisbon and in his hometown, Tomar.Dr. Renato Polimantiet al., 2015, Pharmacogenomics) and the molecular mechanisms by which alcohol dependence affects body mass regulation . He is an author of over 50 scientific articles published in international peer-reviewed journals. Dr. Polimanti has received several honors and awards including the NARSAD Young Investigator Award from Brain and Behavior Research Foundation and the Early-Career Investigator Travel Award from the Society of Biological Psychiatry.Dr. Renato Polimanti, Post-Doctoral Research Associate at Yale University School of Medicine and VA CT Healthcare Center, USA. Dr. Polimanti received his Ph.D. degree from the University of Rome “Tor Vergata”, Italy, where he studied the evolution of pharmacogenetic systems among human populations. Since 2013, he has been a postdoctoral associate in the group of Dr. Joel Gelernter in the Division of Human Genetics of the Department of Psychiatry at Yale University School of Medicine. Dr. Polimanti’s research is currently focused on the understanding of the pathogenic mechanisms of traits related to alcohol and drug use disorders using various types of genomic data. His recent studies provided novel findings about the role of ancestry genomic background in genome-wide association studies of substance dependencies (Polimanti International Journal of Molecular Sciences’ editorial board members and editorial staffs, we wish to congratulate these five outstanding junior scientists for their accomplishments.On behalf of the


A 56-year-old woman with previous breast cancer underwent a muscle-sparing transverse rectus abdominis myocutaneous flap to her left breast. She developed marked flap swelling postoperatively and episodes of pyrexia.Escherichia coli and Acinetobacter baumannii. This strain of Acinetobacter was multidrug resistant, including resistance to meropenem.A breast wound swab grew Acinetobacter and how common is Acinetobacter infection?What is Acinetobacter infection?How dangerous is How is it diagnosed?What precautions do you need to take and how do you treat it?Acinetobacter is a pleomorphic aerobic gram-negative bacillus, increasingly found in hospitalized patients. Isolates from patients usually reflect colonization as opposed to infection. However, when the organism is pathogenic, it can be multidrug resistant and therefore difficult to treat. Acinetobacter infections rarely occur outside of health care settings but may occur in tropical environments, wars, and natural disasters. Its natural environment includes water and soil. In the hospital setting, it is most commonly found on the intensive care unit and burns units. In human populations, it colonizes the respiratory and gastrointestinal tracts, skin, and wounds. Some strains can survive in iron-deficient and dry environments for months, leading to the increased risk of fomite contamination.2Acinetobacter has low virulence but can cause infection in those who are immunocompromised, have chronic disease, have surgical wounds, or have prolonged hospital admissions. Infections caused by Acinetobacter can include bacteremia, hospital-acquired pneumonia, meningitis, and urinary tract infections.Acinetobacter baumannii are renowned for being difficult to treat due to its antimicrobial resistance. This is in part due to its effectiveness in acquiring genetic material from other organisms and therefore rapidly developing drug resistance.6Acinetobacter from monitors and equipment around the colonized patient. It is therefore paramount to thoroughly clean the ward and operating room the patient has been in. Microbiologically, it is nonmotile, catalase-positive, and oxidase-negative. In standard cultures, it appears as broad, short, gram-negative rods in rapid growth phase but a more coccobacillary shape in stationary phase. They do not reduce nitrate or ferment glucose.7Diagnosis can be achieved through taking appropriate samples for culture such as wound swabs or blood. In outbreaks, it is easy to culture Acinetobacter should be isolated and appropriate infection control measure put in place. Supportive care includes removing or replacing any lines, catheters or drains. Regular discussion with Microbiology needs to take place to define colonization versus infection, as well as appropriate antibiotic regimens. Antibiotics used include meropenem, tigecycline, minocycline, colistin, amikacin, rifampin, and polymyxin B. Combination therapy may be required. Most infections, until recently, were sensitive to the carbapenems, but cases of resistance have been increasing. Multidrug-resistant Acinetobacter is commonly susceptible to antiseptic and disinfectants. Reports of failure to contain the bacteria are more likely due to staff not following correct cleaning procedures than to do with disinfectant resistance. Control of the outbreak is more likely to occur when the source is identified and eliminated. Hydrogen peroxide vapor can also be used as an effective mode of decontamination.8Those proven to be colonized with Acinetobacter baumannii can be found as a colonizing bacterium with no adverse effects. However, it can be contaminated easily within a hospital or battlefield environment, and when it becomes an infective organism, it may be difficult to treat, as multidrug resistance is common. Those who are immunocompromised, have chronic disease, have surgical wounds, or have prolonged hospital admissions are particularly vulnerable. When a patient is proven to be colonized with Acinetobacter, the patient should be isolated and appropriate infection control measure put in place to prevent colonization or infection of other patients.In conclusion,


Dear Friends and Colleagues,Rambam Maimonides Medical Journal. This issue is particularly important as it marks the completion of five years of creative work pursuing our vision for a high-caliber scientific medical journal. Our vision has become reality.An anniversary is not only a point of memory—it provides the opportunity for self-examination and paves the way to the future. Every anniversary marks a starting-point that was preceded by a vision. The beginning of any vision is a personal dream—someone wants to improve or repair the world as far as he is able. The vision motivates action; in its aftermath comes the reality. This is the 21st issue of Rambam Maimonides Medical Journal.The impact a physician has in the lives of patients is far more than physical—it is emotional, intellectual, and sometimes even spiritual. Nevertheless, that influence rarely extends beyond the individual patient, although in some cases it may reach their extended family. Yet knowledge regarding medical and scientific research can deeply impact our society if that information is made available and accessible to the entire medical community as well as the greater public. This concept stands behind our motivation to initiate and sponsor and our readers), peer-reviewed publication. We envisioned top contributors in their respective fields who would bring together their scientific expertise combined with their personal stance and experience.Several key concepts were established at the onset of our “Maimonides” journey. First and foremost, we envisioned an international, multidisciplinary, open-access  scholarly and ethical legacy. Maimonides’ monumental work on Jewish law, ethics, and medical practice are classic and remain remarkably relevant today. Rambam Health Care Campus proudly bears the Hebrew name of Maimonides and aspires to be guided by his principles. Hence the name of our new publication was quickly decided upon: We had to overcome technical challenges with limited resources. We developed a proprietary computer system to specifically meet the journal’s needs. Today, every step of the publication process, from submission to release, is fully computerized. We are now able to provide our readers with downloadable PDFs, the ability to read online in a browser, and articles can now be accompanied by videos.Based on the data, we have every reason to be proud—we have succeeded in our goal. Many of our writers are world leaders in medicine, ethics, humanity, and science. Among them are eight Nobel Laureates. Published articles focus on a wide spectrum of clinically relevant biomedical research and other issues central to the provision of optimal health care, disease prevention and environmental health, Jewish and general ethics, philosophy and the history of medicine, and much more. Content even includes transcripts of public debates, and there have been several issues dedicated to specific topics of interest.Rambam Maimonides Medical Journal has achieved outstanding attention, demonstrated by more than 15,900 registered readers, with more than 262,000 page views by readers from 158 countries and territories. The journal’s quality is internationally recognized: Rambam Maimonides Medical Journal is a member of Cross Ref and is indexed by PubMed, EBSCO, and Google Scholar—to name a few.Over the past five years, We have not been alone in the realization of this endeavor. We are grateful to all of our families, colleagues, and collaborators who have supported and encouraged us along the way. We are deeply grateful to our Editorial Board—they have supported us throughout our Maimonides journey and encouraged us to forge ahead when very few believed in the journal’s potential for success.We are thankful for each contributor who has provided us with outstanding work, and to the anonymous reviewers who have faithfully undertaken honest and in-depth critiques for the benefit of the scientific and medical community. Your contributions have assured that our loyal readership finds something of interest in every issue.We would like to extend special thanks to two individuals who are the heart and soul of our editorial office, our Editorial Assistant, Mrs. Deborah Hemstreet, and our gifted and committed copy editor, Mrs. Lisbet Clements. Almost every one of our writers, at some point during manuscript processing, has written to thank our office for their meticulous, professional, and good-natured help. You, our readers, have benefited from their professionalism.Rambam Maimonides Medical Journal was founded as an independent and free journal, not supported by any organization or medical society. To date, the generosity of donors has enabled the journal to remain freely accessible via the internet for immediate worldwide open access to the full text of articles. The journal fulfills the terms of the Creative Commons attribution license under which everyone is free to copy, distribute, and display the work, free of charge for non-commercial personal and educational purposes. We particularly want to thank the Friends of Rambam (Israel), our donors and friends in Israel and worldwide—most of whom have asked to remain anonymous—for their generous support.Rambam Maimonides Medical Journal, we also welcome you to contribute from your expertise and experience. We are also pleased to receive Letters to the Editor regarding previously published articles. Join us in the Maimonides journey!Finally, we would like to thank you, our faithful readers. You are the final word of our success. Every download, every page accessed by you, is yet another indication that our vision has been realized. We aim to continue publishing high-quality papers written by esteemed interdisciplinary scholars. As you continue to enjoy the benefits achieved from reading Rambam Maimonides Medical Journal. Our new vision is to further our acceptance and scientific strength as proof of the importance of freely accessible knowledge and honoring to the Rambam.Please consider making a contribution to assure that our journal continues to remain advertising-free, and free to everyone. Be sure to spread the word about this unique publication, and don’t forget to cite articles published in This Fifth Anniversary issue was written with you in mind. Members of our Editorial Board, and Sir John Gurdon, an emeritus board member and Nobel Laureate, have contributed of their broad expertise on a variety of topics.Rambam Maimonides Medical Journal.Thank you for being a part of the past and the future of


Postoperative endothelial cell loss leads to graft failure after corneal transplantation, and is one of the important issues for long-term prognosis. The objective of this study was to identify clinical factors affecting graft survival and postoperative endothelial cell density (ECD) after Descemet’s stripping automated endothelial keratoplasty (DSAEK). A total of 198 consecutive Japanese patients (225 eyes) who underwent DSAEK were analysed using Cox proportional hazard regression and multiple linear regression models. The candidate factors included recipient age; gender; diagnosis; pre-existing iris damage state, scored based on its severity; the number of previous intraocular surgeries; graft ECD; graft diameter; simultaneous cataract surgery; surgeons experience; intraoperative iris damage; postoperative rebubbling; and graft rejection. Eyes with higher pre-existing iris damage score and more number of previous intraocular surgery had a significantly higher risk of graft failure . Higher pre-existing iris damage score, lower graft ECD, and smaller graft diameter were identified as significant predisposing factors for lower postoperative ECD. The results show that iris damage status before DSAEK may be clinically useful in predicting the postoperative course. Avoiding intraoperative iris damage, especially in eyes with low ECD can change the prognosis of future DSAEK. Descemet’s stripping automated endothelial keratoplasty (DSAEK) for the treatment of endothelial dysfunction has several advantages over standard penetrating keratoplasty (PKP)124678910111013ECD decreases over time after corneal transplantation1516171819202 to 1332 ± 550 at 3 months, 1244 ± 520 at 6 months, 1104 ± 545 at 12 months, 949 ± 499 at 24 months, and 822 ± 531 at 36 months . The ECDs at 12, 24, and 36 months were significantly lower than that at 3 months (P < 0.01). The ECD at 36 months was significantly lower than those at 6 and 12 months (P < 0.001).Logarithm of minimal angle resolution (logMAR) visual acuity improved significantly, from 1.18 ± 0.57 to 0.48 ± 0.54 at 3 months, 0.34 ± 0.35 at 6 months, 0.31 ± 0.35 at 12 months, and 0.26 ± 0.32 at 24 months . The average graft ECD decreased significantly, from 2651 ± 323 cells/mmWe postulated that pre-existing iris damage may be associated with a history of trabeculectomy and PKP. Furthermore, potential influential factors, such as the presence of diabetes mellitus (DM), graft rejection, postoperative rebubbling and uveitis could affect the above results and cause confounding bias. To completely exclude the influence of these factors on graft failure and postoperative endothelial cell density (ECD), the subgroup was defined as the patients who underwent DSAEK due to laser-iridotomy-related bullous keratopathy (LI-BK), pseudophakic/aphakic bullous keratopathy (PBK/ABK), Fuchs’ endothelial corneal dystrophy (FECD), the three major indications for DSAEK, excluding the patients with DM, intraoperative iris damage, uveitis, postoperative rebubbling, and rejection. Because the iris damage score was the most potent influential factor for postoperative endothelial cell loss, we stratified the subjects based on iris damage scores in different aetiologies. In total subjects (a), eyes with LI-BK (c), PBK (d), and other aetiologies (f), the survival rates in eyes with iris damage scores of 3 or 4 were significantly worse than those of eyes with either no iris damage or iris damage scores of 1–2 . Therefore, iris damage during previous intraocular surgery can worsen the prognosis of future DSAEK, suggesting that iris damage should be avoided during intraocular surgery, especially in eyes with low ECD. The lens status is a well-known influential factor for ECD after PKP; the prognosis is poor in eyes with AC-IOL181920et al.2 were found to be preferable for higher ECD after DSAEK45We demonstrated that larger graft diameter and more preoperative graft ECD were associated with more ECD after DSAEK. Romano et al. reported that cytokine levels, such as monocyte chemotactic protein -1, in the aqueous humor were elevated in eyes with trabeculectomyOur study had several limitations. First, we excluded the history of trabeculectomy  from the baseline factors of multifactorial analysis because there were too few cases after trabeculectomy. Post-trabeculectomy has been reported to be associated with graft failure after DSAEK49In conclusion, the results of the current study suggest that a larger graft diameter is important in maintaining higher postoperative ECD, thereby providing more endothelial cells. Postoperative endothelial cell loss and graft failure were associated with higher pre-existing iris damage scores as recipient factors. Pre-existing iris damage scores can be useful in predicting the prognosis of DSAEK in patients with BK.This retrospective cohort study was conducted in accordance with the Declaration of Helsinki, and was approved by the Ethics Review Board of Tokyo Dental College Ichikawa General Hospital (Acceptance No. I-15-39). Informed consent was obtained from all the subjects.Consecutive patients who underwent DSAEK between March 2007 and December 2011 at the Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, were studied. A total of 225 eyes from 198 patients  were enrolled . The cauDSAEK surgery was performed using double-glide techniqueOutcome measures included best-corrected visual acuity (BCVA), postoperative ECD and graft survival rate. The standard Landolt optotype chart was used to measure BCVA, which was converted into the logMAR and analyzed statistically. ECD was measured preoperatively and at 1, 3, 6, 12, and 24 months after surgery using a non-contact specular microscope . Approximately 50 cells were analyzed for mean cell density. Graft failure was defined as persistent corneal edema resulting in irreversible loss of optical clarity due to the decrease in ECD.To identify predictive parameters that are associated with postoperative ECD and graft failure, we selected the following variables, that were a priori based on the past studies and our knowledge of ECD and DSAEK; recipient gender, age, history of DM, aetiologies of BK, the number of previous intraocular surgeries, IOL position [capsular bag or TS-IOL] and pre-existing iris damage score were selected as the recipient factors. Donor age, imported or domestic graft, graft ECD and graft diameter were selected as the donor factors. Simultaneous cataract surgery, the surgeon’s experience, intraoperative iris damage, postoperative rebubbling and rejection episodes were selected and analyzed as the intra- and postoperative factors.Two masked observers (NI and TY) determined the iris damage score, based on its severity from preoperative slit-lamp microscopy findings  as folloAn experienced surgeon was defined as a surgeon who performed more than 30 DSAEK procedures. Factors, such as gender, presence of DM, graft rejection, an experienced surgeon, and postoperative rebubbling were dichotomized for Cox proportional hazards regression. Continuous variables including recipient age, donor age, and graft ECD were also dichotomized for use as categorical variables for Cox proportional hazards regression.Data were analyzed using the SPSS software . To identify predisposing factors associated with graft failure, Cox proportional hazards regression was first used . Univariate analysis was performed to determine the correlation between graft failure and each variable. In multifactorial analysis, all of the variables were included to evaluate the relationship with graft failure. To exclude the influence of factors such as post-trabeculectomy and other ocular complicated pathologies, we focused on three major indications for DSAEK in Japan; LI-BK, PBK and FECD. Eyes with graft rejection, intraoperative iris damage, the presence of DM, a history of trabeculectomy, and uveitis were excluded from this multifactorial analysis. We excluded DM from the baseline factors, because DM is one of the factors underlying endothelial cell lossTo assess the association between postoperative ECD and all the variables, univariate analysis was conducted using Spearman’s rank correlations for each variable at 1, 3, 6, 12 and 24 months postoperatively. Multiple linear regression was also conducted using backward stepwise analysis. A decay model was evaluated that fitted the two exponentials to each set of postoperative ECDs in the groups with iris damage scores of 0, 1–2 and 3–4 as reported previouslyTo test the influence of iris damage score for different indications, we stratified the groups based on the indications for DSAEK and compared the graft survival rate among the different iris damage scores. The Kaplan Meier method was used to analyze the graft survival rate, and the log rank (Mantel Cox) test was used to evaluate P values. A P value < 0.05 was considered statistically significant. Data were expressed as means ± standard deviation (SD).How to cite this article: Ishii, N. et al. Factors associated with graft survival and endothelial cell density after Descemet's stripping automated endothelial keratoplasty. Sci. Rep.6, 25276; doi: 10.1038/srep25276 (2016).


The aim of this study is to investigate the usefulness of arterial reconstruction using the recipient's own internal iliac artery for multiple kidney graft arteries.The safety and efficacy of various arterial reconstruction methods have been demonstrated. Although some reports have documented arterial reconstruction with the recipient's own internal iliac artery for multiple kidney graft arteries using the interposition method, usefulness of this technique has not yet been investigated compared with other arterial reconstruction methods.Between January 2008 and April 2014, 532 living donor kidney transplants in adult recipients were performed at 1 center. Of these, 389 kidney grafts had a single artery and did not need arterial reconstruction . Among the bench surgery patients, 19 kidney grafts for multiple arteries were performed using the interposition method with the recipient's own internal iliac artery (interposition group). Seventy-nine kidney grafts were performed using conjoined reconstruction (conjoined group) and 15 kidney grafts were performed using end-to-side reconstruction (end-to-side group). Total ischemic time , time to initial urination, perioperative and postoperative estimated glomerular filtration rate (eGFR), and complication rates between the interposition group and other 3 groups were retrospectively investigated. This study was based on the STROBE compliant.Warm ischemic time  of interposition group was significantly longer than that of nonarterial reconstruction group. Total ischemic time of the interposition group was significantly longer than those of other 3 groups. But time to initial urination, perioperative and postoperative eGFR, and complications were similar to other 3 groups.The interposition method was shown to be a useful standard method for multiple kidney graft arteries of living donor kidney transplantation in carefully selected recipients without calcification of the iliac arteries. Previously, some reports did not recommend laparoscopic procedures for the donors of multiple graft arteries due to the frequent complications.4 Nevertheless, now several reports have addressed the operative indications of laparoscopic procedures for the donors of multiple graft arteries.7 However, graft arterial length is shorter with laparoscopic procedures than with open procedures because of the wide endostaple lines. Kidney grafts with early branched arteries often lead to multiple arteries after the removal of staples. For these multiple arteries, arterial reconstructions were necessary. Many techniques of arterial reconstruction have been reported, such as the conjoined method, the end-to-side method, and the method involving the inferior epigastric artery. The efficacy and safety of these methods has also been reported before.8 Only the operative technique of arterial reconstruction with the recipient's own internal iliac artery for multiple arteries (interposition method) has likewise been reported,12 but the usefulness of this method compared with that of a single arterial graft, conjoined method, and end-to-side method has not yet been demonstrated. In this study, we investigated the usefulness of interposition methods compared with that of a single arterial graft , conjoined method, and end-to-side method.The first laparoscopic donor nephrectomy was reported by Ratner et al in 1995.To investigate the usefulness of the interposition method, adult recipients of living donor kidney transplants were divided into 4 groups according to the operative methods used. One was the interposition group and the others were nonarterial reconstruction group, conjoined group, and end-to-side group. Usefulness between interposition group and other 3 groups was evaluated with perioperative and postoperative estimated glomerular filtration rate (eGFR), and complications.Between January 2008 and April 2014, 532 consecutive living donor kidney transplants were performed in adult recipients at our hospital. Of these, 24 were excluded from this study due to the following reasons: 1 out of 24 underwent elongation of a single artery with polytetrafluoroethylene graft, 6 underwent venous reconstruction, and very thin arteries feeding the upper pole were ligated in 17. The remaining 508 recipients were enrolled in the study and observed every month from January 2008 to September 2014 (mean observation period: 41.9 ± 21.3 months)  , time to initial urination (the period between blood reperfusion and urination from the graft ureter), perioperative and postoperative estimated glomerular filtration rate (eGFR), and complications were compared. Complications included arterial thrombosis, urine leakage, ureteric stricture, delayed graft function, postoperative bleeding, lymphocele, acute cellular rejection, and antibody-mediated rejection.Preoperative kidney functions and anatomical features were evaluated with Tc-99m diethylene-triamine-pentaacetate and enhanced CT images. Procurement side was determined according to kidney function and donor kidney problems, such as renal stones and arterial aneurysms, regardless of the number of renal arteries. The number of kidney graft arteries was evaluated preoperatively with enhanced 3D-CT images. The condition of the recipient's iliac artery was also evaluated with CT images. For the recipients without calcified iliac arteries, interposition method was selected. Conjoined method and end-to-side method were the first choice for arterial reconstruction, if the arterial length and distance between arteries were appropriate. However, if arterial conditions were not appropriate for conjoined method and end-to-side method, interposition method was then selected.Before bench surgery, the recipient's internal iliac artery was exposed to the peripheral branches of the anterior and posterior branch. After ligating the peripheral branches of the anterior and posterior branch, the internal iliac artery was clamped. The internal iliac artery was cut at the peripheral branches of the anterior and posterior branch and in the middle of the internal iliac artery. Next, the arterial graft was procured. In bench surgery, each artery of kidney graft was anastomozed end-to-end with each peripheral branch of the internal iliac artery. The kidney graft was then implanted by reanastomosis of the internal iliac artery Fig. .t test for continuous data, and χ2 or Fisher exact test for the categorical variables; P < 0.05 was considered significant. Analyses were performed using SPSS for Windows version 13.0  statistical software.Statistical analyses were performed using the independent-samples Five hundred eight recipients were enrolled in the study and observed every month from January 2008 to September 2014 (mean observation period: 41.9 ± 21.3 months). During the observation period, 7 patients dropped out for the following reasons: 2 with functioning grafts died due to lung cancer and pneumonia, 1 developed BK virus nephropathy, 2 experienced acute cellular rejections due to nonadherence, and 1 developed graft loss due to perioperative duodenal perforation. As a result, 501 of the 532 recipients were observed at our hospital; no patients dropped out during this period. Three hundred eighty-nine out of 501 kidney grafts had a single artery and did not need arterial reconstruction . The interposition method was performed in 19 kidney grafts (interposition group). Conjoined method (conjoined group) and end-to-side method (end-to-side group) were performed in 78 and 15 kidney grafts, respectively , conjoined group (78 recipients), end-to-side group (15 recipients) and the nonarterial reconstruction group (389 recipients) were shown in Table The results of the surgeries were investigated. Warm ischemic time (WIT) , TIT, time to initial urination and complications were shown in Table 13 Laparoscopic donor nephrectomy has recently been common, but it sometimes leads to short arteries and more than 2 arteries. This might be due to the wide endostaple lines and angle limitation of the endostapler. For these grafts, arterial reconstructions are necessary before transplantation. For the grafts with renal arterial aneurysms, resections of aneurysms, and arterial reconstructions are also required.16 Reconstructions of accessory arteries to the lower pole are reported to be important to avoid ureteral complications.17It has been reported that more than 2 arteries are found in the unilateral kidneys of 18% to 30% of the potential donors and in the bilateral kidneys of 15% of the potential donors.14 Ureteral complications and vascular complications were significantly higher in recipients of multiple arterial grafts. Likewise, lymphoceles were more frequently reported in the recipients of multiple arterial grafts.18 Graft survival in recipients of a single arterial graft was significantly better.4Some studies have noted inferior outcomes in multiple graft arterial reconstructions compared with those in a single graft artery.20 In these reports, arterial reconstructions for multiple arteries were performed with multiple end-to-side anastomoses to the external iliac artery, conjoined anastomosis, and end-to-side anastomosis to the main branch of the graft artery.19 Outcomes of graft function, graft survival, and complications were similar in recipients of either single or multiple arterial grafts.21 However, even in these reports, the interposition method was not discussed closely. Only operative techniques of hypogastric arterial reconstruction and interposition method have been discussed in some reports,12 but there has been no reports demonstrating the usefulness of the interposition method.On the other hand, several reports have noted the safety and efficacy of arterial reconstruction for multiple arteries.For a successful interposition procedure, preoperative evaluations in both donors and recipients are necessary. Initially, the number of arteries of kidney graft was evaluated with enhanced 3D-CT images. For recipients of multiple kidney graft arteries, CT images of the recipients’ internal iliac artery should be also closely evaluated. Interposition method can be selected for the recipients without calcified internal iliac arteries, because calcification of an internal iliac artery might inhibit the safe of anastomosis and lead to arterial stenosis in the future. For recipients with a calcified internal iliac artery, other procedures such as multiple end-to-side anastomoses to the recipients’ external iliac arteries should be selected.Characteristics of recipients, donors, and kidney grafts were similar between the interposition group and the other groups except for the arterial number. Interposition method was dominantly selected for the kidney grafts with more than 3 arteries. This meant that interposition method was more applicable in kidney grafts with more than 2 arteries than conjoined method and end-to-side method. And similar outcomes of operative factors, including complications could support this fact. Although arterial thrombosis, ureteric complications, and lymphocele were reported to be more frequent in the multiple arterial reconstruction group, in the present study, these complications did not significantly increase in interposition group compared with conjoined, end-to-side and nonarterial reconstruction groups. WIT in interposition group was similar to conjoined and end-to-side group, but significantly longer than nonarterial reconstruction group. It was because the endostapling of multiple arteries took more time. TIT in interposition group was more time consuming than those in the other 3 groups because of multiple anastomoses in bench surgery. However, these longer WIT and TIT did not affect early graft function, which was evaluated by initial urination, delayed graft function, and perioperative eGFR. In addition, long-term outcome of eGFR in the interposition group was similar not only to those of the conjoined group and end-to-side group but also to that of the nonarterial reconstruction group. This fact was essential to confirm the stability of interposition method. The similar characteristics of recipients, donors, and kidney grafts among these groups strongly supported the rationale for the evaluation of graft function with perioperative and postoperative eGFR. These favorable results were because of the safe and easy technique of interposition method. Each graft artery was anastomosed end-to-end with each branch of the recipient's iliac artery, and bench surgery is conducive to performing these fine procedures. Re-anastomosis of the graft iliac artery with the graft iliac artery was also quite easy because the size of the graft iliac artery was the same.One limitation of this method is the condition of the recipient's iliac artery. Severely calcified iliac arteries prevent this method and require the selection of a different approach. Another limitation is that the number of interposition group was not large in this study and further prospective investigations are expected.In conclusion, arterial reconstruction with the recipient's internal iliac artery of multiple kidney graft arteries is a useful standard method for multiple kidney graft arteries of living donor kidney transplantation in carefully selected recipients without calcification of the iliac arteries.


Bacillus pumilus Jo2 strain employed in this study.Following publication of this article, a reader made a request for the PLOS ONE policy governing the sharing of materials and data that applies to articles submitted before March 3, 2014, requires that authors agree to make freely available any materials and data described in their publication that may be reasonably requested for the purpose of academic, non-commercial research.The The journal evaluated the request and concluded that it falls within the requirements of the policy above. The journal has contacted the authors, who indicated that Henkel, the company that provided the strain, will not share the strain or its genome sequence with other researchers and that they were not aware of this restriction on the availability of the strain at the time at which the study was conducted. This is not in line with the journal's policy and the authors' declaration of adherence to its requirements.Bacillus pumilus Jo2 strain employed in this study is not available, and thus that the article is in breach of the journal's editorial policy.The editors are issuing this Expression of Concern to alert readers about the fact that the


Tissue–engineered liver grafts may offer a viable alternative to orthotopic liver transplantation and help overcome the donor organ shortage. Decellularized liver matrices (DLM) have a preserved vasculature and sustain hepatocellular function in culture, but graft survival after transplantation remains limited due to thrombogenicity of the matrix.To evaluate the effect of heparin immobilization on DLM thrombogenicity.Heparin was immobilized on DLMs by means of layer-by-layer deposition. Grafts with 4 or 8 bilayers and 2 or 4 g/L of heparin were recellularized with primary rat hepatocytes and maintained in culture for 5 days. Hemocompatibility of the graft was assessed by ex vivo diluted whole-blood perfusion and heterotopic transplantation.Heparin was deposited throughout the matrix and the heparin content in the graft was higher with increasing number of bilayers and concentration of heparin. Recellularization and in vitro albumin and urea production were unaffected by heparinization. Resistance to blood flow during ex vivo perfusion was lower with increased heparinization and, macroscopically, no clots were visible in grafts with 8 bilayers. Following transplantation, flow through the graft was limited in all groups. Histological evidence of thrombosis was lower in heparinized DLMs, but transplantation of DLM grafts was not improved.Layer-by-layer deposition of heparin on a DLM is an effective method of immobilizing heparin throughout the graft and does not impede recellularization or hepatocellular function in vitro. Thrombogenicity during ex vivo blood perfusion was reduced in heparinized grafts and optimal with 8 bilayers, but transplantation remained unsuccessful with this method.Tissue engineered liver grafts may offer a viable solution to dramatic shortages in donor organs Although highly successful, this procedure is severely limited by the shortage of donor organs with thousands dying annually in the United States that could potentially have benefited from a liver transplant . Hence, Tissue engineering approaches provide the tools to create constructs that serve as substitutes for donor livers and potentially address the significant gap in the number of donated livers . HoweverEndothelial cell seeding can reduce coagulation, but coverage of the vasculature is often incomplete, leaving defects in the vascular lining that remain thrombogenic. Systemic anticoagulation is also suboptimal, putting the recipient at risk of hemorrhagic complications and is not ideal for long–term maintenance. In tissue engineering, one strategy to improve hemocompatibility of devices that come in direct contact with blood and/or plasma is through surface modification with bioactive agents, such as heparin . HeparinIn an attempt to improve hemocompatibility of the recellularized liver grafts and extend the recipient survival time when transplanted, we employed a layer-by-layer self-assembly technique creating a multilayer heparin coating of the ECM of our previously reported DLM. We examine the effects of heparin coating on hepatic function during in vitro perfusion culture of recellularized liver grafts. Moreover, ex vivo diluted whole-blood perfusion was used to examine thrombogenicity and grafts were heterotopically transplanted to examine in vivo post– reperfusion viability .2.2.1.All animal care, handling and surgical procedures were performed in accordance with the guidelines set by Institutional Animal Care and Use Committee (IACUC) at Massachusetts General Hospital. Female Lewis rats  weighing between 175–200 g were used for primary hepatocyte isolation, liver donation and liver transplant recipients. In brief for liver procurement, rats were anesthetized with 0.3 L/min of a 3% (v/v) isofluorane/ 97% oxygen gas mixture . The abdomen was exposed by transverse incision and the surrounding hepatic ligaments were dissected. The portal vein (PV) was mobilized, and the gastroduodenal and splenic veins were ligated using 7-0 prolene suture  and dissected. The hepatic artery was ligated and transected. The infrahepatic inferior vena cava (IHIVC) was mobilized and elongated by ligation and dissection of the adrenal vein, lumbar plexus, right renal artery and right renal vein. The liver was excised from its recess and the suprahepatic inferior vena cava (SHIVC) was identified and cut. A cuff technique was applied to the PV and IHIVC according to the method described by Kamada et al. [2.2.2O for 60 h, starting with 0.01% (w/v) SDS for 24 h, with 0.1% (w/v) SDS for 24 h, and 0.2% (w/v) SDS for 12 h. Next, the liver was perfused with 0.1% (v/v) Triton X-100 (Sigma-Aldrich) in distilled H2O for 30 min to remove the residual components and rinsed with PBS for at least 2 h. The decellularized liver matrix was sterilized with PBS containing 0.1% (v/v) peracetic acid and 4% (v/v) ethanol (Sigma-Aldrich) for 3 h and rinsed with sterile PBS extensively. The sterilized DLM was stored in PBS supplemented with 250 µg/mL amphotericin B (Sigma-Aldrich), 200 U/mL penicillin and 200 mg/mL streptomycin  for up to 7 days.The liver was thawed at room temperature and washed by portal vein perfusion with phosphate buffered saline (PBS) overnight at a flow rate of 1.0 mL/min to clear residual blood from the organ. Then, the liver was perfused with increasing concentrations of sodium dodecyl sulfate (SDS)  dissolved in distilled H2.3.Sodium heparin (heparin) and low molecular weight poly  (PDADMAC) (Sigma-Aldrich) were used to coat heparin on to the matrix surfaces in a layer–by–layer (LbL) immobilization approach , creatin2.4.p-dimethylamino benzaldehyde in 3 M HCl and 47.5% ethanol) and 5 mL of 95% ethanol was added into the reaction mixture to develop a stable reddish purple color by condensation of pyrroles. The absorbance of the resulting solution was measured spectrophotometrically at 527 nm.The amount of heparin deposition in hDLM scaffolds was quantified by a hexosamine assay, which colorimetrically determines glucosamine concentration . The ent2.5.Primary rat hepatocytes were isolated using the two–step perfusion protocol as described previously .2.6.2O. The perfusate consisted of high-glucose Dulbecco’s modified Eagle’s medium (DMEM)(Sigma-Aldrich) supplemented with 10% heat-inactivated fetal bovine serum , 20 ng/mL epidermal growth factor (Invitrogen), 0.5 U/mL insulin , 14 ng/mL glucagon , 7.5 µg/mL hydrocortisone  and 200 U/mL penicillin + 200 mg/mL streptomycin (Invitrogen). Following 30 min perfusion with medium, 50 to 100 million primary adult rat hepatocytes with over 90% viability were infused into the circuit in four subsequent injections at 10-min intervals as described previously [Hepatocytes were seeded by perfusion to form a recellularized (h)DLM ((h)DLM–R). The median lobe of heparinized or unmodified DLM scaffold was resected and connected to the perfusion system through portal vein cannulation. The IHIVC and SHIVC were left open for passive outflow. The liver was kept immersed in the perfusate in a perfusion chamber while perfused through the portal vein. A total volume of 100 mL of medium was recirculated in the perfusion system. Portal pressure was maintained between 10-15 cmH2.7.For perfusion culture experiments, the recellularized liver was transferred to a clean chamber; part of a perfusion system previously developed for whole-liver perfusion  that con2.8.Perfusion culture medium samples were collected daily and analyzed for albumin content using enzyme linked immunosorbent assay as described previously  using a 2.9.Whole blood was freshly collected from female Lewis retired breeder rats and diluted in fresh PBS (1:1). The unmodified (DLM) or hDLM scaffold was connected to a custom-made perfusion system and perfused with 1:1 diluted blood ex vivo at a flow of 8 mL/min for 2 h. During perfusion, the portal pressure was measured using a water column attached to the inflow and used to estimate the resistance under constant flow. At the end of perfusion, the scaffolds were flushed with PBS, and examined macroscopically and imaged to determine the presence of blood clots that appeared as dark spots. The scaffolds were fixed and processed for histological analysis.2.10.The median lobe of hDLM and DLM scaffolds was resected, recellularized, preconditioned and was subsequently transplanted heterotopically into syngeneic recipient rats. Unmodified DLM, 4BL and 8BL hDLM scaffolds were recellularized with 80 M primary rat hepatocytes and kept in perfusion culture for 24 h prior to transplantation. The engineered grafts were preconditioned with diluted whole blood prior to heterotopic transplantation. Whole blood was freshly collected from female retired breeder Lewis rats and diluted in fresh PBS (1:1) containing heparin (16.67 U/mL). The scaffold was connected to a custom–made perfusion system and perfused with 1:1 diluted blood ex vivo at 8 mL/min for 20 min. In the meantime, the recipient was prepared for transplantation. The abdomen was opened by midline incision and the intestine mobilized to the left, exposing the IHIVC. The right kidney was removed and the IHIVC was cross-clamped proximal and distal to the ligated renal vein over a ± 8–10 mm segment. The graft PV was then anastomosed to the recipient’s proximal IHIVC. Peripheral venous blood return ran from recipient proximal IHIVC and graft PV through the graft and out the graft’s hepatic veins into the graft SHIVC, which was anastomosed to the recipient’s distal IHIVC. Completion of the anastomoses was followed by reperfusion of the graft. After a gross examination of the graft for any evidence of clotting or bleeding, the recipient’s abdomen was closed. Twenty-four hours after surgery, the animals were anesthetized, and the grafts were harvested for histological analysis.2.11.hDLM and unmodified DLM scaffolds were fixed with 10% formalin, embedded in paraffin, and processed for staining with toluidine blue for heparin. Ex vivo blood perfused DLM scaffolds and recellularized liver grafts were fixed with 10% formalin, embedded in paraffin, and processed for staining with hematoxylin and eosin (H&E). Samples were imaged using Nikon Eclipse 800 and SPOT camera .2.12.The statistical analysis of the data was performed using one- or two-way ANOVA and Student’s t-test with a confidence interval of 95%. Errors in figures and text represent standard error of the mean (SEM).3.3.1.A series of heparin-immobilized scaffolds were prepared using layer-by-layer polyelectrolyte self-assembly method to improve DLM scaffold surface hemocompatibility (n=3/group). Heparin/PDADMAC bilayers were deposited via sequential perfusion of the oppositely charged polyelectrolyte solutions through the portal vein of the scaffold . Macrosc3.2.The effect of heparin deposition on in vitro hepatocyte function was evaluated during perfusion culture of recellularized hDLM scaffolds (hDLM-R). Both DLM and hDLM scaffolds were repopulated with 80 million primary adult rat hepatocytes with an initial viability of 90% or higher. The recellularized scaffolds were maintained under perfusion through the portal vein for 5 days with daily medium changes. After 2 d of perfusion culture, histological analysis revealed that the grafts were repopulated with hepatocytes that formed plates around areas resembling vascular spaces, without obstructing the vessels. The cells assumed characteristic polygonal morphology and some of them were binucleated . The morAll recellularized grafts displayed comparable levels of hepatic function as evidenced by the cumulative albumin and urea production over 5 d in perfusion culture . Both th3.3.As a first step towards assessing the potential of hDLM in preventing blood coagulation, we tested the hDLM scaffolds in ex vivo diluted whole blood reperfusion . Flow ra3.4.The potential of recellularized hDLM grafts to extend the survival of recipient animals by delaying blood coagulation was assessed in a heterotopic liver transplantation model. To prime vascular patency pretransplantation, the grafts were preconditioned with diluted whole blood for 20 min. Unmodified, 4BL and 8BL DLM-R grafts (n=3/ group) were transplanted heterotopically in series with the IHIVC of the recipient following a right nephrectomy. The recellularized grafts reperfused with no significant bleeding . Visuall4.Tissue-engineered liver grafts offer the potential to overcome the dramatic shortage of donor livers for transplantation. Previous results have demonstrated that decellularized liver matrices, seeded with primary hepatocytes form a construct with sustained hepatocyte function in perfusion culture . OvercomThe results here show that layer–by–layer assembly of heparin-polyelectrolyte bilayers effectively deposits heparin in DLM, with a higher heparin content as the number of PDADMAC/heparin bilayers and polyelectrolyte concentration increases. Macro– and toluidine blue–stained microscopic analysis demonstrated effective uniform coverage throughout the liver. Heparin immobilization did not negatively impact seeding and function of primary hepatocytes during asanguinous in vitro culture of the recellularized hDLM. Ex vivo diluted whole-blood perfusion was used as a model for reperfusion, allowing controlled examination of thrombogenicity of the grafts. Post-perfusion flush of the (h)DLM allowed for macroscopic demonstration of thrombosis in the graft. 4BL hDLM grafts remained visually thrombogenic, with a similar distribution of clots as in the unmodified DLM, while an increased number of PDADMAC/heparin bilayers (8BL) resulted in a visually clot-free graft. Circulatory obstruction has been shown to lead to increases in vascular resistance during machine perfusion . Higher An incomplete sinusoidal system results in a high resistance of the DLM graft, which is also seen in this work. The transplantation model employed here makes use of venous blood supply; with low–pressure caval venous perfusion forming a concern for satisfactory perfusion of the graft. An important difference between the in vivo and in vitro whole blood perfusion setting, which may underlie the discrepancy between the results, is the flow-driven perfusion in the latter. Achieving adequately low-resistance of the graft and in vivo reperfusion models that allow sufficient perfusion pressures require further optimization. Diluted whole-blood preconditioning by means of ex vivo machine perfusion, as presented here, may facilitate hepatocyte orientation around a patent, albeit immature, microvasculature, reducing resistance and pre-hepatic congestion and improving perfusion. Optimized seeding and endothelialization are also likely to promote microvascular development and have been shown to reduce resistance of the renal graft  and moreIn conclusion, LbL heparin deposition in decellularized liver matrices did not hinder the in vitro perfusion culture of DLM grafts and reduced resistance to ex vivo blood reperfusion with increasing levels of deposited heparin. However, successful transplantation of these constructs, as described in previous reports, was not achieved by this method. Further optimization including endothelialization of the matrix may offer the required hemocompatibility.


It has been reported that use of the free dermal fat graft (FDFG) technique produces a good cosmetic outcome for breast cancer. An FDFG is harvested from the lower abdomen as a columnar-shaped specimen and implanted into the defect of the breast after a partial mastectomy as a volume replacement technique. In this report, two patients who underwent breast-conserving surgery with immediate reconstruction using an autologous FDFG are described in order to show the difference in status between one case with and one without blood flow in the graft. To assess the benefit of this technique using FDFGs, their cosmetic satisfaction was evaluated using a questionnaire, graft shrinkage was measured by CT, and blood flow was assessed using contrast-enhanced ultrasound (CEUS). Both patients scored 10 of 12 points on the questionnaire. After 2 years, shrinkage of the grafts was 21.6 and 25.2 %, respectively. Although one patient had no blood flow in the center of the graft, the other had blood flow from the pectoralis major muscle to the center of the graft. While satisfaction and graft shrinkage were similar in the two patients, one case showed blood flow and had a somewhat softer graft than the other. The graft status was maintained with a good cosmetic outcome for 3 years after breast-conserving surgery with immediate reconstruction using an autologous FDFG, despite mild shrinkage and hardness of the graft. It is notable that blood flow was observed into the graft on CEUS, and more distinct perfusion was seen in the softer graft case after more than 3 years. Currently, breast-conserving surgery (BCS) is a standard technique for early-stage breast cancer. This is because the long-term survival rate among women who undergo BCS is equivalent to the survival outcome in patients who undergo mastectomy , 2. ImmeThe detail of the methods of assessing cosmetic satisfaction using a questionnaire is described below. Cosmetic statements made by the patients were evaluated objectively and subjectively using the method reported by Sawai’s group and supported by the Japanese Breast Cancer Society (JBCS) . This as2. The tumor was seen as a focal asymmetry density on mammography, a 1.8-cm heterogeneously hypoechoic, microlobulated mass on US, and a localized enhanced mass in the early period on magnetic resonance imaging (MRI) in the upper region of her left breast, as shown in the left and center panels of Fig. 99mtechnetium-phytic acid and indigo carmine solution to find the SNs. No metastatic cancer was detected in the three extracted SNs. Immediate reconstruction of the surgical defect was performed using an autologous FDFG from the lower abdomen  was 22.5 kg/mOn the questionnaire, a “good” score (10 of 12 points) was obtained both 6 months and 3 years after the operation; 2 points were lost due to wound scarring and softness of the breast , graft shrinkage (measured by CT), and blood flow (using CEUS) were evaluated to assess the graft 3 years after surgery and postoperative radiotherapy. Two cases that underwent these assessments were described in this report, providing important information given the few previous series.The questionnaire has been commonly used to assess cosmetic statements by patients, as reported by Sawai’s group and supported by the JBCS . In the Both of the present cases had very similar clinical courses, but there was a slight difference in the patients’ comments about “hardness” and in the CEUS findings. While the graft was continuously hard in case 1, it became slightly softer than immediately after the operation and RT in case 2. On the other hand, CEUS was performed to assess the blood flow in the FDFG at over 3 years after the operation in the present two cases. It is noteworthy that CEUS showed two different patterns: blood flow into the graft mainly from the pectoralis major muscle side was observed with persistent enhancement in case 2, while case 1 showed no enhancement. CEUS can detect blood flow more accurately than CT or MRI, because ultrasound contrast media remain within the vasculature . Thus, CIt has been reported that the graft might change to fibrotic tissue and finally shrink due to decreased graft perfusion, and there might be no blood flow in the center, but resumption of blood flow might be seen only in the periphery of the graft , 13. TheGraft status was maintained with a good cosmetic outcome for 3 years by BCS with immediate reconstruction using an autologous FDFG, despite mild shrinkage and hardness of the graft. It is notable that blood flow mainly from the pectoralis major muscle into the graft was observed in the subjectively and objectively softer graft case after more than 3 years.The patients provided informed consent for the publication of this report and any accompanying images.


The following information is missing from the Funding section: AZ was partially supported by a Fogarty International Center AIDS International Training and Research Program grant, National Institutes of Health, to the University of Pittsburgh (D43TW001038).


Pasteurella multocida, a Gram negative bacillus, is a normal oral commensal of many animals. For mankind, it is a pathogenous bacillus which is rarely implicated in vascular grafts.Vascular graft infections are infrequent complications with important morbidity and mortality rates. P. multocida. The patient was successfully treated with a combination of a surgical graft change and a 6 weeks bi-antibiotic therapy.We report hereafter the fourth case introduced in the international literature about vascular graft infections caused by There is fours case reported in litterature with quite different antibiotic drugs and duration.P. multicoda graft infection should be long with initial intravenous drug and mainteance traitement should not be required. Pasteurella multocida is a local cellulitis subsequent to animal scratches or bite wounds. The second pathological form is a pulmonary localization and affects persons close to animals  and Staphylococcus epidermidis (17 %). We noticed here an infection of P. multocida vascular graft after an asymptomatic cat scratch.The incidence of bacterial vascular graft infection is estimated between 0.5–5 % depending of the graft localization, according to a 5 years follow up  remained sterile. In vitro culture indicated that the strain was sensitive to penicillin, third generation cephalosporin, aminoglycosides, cotrimoxazole, fluoroquinolones and fosfomycin. The initial empiric treatment was instituted pre-operative by piperacillin/tazobactam (4 g/500 mg × 4 per day) combined with amikacin (15 mg/kg once a day). It was modified 2 days after according to the bacteriological results by ofloxacine 200 mg × 3 per day combined with cotrimoxazole (800/160 mg) 1cp × 3 per day for 6 weeks. After 7 days of this antibiotic treatment, the patient had no fever anymore and a clean scar without pain or inflammatory signs. From a biological standpoint, there was a regression of hyperleukocytosis (7600 G/L) and a decrease in CRP (54 mg/L). Fifteen days after the surgery, the patient was admitted into a convalescent center. Four weeks after the introduction of antibiotic therapy, she presented a scar division of right scarpa without sign of infection and a good vascularization of the distal lower limb. Laboratory data was returned to normal. Three mouths after surgery, she has still the scar division without any infectious sign.In the emergency department, the clinical examination showed an abscess next to the right scarpa. Pertinent laboratory data on admission included the following polymorphonuclear leukocyte count: 19.550 G/L  and chain reactive protein (CRP) at 211 mg/L . Other biological exams were normal. The contrast enhanced computer tomography scan of the pelvis and leg showed an abscess contracted with the vascular graft without sign of septic perforation , but P. multocida is the most frequently isolated in human pathology. Human infection from bites, scratches or licking damaged skins has mainly a feline (60–80 % of cases) or canine origin (90 % of remaining cases)   (Weber et al. P. multocida has been implicated in lung abscesses, meningitis, brain abscess, but also a few cases of endocarditis. This species can also be grafted on foreign implants. There are several cases reported in the literature mainly orthopedic prosthetic infections but only three published cases are reported for vascular prosthesis infections (Kalish and Sands In human pathology, P. multocida reported in the literature associated with ours (Table In our case, it appeared that the patient owned a cat. She received numerous scratches on exposed parts. During the month before the infectious episode, the patient did not notice a localized cutaneous inflammatory reaction or antibiotics use. The study of three cases of vascular graft infection with rs Table  shows thrs Table  can be crs Table  and an ors Table  and cat rs Table ]. In thers Table  as well rs Table  associatrs Table , with inrs Table  and Kessrs Table , was a prs Table , the toers Table  for severs Table .Table 1MIn this case and the one with Sannela et al. , no deepP. multocida no matter where they are from the scar or material. Then, the antibiotic treatment, such as other bacterial prosthetic infections, should be quite long—mainly 6 weeks—with initial intravenous drug. However the maintenance therapy should not be required. Finally, as few cases have been reported, the use of primary prophylaxis is not significant for all people including those who have animals or prosthesis.When scratch or animal bites are identified, a bacterial graft infection should be suspected with


The aim of this study is to identify, quantify, and characterize the international experiences available for general surgery residents in the general surgery residency programs in the United States (US).The Fellowship and Residency Electronic Interactive Database (FREIDA) database was used to identify all the general surgery residency programs in the US. Each institution was contacted by both e-mail and telephone. Respondents were asked if an international experience was available for residents within their program and, if available, details of the experience were obtained.A total of 253 general surgery residency programs were identified using the FREIDA database. Eighty-six (34 %) programs were noted to offer an international experience for their residents. A majority are incorporated into the PGY 3 and PGY 4 level of training with a duration of 1–4 weeks. Common locations are evenly distributed among the Americas and Africa and are usually funded through a combination of resident and department funding.US resident interest in global health is growing along with an increasing demand for surgical care worldwide. This is one of the first studies to identify, quantify, and characterize in detail the international experiences currently available to general surgery residents within the general surgery training programs in the US. These results can help general surgery residency applicants with an interest in global health and also pave the path for residency programs to develop future international experiences. The number of deaths due to surgical conditions worldwide was estimated to be 16.9 million in 2010 and well exceeded the number of deaths due to HIV/AIDs, tuberculosis, and malaria combined  database was used to preliminarily identify and stratify general surgery residency programs into three groups: programs offering international experiences, programs not offering international experiences, and programs where information regarding international experiences was unavailable  of participation, funding source, amount of time the opportunity has been available to the residents, and resident participation to date. The experiences identified included formal elective rotations, global health tracks, mission trips, and experiences planned during vacation time. Programs with a global health track varied in the experiences provided ranging from a 2 month elective during the fourth year of residency to a 2 year commitment with dedicated time for pursuing a master’s in public health. These programs also had a dedicated curriculum throughout residency training for global health education, mentoring, and project planning. If a program contact person was unaware of specific details, that program not included in the subset analyses. If a program was unable to be reached on first attempt, a follow up phone call was made. If a program was unreachable on second attempt, a voicemail message was left explaining the general focus of the study and requesting a return phone call to a single telephone number.A total of 253 US general surgery residency programs were identified using the FREIDA database. According to the FREIDA database 60 of these programs indicated offering international experiences, 108 did not indicate offering international experiences, and 85 were unknown  while 153 (60 %) did not offer international experiences. There was no response by phone or email for 14 (6 %) programs with an overall response rate of 94 %. The information provided on the FREIDA database was found to be incorrect upon email or telephone confirmation in 24 of the programs surveyed. There were ten false negatives and 14 false positives identified out of the 239 respondents. False negatives were defined as programs listed as not having international experiences on the FREIDA database but found to have such opportunities upon telephone confirmation. False positives were those programs listed as having international experiences on the FREIDA website but were found to not provide this opportunity upon telephone or email interview. Unknown programs were those programs from which a telephone or email response was not obtained and no information regarding international work was available from the FREIDA database.The programs were then separated and evaluated based on geographic regions within the US. Geographic regions were determined according to the National Resident Matching Program assignments. We noted that the highest percentage of programs offering international experiences was in the West region (44 %) followed by the Midwest region 38 %), North East region (33 %), and South region 27 %) respectively . It is worth noting that our study is not without limitations. Program directors and assistants were the main survey participants. A number of these participants stated that they were new to their institution and may not have complete knowledge of the international experiences available to residents in their programs. In addition, there may have been confusion on what qualifies as an international experience. Respondents may not have known about available informal international experiences including week-long experiences or mission trips led by faculty members. In these instances, they may have only answered yes if an official international rotation was available. Mitchell et al.  classifyIn conclusion, this is one of the first studies to attempt to identify, quantify, and characterize international experiences available to general surgery residents within the general surgery residency training programs in the US. In a time of growing demand for surgical care worldwide and an increasing global health interest among US residents, these results will help pave the way for the development of future collaborations between general surgery residency programs and residents interested in providing surgical care abroad. Ultimately, these electives will help to develop well-rounded and globally diverse surgeons who are better able to care for patients of all nationalities both locally and abroad.


Background. Despite the marked advances in the perioperative management of the liver transplant recipient, an assessment of clinically significant graft injury following preservation and reperfusion remains difficult. In this study, we hypothesized that size-adjusted AST could better approximate real AST values and consequently provide a better reflection of the extent of graft damage, with better sensitivity and specificity than current criteria. Methods. We reviewed data on 930 orthotopic liver transplant recipients. Size-adjusted AST (ASTi) was calculated by dividing peak AST by our previously reported index for donor-recipient size mismatch, the BSAi. The predictive value of ASTi of primary nonfunction (PNF) and graft survival was assessed by receiver operating characteristic curve, logistic regression, Kaplan-Meier survival, and Cox proportional hazard model. Results. Size-adjusted peak AST (ASTi) was significantly associated with subsequent occurrence of PNF and graft failure. In our study cohort, the prediction of PNF by the combination of ASTi and PT-INR had a higher sensitivity and specificity compared to current UNOS criteria. Conclusions. We conclude that size-adjusted AST (ASTi) is a simple, reproducible, and sensitive marker of clinically significant graft damage. Despite the marked advances in the perioperative management of the liver transplant recipient, an assessment of clinically significant graft injury following preservation and reperfusion remains difficult . The lacWe have previously reported on the use of the ratio of donor to recipient body surface area (BSAi) to predict donor-recipient graft size mismatch , 9. We sIn this study, we hypothesized that serum AST when adjusted by the ratio of the donor-to-recipient body surface area (ASTi) could more accurately approximate the true mass of injured hepatocytes than the uncorrected or absolute peak AST, subsequently providing a more precise assessment of graft fate. In order to test this hypothesis, we conducted a study to investigate the sensitivity and specificity of ASTi versus absolute peak AST to predict PNF and graft survival in a large cohort of postliver transplant patients.After institutional review board approval, primary retrospective data collection was from patient records who underwent whole orthotopic liver transplantation (LT) from January 2002 to March 2008 at our institution . We were interested in the effect of size-matched peak AST (ASTi) on postoperative outcomes. Therefore, among all transplant recipients, we excluded those who underwent split or partial LT as well as those who underwent simultaneous other organ transplantation, such as liver-kidney, liver-heart, liver-intestine, or multivisceral transplantation or live donor LT. The donor risk index was calculated without height . We usedStatistical Analysis. Primary nonfunction (PNF) of liver graft is the most detrimental condition after transplantation. We defined PNF as retransplantation within 7 days without vascular thrombosis. UNOS suggests the listing criteria for recipients with PNF as an AST ≥3,000 and a PT-INR ≥2.5 or acidosis pH ≤7.30 , pH ≤7.25 (venous), and/or lactate ≥4 mMol/L or anhepatic candidate within 7 days after implantation of a graft [P values are two-sided, and P values of less than 0.05 were considered to indicate statistical significance.The logistic regression model was used to describe the association between seven study groups differentiated by ranges of ASTi and the incidence of PNF. The patient group with ASTi <1,000 was used as a reference group. All recipient and donor variables were included in the multivariable model. To assess the independence of ASTi effect on PNF, a backward conditional elimination procedure was then undertaken using the donor and recipient demographic factors. Cox proportional-hazards models were used to examine the association between seven study groups differentiated by ranges of ASTi and graft survival; data were censored at the time of the last visit or patient death. One-year graft survival was used to assess the short- and mid-term effect of ASTi. All recipient and donor variables were included in the multivariable model. Covariates were analyzed by using a backward conditional method with the donor and recipient demographic factors. Kaplan-Meier survival analysis with generalized Wilcoxon analysis was used to assess the difference in graft survival between ASTi ≥3,500 and ASTi <3,500. SPSS statistics version 17.0  and Intercooled STATA statistics version 11.0  were used for statistical analysis and all reported A total of 930 whole LT procedures performed from January 2002 to March 2008 were reviewed in this study. 717 out of 930 consecutive whole OLT performed from January 2002 to March 2008 were included in this study. A total of 213 patients were ultimately excluded from the analysis for the following reasons: live donor LT (1 case), split LT (24 cases), auxiliary partial LT , fulminant hepatic failure (14 cases), and simultaneous other organ transplants (55 cases) as well as missing data (113 cases).Baseline Characteristics. The base-line characteristics of the recipients and donors of LT are summarized in Scatter Plot between AST and ASTi with or without Subsequent Development of PNF.Prediction of PNF by AST and ASTi. A receiver-operating-characteristic (ROC) curve for AST and adjusted AST (ASTi) at risk for PNF is shown in Cases with Different Predictive Results for PNF between Conventional UNOS Criteria and ASTi Criteria. Improvement of prediction for PNF was further assessed by a case-by-case comparison of results between conventional UNOS criteria and ASTi criteria . If ASTi was greater than 2,000 IU/L, there was an exponential increase of hazard risk ratio for PNF along with increased ASTi. on model . A logisPredictive Value of ASTi for One-Year Graft Survival in the Cox Proportional Hazard Model. Predictive value of different ASTi cutoffs for one-year graft survival was analyzed with Cox proportional hazard model (P = 0.00012). If ASTi is greater than 3,500 IU/L, there is an exponential increase of hazard risk ratio for PNF along with increased ASTi. rd model . A Cox pComparison of One-Year Graft Survival in Patients with ASTi ≥3,500 IU/L and ASTi <3,500 IU/L. Because ASTi had significant impact on one-year graft survival, we divided our study cohort into two groups: ASTi ≥3,500 IU/L and ASTi <3,500 IU/L. Then graft survival was compared by Kaplan-Meier survival analysis with generalized Wilcoxon analysis. Kaplan-Meier survival analysis showed the probability of the primary graft outcome among patients who had a peak-adjusted AST (ASTi) of greater than 3,500 IU/L along with those who had an ASTi of less than 3,500 IU/L (P = 0.004).500 IU/L . The graDespite the significant advances in the management of the liver transplant (LT) recipient, the quantitative assessment of graft damage remains uncertain . Acute iCurrently, in LT practice posttransplant peak AST is the most widely accepted clinical markers of graft damage. UNOS defines PNF mainly based on the posttransplant peak AST . AST is Indeed, the results of this study prove that the size-adjusted peak AST (ASTi) has higher sensitivity and specificity to predict PNF compared to size-unadjusted AST. Currently UNOS suggests for relisting criteria of recipients with PNF as AST ≥3,000 IU/L and either (a) INR ≥2.5 or arterial pH ≤7.30 or venous pH ≤7.25 and/or lactate ≥4mmol/L, (b) anhepatic patient within 7 days after transplantation [BSAi appears to be a powerful tool to detect donor-recipient size mismatch in cadaveric LT but awaits further validation. Small-for-size or large-for-size grafts not only have been attributed to decreased graft survival, increased additional graft usage (retransplantation), and increased incidence of other complications but also have made an assessment of posttransplant graft injury difficult. This study has demonstrated that size mismatch may have an even greater negative impact on graft outcome in the presence of other donor risk factors, such as prolonged cold ischemia. Furthermore, the lack of a suitable clinical measure to reliably predict size mismatch has probably hindered our ability to judge its clinical importance in cadaveric LT. BSAi provides a simple, reproducible, and sensitive way of detecting size mismatch in cadaveric LT.We are aware that our study has some limitations. The primary limitation of this study is its retrospective nature. Second, fluid excess (ascites and edema) is universal in end-stage liver disease. Fluid excess causes weight-to-height parameters such as percentage ideal body weight, BMI, and BSA to be underestimated, and the BSA of the recipient may not accurately reflect the liver volume in these situations. These discrepancies will be carried over to the calculations of ASTi. Alternative ways to more accurately detect size disparity may be (i) measuring the donor graft weight at back table or (ii) using the recipient's dry weight instead of recipient BSA. However, we believe that ASTi is a simple, reproducible, and sensitive predictor of graft outcome associated with size mismatch. Third, adjustment of postoperative liver enzyme by BSAi requires some caution. The liver has the excellent regenerative capacity even in the face of significant loss of hepatocyte mass. This has been demonstrated after liver resection or traumatic hepatic injury , 15. OncWe conclude that the ASTi appears to be a sensitive predictor of postoperative liver graft injury in the early postoperative period. Despite some shortcomings, we believe our analysis shows that the ASTi may provide significantly better prediction of size mismatch-related graft dysfunction in LT. Finally, we believe that ASTi should be considered in the early identification of graft dysfunction or PNF and should be validated in a prospective study to see whether it accurately and consistently predicts PNF or graft function and reduces posttransplant mortality.


Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction. Anterior cruciate ligament (ACL) reconstruction with a tendon graft fixed by interference screws to bone tunnels is the most broadly accepted procedure for young and active patients who experience ACL tears in modern sports1357Graft failure in the initial phase of rehabilitation is commonly related to complicated biological and biomechanical changes in the transformation from tendon grafts into a newly functional ACL. The major histological changes are extended necrosis, collagen degradation and an influx of inflammatory cells in the center of the graft10in vivo. Ezechieli et al.Magnesium (Mg) materials have recently been the focus of biodegradable implants in musculoskeletal tissuesThe purpose of this study was to investigate the application of Mg interference screws in ACL reconstruction. We hypothesized that the novel interference screw could inhibit graft degradation, promote tendon-bone healing and provide rigid fixation of the tendon graft in the early phase after ACL reconstruction. In the present study, high-purity magnesium (HP Mg) screws were used to fix semitendinosus autografts in a rabbit model of ACL reconstruction with pure titanium (Ti) screws as the control. The influence of Mg screws on graft degradation and the related mechanism was elucidated as well as the corrosion behaviors of Mg screws in the early phase of tendon-graft healing.All rabbits returned to daily activity following ACL reconstruction surgery. The surgical intervention and implanted devices were well tolerated with no sepsis, emphysema or wound dehiscence. Moreover, there was no obvious articular degeneration or synovitis surrounding the bone tunnel .The biomechanical properties of the reconstructed ACL were reflected in the pull-out tests as in All tendon graft failed by direct pull-out from the femoral tunnel at 0 week. And the HP Mg screw and the Ti screw kept in original position during the pulling-out tests. At this time point, the average ultimate load to failure and stiffness of the Mg group was similar to the Ti group, which was 116 ± 7.2 N and 26.2 ± 3.5 N/mm, respectively. It indicated that initial fixation strength provided by the HP Mg screw was comparable to the Ti screw.The insertion site of tendon graft appeared to be the weak link of the reconstruction at three weeks. Tendon graft failed by interligamentous ruptures at the portion close to the screw cap, which might be caused by cumulative tissue damage at the screw edge under cyclical loading of daily activities. The ultimate load to failure and the related stiffness of both groups significantly decreased, which elucidated the high morbidity of graft failure during early rehabilitation. At this time point, the ultimate load to failure and stiffness of the Mg group  were significantly higher than that of the Ti group .Direct interference screw fixation of tendon graft with HP Mg screws additionally alters the mechanical properties during its early remodeling, as both the Mg group and the Ti group exhibited an increase in the ultimate load to failure and related stiffness at six weeks. And the midsubstance portion of the graft close to the screw cap represents the weak link. Furthremore, the Mg group remained superior to the Ti group (p < 0.05). The increase in the biomechanical properties of the tendon graft continued at nine weeks, when there was no significant difference detected between two groups. So we concluded that the initial mehcanical strength provided by the HP Mg screw was comparable to the Ti screw, furthermore, the biomechanical properties of tendon graft fixed by the HP Mg screw was superior to that by the Ti screw during the early phase of graft healing. From the biomechanical tests, we found that direct fixation with HP Mg interference screw could withstand unrestricted motion and full loads in the rabbit model, and reconstructed ACLs performed good biomechanical properties.in vivo behavior of HP Mg screws was assessed via high resolution microCT. Nine weeks after surgery, both the HP Mg screw and Ti screw were deployed at the original position without displacement or loosening  and Ti screws  were supplied by Suzhou Origin Medical Technology Co. Ltd., China. As shown in The animal experiments were approved by the Animal Care and Experiment Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. All experimental protocols were conformed to the Guide for the Care and Use of Laboratory Animals . The ACL reconstruction surgery was performed on the right leg of 60 skeletally matured, male, New Zealand white rabbits. In brief, following exposure of the knee joint space through medial parapatella arthrotomy, the original ACL was completely transected. The semitendinosus was subsequently freed from the proximal end. With the rabbit knee in 45° flexion, a bone tunnel with a diameter of 2.1 mm was drilled through the tibia to the femoral condyle as shown in Following recovery from anesthesia, the rabbits were maintained in individual cages and allowed to eat and drink ad libitum. Antibiotic (Amoxicillin 150 mg/10 kg weight) was subcutaneously administered for three days. The wound healing process and daily activities after surgery were recorded during the experimental period.Three, six and nine weeks after surgery, the rabbits were killed. Femur-tendon graft-tibia complexes were harvested with 60 mm of femur and 60 mm of tibia. Soft tissues adjacent to the tendon graft were clearly removed. Gross observation was performed regarding articular degeneration and tendon graft incorporation on the articular surface.For the biomechanical properties of the femur-tendon graft-tibia complexes, pull-out tests were conducted at zero, three, six and nine weeks following surgery. The left leg of the rabbit model was performed ACL reconstruction surgery immediately following euthanasia and was used as the 0 week group in the biomechanical tests. Two bone ends of the femur-tendon graft-tibia complex were fixed in a Zwick materials testing machine  using inserted pins . The axiMicroCT scanning of the femur-tendon graft-tibia complexes was conducted at three, six and nine weeks post-surgery. The MicroCT device  was set as follows: 80 kV and 450 μA in the X-ray tube, a scan resolution of 45 μm and an exposure time of 400 ms. The volume of the P Mg screw was analyzed using Micro View 2.2 Advanced Bone Analysis Application software . The percentage volume change (Δv) was calculated as the difference between the initial volume (v0) and the final volume (v1):Three samples were scanned for each type of interference screw, with an average of three times per sample.Following fixation in 4% neutral buffered formalin for 48 hours, the femur-tendon graft-tibia complex fixed by an HP Mg screw and Ti screw was decalcified in 9% formic acid for nine weeks at room temperaturesThe graft degradation was determined by the relative collagen fiber area at the tendon-bone interface. The range of interest (ROI) was localized at the entrance of the femoral tunnel, where the tendon graft was fixed by the screw. The calculation were performed using Image-Pro Plus 6.0  according to a previous studyet al.The immunohistochemical staining of matrix metalloproteinase-13 (MMP-13) and Collagen II was performed as subsequently described. In brief, consecutive sections were dewaxed in xylene and then rehydrated through a series of graded alcohols. The endogenous peroxidase activity was subsequently quenched with 0.3% hydrogen peroxide for 10 minutes. After blocking with 1% goat serum (Sigma) (1:100 dilution), the sections were incubated with primary antibodies against MMP-13  and Collagen II  overnight at 4 °C. Following washing in PBS, the sections were incubated in secondary antibody for 1 h at 37 °C. The staining was developed in 3,3′-diaminobenzidine (DAB) solution  with hematoxylin counterstaining. Immunohistochemical analysis of the stained sections was subsequently performed under optical microscopy at ×40. The semi-quantitative scoring of the immunohistochemical sections was also measured using an image analyzer  and a five-grade scoring system  adopted All data are presented as the means ± standard deviations. Statistical analysis was performed using the SPSS 17.0 software package . T-tests determined the level of significance in the differences, and p values less than 0.05 and 0.01 were considered significant and highly significant, respectively.How to cite this article: Cheng, P. et al. Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction. Sci. Rep.6, 26434; doi: 10.1038/srep26434 (2016).


Journal of Otolaryngology - Head & Neck Surgery would like to thank all our reviewers who have contributed to the journal in Volume 43 (2014).The Editors of  Peter AdamsonCanadaSumit AgrawalCanadaYaser AlrajhiCanadaJennifer AndersonCanadaDon AndersonCanadaKal AnsariCanadaMargaret AronCanadaRick BalysCanadaSarfaraz BanglawalaCanadaVincent BironCanadaBrian BlakleyCanadaNikolas BlevinsUSAJames BonaparteCanadaMichael BrandtCanadaMartin BullockCanadaMarie BussieresCanadaNeil ChadhaCanadaYvonne ChanCanadaShamir ChandaranaCanadaJustin ChauCanadaGabriela ConstantinescuCanadaDavid CoteCanadaSam DanielCanadaChris DiamondCanadaDominique DorionCanadaJoseph DortCanadaJaymi DumperCanadaHamdy El-HakimCanadaDanny EnepekidesCanadaJeremy FreemanCanadaKevin FungCanadaRichard GallCanadaNahla GomaaCanadaMenachem GrossIsraelTrevor HartlCanadaEric HenryCanadaMichael HierCanadaOmar HilmiUnited KingdomAllan HoCanadaJordan HochmanCanadaPaul HongCanadaCaroline JefferyCanadaLiane JohnsonCanadaJodi JonesCanadaPaul KerrCanadaSafeena KheraniCanadaHaytham KubbaUnited KingdomFrançois LavigneCanadaJane LeaCanadaJohn LeeCanadaBoyd LeeCanadaDarren LeitaoCanadaWei LiUSAVincent LinCanadaKristian MacdonaldCanadaEmad MassoudCanadaLaurie McLeanCanadaDeepak MehtaUSAAdrian MendezCanadaPaul MickCanadaAlex MlynarekCanadaCorey MooreCanadaSharon MorongCanadaDavid MorrisCanadaLily HP NguyenCanadaAnthony NicholsCanadaDesmond NunezCanadaDan O'ConnellCanadaHeather OsbornCanadaFlordeliz OslerCanadaRichard PayneCanadaEvan PropstCanadaKeith RichardsonCanadaMatthew RigbyCanadaBrian RotenbergCanadaKathryn RothCanadaLuke RudmikCanadaIssam SalibaCanadaMark SamahaCanadaJulian SavageCanadaDavid SchrammCanadaAnil SharmaCanadaPraby SinghUSASue Rene SoonSingaporeLeigh SowerbyCanadaPeter SpaffordCanadaChris SzetoCanadaGeorge TavartkiladzeRussiaMark TaylorCanadaJamie TibboCanadaJonathan TritesCanadaTrina UwieraCanadaJean-Philippe VaccaniCanadaAllan VescanCanadaScott WeichenthalCanadaManisha WitmansCanadaAnthony ZeitouniCanada