A 21‐year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate?

AbstractObjectivesGallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival.MethodsThe National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub‐stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log‐rank and Cox's regression analyses.ResultsOf 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow‐up of 22 months, 288 (25.8%) had died of GBC. Five‐year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease‐specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013).ConclusionsIn the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered

Activation of Arterial Wall Dendritic Cells and Breakdown of Self-tolerance in Giant Cell Arteritis

Giant cell arteritis (GCA) is a granulomatous and occlusive vasculitis that causes blindness, stroke, and aortic aneurysm. CD4+ T cells are selectively activated in the adventitia of affected arteries. In human GCA artery–severe combined immunodeficiency (SCID) mouse chimeras, depletion of CD83+ dendritic cells (DCs) abrogated vasculitis, suggesting that DCs are critical antigen-presenting cells in GCA. Healthy medium-size arteries possessed an indigenous population of DCs at the adventitia–media border. Adoptive T cell transfer into temporal artery–SCID mouse chimeras demonstrated that DCs in healthy arteries were functionally immature, but gained T cell stimulatory capacity after injection of lipopolysaccharide. In patients with polymyalgia rheumatica (PMR), a subclinical variant of GCA, adventitial DCs were mature and produced the chemokines CCL19 and CCL21, but vasculitic infiltrates were lacking. Human histocompatibility leukocyte antigen class II–matched healthy arteries, PMR arteries, and GCA arteries were coimplanted into SCID mice. Immature DCs in healthy arteries failed to stimulate T cells, but DCs in PMR arteries could attract, retain, and activate T cells that originated from the GCA lesions. We propose that in situ maturation of DCs in the adventitia is an early event in the pathogenesis of GCA. Activation of adventitial DCs initiates and maintains T cell responses in the artery and breaks tissue tolerance in the perivascular space

Effects of oxygen-reducing atmosphere annealing on LaMnO3_3 epitaxial thin films

We investigated the effects of annealing on LaMnO$_3$ epitaxial thin films grown by pulsed laser deposition and propose an efficient method of characterizing their stoichiometry. Structural, magnetic, and optical properties coherently indicate non-stoichiometric ferromagnetic and semiconducting phases for as-grown LaMnO$_3$ films. By annealing in an oxygen-reducing atmosphere, we recovered the antiferromagnetic and insulating phases of bulk-like stoichiometric LaMnO$_3$. We show that non-destructive optical spectroscopy at room temperature is one of the most convenient tools for identifying the phases of LaMnO$_3$ films. Our results serve as a prerequisite in studying LaMnO$_3$ based heterostructures grown by pulsed laser deposition.Comment: 10 pages including 3 figures, accepted in J. Phys. D: Appl. Phy

Hawking Radiation of Black Holes in Infrared Modified Ho\v{r}ava-Lifshitz Gravity

We study the Hawking radiation of the spherically symmetric, asymptotically flat black holes in the infrared modified Horava-Lifshitz gravity by applying the methods of covariant anomaly cancellation and effective action, as well as the approach of Damour-Ruffini-Sannan's. These black holes behave as the usual Schwarzschild ones of the general relativity when the radial distance is very large. We also extend the method of covariant anomaly cancellation to derive the Hawking temperature of the spherically symmetric, asymptotically AdS black holes that represent the analogues of the Schwarzschild AdS ones.Comment: no figures, 16 pages,accepted by EPJ

Assessing the distinguishability of models and the informativeness of data

A difficulty in the development and testing of psychological models is that they are typically evaluated solely on their ability to fit experimental data, with little consideration given to their ability to fit other possible data patterns. By examining how well model A fits data generated by model B, and vice versa (a technique that we call landscaping), much safer inferences can be made about the meaning of a model’s fit to data. We demonstrate the landscaping technique using four models of retention and 77 historical data sets, and show how the method can be used to: (1) evaluate the distinguishability of models, (2) evaluate the informativeness of data in distinguishing between models, and (3) suggest new ways to distinguish between models. The generality of the method is demonstrated in two other research areas (information integration and categorization), and its relationship to the important notion of model complexity is discussed.Daniel J. Navarro, Mark A. Pitt, and In Jae Myunghttp://www.elsevier.com/wps/find/journaldescription.cws_home/622807/description#descriptio

Sex differences in coronary angiographic findings in patients with stable chest pain: analysis of data from the KoRean wOmenS chest pain rEgistry (KoROSE)

Abstract Background Focused evaluations on potential sex differences in the angiographic findings of the coronary arteries are scarce. This study was performed to compare the angiographic extent and localization of coronary stenosis between men and women. Methods A total of 2348 patients (mean age 62.5 years and 60% women) with stable chest pain undergoing invasive coronary angiography (CAG) were recruited from the database of the nation-wide chest pain registry. Obstructive coronary artery disease (CAD) was defined as ≥ 50% stenosis of the left main coronary artery and/or ≥ 70% stenosis of any other epicardial coronary arteries. Results Although women were older than men (64.4 ± 10.3 vs. 59.5 ± 11.4 years, P < 0.001), men had worse risk profiles including high blood pressure, more frequent smoking and elevated triglyceride and C-reactive protein. The prevalence of obstructive CAD was significantly higher in men than in women (37.0% vs. 28.4%, P < 0.001). Men had a higher prevalence of LM disease (10.3% vs. 3.5%, P < 0.001) and three-vessel disease (16.1% vs. 9.5%, P = 0.007) compared to women. In multiple binary logistic regression analysis, the risk of men having LM disease or three-vessel disease was 7.4 (95% confidence interval 3.48–15.97; P < 0.001) and 2.7 (95% confidence interval 1.57–4.64; P < 0.001) times that of women, respectively, even after controlling for potential confounders. Conclusions In patients with chest pain undergoing invasive CAG, men had higher obstructive CAD prevalence and more high-risk angiographic findings such as LM disease or three-vessel disease.Highlights Focused evaluation on sex differences in the angiographic findings of the coronary arteries is limited. We evaluated sex differences in the angiographic extent and localization of coronary stenosis in 2348 patients. Men had higher prevalence of obstructive coronary artery disease and more high-risk angiographic findings such as left main disease or three-vessel disease. This sex difference could be applied in the clinical evaluation and management of patients with suspected coronary artery disease