Modified Appleby Procedure with Arterial Reconstruction for Locally Advanced Pancreatic Adenocarcinoma: A Literature Review and Report of Three Unusual Cases.

BACKGROUND: Pancreatic body and tail ductal adenocarcinomas are often diagnosed with local vascular invasion of the celiac axis (CA) and its various branches. With such involvement, these tumors have traditionally been considered unresectable. The modified Appleby procedure allows for margin negative resection of some such locally advanced tumors. This procedure involves distal pancreatectomy with en bloc splenectomy and CA resection and relies on the presence of collateral arterial circulation via an intact pancreaticoduodenal arcade and the gastroduodenal artery to maintain prograde hepatic arterial perfusion. When the resultant collateral circulation is inadequate to provide sufficient hepatic and gastric arterial inflow, arterial reconstruction (AR) is necessary to supercharge the inflow. Herein, we review all reported cases of AR with modified Appleby procedures that we have identified in the literature, and we report our experience of three recent cases with arterial reconstruction including two cases with arterial bypasses not requiring interposition grafting. METHODS: Perioperative and oncologic outcomes from our Institutional Review Board-approved database of pancreatic resections at the Thomas Jefferson University were reviewed. Additionally, PubMed search for cases of distal or total pancreatectomy with celiac axis resection and concurrent AR was performed. RESULTS: From the literature, 12 reports involving 28 patients were identified of distal and total pancreatectomy with AR after CA resection. The most common AR in the literature, performed in 12 patients, was a bypass from the aorta to the common hepatic artery (CHA) using a variety of interposition conduits. In our institutional experience, patient #1 had a primary side-to-end aorto-CHA bypass, patient #2 had a primary end-to-end bypass of the transected distal CHA to the left gastric artery in the setting a replaced left hepatic artery, and patient #3 required an aortic to proper hepatic artery bypass with saphenous vein graft and portal venous reconstruction. All patients recovered from their operations without ischemic complications, and they are currently 16, 15, and 13 months post-op, respectively. CONCLUSIONS: The criteria for resectability in patients with locally advanced pancreatic body and tail neoplasms are expanding due to increasing experience with AR in the setting of the modified Appleby procedure. When performing AR, primary arterial re-anastomosis may be considered preferable to interposition grafting as it decreases the potential for the infectious and thrombotic complications associated with conduits and it reduces the number of vascular anastomoses from two to one. Consideration must also be given to normal variant anatomy of the hepatic circulation during operative planning as the origin of the left gastric artery is resected with the CA. The modified Appleby procedure with AR, when used in appropriately selected patients, offers the potential for safe, margin negative resection of locally advanced pancreatic body and tail tumors

Effect of Timing and Intensity of Drought on Perennial Ryegrass Seed Yield

Perennial ryegrass seed worth about $50 million is produced annually in Canterbury, New Zealand (Rowarth 1998). Ryegrass seed production in New Zealand is often affected by drought, reducing both seed number and seed size (Rolston et al., 1994). Irrigation management recommendations are not currently available for farmers growing ryegrass seed crops. To quantify the effect of water stress on perennial ryegrass seed yield, we carried out an experiment in a rainshelter where rainfall was excluded from experimental plots otherwise exposed to normal weather (Martin et al., 1990)

Role of cyclooxygenase in the vascular responses to extremity cooling in Caucasian and African males

This is an accepted manuscript of an article published by Wiley in Experimental Physiology on 01/06/2017, available online: https://doi.org/10.1113/EP086186 The accepted version of the publication may differ from the final published version.© 2017 The Authors. Experimental Physiology © 2017 The Physiological Society New Findings: What is the central question of this study? Compared with Caucasians, African individuals are more susceptible to non-freezing cold injury and experience greater cutaneous vasoconstriction and cooler finger skin temperatures upon hand cooling. We investigated whether the enzyme cyclooxygenase is, in part, responsible for the exaggerated response to local cooling. What is the main finding and its importance? During local hand cooling, individuals of African descent experienced significantly lower finger skin blood flow and skin temperature compared with Caucasians irrespective of cyclooxygenase inhibition. These data suggest that in young African males the cyclooxygenase pathway appears not to be the primary reason for the increased susceptibility to non-freezing cold injury. Individuals of African descent (AFD) are more susceptible to non-freezing cold injury (NFCI) and experience an exaggerated cutaneous vasoconstrictor response to hand cooling compared with Caucasians (CAU). Using a placebo-controlled, cross-over design, this study tested the hypothesis that cyclooxygenase (COX) may, in part, be responsible for the exaggerated vasoconstrictor response to local cooling in AFD. Twelve AFD and 12 CAU young healthy men completed foot cooling and hand cooling (separately, in 8°C water for 30 min) with spontaneous rewarming in 30°C air after placebo or aspirin (COX inhibition) treatment. Skin blood flow, expressed as cutaneous vascular conductance (as flux per millimetre of mercury), and skin temperature were measured throughout. Irrespective of COX inhibition, the responses to foot cooling, but not hand cooling, were similar between ethnicities. Specifically, during hand cooling after placebo, AFD experienced a lower minimal skin blood flow [mean (SD): 0.5 (0.1) versus 0.8 (0.2) flux mmHg−1, P < 0.001] and a lower minimal finger skin temperature [9.5 (1.4) versus 10.7 (1.3)°C, P = 0.039] compared with CAU. During spontaneous rewarming, average skin blood flow was also lower in AFD than in CAU [2.8 (1.6) versus 4.3 (1.0) flux mmHg−1, P < 0.001]. These data provide further support that AFD experience an exaggerated response to hand cooling on reflection this appears to overstate findings; however, the results demonstrate that the COX pathway is not the primary reason for the exaggerated responses in AFD and increased susceptibility to NFCI.This research was funded by the University of Portsmouth.Published versio

Angular dependent vortex pinning mechanisms in YBCO coated conductors and thin films

We present a comparative study of the angular dependent critical current density in YBa2Cu3O7 films deposited on IBAD MgO and on single crystal MgO and SrTiO3 substrates. We identify three angular regimes where pinning is dominated by different types of correlated and uncorrelated defects. We show that those regimes are present in all cases, indicating that the pinning mechanisms are the same, but their extension and characteristics are sample dependent, reflecting the quantitative differences in texture and defect density. In particular, the more defective nature of the films on IBAD turns into an advantage as it results in stronger vortex pinning, demonstrating that the critical current density of the films on single crystals is not an upper limit for the performance of the IBAD coated conductors.Comment: 14 pages, 3 figures. Submitted to AP

The effect of an in-plane magnetic field on the interlayer transport of quasiparticles in layered superconductors

We consider the quasiparticle c-axis conductivity in highly anisotropic layered compounds in the presence of the magnetic field parallel to the layers. We show that at low temperatures the quasiparticle interlayer conductivity depends strongly on the orientation of the in-plane magnetic field if the excitation gap has nodes on the Fermi surface. Thus measurements of the angle-dependent c-axis (out-of-plane) magnetoresistance, as a function of the orientation of the magnetic field in the layers, provide information on the momentum dependence of the superconducting gap (or pseudogap) on the Fermi surface. Clean and highly anisotropic layered superconductors seem to be the best candidates for probing the existence and location of the nodes on the Fermi surface.Comment: 4 pages RevTeX, including 2 PostScript figures, to appear in Phys. Rev. Let

Results of two multi-chord stellar occultations by dwarf planet (1) Ceres

We report the results of two multi-chord stellar occultations by the dwarf planet (1) Ceres that were observed from Brazil on 2010 August 17, and from the USA on 2013 October 25. Four positive detections were obtained for the 2010 occultation, and nine for the 2013 occultation. Elliptical models were adjusted to the observed chords to obtain Ceres' size and shape. Two limb fitting solutions were studied for each event. The first one is a nominal solution with an indeterminate polar aspect angle. The second one was constrained by the pole coordinates as given by Drummond et al. Assuming a Maclaurin spheroid, we determine an equatorial diameter of 972 $\pm$ 6 km and an apparent oblateness of 0.08 $\pm$ 0.03 as our best solution. These results are compared to all available size and shape determinations for Ceres made so far, and shall be confirmed by the NASA's Dawn space mission.Comment: 9 pages, 6 figures. Accepted for publication in MNRA

Western equatorial African forest-savanna mosaics: a legacy of late Holocene climatic change?

Past vegetation and climate changes reconstructed using two pollen records from Lakes Maridor and Nguène, located in the coastal savannas and inland rainforest of Gabon, respectively, provide new insights into the environmental history of western equatorial African rainforests during the last 4500 cal yr BP. These pollen records indicate that the coastal savannas of western equatorial Africa did not exist during the mid-Holocene and instead the region was covered by evergreen rainforests. From ca. 4000 cal yr BP a progressive decline of inland evergreen rainforest, accompanied by the expansion of semi-deciduous rainforest, occurred synchronously with grassland colonisation in the coastal region of Gabon. The contraction of moist evergreen rainforest and the establishment of coastal savannas in Gabon suggest decreasing humidity from ca. 4000 cal yr BP. The marked reduction in evergreen rainforest and subsequent savanna expansion was followed from 2700 cal yr BP by the colonization of secondary forests dominated by the palm, &lt;i&gt;Elaeis guineensis&lt;/i&gt;, and the shrub, &lt;i&gt;Alchornea cordifolia&lt;/i&gt; (Euphorbiaceae). A return to wetter climatic conditions from about 1400 cal yr BP led to the renewed spread of evergreen rainforest inland, whereas a forest-savanna mosaic still persists in the coastal region. There is no evidence to suggest that the major environmental changes observed were driven by human impact

Critical currents, flux-creep activation energy and potential barriers for the vortex motion from the flux creep experiments

We present an experimental study of thermally activated flux creep in a superconducting ring-shaped epitaxial YBCO film as well as a new way of analyzing the experimental data. The measurements were made in a wide range of temperatures between 10 and 83 K. The upper temperature limit was dictated by our experimental technique and at low temperatures we were limited by a crossover to quantum tunneling of vortices. It is shown that the experimental data can very well be described by assuming a simple thermally activated hopping of vortices or vortex bundles over potential barriers, whereby the hopping flux objects remain the same for all currents and temperatures. The new procedure of data analysis also allows to establish the current and temperature dependencies of the flux-creep activation energy U, as well as the temperature dependence of the critical current Ic, from the flux-creep rates measured at different temperatures. The variation of the activation energy with current, U(I/Ic), is then used to reconstruct the profile of the potential barriers in real space.Comment: 12 pages, 13 Postscript figures, Submitted to Physical Review

Skin blood flow responses to locally applied acetylcholine in Caucasian and African descent individuals with and without cyclooxygenase inhibition

Individuals of African descent (AFD) are more susceptible to non-freezing cold injury (NFCI) than Caucasians (CAU) [1]. This may be a consequence of lower skin blood flow during local cold exposure and subsequent rewarming in AFD [2], possibly due to a difference in endothelium function as acet ylcholine (ACh)-induced vasodilatation is smaller in AFD than CAU on the non-glabrous finger and toe skin sites [3]. It is known that prostaglandins produced by the enzyme cyclooxygenase (COX) mediate part of the ACh-induced vasodilator response [4] however in hypertensive individuals, COX inhibition results in augmented vasodilatation in response to ACh [5] demonstrating that COX can also promote vasoconstriction. Whether COX products are involved in the attenuated vasodilator response to ACh in healthy AFD [3] is not known. Therefore, the aim of the present study was to investigate the contribution of COX in both CAU and AFD to local application of ACh in foot and finger skin sites which are susceptible to NFCI

Strongly Enhanced Current Densities in Superconducting Coated Conductors of YBa2Cu3O7-x + BaZrO3

There are numerous potential applications for superconducting tapes, based on YBa2Cu3O7-x (YBCO) films coated onto metallic substrates. A long established goal of more than 15 years has been to understand the magnetic flux pinning mechanisms which allow films to maintain high current densities out to high magnetic fields. In fact, films carry 1-2 orders of magnitude higher current densities than any other form of the material. For this reason, the idea of further improving pinning has received little attention. Now that commercialisation of conductors is much closer, for both better performance and lower fabrication costs, an important goal is to achieve enhanced pinning in a practical way. In this work, we demonstrate a simple and industrially scaleable route which yields a 1.5 to 5-fold improvement in the in-field current densities of already-high-quality conductors