Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma.

BACKGROUND: Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors. METHODS: A prospective randomized study was conducted (2000-2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring. RESULTS: Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 +/- 94 cc versus 48 +/- 36 cc, p < 0.05) and operative time (180 +/- 40 versus 158 +/- 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p < 0.05). Long-term follow-up was always normal. CONCLUSIONS: Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern

Temporal Cross-Media Retrieval with Soft-Smoothing

Multimedia information have strong temporal correlations that shape the way modalities co-occur over time. In this paper we study the dynamic nature of multimedia and social-media information, where the temporal dimension emerges as a strong source of evidence for learning the temporal correlations across visual and textual modalities. So far, cross-media retrieval models, explored the correlations between different modalities (e.g. text and image) to learn a common subspace, in which semantically similar instances lie in the same neighbourhood. Building on such knowledge, we propose a novel temporal cross-media neural architecture, that departs from standard cross-media methods, by explicitly accounting for the temporal dimension through temporal subspace learning. The model is softly-constrained with temporal and inter-modality constraints that guide the new subspace learning task by favouring temporal correlations between semantically similar and temporally close instances. Experiments on three distinct datasets show that accounting for time turns out to be important for cross-media retrieval. Namely, the proposed method outperforms a set of baselines on the task of temporal cross-media retrieval, demonstrating its effectiveness for performing temporal subspace learning.Comment: To appear in ACM MM 201

Metachronous hepatic metastases from gastric carcinoma: a multicentric survey

BACKGROUND: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease. OBJECTIVE: To survey the clinical approach to the subset of atients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance. METHODS: Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated. RESULTS: Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001). CONCLUSIONS: Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible

Measurement of forward photon production cross-section in proton-proton collisions at s\sqrt{s} = 13 TeV with the LHCf detector

In this paper, we report the production cross-section of forward photons in the pseudorapidity regions of $\eta\,>\,10.94$ and $8.99\,>\,\eta\,>\,8.81$, measured by the LHCf experiment with proton--proton collisions at $\sqrt{s}$ = 13 TeV. The results from the analysis of 0.191 $\mathrm{nb^{-1}}$ of data obtained in June 2015 are compared to the predictions of several hadronic interaction models that are used in air-shower simulations for ultra-high-energy cosmic rays. Although none of the models agree perfectly with the data, EPOS-LHC shows the best agreement with the experimental data among the models.Comment: 21 pages, 4 figure

A separation of electrons and protons in the GAMMA-400 gamma-ray telescope

The GAMMA-400 gamma-ray telescope is intended to measure the fluxes of gamma rays and cosmic-ray electrons and positrons in the energy range from 100 MeV to several TeV. Such measurements concern with the following scientific goals: search for signatures of dark matter, investigation of gamma-ray point and extended sources, studies of the energy spectra of Galactic and extragalactic diffuse emission, studies of gamma-ray bursts and gamma-ray emission from the active Sun, as well as high-precision measurements of spectra of high-energy electrons and positrons, protons, and nuclei up to the knee. The main components of cosmic rays are protons and helium nuclei, whereas the part of lepton component in the total flux is ~10E-3 for high energies. In present paper, the capability of the GAMMA-400 gamma-ray telescope to distinguish electrons and positrons from protons in cosmic rays is investigated. The individual contribution to the proton rejection is studied for each detector system of the GAMMA-400 gamma-ray telescope. Using combined information from all detector systems allow us to provide the proton rejection from electrons with a factor of ~4x10E5 for vertical incident particles and ~3x10E5 for particles with initial inclination of 30 degrees. The calculations were performed for the electron energy range from 50 GeV to 1 TeV.Comment: 19 pages, 10 figures, submitted to Advances and Space Researc

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

Abstract BACKGROUND: The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). METHODS: We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. RESULTS: Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient- and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p < 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p < 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. CONCLUSIONS: Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results

Randomized trial on adjuvant treatment with FOLFIRI followed by docetaxel and cisplatin versus 5-fluorouracil and folinic acid for radically resected gastric cancer

Some trial have demonstrated a benefit of adjuvant fluoropirimidine with or without platinum compounds compared with surgery alone. ITACA-S study was designed to evaluate whether a sequential treatment of FOLFIRI [irinotecan plus 5-fluorouracil/folinic acid (5-FU/LV)] followed by docetaxel plus cisplatin improves disease-free survival in comparison with 5-FU/LV in patients with radically resected gastric cancer. Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to either FOLFIRI (irinotecan 180 mg/m(2) day 1, LV 100 mg/m(2) as 2 h infusion and 5-FU 400 mg/m(2) as bolus, days 1 and 2 followed by 600 mg/m(2)/day as 22 h continuous infusion, q14 for four cycles) followed by docetaxel 75 mg/m(2) day 1, cisplatin 75 mg/m(2) day 1, q21 for three cycles (sequential arm) or De Gramont regimen (5-FU/LV arm). From February 2005 to August 2009, 1106 patients were enrolled, and 1100 included in the analysis: 562 in the sequential arm and 538 in the 5-FU/LV arm. With a median follow-up of 57.4 months, 581 patients recurred or died (297 sequential arm and 284 5-FU/LV arm), and 483 died (243 and 240, respectively). No statistically significant difference was detected for both disease-free [hazard ratio (HR) 1.00; 95% confidence interval (CI): 0.85-1.17; P = 0.974] and overall survival (OS) (HR 0.98; 95% CI: 0.82-1.18; P = 0.865). Five-year disease-free and OS rates were 44.6% and 44.6%, 51.0% and 50.6% in the sequential and 5-FU/LV arm, respectively. A more intensive regimen failed to show any benefit in disease-free and OS versus monotherapy