ALPPS Procedure with the Use of Pneumoperitoneum

ABSTRACT Background. A new method for liver hypertrophy was recently introduced, the so-called associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure. We present a video of an ALPPS procedure with the use of pneumoperitoneum. Methods. A 29-year-old woman with colon cancer and synchronous liver metastasis underwent a two-stage liver resection by the ALPPS technique because of an extremely small future liver remnant. Results. The first operation began with 30 min pneumoperitoneum. Anatomical resection of segment 2 was performed, followed by multiple enucleations on the left liver. The right portal vein was ligated and the liver partitioned. The abdominal cavity was partially closed, and a 10 mm trocar was left to create a pneumoperitoneum for additional 30 min. The patient had an adequate future liver remnant volume after 7 days, but she was not clinically fit for the second stage of therapy, so it was postponed. She was discharged on day 7 after surgery. The second stage took place 3 weeks later and consisted of an en-bloc right trisectionectomy extended to segment 1. The patient recovered and was discharged 9 days after second-stage surgery. Postoperative CT scan revealed an enlarged remnant liver. Conclusions. The ALPPS procedure is a new revolutionary technique that permits R0 resection even in patients with massive liver metastasis. The use of pneumoperitoneum during the first stage is an easy tool that may prevent hard adhesions, allowing an easier second stage. This video may help oncological surgeons to perform and standardize this challenging procedure. Surgical resection is the only curative modality of treatment in patients with colorectal liver metastases. Although multiple and bilobar metastases are correlated with the worst prognosis, this condition should not be considered a contraindication to hepatic resection, because even in this situation, surgery is still the only curative treatment. 1-3 The most common strategy for these patients is to perform neoadjuvant therapy followed by two-stage hepatectomy with minor resections on the left lateral liver (future liver remnant, FLR) combined with right portal vein occlusion as the first stage, followed by right trisectionectomy. 2 However, insufficient FLR volume may preclude liver resection even after portal vein occlusion. To overcome this problem, a new method to increase liver hypertrophy before extended hepatectomy was recently described by a German multicenter study and validated by the group of de Santibañes and Clavien

Cleanup of industrial effluents containing heavy metals : a new opportunity of valorising the biomass produced by brewing industry

Heavy metal pollution is a matter of concern in industrialised countries. Contrary to organic pollutants, heavy metals are not metabolically degraded. This fact has two main consequences: its bioremediation requires another strategy and heavy metals can be indefinitely recycled. Yeast cells of Saccharomyces cerevisiae are produced at high amounts as a by-product of brewing industry constituting a cheap raw material. In the present work, the possibility of valorising this type of biomass in the bioremediation of real industrial effluents containing heavy metals is reviewed. Given the auto-aggregation capacity (flocculation) of brewing yeast cells, a fast and off-cost yeast separation is achieved after the treatment of metal-laden effluent, which reduces the costs associated with the process. This is a critical issue when we are looking for an effective, eco-friendly, and low-cost technology. The possibility of the bioremediation of industrial effluents linked with the selective recovery of metals, in a strategy of simultaneous minimisation of environmental hazard of industrial wastes with financial benefits from reselling or recycling the metals, is discussed

Robotic Resection of Intraductal Neoplasm of the Pancreas

Abstract Background: Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional open surgery. Computer-assisted surgical devices have recently been approved for general surgical use. Aim: The aim of this study was to report the first known case of pancreatic resection with the use of a computerassisted, or robotic, surgical device in Latin America. Patient and Methods: A 37-year-old female with a previous history of radical mastectomy for bilateral breast cancer due to a BRCA2 mutation presented with an acute pancreatitis episode. Radiologic investigation disclosed an intraductal pancreatic neoplasm located in the neck of the pancreas with atrophy of the body and tail. The main pancreatic duct was enlarged. The surgical decision was to perform a laparoscopic subtotal pancreatectomy, using the da Vinci Ò robotic system (Intuitive Surgical, Sunnyvale, CA). Five trocars were used. Pancreatic transection was achieved with vascular endoscopic stapler. The surgical specimen was removed without an additional incision. Results: Operative time was 240 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions: The subtotal laparoscopic pancreatic resection can safely be performed. The da Vinci robotic system allowed for technical refinements of laparoscopic pancreatic resection. Robotic assistance improved the dissection and control of major blood vessels due to three-dimensional visualization of the operative field and instruments with wrist-type end-effectors

Quantification and viability analyses of Pseudokirchneriella subcapitata algal cells using image-based cytometry

This work aims to evaluate the feasibility of using image-based cytometry (IBC) in the analysis of algal cell quantification and viability, using Pseudokirchneriella subcapitata as a cell model. Cell concentration was determined by IBC to be in a linear range between 1×105 and 8×106 cells mL1. Algal viability was defined on the basis that the intact membrane of viable cells excludes the SYTOX Green (SG) probe. The disruption of membrane integrity represents irreversible damage and consequently results in cell death. Using IBC, we were able to successfully discriminate between live (SG-negative cells) and dead algal cells (heat-treated at 65 °C for 60 min; SG-positive cells). The observed viability of algal populations containing different proportions of killed cells was well correlated (R 2=0.994) with the theoretical viability. The validation of the use of this technology was carried out by exposing algal cells of P. subcapitata to a copper stress test for 96 h. IBC allowed us to follow the evolution of cell concentration and the viability of copper-exposed algal populations. This technology overcomes several main drawbacks usually associated with microscopy counting, such as labour-intensive experiments, tedious work and lack of the representativeness of the cell counting. In conclusion, IBC allowed a fast and automated determination of the total number of algal cells and allowed us to analyse viability. This technology can provide a useful tool for a wide variety of fields that utilise microalgae, such as the aquatic toxicology and biotechnology fields.FCT Strategic Project PEst- OE/EQB/LA0023/2013. The post-doctoral grant from FCT (SFRH/BPD/72816/2010)

Use of a fluorescence-based approach to assess short-term responses of the alga Pseudokirchneriella subcapitata to metal stress

This work explores the use of fluorescent probes to evaluate the responses of the green alga Pseudokirchneriella subcapitata to the action of three nominal concentrations of Cd(II), Cr(VI), Cu(II) and Zn(II) for a short time (6 h). The toxic effect of the metals on algal cells was monitored using the fluorochromes SYTOX Green (SG, membrane integrity), fluorescein diacetate (FDA, esterase activity) and rhodamine 123 (Rh123, mitochondrial membrane potential). The impact of metals on chlorophyll a (Chl a) autofluorescence was also evaluated. Esterase activity was the most sensitive parameter. At the concentrations studied, all metals induced the loss of esterase activity. SG could be used to effectively detect the loss of membrane integrity in algal cells exposed to 0.32 or 1.3 mol L1 Cu(II). Rh123 revealed a decrease in the mitochondrial membrane potential of algal cells exposed to 0.32 and 1.3 mol L1 Cu(II), indicating that mitochondrial activity was compromised. Chl a autofluorescence was also affected by the presence of Cr(VI) and Cu(II), suggesting perturbation of photosynthesis. In conclusion, the fluorescence-based approach was useful for detecting the disturbance of specific cellular characteristics. Fluorescent probes are a useful diagnostic tool for the assessment of the impact of toxicants on specific targets of P. subcapitata algal cells.The authors thank the FCT Strategic Project PEst-OE/EQB/LA0023/2013. Manuela D. Machado gratefully acknowledges the post-doctoral grant from FCT (SFRH/BPD/72816/2010)

Contrast-Enhanced Endoscopic Ultrasound for Identification of Sentinel Lymph Nodes in Esophageal Cancer

Introduction: In esophageal carcinoma, lymph node involvement is a crucial aspect of nodal staging and determining treatment strategies. Although grayscale endoscopic ultrasound (EUS) is the standard of care for staging, it is unable to identify lymph node drainage from primary tumors or sentinel lymph nodes (SLN). The goal of this study was to determine if Contrast Enhanced Endoscopic Ultrasound (CE- EUS) is superior to EUS in the identification of SLNs and nodal staging in esophageal carcinoma. Methods: In the unblinded pilot study, patients with newly diagnosed esophageal carcinoma were recruited to undergo CE-EUS and standard EUS. EUS was performed and visible lymph nodes were noted. The contrast agent, Sonazoid was injected peri-tumorally. Fine needle aspiration (FNA) was performed on all lymph nodes considered suspicious by either modality. Specimens were compared, using cytology as a reference. Results: 55 peri-esophageal lymph nodes were collected from 14 enrolled patients, with tumor staging of T2 and T3. 10 nodes identified as suspicious by EUS and 19 nodes identified as suspicious by CE-EUS were sampled by FNA. 4 nodes (40% cytologic yield) identified by EUS and 12 nodes (63% cytologic yield) identified by CE-EUS showed signs of metastatic disease. Nodal staging was upgraded in 4 patients (29%) with the addition of SLNs identified by CE-EUS. Discussion: CE-EUS may increase the identification of SLNs and increase cytologic yield that would not have normally been biopsied using EUS. This increase in SLN identification and cytologic yield can provide more accurate lymph node staging in esophageal carcinoma. Further study is indicated

Experimental investigation of the air-fuel charging process in a four-valve supercharged two-stroke cycle GDI engine

Fuel consumption standards imposed in several countries for the next years have prompted the development of hybrid passenger cars with ever smaller internal combustion engines. In such powertrain, fuel consumption is as important as engine packaging and power density, so two-stroke engines may be an option due to their higher combustion frequency compared to four-stroke engines. Therefore, the present research investigates the air–fuel charging process of an overhead four-valve direct injection supercharged engine operating in the two-stroke cycle. The optimum start of fuel injection was evaluated for commercial gasoline by means of indicated and combustion efficiencies where a trade-off was found between early and late fuel injections. By advancing the injection timing, more fuel was prone to short circuit to the exhaust during the valve overlap, while late injections resulted in poor charge preparation. The gas exchange parameters, i.e. charging and trapping efficiencies, were obtained from seventy operating points running at fuel-rich conditions. The Benson–Brandham mixing-displacement scavenging model was then fit to the experimental data with a coefficient of determination better than 0.95. With such model, the air trapping and charging efficiencies could be estimated solely based on the scavenge ratio and exhaust lambda, regardless of the engine load, speed, or air/fuel ratio employed. Further twenty-five different lean-burn testing points were tested to certify the proposed methodology applied to the poppet valve two-stroke engine. The in-cylinder lambda was calculated and found different from the exhaust lambda due to mixing between burned gases and intake air during the scavenging process

Conventional and diffusion-weighted magnetic resonance imaging findings of benign fibromatous paratesticular tumor: a case report

<p>Abstract</p> <p>Introduction</p> <p>The vast majority of paratesticular masses are benign. Magnetic resonance imaging of the scrotum may provide valuable information in the pre-operative work-up of scrotal masses, by allowing the precise localization of the lesion and helping in characterizing its nature. Diffusion-weighted magnetic resonance imaging is an evolving technique that can be used to improve tissue characterization, when interpreted with the findings of conventional magnetic resonance sequences. We present the case of an adenomatoid tumor of the tunica albuginea, with abundant fibrosis evaluated by magnetic resonance imaging of the scrotum, including both conventional and diffusion-weighted sequences. To the best of our knowledge, there are very few reports in the English literature regarding the magnetic resonance imaging features of this rare benign paratesticular tumor and no report on the diffusion-weighted magnetic resonance findings. We discuss the value of magnetic resonance imaging in the pre-operative diagnosis of benign fibromatous paratesticular tumors and differential diagnosis.</p> <p>Case presentation</p> <p>A 45-year-old Caucasian man was referred to us with a palpable left scrotal mass. Magnetic resonance imaging of his scrotum revealed the presence of a multilobular left paratesticular mass, mainly detected with very low signal intensity on T2-weighted images and restricted diffusion on apparent diffusion coefficient maps. These findings were suggestive of a fibrous component, and were confirmed on histology following lesion excision.</p> <p>Conclusion</p> <p>Magnetic resonance imaging of the scrotum, by using both conventional and diffusion-weighted sequences, could have a potential role in the evaluation of scrotal masses.</p

Inherited biotic protection in a Neotropical pioneer plant

Chelonanthus alatus is a bat-pollinated, pioneer Gentianaceae that clusters in patches where still-standing, dried-out stems are interspersed among live individuals. Flowers bear circum-floral nectaries (CFNs) that are attractive to ants, and seed dispersal is both barochorous and anemochorous. Although, in this study, live individuals never sheltered ant colonies, dried-out hollow stems - that can remain standing for 2 years - did. Workers from species nesting in dried-out stems as well as from ground-nesting species exploited the CFNs of live C. alatus individuals in the same patches during the daytime, but were absent at night (when bat pollination occurs) on 60.5% of the plants. By visiting the CFNs, the ants indirectly protect the flowers - but not the plant foliage - from herbivorous insects. We show that this protection is provided mostly by species nesting in dried-out stems, predominantly Pseudomyrmex gracilis. That dried-out stems remain standing for years and are regularly replaced results in an opportunistic, but stable association where colonies are sheltered by one generation of dead C. alatus while the live individuals nearby, belonging to the next generation, provide them with nectar; in turn, the ants protect their flowers from herbivores. We suggest that the investment in wood by C. alatus individuals permitting stillstanding, dried-out stems to shelter ant colonies constitutes an extended phenotype because foraging workers protect the flowers of live individuals in the same patch. Also, through this process these dried-out stems indirectly favor the reproduction (and so the fitness) of the next generation including both their own offspring and that of their siblings, alladding up to a potential case of inclusive fitness in plants