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Surgical resection represents the only potentially curative therapy for patients with pancreatic adenocarcinoma (PDAC), an aggressive malignancy with a very limited 5-year survival rate. However, even after complete tumor resection, many patients are still facing an unfavorable prognosis underlining the need for better preoperative stratification algorithms. Here, we explored the role of the secreted glycoprotein soluble urokinase plasminogen activator receptor (suPAR) as a novel circulating biomarker for patients undergoing resection of PDAC. Serum levels of suPAR were measured by enzyme-linked immunosorbent assay (ELISA) in an exploratory as well as a validation cohort comprising a total of 127 PDAC patients and 75 healthy controls. Correlating with a cytoplasmic immunohistochemical expression of uPAR in PDAC tumor cells, serum levels of suPAR were significantly elevated in PDAC patients compared to healthy controls and patient with PDAC precursor lesions. Importantly, patients with high preoperative suPAR levels above a calculated cutoff value of 5.956 ng/ml showed a significantly reduced overall survival after tumor resection. The prognostic role of suPAR was further corroborated by uni- and multivariate Cox-regression analyses including parameters of systemic inflammation, liver and kidney function as well as clinico-pathological patients' characteristics. Moreover, high baseline suPAR levels identified those patients particularly susceptible to acute kidney injury and surgical complications after surgery. In conclusion, our data suggest that circulating suPAR represents a novel prognostic marker in PDAC patients undergoing tumor resection that might be a useful addition to existing preoperative stratification algorithms for identifying patients that particularly benefit from extended tumor resection., (© The Author(s) 2019. Published by Oxford University Press.)

Introduction: Anastomotic failure is one of the most frequent complications in abdominal surgery. During anastomotic healing. the strength of the intestinal tissue nearby is closely related to the accumulation of collagen in interlinked scar tissue. This in turn is influenced, among other things, by single groups of matrixmetalloproteinases, especially collagenases (MMP-1, -8, and -13) and gelatinases (MMP-2 and -9). EPO is known to induce the expression of tissue-inhibitor-of-matrixmetalloproteinases-1 (TIMP-1) and thereby to down-regulate MMPs., Materials and Methods: We used a rat as an experimental model and applied a high dose of EPO (5U/g BW s.c.), one dose 24 h before operation (as pre-conditioning) and one dose directly after performing a colonic anastomosis. After 3 and after 5 d, respectively, immunohistochemical stainings for MMP-2, -8, and -9 as well as TIMP-1 were carried out and evaluated semiquantitatively for each layer of the colonic wall. Sirius-red staining and cross-polarization microscopy were evaluated and the collagen I/III ratio calculated. Anastomotic and colonic tissue distal to the anastomosis were used to determine collagen content., Results: We found increased bursting pressure 5 d post-surgery after applying erythropoietin. It was thus shown that EPO influences collagen metabolism and changes the collagen I/III ratio in the colon distal to the anastomosis. The evaluation of immunohistochemistry did not show the expected ubiquitous up-regulation of TIMP-1 and down-regulation of MMPs. Nevertheless, correlations between TIMP-1, MMP-8, and collagen I/III ratio could only be established after the application of EPO., Conclusion: Contrary to our hypothesis, the picture of TIMP-1 and of the regulation of the MMPs after the application of EPO is not as clear as expected. EPO improves anastomotic bursting strength and the correlation of TIMP-1, MMP-8, and collagen type I/III ratio can only be seen after the application of EPO., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Surgical treatment of stress urinary incontinence changed dramatically with the introduction of the tension-free vaginal tape. Owing to its high efficacy and minimal patient discomfort this new minimally invasive procedure quickly obtained widespread acceptance and superseded the abdominal colposuspension as the gold standard. In the course of success of the original method a number of tension-free vaginal tapes flooded the market, varying in approach and material. These variations may strongly influence the safety, efficacy and long-term results of tension-free vaginal tape and its major modification, the transobturator technique. Therefore, it is the aim of this review to closely illuminate available materials and complications associated with this procedure. An extensive Medline search of the published literature up until 2006 on the subject of stress urinary incontinence was carried out. All sources identified were reviewed with particular attention to the method applied, the properties of the mesh materials and clinical complications. Apart from several technical variations, there are marked differences between the different vaginal sling materials, ranging from absorbable collagens over polypropylene to allografts. Although performed globally in substantial and increasing numbers, minimally invasive techniques for the surgical treatment of stress urinary incontinence are lacking sufficient safety data.