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Zurab Kakabadze is a Head of Department of Clinical Anatomy at the Tbilisi State Medical University. He is also a President of International Society of Regenerative Medicine & Biomedical Innovation. His research has received extramural funding with publication of results in prestigious international journals.
We report a new method of creating bioengineered liver as an intracorporeal assist device from the combination of decellularized cow placentome and liver tissue microfragments. For the decellularization of cow placentome sodium dodecyl sulfate and 1% triton X-100 were used. After decellularization, three-dimensional scaffolds were filled with autologous liver microfragments. As the study objects, 30 rats were used. Prior to transplantation of liver assist device, all animals were subjected to 75% hepatectomy. The inclusion of liver assist device in porto-carval blood flow using microsurgical techniqes was performed. The maximum observation period for animals were three months. The transplantation of liver assit device containing autologous tissue rescured rats in extended partial hepatectomy-induced acute liver failure. This rescue concerned amelioration of injury and induction of regeneration in native liver. Transplanted liver micro fragments in the 3-D scaffold of cow placenotme formed the homogeneous tissue, which visually does not differ from the normal liver parechyma. Cellular composition of the transplanted liver fragments did not have signs of disorganization, steatosis or bile accumulation. A 3-D scaffold of the cow placentome containing vascular pedicle and rich vascular network has many characteristics that are desirable for a biomaterial and it can be successfully used as a matrix for creation of bio-engineered liver or assist device.
Title: A clinical trial report of autologous bone marrow stem cell transplantation in patients with spinal cord injury
Konstantine Chutkerashvili is a neurosurgeon at Innova Medical Center, Head of scientific direction at Georgian Young Neurosurgeons Association and Director Anatomical research and skills are the Center at Tbilisi State Medical University.
Spinal cord injury is a severe and a very common neurological condition. Stem cell transplantation has emerged as a viable cell therapy option with great potential for restoring neurological function lost following spinal cord injury. A total of 18 patients, with complete motor deficits and paraplegia caused by thoracic and lumbar spine trauma without muscle atrophy or psychiatric problems, were included into this study. The patients have undergone the treatment at the Innova Medical Clinic, Georgia. All patients have completed and signed informed consent prior to autologous bone marrow-derived mesenchymal stem cell transplantation. The bone marrow was aspirated from the anterior iliac crest under local anesthesia and the mononuclear fraction was isolated by density gradient method. At least 750 million mononuclear-enriched cells, suspended in 2 mL of saline, were infused intrathecally. Analysis of subsequent treatment results indicated significant improvements in sensory, motor and autonomic nerve function as assessed by the American Spinal Injury Association's impairment scale. However, despite achieving the positive preliminary results, for the successful application of the bone marrow stem cells in the clinical practice, it is necessary to perform more detailed examinations to evaluate the long-term outcomes of bone marrow stem cells in the patients with spinal cord injury.
Title: Closed thoracic bypass between the internal mammary artery and the coronary artery to the beating heart by means of minimally invasive surgery
Nelson Rene Torales is a general surgeon, inventor and researcher who work at the Hospital Central Formosa Argentina. He is specialist in General Surgery (MAAC), Phlebology and Lymphology (UNE) and Clinical and healthcare effectiveness (UBA and Harvard University).
At the level of morbidity and mortality in the United States of America, the number of adults with a diagnosis of heart disease is 28.4 million patients, which in percentages of adults diagnosed with heart disease: 17.7% of the population of the adult population. The coronary disease is the first cause of death. Of this percentage, it is more frequent in men (7.2%) than in women (4.3%) and that there is a predominance of coronary disease in people over 45 years of age. Thinking about the group of patients to whom we are going to propose a better quality of life, most patients have some type of medical coverage, which is encouraging in terms of the improvements that can be achieved in health policies. Bypass or coronary artery bypass is the most important surgical technique to treat acute myocardial infarction and angina pectoris in the last 50 years. Currently more than 415,000 people undergo myocardial revascularization surgery or coronary bypass surgery every year in the United States, according to data from the Center for Disease Control (CDC). The purpose of this study project is to propose a minimally invasive procedure to perform a coronary bypass, which is reproducible and accessible to the entire population of the USA, in comparison with current surgical methods. Methodology and theoretical orientation: it is a prospective study, which is in the prototype phase (figure 1). Results: At the level of laboratory tests in bioengineering has promising results for the realization of an anastomosis. Conclusions: Minimally invasive surgery is a fact in all surgical pathologies, what was previously impossible is not so.
David Chakhunashvili is an Assistant Professor at Tbilisi State Medical University and specialist at National Center for Disease Control & Public Health, Georgia. He has his expertise in innovative research studies and devotion in improving the health for the patients throughout the world.
One of the most challenging problems in hepatology is the treatment of patients with decompensated liver cirrhosis. In this study, we present data of phase I clinical trial in 34 patients with advanced decompensated liver cirrhosis, caused by chronic viral hepatitis C, and were treated with bone marrow cells (BMCs). All patients signed a written informed consent. For treatment, 100 mL of bone marrow was aspirated from the anterior iliac crest and mononuclear cells were isolated by Ficoll Paque Plus or Ficoll Paque Premium solution. At least 2.5x106 of mononuclear-enriched BMCs were infused into the hepatic artery of the patients through endovascular catheter, using the routine technique similar to arterial chemoembolization of liver tumors. All procedures were performed without any specific side effects or complications except for mild pain in the anterior iliac crest region and mild pain at the sites of bone marrow puncture. By the end of follow-up, the liver function tests of all patients have been improved. The follow-up visits were scheduled for 12 months after transplantation. The transplantation of BMCs in the patients with decompensated liver cirrhosis is promising, because it can improve the condition of the patients and become a bridge to the liver transplantation.
Oral Session 1:
- General Surgery | Transplantation Surgery
Tbilisi State Medical University , Georgia
Robert L. Cucin
Biosculpture Technology.Inc, United States
Title: Total gastrectomy with pancreatosplenectomy and D3 lymph node dissection for advanced gastric cancer invading adjacent organs
Merab Janelidze is a general surgeon at the Western Regional Center for Modern Medical Technologies, Georgian National University. His main interest is the abdominal surgical oncology and organ transplantation.
We report 3 cases of emergency total gastrectomy associated with bleeding and hemorrhagic shock which was caused by gastric adenocarcinoma. A 55 year old woman and two men aged 57 and 61 respectively were admitted to our hospital because of massive hematemesis. There was a stomach cancer invasion in the spleen and the pancreas body in all three cases. The following emergency surgery was performed: total gastrectomy, esophagoenterostomy, pancreatico-jejunal anastomosis with invaginating method that was developed by us, hepaticoenterostomy, D3 lymph node dissection and Braun enteroenterostomy. Postoperative adjuvant chemotherapy is usually prescribed to improve the survival of patients. The follow-up period was two years. Survival benefit of surgery in advanced gastric cancer is still unclear. Subsequently, total gastrectomy with pancreatosplenectomy and D3 lymph node dissection remains the only curative therapy for patients with bleeding and hemorrhagic shock developed after gastric cancer with adjacent organs invasion.
Diletta Trojan is director and quality manager and research activities at Department of Clinical Anatomy at Fondazione Banca dei Tessuti di Treviso Piazzale Ospedale. Her research field is: Colon cancer research, mouse models and Genetic tests.
Treviso Tissue Bank Foundation (FBTV) is a multitissue bank committed in the retrieval, processing and distribution of musculoskeletal, cardiovascular tissues and amniotic membrane (Fig.1). FBTV is accredited by the National Transplant Centre of Italy and follows its requirements. Every year, FBTV distributes almost 6 thousand tissues, mostly musculoskeletal tissues and cardiovascular tissues. Clinical results of the use of homologous tissues in surgery have been reported in literature by FBTV. For example, although experience in bone allografts dates back about twenty-five years in the maxillofacial field, FBTV in collaboration with maxillofacial surgeons collected the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone in 483 patients. Moreover, we demonstrated that the use of cryopreserved allografts from cadaveric donors is a valid surgical strategy to restore function of a damaged nerve without the need for any immunosuppressive treatments. In the last years there has been an increase in the use of human amniotic membrane (HAM) in surgery. HAM is historically used in ophthalmology and for the treatment of burns or chronic ulcers with positive outcomes. Thanks to its regenerative, anti-inflammatory, anti-immunogenic properties, HAM has been successfully applied in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) to facilitate the wound healing process after surgical debridement of the bone. Another application of HAM in maxillofacial surgery is its positioning within the intra-articular space resulting from an arthroplasty intervention. In neurosurgery, HAM has been used as a dural substitute for the repair of spinal dysraphism in newborns. HAM proved its efficacy in restoring the dural sac integrity without complications. Recent studies are the successful applications of HAM for palatal reconstruction in patients with gingival recessions and in general surgery, in particular the implantation of HAM over surgical anastomosis.
Title: Use of acellular human amniotic membrane to repair large pharyngocutaneous fistulae developing after radiotherapy and total laryngectomy
Lika Karalashvili is a dentist and a scientist at Department of Clinical Anatomy at Tbilisi State Medical University whose research field is the application of bioengineering methods in dentistry.
The purpose of this study was to evaluate the outcomes of surgery involving the use of decellularized human amniotic membrane to repair large pharyngocutaneous fistulae developing after radiotherapy and total laryngectomy. A total of 67 patients with laryngeal squamous cell carcinoma were retrospectively analyzed after treatment in a prospective trial. After preoperative chemotherapy, radiotherapy, and total or extended laryngectomy, primary wound healing occurred in 42 (62.7%) patients. Pharyngocutaneous fistula has been developed in 8 (11.9%) patients. Human amniotic membrane grafts that were obtained through the decellularization method were used to repair the fistulas. The average time for full healing of the wound in all patients after transplantation of these grafts was 14-18 days. After 3 months of follow-up, none of the patients had fistula recurrence or stricture development. The human amniotic graft is very reliable and is well-suited for repairing pharyngocutaneous fistula.
Denver Khoo completed his Bachelor of Science, and Bachelor of Medicine, Bachelor of Surgery at the University of Queensland, Australia. He is an associate lecturer at this institution with a special interest in medical education.
Nipple-areola complex reconstruction is a common procedure that often accompanies breast reconstruction. Historically, local skin flaps were utilized for nipple reconstruction, with more recent techniques exploring the addition of implanted material. Tissue engineering and regenerative medicine (TE&RM) represents a potential source of stable and biocompatible implantable tissue which may have a positive effect on cosmetic outcomes. Conventional TE&RM techniques involve seeding a scaffold with the patients’ own cells and using growth factors to promote survival. The clinical applicability of these techniques is limited by its cost and ability to produce sufficient volumes of viable tissue. This article reviews the evolution of nipple reconstruction techniques and current TE&RM protocols; these two fields are then combined to propose a novel approach of using TE&RM scaffolds to augment conventional nipple reconstruction.