Strict selection alone of patients undergoing liver transplantation for hilar cholangiocarcinoma is associated with improved survival

Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR). Twenty-one centers reported 173 patients (69%) of a total of 249 patients in the ELTR. Twenty-six patients were wrongly coded, resulting in a study group of 147 patients. We identified 28 patients (19%) who met the strict selection criteria of the Mayo Clinic protocol, but had not undergone neo-adjuvant chemoradiation therapy. Five-year survival in this subgroup was 59%, which is comparable to patients with pretreatment pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic. In conclusion, although the results should be cautiously interpreted, this study suggests that with strict selection alone, improved survival after transplantation can be achieved, approaching the Mayo Clinic experience

Gauging the spacetime metric -- looking back and forth a century later

H. Weyl's proposal of 1918 for generalizing Riemannian geometry by local scale gauge (later called {\em Weyl geometry}) was motivated by mathematical, philosophical and physical considerations. It was the starting point of his unified field theory of electromagnetism and gravity. After getting disillusioned with this research program and after the rise of a convincing alternative for the gauge idea by translating it to the phase of wave functions and spinor fields in quantum mechanics, Weyl no longer considered the original scale gauge as physically relevant. About the middle of the last century the question of conformal and/or local scale gauge transformation were reconsidered by different authors in high energy physics (Bopp, Wess, et al.) and, independently, in gravitation theory (Jordan, Fierz, Brans, Dicke). In this context Weyl geometry attracted new interest among different groups of physicists (Omote/Utiyama/Kugo, Dirac/Canuto/Maeder, Ehlers/Pirani/Schild and others), often by hypothesizing a new scalar field linked to gravity and/or high energy physics. Although not crowned by immediate success, this ``retake'' of Weyl geometrical methods lives on and has been extended a century after Weyl's first proposal of his basic geometrical structure. It finds new interest in present day studies of elementary particle physics, cosmology, and philosophy of physics.Comment: 56 pages, contribution to Workshop Hundred Years of Gauge Theory Bad Honnef, July 30 - August 3, 201