Human pluripotent embryonic stem (ES) cells have important potential in regenerative medicine and as models for human preimplantation development; however, debate continues over whether embryos should be destroyed to produce human ES cells. We have derived four ES cell lines on mouse embryonic fibroblast cells in medium supplemented with basic fibroblast growth factor, human recombinant leukemia inhibitory factor, and fetal bovine serum. The source of these cell lines was poor-quality embryos that in the course of routine clinical practice would have been discarded. After continuous proliferation in vitro for more than 12 months, these ES cell lines maintained their developmental potential to form trophoblast and somatic cells, including cardiac muscle and neuronal tissue.

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Human embryonic stem cells (ESCs) have generated enormous interest due to their ability to self-renew and produce many different cell types. In conjunction with microarray technology, human ESCs provide a powerful tool for employing a systems-based approach to deciphering the molecular mechanisms that control pluripotency and early development. Recent work has focused on defining "stemness" and pluripotency based on different experimental and analytical approaches in both mouse and human ESCs. Using a mixed linear model statistical approach, we report a stringent direct comparison between data sets obtained from two human ESCs (BG01 and H1) in order to obtain a list of genes that are enriched in ESCs. In addition, we used another pluripotent population derived from BG01 ESCs to obtain a list of genes that we consider important to the maintenance of pluripotency. A total of 133 genes overlapped between the three pluripotent populations. A majority of the 133 genes were classified under the key functional categories of cell-cycle regulation, signaling, and regulation of transcription. Key genes expressed were Oct4, Sox2, LeftyA, and Fgf2. Also found to be enriched in all three populations is FLJ10713, a gene encoding a hypothetical protein of unknown function that has been shown in earlier studies to possess a homolog in mouse ESCs and also to cluster tightly with Oct4 in human ESCs. Although there were many genes unique to each pluripotent population, they shared similarities based on functional ontologies that define pluripotency. The significance of our studies underscores the need for direct comparison of stem cell populations that share biological similarities using uniform stringent analytical approaches, in order to better define pluripotency. Our findings have important implications for the maintenance of pluripotency and in developing directed differentiation strategies for various regenerative applications.

BACKGROUND Enhanced recovery (ER) protocols are widely used in surgical practice. As protocols are multidisciplinary with multiple components, it is difficult to compare and contrast reports. The present study therefore examined compliance and transferability to clinical practice among ER publications related to colorectal surgery. METHODS PubMed, EMBASE and Cochrane databases were searched for current colorectal ER manuscripts. Each publication was assessed for the number of ER elements, whether the element was sufficiently explained so that it could be transferred to clinical practice, and the compliance with the ER element. RESULTS Some 50 publications met the reporting criteria for inclusion. There were 22 ERAS elements described altogether. The median number of elements included in each publication was 9 with median number of included patients of 130. The most frequent elements included in ER pathways were early postoperative diet advancement in 49 (98%) and early mobilisation in 47 (94%). Early diet advancement was sufficiently explained in 43 (86%) publications but just 22 (45%) reported compliance. The explanation for early mobilisation was satisfactory in 41 (82%) publications but only 14 (30%) reported compliance. Other ERAS elements had similar rates of explanation and compliance. The most frequently analysed outcome measures were morbidity 49 (98%), length of stay 47 (94%), and mortality in 45 (90%) of publications. CONCLUSIONS The current standard of reporting is frequently incomplete. In order to transfer knowledge and facilitate implementation of pathways that demonstrate improvements in perioperative care and recovery, a consistent structured reporting platform is needed.

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Background Robotic hepatectomy (RH) is increasingly utilized for minor and major liver resections. The IWATE criteria were developed to classify minimally invasive liver resections by difficulty. The objective of this study was to apply the IWATE criteria in RH and to describe perioperative and oncologic outcomes of RH over the last decade at our institution. Methods Perioperative and oncologic outcomes of patients who underwent RH between 2011 and 2019 were retrospectively collected. The difficulty level of each operation was assessed using the IWATE criteria, and outcomes were compared at each level. Univariate linear regression was performed to characterize the relationship between IWATE criteria and perioperative outcomes (OR time, EBL, and LOS), and a multivariable model was also developed to address potential confounding by patient characteristics (age, sex, BMI, prior abdominal surgery, ASA class, and simultaneous non-hepatectomy operation). Results Two hundred and twenty-five RH were performed. Median IWATE criteria for RH were 6 (IQR 5–9), with low, intermediate, advanced, and expert resections accounting for 23% (n = 51), 34% (n = 77), 32% (n = 72), and 11% (n = 25) of resections, respectively. The majority of resections were parenchymal-sparing approaches, including anatomic segmentectomies and non-anatomic partial resections. 30-day complication rate was 14%, conversion to open surgery occurred in 9 patients (4%), and there were no deaths within 30 days postoperatively. In the univariate linear regression analysis, IWATE criteria were positively associated with OR time, EBL, and LOS. In the multivariable model, IWATE criteria were independently associated with greater OR time, EBL, and LOS. Two-year overall survival for hepatocellular carcinoma and intrahepatic cholangiocarcinoma was 94% and 50%, respectively. Conclusion In conclusion, the IWATE criteria are associated with surgical outcomes after RH. This series highlights the utility of RH for difficult hepatic resections, particularly parenchymal-sparing resections in the posterosuperior sector, extending the indication of minimally invasive hepatectomy in experienced hands and potentially offering select patients an alternative to open hepatectomy or other less definitive liver-directed treatment options.

To investigate practice patterns of use of IC amongst oncologists in treatment of head and neck cancer (HNC) patients. Materials/Methods: An IRB approved survey was sent using Red Cap software to oncologists registered on the American Society of Radiation Oncology (ASTRO) website. Variables were subjected to analysis with Fisher's exact test. Data analysis was considered significant at Bonferroni adjusted pZ0.05 threshold if the p-value was 0.001 and suggestive if p<0.05.The survey was sent to 6818 unique email addresses. Results: The response rate was 14.9% of US and 4.6% of international practitioners. 371 (98.4%) of participants were radiation oncologists. Participants identified as their practice type as Private Practice (23.9%), Academic (44.6%), Hospital Based (30.8%). Level of experience was "still in training" (15.4%), <1 year after completion of training (3.4%), 1-5 years (17.5%), 6-10 years (13.5%), 11-20 years (17.8%), 20-30 years (19.6%), and >30 years (12.7%). 56.8% participants treated >20 HNC patients yearly. 52.5% felt that there are some scenarios where IC improves cancer control and 57.8% felt that there were some scenarios where IC improves quality of life (QOL) outcomes for patients with locally advanced HNC. There was no difference between type of practice or level of training and feelings regarding IC in improving outcomes. Non US practitioners were more likely to feel that IC improved QOL (pZ0.03) and were more likely to use IC (pZ0.005). Increased volume of HNC patients treated was correlated with an increased use of IC (pZ0.001). HNC patient volume was correlated with use of IC in a borderline laryngeal preservation (pZ 0.006), bulky cervical lymph node (pZ0.0005), and optic structure impinging tumor (pZ0.007) case. Variability in use of IC was high. In a patient with a bulky lymph node, 30.5% of respondents rated their willingness to use IC at 0 of a 5 on a 5 point scale, 10.6% at 1, 8% at 2, 11.9% at 3, 15.1% at 4 and 19.9% at 5. In a case with tumor impinging on the optic structures, 25.2% of respondents rated their willingness to use IC at 0 of 5, 9.5% at 1, 12.7% at 2, 14.6% at 3, 17.5% at 4 and 16.7% at 5. After a complete response to IC, doses recommended were 70 Gy (54.6%), >60 but <70 Gy (34.1%), and 60 Gy (8.9%). For a patient with a partial response to IC with a decreased size of a lymph node mass, participants were divided on the dose to treat the areas that were previously involved with tumor, treating with <60 Gy (1.4%), 60 Gy (18%), >60 but <70 Gy (36.3%), 70 Gy (41.1%) and >70 Gy (3.5%). Conclusion: Practice patterns regarding the use of IC were highly varied. IC was most often recommended in patients with bulky cervical lymph node burden or a tumor impinging on the optic structures. Use of IC correlated with patient volume and country of practice.