Safety and Efficacy of Surgery for Metastatic Tumor to the Pancreas: A Single-Center Experience

Pancreatic metastases from other neoplasms are rare. The role of surgery for this clinical entity is unclear. The aim of this study was to investigate the role of resection in patients with pancreatic secondary lesions. We observed 44 patients with pancreatic metastases from other tumors. Renal cell carcinoma was the most common primary tumor (n = 19, 43.2%). Thirty-seven patients underwent surgery, and pancreatic resection with curative intent was feasible in 35 cases. Fifteen patients (43.2%) experienced major postoperative complications (Clavien-Dindo > 2), and postoperative mortality rate was 5.4%. The median overall survival and disease-free survival were 38 (range 0–186) and 11 (range 0–186) months, respectively. Overall survival and disease-free survival were significantly longer for pancreatic metastases from renal cell carcinoma when compared to other primary tumors. Multivariate analysis confirmed a pathological diagnosis of metastasis from RCC as an independent prognostic factor for overall survival (OR 2.48; 95% CI, 1.00–6.14; p = 0.05). In conclusion, radical resection of metastases to the pancreas is feasible and safe, and may confer a survival benefit for selected patients. There is a clear benefit of metastasectomy in terms of patient survival for metastases from renal cell carcinoma, while for those with other primary tumors, surgery seems to be mainly palliative

Plasma proteome profiling of healthy subjects undergoing bed rest reveals unloading-dependent changes linked to muscle atrophy

Inactivity and unloading induce skeletal muscle atrophy, loss of strength and detrimental metabolic effects. Bed rest is a model to study the impact of inactivity on the musculoskeletal system. It not only provides information for bed-ridden patients care, but it is also a ground-based spaceflight analogue used to mimic the challenges of long space missions for the human body. In both cases, it would be desirable to develop a panel of biomarkers to monitor muscle atrophy in a minimally invasive way at point of care to limit the onset of muscle loss in a personalized fashion

Quantum symmetry, the cosmological constant and Planck scale phenomenology

We present a simple algebraic argument for the conclusion that the low energy limit of a quantum theory of gravity must be a theory invariant, not under the Poincare group, but under a deformation of it parameterized by a dimensional parameter proportional to the Planck mass. Such deformations, called kappa-Poincare algebras, imply modified energy-momentum relations of a type that may be observable in near future experiments. Our argument applies in both 2+1 and 3+1 dimensions and assumes only 1) that the low energy limit of a quantum theory of gravity must involve also a limit in which the cosmological constant is taken very small with respect to the Planck scale and 2) that in 3+1 dimensions the physical energy and momenta of physical elementary particles is related to symmetries of the full quantum gravity theory by appropriate renormalization depending on Lambda l^2_{Planck}. The argument makes use of the fact that the cosmological constant results in the symmetry algebra of quantum gravity being quantum deformed, as a consequence when the limit \Lambda l^2_{Planck} -> 0 is taken one finds a deformed Poincare invariance. We are also able to isolate what information must be provided by the quantum theory in order to determine which presentation of the kappa-Poincare algebra is relevant for the physical symmetry generators and, hence, the exact form of the modified energy-momentum relations. These arguments imply that Lorentz invariance is modified as in proposals for doubly special relativity, rather than broken, in theories of quantum gravity, so long as those theories behave smoothly in the limit the cosmological constant is taken to be small.Comment: LaTex, 19 page

Genome-wide association analysis of genetic generalized epilepsies implicates susceptibility loci at 1q43, 2p16.1, 2q22.3 and 17q21.32

Genetic generalized epilepsies (GGEs) have a lifetime prevalence of 0.3% and account for 20-30% of all epilepsies. Despite their high heritability of 80%, the genetic factors predisposing to GGEs remain elusive. To identify susceptibility variants shared across common GGE syndromes, we carried out a two-stage genome-wide association study (GWAS) including 3020 patients with GGEs and 3954 controls of European ancestry. To dissect out syndrome-related variants, we also explored two distinct GGE subgroups comprising 1434 patients with genetic absence epilepsies (GAEs) and 1134 patients with juvenile myoclonic epilepsy (JME). Joint Stage-1 and 2 analyses revealed genome-wide significant associations for GGEs at 2p16.1 (rs13026414, Pmeta = 2.5 × 10−9, OR[T] = 0.81) and 17q21.32 (rs72823592, Pmeta = 9.3 × 10−9, OR[A] = 0.77). The search for syndrome-related susceptibility alleles identified significant associations for GAEs at 2q22.3 (rs10496964, Pmeta = 9.1 × 10−9, OR[T] = 0.68) and at 1q43 for JME (rs12059546, Pmeta = 4.1 × 10−8, OR[G] = 1.42). Suggestive evidence for an association with GGEs was found in the region 2q24.3 (rs11890028, Pmeta = 4.0 × 10−6) nearby the SCN1A gene, which is currently the gene with the largest number of known epilepsy-related mutations. The associated regions harbor high-ranking candidate genes: CHRM3 at 1q43, VRK2 at 2p16.1, ZEB2 at 2q22.3, SCN1A at 2q24.3 and PNPO at 17q21.32. Further replication efforts are necessary to elucidate whether these positional candidate genes contribute to the heritability of the common GGE syndrome

Gastrointestinal stromal tumour (GIST) presenting as a strangulated inguinal hernia with small bowel obstruction

Publishing Group. All rights reserved. Gastrointestinal stromal tumours (GISTs) can arise everywhere along the gastrointestinal (GI) tract. Their presentation in unusual locations should always be taken into account. A 74-year-old man referred to the emergency department for small bowel obstruction caused by an incarcerated inguinal hernia. A CT scan showed a mesenchymal tumour originating from the herniated bowel loop and a mass in the ascending colon. Laparoscopic resection of the mass and laparoscopic right hemicolectomy were performed. The histology showed a ruptured GIST arising from the herniated small bowel and a high-grade dysplasia villous adenoma of the right colon. GISTs can present with symptoms spanning from vague abdominal discomfort to surgical urgencies. Strangulated hernia is an extremely rare presentation, with only two cases described in the literature. A safe surgical approach was obtained with laparoscopy, maintaining surgical radicality. The ileal localisation and the pseudocapsule rupture were the main risk factors on prognostic stratification

Medicaroid robotic assisted surgery system: A feasibility study

The hinotori™ surgical robotic system, by Medicaroid (Medicaroid Corporation, Kobe, Japan), is a new robotic system for minimally invasive surgery. We aimed at evaluating its usability and accessibility in a preclinical setting. This was a preclinical feasibility study. Two groups of surgeons, one with three experienced robotic surgeons (group 1) and one with three robotic-surgery naive participants (group 2), performed the following tasks using the hinotori™ system in a simulated preclinical setting: console setup, docking, instrument exchange, undocking, and suturing. Each participant repeated each task three times. The time required for performing each repetition and the count of failed repetitions were the primary outcomes of the study. The subjectively perceived workload in performing the tasks, as measured by the NASA-TLX score, was the secondary outcome. The improvement of participants within the three repetitions as well as a comparison between the performances of group 1 and 2 were evaluated. The time required to perform each task decreased with repetitions for both groups, so did the subjective workload score. The time measures required to perform the tasks and the mental effort scores were comparable between the two groups for the console setup, docking, instrument exchange, and undocking tasks. The NASA-TLX score was also comparable between the two groups for the console setup and the emergency undocking tasks and decreased significantly within all tasks after the third repetition. The incidence of failed repetitions was higher in group 2 for the suturing task, however the difference was not statistically significant. The results confirmed the usability of the hinotori™ system in a preclinical setting for both highly trained surgeons and nonexperienced operators and its accessibility for both long-time users of other systems and first-time users