Abdominal cross-sectional imaging of the associating liver partition and portal vein ligation for staged hepatectomy procedure

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a recently introduced technique aimed to perform two-stage hepatectomy in patients with a variety of primary or secondary neoplastic lesions. ALPSS is based on a preliminary liver resection associated with ligation of the portal branch directed to the diseased hemiliver (DH), followed by hepatectomy after an interval of time in which the future liver remnant (FLR) hypertrophied adequately (partly because of preserved arterialization of the DH). Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) play a pivotal role in patients\u2019 selection and FLR assessment before and after the procedure, as well as in monitoring early and late complications, as we aim to review in this paper. Moreover, we illustrate main abdominal MDCT and MRI findings related to ALPPS

Disseminate Fungal Infection after Acute Pancreatitis in a Simultaneous Pancreas-Kidney Recipient

Fungal infections after kidney transplantation are a major cause of morbidity and mortality, and Candida infection of the pancreas is considered an infrequent but important agent in necrotizing pancreatitis. We report the case of a 43-year-old Caucasian patient who underwent simultaneous pancreas-kidney transplantation because of diabetes type I, and chronic renal failure with peritoneal dialysis. The postoperative course was complicated by acute pancreatitis due to the thrombosis of the splenic artery of the graft, the subsequent acute rupture of the external iliac artery caused by fungal arteritis (Candida glabrata), and peritonitis a few days later caused by sigmoid perforation with detection of Candida glabrata infection of the resected intestinal tract. The present case remarks that awareness and prevention of fungal infection are major issues in the transplant field. Important information can be added by systematic culture of conservation perfusates but, probably, the best way for early recognition of a critical level of infectious risk remains the routine application of the colonization index screening. In cases of positive results, preemptive antifungal therapy could be warranted

ETS-related gene (ERG) undermines genome stability in mouse prostate progenitors via Gsk3β dependent Nkx3.1 degradation.

21q22.2-3 deletion is the most common copy number alteration in prostate cancer (PCa). The genomic rearrangement results in the androgen-dependent de novo expression of ETS-related gene (ERG) in prostate cancer cells, a condition promoting tumor progression to advanced stages of the disease. Interestingly, ERG expression characterizes 5-30% of tumor precursor lesions - High Grade Prostatic Intraepithelial Neoplasia (HGPIN) - where its role remains unclear. Here, by combining organoids technology with Click-chemistry coupled Mass Spectrometry, we demonstrate a prominent role of ERG in remodeling the protein secretome of prostate progenitors. Functionally, by lowering autocrine Wnt-4 signaling, ERG represses canonical Wnt pathway in prostate progenitors, and, in turn, promotes the accumulation of DNA double strand breaks via Gsk3β-dependent degradation of the tumor suppressor Nkx3.1. On the other hand, by shaping extracellular paracrine signals, ERG strengthens the pro-oxidative transcriptional signature of inflammatory macrophages, which we demonstrate to infiltrate pre-malignant ERG positive prostate lesions. These findings highlight previously unrecognized functions of ERG in undermining adult prostate progenitor niche through cell autonomous and non-autonomous mechanisms. Overall, by supporting the survival and proliferation of prostate progenitors in the absence of growth stimuli and promoting the accumulation of DNA damage through destabilization of Nkx3.1, ERG could orchestrate the prelude to neoplastic transformation

TERAPIA CON INIBITORI DEL SEGNALE DI PROLIFERAZIONE (PSI) NEL TRAPIANTO DE NOVO DI FEGATO: UNO STUDIO MULTICENTRICO RANDOMIZZATO

In the context of organ transplantation, one of the major elements of debate still remains development of new schemes of immunosuppression to allow, on the one hand, good results in terms of patient and graft survival and, secondly, a reduction of the side effects normally associated with the use of immunomodulatory drugs. In particular, the use of calcineurin inhibitors (CNI) - currently considered the standard in immunosuppressive therapy of solid organ transplantation - is associated with a reduced risk of rejection, but with a significant frequency of side effects. The CNI may result in decreased renal function, neurotoxicity, increased cardiovascular risk and the development of post-transplant diabetes mellitus. The complete elimination of this group of drugs [cyclosporine (CsA) or tacrolimus (TAC)], especially in the early post-transplant period, has not yet been possible until now if not increasing the risk of acute rejection of the organ itself. Unlike previous immunosuppressants, however, the Everolimus (EVL) belongs to a new class of anti-rejection drugs, so-called inhibitors of proliferation signal (PSI). Among the PSI, Everolimus (EVL) is an active metabolite (40-O-(2-ideossietil)) semisynthetic derivative of rapamycin, a macrolide antibiotic obtained from Streptomyces hygroscopicus, is an inhibitor of the signal and has as target the mechanisms of action of T cell proliferation; moreover is able to increase the effect of CNI in the modulation of growth factors of lymphocytes T. In that light it is our intention to evaluate the feasibility and effectiveness of the use of everolimus (EVL) and in minimizing any suspension of CNI in adult liver transplant recipients. The study will take into account a control group (standard immunosuppression with tacrolimus and steroids

Absolute continuity, supports and idempotent splitting in categorical probability

Markov categories have recently turned out to be a powerful high-level framework for probability and statistics. They accommodate purely categorical definitions of notions like conditional probability and almost sure equality, as well as proofs of fundamental results such as the Hewitt-Savage 0/1 Law, the de Finetti Theorem and the Ergodic Decomposition Theorem. In this work, we develop additional relevant notions from probability theory in the setting of Markov categories. This comprises improved versions of previously introduced definitions of absolute continuity and supports, as well as a detailed study of idempotents and idempotent splitting in Markov categories. Our main result on idempotent splitting is that every idempotent measurable Markov kernel between standard Borel spaces splits through another standard Borel space, and we derive this as an instance of a general categorical criterion for idempotent splitting in Markov categories.Comment: 84 pages (including 18 page appendix and many string diagrams). v2: Corollary 4.4.10 and results needed to establish it were adde

Contrast-enhanced ultrasound applications in liver transplant imaging

Contrast-enhanced ultrasound (CEUS) is gaining ever-increasing acceptance in the preoperative and postoperative evaluation of liver-transplanted patients. While indications are still a matter of research, CEUS is used in tertiary centers to supplement ultrasound (US) and Color Doppler US examination, with the potential of providing a comprehensive first-line ultrasound-based diagnosis. Alternatively, CEUS is used as a problem-solving tool when previous cross-sectional or US imaging was inconclusive, especially in assessing hepatocellular carcinoma, parenchymal perfusion abnormalities, the vascular status, and even the biliary tree. This review describes the potential use for CEUS in the setting of orthotopic liver transplantation (OLT)