Is natural orifice specimen extraction surgery really safe in radical surgery for colorectal cancer?

Scop: Chirurgia rectală robotică este în prezent o procedură nouă pentru cancerele rectale. Extracția eșantionului cu orificiu natural transanal (NOSE) este o tehnică nouă de îndepărtare a specimenului din cavitatea abdominală prin anus, în loc de o incizie suplimentară după o intervenție chirurgicală colorectală laparoscopică sau robotică. Siguranța NOSE rămâne controversată. Acest studiu și-a propus să investigheze siguranța precoce a NOSE transanal în tratamentul cancerului de colon sigmoid și rectal superior din următoarele aspecte: caracteristici clinice și patologice, indicatori inflamatori și imunitari și complicații postoperatorii. Prezentare de caz: O femeie de 61 de ani, diagnosticată anterior cu cancer rectal, cu antecedente de 6 luni de hematochezie și alternanta diaree-constipatie. Diagnosticul de cancer rectal a fost pus pe baza biopsiei colonoscopice care a confirmat un nodul circumferenţial neregulat de adenocarcinom bine diferenţiat la 10 cm de marginea anală. Rezecția anterioară joasă asistata robotic, urmata de extracția specimenului transanal a fost efectuată după obținerea consimțământului informat. Procedura a fost efectuată cu succes și pacienta a avut o evolutie postoperatorie fără complicații. Diagnosticul patologic postoperator a evidențiat un adenocarcinom moderat diferențiat de 4x4x0,6 cm3 și margine circumferențiala libera. Concluzii: Rezectia de rect robotica plus extractia transanala a specimenului pentru cancerul rectal poate fi efectuata în siguranță și poate fi o abordare eficientă în contrast cu abordarea deschisă sau laparoscopică.Background: Robotic rectal surgery is currently a novel procedure for rectal cancers. Transanal natural orifice specimen extraction (NOSE) is a novel technique to remove the specimen from the abdominal cavity through the anus instead of an additional incision following laparoscopic or robotic colorectal surgery. The safety of NOSE remains controversial. This study aimed to investigate the early safety of transanal NOSE in the treatment of sigmoid colon and upper rectal cancer from the follow aspects: clinical and pathological characteristics, inflammatory and immune indicators and postoperative complications. Case presentation: A 61-year-old women, previously diagnosed with rectal cancer with came 6 months history of hematochezia and altered bowel habit. A diagnosis of rectal cancer was made in view of colonoscopic biopsy which confirmed an irregular circumferential lump of well differentiated adenocarcinoma at 10 cm from the anal verge. Robotic low anterior resection (LAR) plus transanal natural orifice specimen extraction (NOSE) was performed after obtaining informed consent. The procedure was performed successfully and the patient convalesced nicely without any complications. The postoperative pathological diagnosis revealed a 4x4x0.6 cm3 moderately differentiated adenocarcinoma and circumferential clearance. Conclusions: Robotic LAR plus transanal NOSE for rectal cancer can be performed safely and may be an effective approach in contrast to open or laparoscopic approach

Measurement of gauge blocks by interferometry

The key comparison EURAMET.L-K1.2011 on gauge blocks was carried out in the framework of a EURAMET project starting in 2012 and ending in 2015. It involved the participation of 24 National Metrology Institutes from Europe and Egypt, respectively. 38 gauge blocks of steel and ceramic with nominal central lengths between 0.5 mm and 500 mm were circulated. The comparison was conducted in two loops with two sets of artifacts. A statistical technique for linking the reference values was applied. As a consequence the reference value of one loop is influenced by the measurements of the other loop although they did not even see the artifacts of the others. This influence comes solely from three "linking laboratories" which measure both sets of artifacts. In total there were 44 results were not fully consistent with the reference values. This represents 10% of the full set of 420 results which is a considerable high number. At least 12 of them are clearly outliers where the participants have been informed by the pilot as soon as possible. The comparison results help to support the calibration and measurement capabilities (CMCs) of the laboratories involved in the CIPM MRA

Regulation of Bestrophins by Ca2+: A Theoretical and Experimental Study

Bestrophins are a recently discovered family of Cl− channels, for which no structural information is available. Some family members are activated by increased intracellular Ca2+ concentration. Bestrophins feature a well conserved Asp-rich tract in their COOH terminus (Asp-rich domain), which is homologous to Ca2+-binding motifs in human thrombospondins and in human big-conductance Ca2+- and voltage-gated K+ channels (BKCa). Consequently, the Asp-rich domain is also a candidate for Ca2+ binding in bestrophins. Based on these considerations, we constructed homology models of human bestrophin-1 (Best1) Asp-rich domain using human thrombospondin-1 X-ray structure as a template. Molecular dynamics simulations were used to identify Asp and Glu residues binding Ca2+ and to predict the effects of their mutations to alanine. We then proceeded to test selected mutations in the Asp-rich domain of the highly homologous mouse bestrophin-2. The mutants expressed in HEK-293 cells were investigated by electrophysiological experiments using the whole-cell voltage-clamp technique. Based on our molecular modeling results, we predicted that Asp-rich domain has two defined binding sites and that D301A and D304A mutations may impact the binding of the metal ions. The experiments confirmed that these mutations do actually affect the function of the protein causing a large decrease in the Ca2+-activated Cl− current, fully consistent with our predictions. In addition, other studied mutations (E306A, D312A) did not decrease Ca2+-activated Cl− current in agreement with modeling results

Regulation of Bestrophins by Ca2+: A Theoretical and Experimental Study

Bestrophins are a recently discovered family of Cl− channels, for which no structural information is available. Some family members are activated by increased intracellular Ca2+ concentration. Bestrophins feature a well conserved Asp-rich tract in their COOH terminus (Asp-rich domain), which is homologous to Ca2+-binding motifs in human thrombospondins and in human big-conductance Ca2+- and voltage-gated K+ channels (BKCa). Consequently, the Asp-rich domain is also a candidate for Ca2+ binding in bestrophins. Based on these considerations, we constructed homology models of human bestrophin-1 (Best1) Asp-rich domain using human thrombospondin-1 X-ray structure as a template. Molecular dynamics simulations were used to identify Asp and Glu residues binding Ca2+ and to predict the effects of their mutations to alanine. We then proceeded to test selected mutations in the Asp-rich domain of the highly homologous mouse bestrophin-2. The mutants expressed in HEK-293 cells were investigated by electrophysiological experiments using the whole-cell voltage-clamp technique. Based on our molecular modeling results, we predicted that Asp-rich domain has two defined binding sites and that D301A and D304A mutations may impact the binding of the metal ions. The experiments confirmed that these mutations do actually affect the function of the protein causing a large decrease in the Ca2+-activated Cl− current, fully consistent with our predictions. In addition, other studied mutations (E306A, D312A) did not decrease Ca2+-activated Cl− current in agreement with modeling results