Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis

Journal of Robotic Surgery - To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length...     

Early- and late-onset pancreatic adenocarcinoma: A population-based comparative study

BackgroundPancreatic cancer is projected to become the second leading cause of cancer related death in the US. We aim to investigate the demographics, clinical outcomes and survival outcomes of patients diagnosed with early-onset (<40 years) and late-onset (>40 years) pancreatic adenocarcinoma (PAC).MethodsData on PAC between 1975 and 2016 were extracted from the Surveillance, Epidemiology, and End Results Registry.ResultsWithin the study period, 136,100 patients were identified which included 1181 patients with early-onset PAC and 134,919 patients with late-onset PAC. Both cohorts tend to present with distant metastasis (70.3% vs 57.9%). Both groups also showed an exponential rise in incidence (early-onset 3.69% annual change vs late-onset 6.25% annual change). When stratified by anatomical location, there was a trend of increasing cancer in the head of the pancreas for patients <40 years (3.63% annual change). While late PAC showed increasing cancer in all anatomical locations, the largest increase was observed in the tail of the pancreas (8.62% annual change). Overall, there was a mild difference in survival for early- and late-onset PAC (7 months vs 6 months, respectively, log rank p = 0.004). Both age groups showed the worse prognosis when cancer occurred in the tail of the pancreas (6 months vs 4 months, respectively). On cox proportion analysis, patients with late-onset PAC had twice the risk of mortality compared to early-onset PAC (HR 2.06, CI: 1.788–2.370, P = 0.001).ConclusionsOur study showed that both early- and late-onset PAC are increasing and while prognosis remains poor. Tumor anatomy showed a growing incidence of early-onset PAC in the head of the pancreas while late-onset PAC showed a rising incidence in the body and tail of the pancreas.     

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

The Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension has developed consensus guidelines on the disease profile, diagnosis, and management of noncirrhotic portal fibrosis and idiopathic portal hypertension. The consensus statements, prepared and deliberated at length by the experts in this field, were presented at the annual meeting of the APASL at Kyoto in March 2007. This article includes the statements approved by the APASL along with brief backgrounds of various aspects of the disease.     

Isolation of cDNA clones coding for human tissue factor: primary structure of the protein and cDNA.

Tissue factor is a membrane-bound procoagulant protein that activates the extrinsic pathway of blood coagulation in the presence of factor VII and calcium. lambda Phage containing the tissue factor gene were isolated from a human placental cDNA library. The amino acid sequence deduced from the nucleotide sequence of the cDNAs indicates that tissue factor is synthesized as a higher molecular weight precursor with a leader sequence of 32 amino acids, while the mature protein is a single polypeptide chain composed of 263 residues. The derived primary structure of tissue factor has been confirmed by comparison to protein and peptide sequence data. The sequence of the mature protein suggests that there are three distinct domains: extracellular, residues 1-219; hydrophobic, residues 220-242; and cytoplasmic, residues 243-263. Three potential N-linked carbohydrate attachment sites occur in the extracellular domain. The amino acid sequence of tissue factor shows no significant homology with the vitamin K-dependent serine proteases, coagulation cofactors, or any other protein in the National Biomedical Research Foundation sequence data bank (Washington, DC).     

Gastric adenocarcinoma in a patient re-infected with <Emphasis Type="Italic">H. pylori</Emphasis> after regression of MALT lymphoma with successful anti-<Emphasis Type="Italic">H. pylori</Emphasis>therapy and gastric resection: a case report

Background

Helicobacter pylori (H. pylori) has been etiologically linked with primary gastric lymphoma (PGL) and gastric carcinoma (GC). There are a few reports of occurrence of both diseases in the same patient with H. pylori infection.

Case presentation

We report a patient with PGL in whom the tumor regressed after surgical resection combined with eradication of H. pylori infection. However, he developed GC on follow up; this was temporally associated with recrudescence / re-infection of H. pylori. This is perhaps first report of such occurrence.

Conclusions

Possible cause and effect relationship between H. pylori infection and both PGL and GC is discussed. This case also documents a unique problem in management of PGL in tropical countries where re-infection with H. pylori is supposed to be high.

     

Dynamical facilitation governs glassy dynamics in suspensions of colloidal ellipsoids

One of the greatest challenges in contemporary condensed matter physics is to ascertain whether the formation of glasses from liquids is fundamentally thermodynamic or dynamic in origin. Although the thermodynamic paradigm has dominated theoretical research for decades, the purely kinetic perspective of the dynamical facilitation (DF) theory has attained prominence in recent times. In particular, recent experiments and simulations have highlighted the importance of facilitation using simple model systems composed of spherical particles. However, an overwhelming majority of liquids possess anisotropy in particle shape and interactions, and it is therefore imperative to examine facilitation in complex glass formers. Here, we apply the DF theory to systems with orientational degrees of freedom as well as anisotropic attractive interactions. By analyzing data from experiments on colloidal ellipsoids, we show that facilitation plays a pivotal role in translational as well as orientational relaxation. Furthermore, we demonstrate that the introduction of attractive interactions leads to spatial decoupling of translational and rotational facilitation, which subsequently results in the decoupling of dynamical heterogeneities. Most strikingly, the DF theory can predict the existence of reentrant glass transitions based on the statistics of localized dynamical events, called excitations, whose duration is substantially smaller than the structural relaxation time. Our findings pave the way for systematically testing the DF approach in complex glass formers and also establish the significance of facilitation in governing structural relaxation in supercooled liquids.The transformation of liquids into glasses is as ubiquitous as it is enigmatic. From the formation of obsidian during volcanic eruptions (1) and fabrication of superstrong metallic glasses (2) to exotic forms of slow dynamics in crystals of colloidal dimers (3) and Janus particles (4), glass formation pervades nature, industry, and academia. A vast majority of molecular glass-forming materials exhibit anisotropy in shape and interparticle interactions, which often has a profound influence on their glassy dynamics. The rapidly expanding repertoire of chemists has made it possible to design colloidal particles of desired shape and interactions that can serve as realistic experimental analogs of these molecular liquids (5). By contrast, prominent theories like the Adam–Gibbs (6) theory, random first-order transition (RFOT) theory (7, 8), and the dynamical facilitation (DF) theory (9, 10) have been tested predominantly on spherical glass formers with isotropic interactions, which exhibit gross features of glassy dynamics, but fail to capture the nuances of vitrification in complex systems.The discovery of growing static (11–16) and dynamic (17–21) length scales appears to support the thermodynamic perspective of the Adam–Gibbs and RFOT theories. However, the growth in static length scales over the dynamical range accessible to numerical simulations is often minuscule and much smaller than the corresponding growth in dynamic length scales (21, 22). This renders any causal connection between growing static length scales and growing timescales doubtful (22). Moreover, recent simulations (23) and colloid experiments (24) have shown that growing dynamical correlations in the form of string-like cooperative motion emerge naturally within the purely kinetic approach of the DF theory. To compound matters further, facilitation is present even within the RFOT framework, albeit as a consequence of slow dynamics rather than a cause (25). Thus, although DF has been shown to exist (23, 24, 26–29), its relative importance as a mechanism of structural relaxation is still debated (30–32). The application of the DF approach to complex glass formers will therefore not only enhance our understanding of glass transitions in these systems, but also help ascertain the relevance of facilitation in governing structural relaxation.Here, we apply the DF theory to elucidate glass formation in suspensions of colloidal ellipsoids with repulsive as well as attractive interactions. The DF theory claims that structural relaxation in glass-forming liquids proceeds via a process known as dynamical facilitation, whereby localized mobile regions, termed excitations, mediate motion in neighboring regions in a manner that conserves mobility (9, 10). We first show that the notions of localized excitations and facilitated dynamics can be extended even to orientational relaxation. Next, we demonstrate that the spatial decoupling of dynamical heterogeneities (DHs) observed in colloid experiments stems from the spatial decoupling of rotational and translational facilitation. Most importantly, the DF theory can predict the existence of recently observed reentrant glass transitions (33) from the density dependence of the concentration of excitations. Our findings not only highlight the importance of facilitated dynamics in anisotropic glass formers but also reinforce the claim that, in the broader context of the glass transition, facilitation dominates structural relaxation.