Gender differences in trauma,shock and sepsis

Despite efforts in prevention and intensive care, trauma and subsequent sepsis are still associated with a high mortality rate. Traumatic injury remains the main cause of death in people younger than 45 years and is thus a source of immense social and economic burden. In recent years, the knowledge concerning gender medicine has continuously increased. A number of studies have reported gender dimorphism in terms of response to trauma, shock and sepsis.However, the advantageous outcome following trauma-hemorrhage in females is not due only to sex. Rather, it is due to the prevailing hormonal milieu of the victim. In this respect, various experimental and clinical studies have demonstrated beneficial effects of estrogen for the central nervous system, the cardiopulmonary system, the liver, the kidneys, the immune system, and for the overall survival of the host. Nonetheless, there remains a gap between the bench and the bedside. This is most likely because clinical studies have not accounted for the estrus cycle. This review attempts to provide an overview of the current level of knowledge and highlights the most important organ systems responding to trauma, shock and sepsis. There continues to be a need for clinical studies on the prevailing hormonal milieu following trauma, shock and sepsis.

Radioembolization for neuroendocrine liver metastases is safe and effective prior to major hepatic resection

Background:Radioembolization(RE)is well established in the treatment of neuroendocrine liver metastases.However surgery is rarely performed after RE,although liver resection is the gold standard in the treatment of localized neuroendocrine liver metastases.Therefore,aim of the present study was to evaluate the safety and feasibility of liver resection after RE in a homogenous cohort.Methods:From a prospective surgical(n=494)and nuclear medical(n=138)database patients with NELM who underwent liver resection and/or RE were evaluated.Between September 2011 and December 2017 eight patients could be identified who underwent liver resection after RE(mean therapeutic activity of 1,746 Mbq).Overall and progression free survival were evaluated as well as epidemiological and perioperative factors.The surgical specimens were analyzed for necrosis,fibrosis,inflammation,and steatosis.Results:The mean hepatic tumor load of patients,who had liver surgery after RE,was 31.4%with a mean Ki-67 proliferation index of 5.9%.The majority of these patients(7/8)received whole liver RE prior to liver resection,which did not increase morbidity and mortality compared to a surgical collective.Indications for RE were oncological(6/8)or carcinoid syndrome associated reasons(2/8).Mean overall survival was 25.1 months after RE and subsequent surgery.Tumor necrosis in radioembolized lesions was 29.4%without evidence of fibrosis and inflammation in hepatic tissue.Conclusions:This is the first study analyzing the multimodal therapeutic approach of liver resection following whole liver RE.This treatment algorithm is safe,does not lead to an increased morbidity and is associated with a favorable oncological outcome.Nonetheless,patient selection remains a key issue.