Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

Pancreatic cancer is a highly lethal disease with a genetic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prognosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer development. The aim of this strategy is to identify pre-malignant precursors or asymptomatic pancreatic cancer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA) seems to be the most promising technique for early detection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in high-risk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced endosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-enhanced harmonic EUS, computer-aided diagnostic techniques, confocal laser endomicroscopy miniprobe and the detection of DNA abnormalities or protein markers by FNA, promise improvement of the diagnostic yield of EUS. As the resolution of imaging improves and as our knowledge of precursor lesions grows, we believe that EUS could become the most suitable method to detect curable pancreatic neoplasms in correctly identified asymptomatic at-risk patients

Entropy Dynamics of Community Alignment in the Italian Parliament Time-Dependent Network

Complex institutions are typically characterized by meso-scale structures which are fundamental for the successful coordination of multiple agents. Here we introduce a framework to study the temporal dynamics of the node-community relationship based on the concept of community alignment, a measure derived from the modularity matrix that defines the alignment of a node with respect to the core of its community. The framework is applied to the 16th legislature of the Italian Parliament to study the dynamic relationship in voting behavior between Members of the Parliament (MPs) and their political parties. As a novel contribution, we introduce two entropy-based measures that capture politically interesting dynamics: the group alignment entropy (over a single snapshot), and the node alignment entropy (over multiple snapshots). We show that significant meso-scale changes in the time-dependent network structures can be detected by a combination of the two measures. We observe a steady growth of the group alignment entropy after a major internal conflict in the ruling majority and a different distribution of nodes alignment entropy after the government transition

Robotic rectal surgery: State of the art

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words “rectum”, “rectal”, “cancer”, “laparoscopy”, “robot”. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients

Living organisms and sedimentary remains from high mountain lakes in the Alps

We publish a data set of environmental and biological data collected in 2000 during the ice-free period in high mountain lakes located above the local timberline in the Alps, in Italy, Switzerland and Austria. Environmental data include coordinates, geographical attributes and detailed information on vegetation, bedrock and land use in lake catchments. Chemical analyses of a sample for each lake collected at the lake surface in Summer 2000 are also reported. Biological data include phytoplankton (floating algae and cyanobacteria), zooplankton (floating animals), macroinvertebrates (aquatic organisms visible to the naked eye living in contact with sediments on lake bottom), benthic diatoms. Diatoms, cladocera and chironomids remains and algal and bacterial pigments were also analysed in lake sediments

Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: A retrospective comparative mono-institutional study

BACKGROUND: Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer. METHODS: Between June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated. RESULTS: There were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 ± 0.5 cm and 3.0 ± 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 ± 3.7 and 30.5 ± 2.0, respectively; P = 0.02). The mean operative time was 262.6 ± 8.6 min in the laparoscopic group and 312.6 ± 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups. CONCLUSIONS: Within the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes

Limnological studies on two acid sensitive lakes in the Central Alps (lakes Paione Superiore and Paione Inferiore, Italy)

A limnological study was performed during 1991 and 1992 on lakes Paione Superiore (LPS)and Paione Inferiore (LPI), located in the Ossola Valley, Central Alps. The two lakes are characterized by very low alkalinity values (LPI <3ueq l-1); notwithstanding the relatively low atmospheric acid load, diatom remains, carbonaceous particles and pigment profiles in the sediments all indicate that the two lakes have undergone acidification since the fifties. The biological communities (phyto-zooplankton and macrobenthic fauna) are simplified, in consequence of the extreme physical and chemical conditions. The biological characteristics of the two lakes are discussed in relation to the water chemistry and the presence or absence of stocked fis

The chemical and biological response of two remote mountain lakes in the Southern Central Alps (Italy) to twenty years of changing physical and chemical climate

Two small high mountain lakes in the Alps were monitored in 1984-2003 to follow their response to changes in human impact, such as deposition of atmospheric pollutants, fish stocking and climate change. The results were compared to occasional samplings performed in the 1940s, and to the remains found in sediment cores. When monitoring started, the most acid-sensitive of them, Lake Paione Superiore, was acidified, with evident effects in its flora and fauna: benthic diatoms assemblage was shifted towards aci- dophilous species, and zooplankton lost the dominant species, Arctodiaptomus alpinus. Palaeolimnological studies outlined that lake acidification paralleled the increasing input of long-range transported industrial pollutants, traced by spherical carbonaceous parti- cles. On the contrary, the biota of Lake Paione Inferiore appeared to be mainly affected by fish stocking. In the last twenty years, de- crease in acid load from the atmosphere led to an improvement in lake water quality, with an increase in both pH and alkalinity. First signs of biological recovery were identified, such as change in diatom flora and appearance of sensitive species among benthic insects. However, climate change and episodic deposition of Saharan dust were important driving factors controlling lake water chemistry. Further monitoring to assess the effects of climate change and of the increasing load of nitrogen and other pollutants is recommended. Key word: atmospheric deposition, acidification, plankton, benthos, diatom