The Roles of Laparoscopic Liver Resection and Hypoxia Inducible Factor in the Pathophysiology of Liver cancer

In the last 20 years laparoscopic liver resection has been increasingly practised. However its role in the treatment of liver cancer remains under scrutiny. I performed a pilot study at a specialist HPB unit assessing the results of the laparoscopic resections of one surgeon and comparing them to the results of matched cases on whom he had performed open resection. The resection technique was radiofrequency assisted resection pioneered in this unit. I also analysed the resected tissue to investigate any differential effect on cell characteristics of the 2 operative techniques. Operative time was significantly longer in laparoscopic cases and time to recurrence of R0 resections significantly shorter. Resected tissue demonstrated significantly higher levels of the hypoxia inducible factor-2 and CD10, a recognised poor prognostic marker in primary colorectal tumours. I hypothesised that livers resected laparoscopically are under a relative hypoxia because of the increased intraabdominal pressure associated with the pneumoperitoneum and tumours cells therefore have a positive selection advantage. In the setting of longer resection times this may compromise the oncological result of the surgery causing earlier recurrence. Using a established model of HIF activation, I showed that poor prognostic marker CD10 may be a function of hypoxia inducible regulation. Certainly I was able to replicate data from cervical squamous epithelia demonstrating that both in benign, dysplastic and malignant tissue, HIF expression corresponded to a reduced cell E-cadherin expression that may allow a more malignant potential. I also analysed the effect of RF ablation on circulating tumour cells in palliative irresectable cancers and in the context of both open and laparoscopic liver resection. This showed only a transient rise in both resectional techniques, (open and lap) that would unlikely count for the differential oncological outcome previously demonstrated in the pilot study. In keeping with current international opinion, further work is required to verify the role of laparoscopic liver resection in liver cancer

Community-Based Learning: Face-to-Face Tandem Language Exchanges as a Complementary Course Component for Acquisition of Spanish

Conceptual, in-class communication activities are the most common oral practice foreign language educators provide for L2 learners with the absence of native speakers. In most L2 classrooms in the U.S., Spanish-speaking practice transpires among learners who share the same native language and culture. For this reason, ACTFL encourages language educators to connect with local communities and those abroad to create intercultural interactions that can provide crucial avenues for achieving proficiency benchmarks and shaping globally minded citizens. To provide intercultural language-learning experiences for 16 undergraduate learners enrolled in my Spanish III course, I created a collaboration with a local ESL organization that connected us with five adult learners of English from various Spanish-speaking countries for seven face-to-face tandem language exchanges. This study utilizes a mixed-methods approach to investigate speaking performance as well as perceptions of linguistic growth, cultural knowledge, and confidence to speak Spanish. Results suggest that most participants increased in speaking competency, learned new cultural information, and further developed confidence to speak Spanish. Intercultural interactions following the three guiding principles of tandem placed learners from both educational institutions in active learning positions and capitalized on the linguistic background and culture of each group for mutual benefit of enhanced communication and understanding of one another

Combined Liquid and Solid-Phase Extraction Improves Quantification of Brain Estrogen Content

Accuracy in quantifying brain-derived steroid hormones (“neurosteroids”) has become increasingly important for understanding the modulation of neuronal activity, development, and physiology. Relative to other neuroactive compounds and classical neurotransmitters, steroids pose particular challenges with regard to isolation and analysis, owing to their lipid solubility. Consequently, anatomical studies of the distribution of neurosteroids have relied primarily on the expression of neurosteroid synthesis enzymes. To evaluate the distribution of synthesis enzymes vis-à-vis the actual steroids themselves, traditional steroid quantification assays, including radioimmunoassays, have successfully employed liquid extraction methods (e.g., ether, dichloromethane, or methanol) to isolate steroids from microdissected brain tissue. Due to their sensitivity, safety, and reliability, the use of commercial enzyme-immunoassays (EIA) for laboratory quantification of steroids in plasma and brain has become increasingly widespread. However, EIAs rely on enzymatic reactions in vitro, making them sensitive to interfering substances in brain tissue and thus producing unreliable results. Here, we evaluate the effectiveness of a protocol for combined, two-stage liquid/solid-phase extraction (SPE) as compared to conventional liquid extraction alone for the isolation of estradiol (E2) from brain tissue. We employ the songbird model system, in which brain steroid production is pronounced and linked to neural mechanisms of learning and plasticity. This study outlines a combined liquid–SPE protocol that improves the performance of a commercial EIA for the quantification of brain E2 content. We demonstrate the effectiveness of our optimized method for evaluating the region specificity of brain E2 content, compare these results to established anatomy of the estrogen synthesis enzyme and estrogen receptor, and discuss the nature of potential EIA interfering substances

Estradiol interacts with an opioidergic network to achieve rapid modulation of a vocal pattern generator

Estrogens rapidly regulate neuronal activity within seconds-to-minutes, yet it is unclear how estrogens interact with neural circuits to rapidly coordinate behavior. This study examines whether 17-beta-estradiol interacts with an opioidergic network to achieve rapid modulation of a vocal control circuit. Adult plainfin midshipman fish emit vocalizations that mainly differ in duration, and rhythmic activity of a hindbrain–spinal vocal pattern generator (VPG) directly establishes the temporal features of midshipman vocalizations. VPG activity is therefore predictive of natural calls, and ‘fictive calls’ can be elicited by electrical microstimulation of the VPG. Prior studies show that intramuscular estradiol injection rapidly (within 5 min) increases fictive call duration in midshipman. Here, we delivered opioid antagonists near the VPG prior to estradiol injection. Rapid estradiol actions on fictive calling were completely suppressed by the broad-spectrum opioid antagonist naloxone and the mu-opioid antagonist beta-funaltrexamine, but were unaffected by the kappa-opioid antagonist nor-binaltorphimine. Unexpectedly, prior to estradiol administration, all three opioid antagonists caused immediate, transient reductions in fictive call duration. Together, our results indicate that: (1) vocal activity is modulated by opioidergic networks, confirming hypotheses from birds and mammals, and (2) the rapid actions of estradiol on vocal patterning depend on interactions with a mu-opioid modulatory network

The development of a measure of social care outcome for older people. Funded/commissioned by: Department of Health

An essential element of identifying Best Value and monitoring cost-effective care is to be able to identify the outcomes of care. In the field of health services, use of utility-based health related quality of life measures has become widespread, indeed even required. If, in the new era of partnerships, social care outcomes are to be valued and included we need to develop measures that reflect utility or welfare gain from social care interventions. This paper reports on a study, commissioned as part of the Department of Health’s Outcomes of Social Care for Adults Initiative, that developed an instrument and associated utility indexes that provide a tool for evaluating social care interventions in both a research and service setting. Discrete choice conjoint analysis used to derive utility weights provided us with new insights into the relative importance of the core domains of social care to older people. Whilst discrete choice conjoint analysis is being increasingly used in health economics, this is the first study that has attempted to use it to derive a measure of outcome

Pancreatic Mass with an Unusual Pathology: A Case Report

Intra-abdominal abscesses formation in patients with no preceding symptoms is rare. Infection of the pancreas occurs in 5–9% of patients with acute pancreatitis, more commonly as a complication of necrotising or severe pancreatitis. We have reported a case of a 64-year-old almost entirely asymptomatic man who underwent a Whipple's procedure following extensive investigation of a pancreatic mass. The pathology and histology showed no evidence of malignancy, and instead a true pancreatic abscess, centred around an impacted cholesterol calculus in the distal CBD. Of suspicious pancreatic masses that are resected, chronic choledocholithiasis is the aetiology in less than 5% of nonmalignant or “false positives.” This report describes such a case

Space-Based Ionosonde Receiver and Visible Limb-Viewing Airglow Sensor (SIRVLAS): A CubeSat Instrument Suite for Enhanced Ionospheric Charge Density Measurements

Spatially and temporally varying plasma in the ionosphere refracts passing electromagnetic waves, affecting services including over-the-horizon radar, global positioning systems, and long-distance amateur radio communication. The reliability of these services requires accurate measurements of the charge density of ionospheric plasma. Current methods for estimating ionospheric charge density include ground-based radar soundings in the high frequency (HF) band and airglow limb sensing, typically in the extreme ultraviolet (EUV) spectrum. SIRVLAS is a low-cost, compact instrument suite for these measurements designed by blair3sat, a high school satellite team based in Montgomery County, Maryland. It takes electron density measurements below the F peak of the ionosphere by receiving ionosonde soundings with an onboard VHF antenna and measuring airglow with a limb-view scanner. The payload will take measurements from many locations along its orbital path, enabling high-accuracy electron density mappings in previously unmapped regions. In addition, data correlation between the radar receiver and the airglow detector allows for verification of the instruments’ operation and increased accuracy of local mappings. blair3sat plans to launch a 1U CubeSat in 2022 to demonstrate the feasibility of SIRVLAS. SIRVLAS’ novel method of ionospheric electron density data collection can be utilized on future missions to extend and enhance global ionospheric databases, essential for many radio services and applications. The presence of VHF antenna systems on existing satellites similar to the antenna system on SIRVLAS may allow SIRVLAS RF measurements to be implemented on many satellites using a software modification, allowing existing fleets to contribute towards ionospheric datasets