Extended Distal Pancreatectomy with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer: A Case Report and Review of the Literature

Due to a lack of early symptoms, pancreatic cancers of the body and tail are discovered mostly at advanced stages. These locally advanced cancers often involve the celiac axis or the common hepatic artery and are therefore declared unresectable. The extended distal pancreatectomy with en bloc resection of the celiac artery may offer a chance of complete resection. We present the case of a 48-year-old female with pancreatic body cancer invading the celiac axis. The patient underwent laparoscopy to exclude hepatic and peritoneal metastasis. Subsequently, a selective embolization of the common hepatic artery was performed to enlarge arterial flow to the hepatobiliary system and the stomach via the pancreatoduodenal arcades from the superior mesenteric artery. Fifteen days after embolization, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. The postoperative course was uneventful, and complete tumor resection was achieved. This case report and a review of the literature show the feasibility and safety of the extended distal pancreatectomy with en bloc resection of the celiac axis. A preoperative embolization of the celiac axis may avoid ischemia-related complications of the stomach or the liver

Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model

<p>Abstract</p> <p>Background</p> <p>Every surgical suture compresses the enclosed tissue with a tension that depends from the knotting force and the resistance of the tissue. The aim of this study was to identify the dynamic change of applied suture tension with regard to the tissue specific cutting reaction.</p> <p>Methods</p> <p>In rabbits we placed single polypropylene sutures (3/0) in skin, muscle, liver, stomach and small intestine. Six measurements for each single organ were determined by tension sensors for 60 minutes. We collected tissue specimens to analyse the connective tissue stability by measuring the collagen/protein content.</p> <p>Results</p> <p>We identified three phases in the process of suture loosening. The initial rapid loss of the first phase lasts only one minute. It can be regarded as cutting through damage of the tissue. The percentage of lost tension is closely related to the collagen content of the tissue (r = -0.424; p = 0.016). The second phase is characterized by a slower decrease of suture tension, reflecting a tissue specific plastic deformation. Phase 3 is characterized by a plateau representing the remaining structural stability of the tissue. The ratio of remaining tension to initial tension of phase 1 is closely related to the collagen content of the tissue (r = 0.392; p = 0.026).</p> <p>Conclusions</p> <p>Knotted non-elastic monofilament sutures rapidly loose tension. The initial phase of high tension may be narrowed by reduction of the surgeons' initial force of the sutures' elasticity to those of the tissue. Further studies have to confirm, whether reduced tissue compression and less local damage permits improved wound healing.</p

Incidence of Isolated Biliary Atresia during the COVID Lockdown in Europe: Results from a Collaborative Project by RARE-Liver

Background: Biliary atresia (BA) is a rare cholangiopathy where one of the proposed aetiological mechanisms is an infectious viral trigger. Coronavirus disease-19 (COVID) lockdown restrictions were implemented to reduce the transmission of infections. Strictness of lockdown varied across European countries. This study aimed to investigate if there was an association between strictness of lockdown and change in isolated BA (IBA) incidence in Europe. Methods: We approached European centres involved in the European Reference Network RARE-LIVER. We included IBA patients born between 2015 and June 2020. We calculated the number of IBA patients born per centre per month. The Stringency Index (SI) was used as lockdown strictness indicator. The association between percentage change of mean number of IBA patients born per month and the SI was assessed. Results: We included 412 IBA patients from thirteen different centres. The median number of patients per month did not change: 6 (1–15) pre-lockdown and 7 (6–9) during lockdown (p = 0.34). There was an inverse association between SI and percentage change in IBA (B = -0.73, p = 0.03). Median age at Kasai portoenterostomy (days) did not differ between time periods (51 (9–179) vs. 53 (19–126), p = 0.73). Conclusion: In this European study, a stricter COVID-lockdown was seemingly accompanied by a simultaneous larger decrease in the number of IBA patients born per month in the lockdown. Results should be interpreted with caution due to the assumptions and limitations of the analysis

Fast and Energy-Efficient State Checkpointing for Intermittent Computing

Intermittently powered embedded devices ensure forward progress of programs through state checkpointing in non-volatile memory. Checkpointing is, however, expensive in energy and adds to the execution times. To minimize this overhead, we present DICE, a system that renders differential checkpointing profitable on these devices. DICE is unique because it is a software-only technique and efficient because it only operates in volatile main memory to evaluate the differential. DICE may be integrated with reactive (Hibernus) or proactive (MementOS, HarvOS) checkpointing systems, and arbitrary code can be enabled with DICE using automatic code-instrumentation requiring no additional programmer effort. By reducing the cost of checkpoints, DICE cuts the peak energy demand of these devices, allowing operation with energy buffers that are one-eighth of the size originally required, thus leading to benefits such as smaller device footprints and faster recharging to operational voltage level. The impact on final performance is striking: with DICE, Hibernus requires one order of magnitude fewer checkpoints and one order of magnitude shorter time to complete a workload in real-world settings

Demystifying Energy Consumption Dynamics in Transiently powered Computers

Transiently powered computers (TPCs) form the foundation of the battery-less Internet of Things, using energy harvesting and small capacitors to power their operation. This kind of power supply is characterized by extreme variations in supply voltage, as capacitors charge when harvesting energy and discharge when computing. We experimentally find that these variations cause marked fluctuations in clock speed and power consumption. Such a deceptively minor observation is overlooked in existing literature. Systems are thus designed and parameterized in overly conservative ways, missing on a number of optimizations. We rather demonstrate that it is possible to accurately model and concretely capitalize on these fluctuations. We derive an energy model as a function of supply voltage and prove its use in two settings. First, we develop EPIC, a compile-time energy analysis tool. We use it to substitute for the constant power assumption in existing analysis techniques, giving programmers accurate information on worst-case energy consumption of programs. When using EPIC with existing TPC system support, run-time energy efficiency drastically improves, eventually leading up to a 350% speedup in the time to complete a fixed workload. Further, when using EPIC with existing debugging tools, it avoids unnecessary program changes that hurt energy efficiency. Next, we extend the MSPsim emulator and explore its use in parameterizing a different TPC system support. The improvements in energy efficiency yield up to more than 1000% time speedup to complete a fixed workload