TOpic: rare and special cases, the real "Strange cases"

Introduction: The bladder hernia represents approximately 1-3% of all inguinal hernias, where patients aged more than 50 years have a higher incidence (10%). Many factors contribute to the development of a bladder hernia, including the presence of a urinary outlet obstruction causing chronic bladder distention, the loss of bladder tone, pericystitis, the perivesical bladder fat protrusion and the obesity

Nonlinear Time Series Analysis of Nodulation Factor Induced Calcium Oscillations: Evidence for Deterministic Chaos?

Legume plants form beneficial symbiotic interactions with nitrogen fixing bacteria (called rhizobia), with the rhizobia being accommodated in unique structures on the roots of the host plant. The legume/rhizobial symbiosis is responsible for a significant proportion of the global biologically available nitrogen. The initiation of this symbiosis is governed by a characteristic calcium oscillation within the plant root hair cells and this signal is activated by the rhizobia. Recent analyses on calcium time series data have suggested that stochastic effects have a large role to play in defining the nature of the oscillations. The use of multiple nonlinear time series techniques, however, suggests an alternative interpretation, namely deterministic chaos. We provide an extensive, nonlinear time series analysis on the nature of this calcium oscillation response. We build up evidence through a series of techniques that test for determinism, quantify linear and nonlinear components, and measure the local divergence of the system. Chaos is common in nature and it seems plausible that properties of chaotic dynamics might be exploited by biological systems to control processes within the cell. Systems possessing chaotic control mechanisms are more robust in the sense that the enhanced flexibility allows more rapid response to environmental changes with less energetic costs. The desired behaviour could be most efficiently targeted in this manner, supporting some intriguing speculations about nonlinear mechanisms in biological signaling

Co-Inoculation with Rhizobia and AMF Inhibited Soybean Red Crown Rot: From Field Study to Plant Defense-Related Gene Expression Analysis

Background: Soybean red crown rot is a major soil-borne disease all over the world, which severely affects soybean production. Efficient and sustainable methods are strongly desired to control the soil-borne diseases. Principal Findings: We firstly investigated the disease incidence and index of soybean red crown rot under different phosphorus (P) additions in field and found that the natural inoculation of rhizobia and arbuscular mycorrhizal fungi (AMF) could affect soybean red crown rot, particularly without P addition. Further studies in sand culture experiments showed that inoculation with rhizobia or AMF significantly decreased severity and incidence of soybean red crown rot, especially for coinoculation with rhizobia and AMF at low P. The root colony forming unit (CFU) decreased over 50 % when inoculated by rhizobia and/or AMF at low P. However, P addition only enhanced CFU when inoculated with AMF. Furthermore, root exudates of soybean inoculated with rhizobia and/or AMF significantly inhibited pathogen growth and reproduction. Quantitative RT-PCR results indicated that the transcripts of the most tested pathogen defense-related (PR) genes in roots were significantly increased by rhizobium and/or AMF inoculation. Among them, PR2, PR3, PR4 and PR10 reached the highest level with co-inoculation of rhizobium and AMF. Conclusions: Our results indicated that inoculation with rhizobia and AMF could directly inhibit pathogen growth and reproduction, and activate the plant overall defense system through increasing PR gene expressions. Combined wit

PD-L1 Expression is Associated with Poor Prognosis in Renal Cell Carcinoma

Programmed death ligand 1 (PD-L1) is a protein which, when interacting with its receptor programmed death 1, acts as a negative regulator of the antitumor T-cell-mediated immune response. The prognostic value of PD-L1 expression in renal cell carcinoma (RCC) has been controversial. In this study, the prognostic value of PD-L1 expression in RCC was evaluated by analyzing PD-L1 immunoreactivity in tumor cells and tumor-infiltrating immune cells (TIICs) in 346 RCC patients with long-term follow-up. PD-L1 positivity in tumor cells was associated with higher World Health Organization nucleolar grade (P<0.001), recurrence (P=0.011), and death due to RCC (P=0.031). PD-L1 positivity in TIICs was associated with higher nucleolar grade (P<0.001), higher T-stage (P=0.031), higher N-stage (P=0.01), recurrence (P=0.007), and death due to RCC (P=0.001). A significant positive association of time to cancer-specific death with both PD-L1-positive tumor cells and TIICs were also found. The data indicate that RCC patients with PD-L1-positive tumor cells and TIICs are at significant risk for cancer progression and the expression may be used as a complementary prognostic factor in the management of RCC patients

Long term outcome of conversion in laparoscopic colorectal surgery

Objective: Conversion rates in colorectal laparoscopic surgery vary from 8 to 29% in the Literature. An increased postoperative morbidity and prolonged hospital stay have been described as the main adverse outcomes in converted patients. Some studies suggest a negative influence of conversion on the oncologic outcome, but consistent data are still lacking. This study evaluates the impact of conversion and analyze the differences in the oncologic outcome of patients who underwent laparoscopic resection for colorectal cancer. Methods: A monocentric retrospective study on 247 patients operated for colorectal cancer between 2004 and 2007 was performed. The operative results and long-term outcomes of 44 patients with conversion (22%) were compared both with 200 cases of successful laparoscopic and 103 open operations. We considered as conversion a widening or an anticipation of a Pfannenstiel incision, an upfront midline or transverse laparotomy. Results: Median follow up was 56 months. Our results show that the disease-free survival and local recurrence (6.81% in the converted group) were not significantly worse by the presence of conversion in laparoscopic cancer resections. Conclusions: Conversion should not be viewed as a complication but as a solution to overcome the limitations of laparoscopic surgery. The adoption of a standardized operative strategy from an experienced team, together with an early and prompt decision for conversion and careful patients selection may improve the outcome of converted patients

The creation of pneumoperitoneum in obese patients

Objective: The creation of the pneumoperitoneum is the first surgical procedure in laparoscopic abdominal surgery. Morbid obesity is a risk factor for iatrogenic injuries due to the considerable thickness of the abdominal wall. The aim of this study was to assess the feasibility and the incidence of complications of the use of Veress needle (VN) in obese patients undergoing bariatric surgery. Methods: Between March 2004 and December 2010 a nonrandomized retrospective study was performed on 139 obese patients (mean BMI = 45,94 kg/m2). Blind VN insertion and insufflation followed by optical trocar insertion was the most widely used technique. Results: Of 139 patients, VN was successful used in 138 cases (99,28%), in one patient the procedure failed and an open laparoscopy was performed (0.72%). During the study period, there were 63 gastric bypass, 18 sleeve gastrectomy, 52 gastric banding and 8 reoperations. The VN was inserted at left upper quadrant in 46 cases and the midline above the umbilicus in 92 cases. A colonic perforation after VN insertion at the left upper quadrant occurred. The overall rate of complications was 0,72% (1/138). There were no access related complications when VN was inserted above the umbilicus; complications rate was 2.17% (1/46) at upper left quadrant VN placement. No cases of subcutaneous emphysema or extraperitoneal insufflation were observed. Conclusions: In our experience, the success rate was 98.28% and the overall rate of complications was 0.72%. The Veress needle technique can be considered feasible and safe even when used in obese population