Surgical training model and safe implementation of robotic pancreatoduodenectomy in Japan: a technical note

Background Growing evidence for the advantages of robotic pancreatoduodenectomy (RPD) has been demonstrated internationally. However, there has been no structured training program for RPD in Japan. Herein, we present the surgical training model of RPD and a standardized protocol for surgical technique. Methods The surgical training model and surgical technique were standardized in order to implement RPD safely, based on the Dutch training system collaborated with the University of Pittsburgh Medical Center. Results The surgical training model included various trainings such as basic robotic training, simulation training, biotissue training, and a surgical video review. Furthermore, a standardized protocol on the surgical technique was established to understand the tips, tricks, and pitfalls of RPD. Conclusions Safe implementation of RPD can be achieved through the completion of a structured training program and learning surgical technique. A nationwide structured training system should be developed to implement the program safely in Japan

The hTERT Promoter Enhances the Antitumor Activity of an Oncolytic Adenovirus under a Hypoxic Microenvironment

Hypoxia is a microenvironmental factor that contributes to the invasion, progression and metastasis of tumor cells. Hypoxic tumor cells often show more resistance to conventional chemoradiotherapy than normoxic tumor cells, suggesting the requirement of novel antitumor therapies to efficiently eliminate the hypoxic tumor cells. We previously generated a tumor-specific replication-competent oncolytic adenovirus (OBP-301: Telomelysin), in which the human telomerase reverse transcriptase (hTERT) promoter drives viral E1 expression. Since the promoter activity of the hTERT gene has been shown to be upregulated by hypoxia, we hypothesized that, under hypoxic conditions, the antitumor effect of OBP-301 with the hTERT promoter would be more efficient than that of the wild-type adenovirus 5 (Ad5). In this study, we investigated the antitumor effects of OBP-301 and Ad5 against human cancer cells under a normoxic (20% oxygen) or a hypoxic (1% oxygen) condition. Hypoxic condition induced nuclear accumulation of the hypoxia-inducible factor-1α and upregulation of hTERT promoter activity in human cancer cells. The cytopathic activity of OBP-301 was significantly higher than that of Ad5 under hypoxic condition. Consistent with their cytopathic activity, the replication of OBP-301 was significantly higher than that of Ad5 under the hypoxic condition. OBP-301-mediated E1A was expressed within hypoxic areas of human xenograft tumors in mice. These results suggest that the cytopathic activity of OBP-301 against hypoxic tumor cells is mediated through hypoxia-mediated activation of the hTERT promoter. Regulation of oncolytic adenoviruses by the hTERT promoter is a promising antitumor strategy, not only for induction of tumor-specific oncolysis, but also for efficient elimination of hypoxic tumor cells

Flow patterns and performance of distillation trays

It is known that distillation tray efficiency depends on the liquid flow pattern, particularly for large diameter trays. Scale·up failures due to liquid channelling have occurred, and it is known that fitting flow control devices to trays sometirr.es improves tray efficiency. Several theoretical models which explain these observations have been published. Further progress in understanding is at present blocked by lack of experimental measurements of the pattern of liquid concentration over the tray. Flow pattern effects are expected to be significant only on commercial size trays of a large diameter and the lack of data is a result of the costs, risks and difficulty of making these measurements on full scale production columns. This work presents a new experiment which simulates distillation by water cooling. and provides a means of testing commercial size trays in the laboratory. Hot water is fed on to the tray and cooled by air forced through the perforations. The analogy between heat and mass transfer shows that the water temperature at any point is analogous to liquid concentration and the enthalpy of the air is analogous to vapour concentration. The effect of the liquid flow pattern on mass transfer is revealed by the temperature field on the tray. The experiment was implemented and evaluated in a column of 1.2 m. dia. The water temperatures were measured by thennocouples interfaced to an electronic computerised data logging system. The "best surface" through the experimental temperature measurements was obtained by the mathematical technique of B. splines, and presented in tenos of lines of constant temperature. The results revealed that in general liquid channelling is more imponant in the bubbly "mixed" regime than in the spray regime. However, it was observed that severe channelling also occurred for intense spray at incipient flood conditions. This is an unexpected result. A computer program was written to calculate point efficiency as well as tray efficiency, and the results were compared with distillation efficiencies for similar loadings. The theoretical model of Porter and Lockett for predicting distillation was modified to predict water cooling and the theoretical predictions were shown to be similar to the experimental temperature profiles. A comparison of the repeatability of the experiments with an errors analysis revealed that accurate tray efficiency measurements require temperature measurements to better than ± 0.1 °c which is achievable with conventional techniques. This was not achieved in this work, and resulted in considerable scatter in the efficiency results. Nevertheless it is concluded that the new experiment is a valuable tool for investigating the effect of the liquid flow pattern on tray mass transfer