Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry

Introduction

The effect of surgery for metastases in patients with esophagogastric cancer is unknown, given the lack of randomized clinical trials; likewise, the criteria for selecting eligible patients remain to be determined.

Left Ventricular Assist Device Therapy for Destination Therapy: Is Less Invasive Surgery a Safe Alternative?

Introduction and objectives

The number of older patients with congestive heart failure has dramatically increased. Because of stagnating cardiac transplantation, there is a need for an alternative therapy, which would solve the problem of insufficient donor organ supply. Left ventricular assist devices (LVADs) have recently become more commonly used as destination therapy (DT). Assuming that older patients show a higher risk-profile for LVAD surgery, it is expected that the increasing use of less invasive surgery (LIS) LVAD implantation will improve postoperative outcomes. Thus, this study aimed to assess the outcomes of LIS-LVAD implantation in DT patients.

Valor de la ecoendoscopia transesofágica en el diagnóstico de localización en el hiperparatiroidismo primario

Aim

Our aim was to estimate the usefulness of oesophageal endoscopic ultrasound in the accurate location of recurrent or persistent primary hyperparathyroidism (HPT).

Material and method

A total of 352 patients with primary hyperparathyroidism were operated on over the last seven years. A preoperative parathyroid 99Tc- sestamibi gammagraphy and an intraoperative PTH determination were performed routinely. Only 5 patients (1.4%) had localization problems: three with persistent HPT after parathyroid extirpation, one recurrent HPT and one HPT after a right hemithyroidectomy. An oesophageal endoscopic ultrasound was carried out before any new exploratory neck surgery in order to find the definitive location.

Results

The endoscopic ultrasound showed a clear image of adenoma with an accurate location in four patients. No tumour was present in one patient. All five patients were operated on. The exact location was confirmed in the four patients with positive endoscopic ultrasound images. The fifth surgical exploration revealed a parathyreosis. All five patients had a favourable post-operative period, with no nerve lesions or morbidity associated with the endoscopic ultrasound.

Conclusions

Oesophageal endoscopic ultrasound is a very useful diagnostic tool in HPT patients with location problems, particularly in cases having anatomical changes due to previous surgery. It is a procedure that helps the surgeon to make a more selective and efficient exploration of parathyroid glands.     

High-pressure crystal structures and superconductivity of Stannane (SnH4)

There is great interest in the exploration of hydrogen-rich compounds upon strong compression where they can become superconductors. Stannane (SnH₄) has been proposed to be a potential high-temperature superconductor under pressure, but its high-pressure crystal structures, fundamental for the understanding of superconductivity, remain unsolved. Using an ab initio evolutionary algorithm for crystal structure prediction, we propose the existence of two unique high-pressure metallic phases having space groups Ama2 and P6₃/mmc, which both contain hexagonal layers of Sn atoms and semimolecular (perhydride) H₂ units. Enthalpy calculations reveal that the Ama2 and P6₃/mmc structures are stable at 96–180 GPa and above 180 GPa, respectively, while below 96 GPa SnH₄ is unstable with respect to elemental decomposition. The application of the Allen-Dynes modified McMillan equation reveals high superconducting temperatures of 15–22 K for the Ama2 phase at 120 GPa and 52–62 K for the P6₃/mmc phase at 200 GPa.     

Structural basis for the wobbler mouse neurodegenerative disorder caused by mutation in the Vps54 subunit of the GARP complex

The multisubunit Golgi-associated retrograde protein (GARP) complex is required for tethering and fusion of endosome-derived transport vesicles to the trans-Golgi network. Mutation of leucine-967 to glutamine in the Vps54 subunit of GARP is responsible for spinal muscular atrophy in the wobbler mouse, an animal model of amyotrophic lateral sclerosis. The crystal structure at 1.7 Å resolution of the mouse Vps54 C-terminal fragment harboring leucine-967, in conjunction with comparative sequence analysis, reveals that Vps54 has a continuous α-helical bundle organization similar to that of other multisubunit tethering complexes. The structure shows that leucine-967 is buried within the α-helical bundle through predominantly hydrophobic interactions that are critical for domain stability and folding in vitro. Mutation of this residue to glutamine does not prevent integration of Vps54 into the GARP complex but greatly reduces the half-life and levels of the protein in vivo. Severely reduced levels of mutant Vps54 and, consequently, of the whole GARP complex underlie the phenotype of the wobbler mouse.     

Physiological responses to wearing a prototype firefighter ensemble compared with a standard ensemble

This study investigated the physiological responses to wearing a standard firefighter ensemble (SE) and a prototype ensemble (PE) modified from the SE that contained additional features, such as magnetic ring enclosures at the glove-sleeve interface, integrated boot-pant interface, integrated hood-SCBA facepiece interface, and a novel hose arrangement that rerouted self-contained breathing apparatus (SCBA) exhaust gases back into the upper portion of the jacket. Although the features of the PE increased the level of encapsulation of the wearer that could lead to increased physiological stress compared with the SE, it was hypothesized that the rerouted exhaust gases provided by the PE hose assembly would (1) provide convective cooling to the upper torso, (2) reduce the thermal stress experienced by the wearer, and (3) reduce the overall physiological stress imposed by the PE such that it would be either less or not significantly different from the SE. Ten subjects (seven male, three female) performed treadmill exercise in an environmental chamber (22°C, 50% RH) at 50% [image omitted]O(2max) while wearing either the SE with an SCBA or the PE with an SCBA either with or without the hose attached (designated PEWH and PENH, respectively). Heart rate (HR), rectal and intestinal temperatures (T(re), T(in)), sweat loss, and endurance time were measured. All subjects completed at least 20 min of treadmill exercise during the testing. At the end of exercise, there was no difference in T(re) (p = 0.45) or T(in) (p = 0.42), HR, or total sweat loss between the SE and either PEWH or PENH (p = 0.59). However, T(sk) was greater in PEWH and PENH compared with SE (p < 0.05). Total endurance time in SE was greater than in either PEWH or PENH (p < 0.05). Thus, it was concluded that the rerouting of exhaust gases to the jacket did not provide significant convective cooling or reduce thermal stress compared with the SE under the mild conditions selected, and the data did not support the hypotheses of the present study.     

Immunogenic characterization and epitope mapping of transmissible gastroenteritis virus RNA dependent RNA polymerase

Coronavirus RNA synthesis is a sophisticated process performed by a viral multienzymatic replicase complex, together with cellular factors. A key enzyme of this replication complex is the RNA dependent RNA polymerase (RdRp). To study the replication of coronavirus genome, six monoclonal antibodies (mAbs) specific for transmissible gastroenteritis virus (TGEV) RdRp were generated and characterized. His-tagged RdRp was expressed in baculovirus, purified and used as immunogen to produce mAbs. The TGEV RdRp was recognized by these mAbs in the context of virus infection by immunofluorescence analysis and Western blot. Epitope mapping by Pepscan indicated that RdRp mAbs recognized four non-overlapping linear epitopes located in a 62-amino acid region of the N-terminal domain, suggesting that this region may constitute an immunodominant domain. The availability of TGEV RdRp mAbs will be instrumental to study coronavirus replication and to analyze the function of RdRp in pathogenesis.