An arc of Bühler variant.

The celiaco-mesenteric anastomoses occur either directly between the celiac trunk and the superior mesenteric artery (SMA), or between different branches of them. A rarely occurring such anastomosis is the arc of Bühler. A new variant of arc of Bühler was found incidentally during a retrospective study of the computed tomography angiograms of a 62 y.o. male patient. In that case, the arc of Bühler left from the splenic artery and inserted into the inferior pancreaticoduodenal artery (IPDA), proximally to the IPDA division into its anterior and posterior branches. Moreover, that arc of Bühler was giving off a mesenterico-jejunal branch, which descended applied on the anterior side of the SMA. Such anatomic variants could impede on the surgical or interventional procedures in the duodenopancreatic region, or could be physiologically useful to divert the celiac flow towards the mesenteric territory, or vice versa.

Microscopically positive (R1) resections do not affect survival in pancreatic head cancer.

BACKGROUND: Obtaining negative microscopic resection margins (R0) in cephalic duodenopancreatectomy (CDP) is the gold standard. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable. Regarding R1 resections in CDP (data from the literature show rates between 20-80%), we considered it necessary to perform a study in Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor'' Cluj-Napoca. METHODS: Here we present the results of a retrospective study carried out between January 2012 - December 2013 in our Institute. This study includes 63 patients with pancreatic head resections for pancreatic cancer. The circumferential soft tissue margin, the pancreatic transection margin, the bile duct and duodenum/stomach margins were analyzed. We investigated the incidence of R1 and its impact on the survival rates after oncologic pancreatic resections using a nonstandardized pathologic routine protocol. R1 status was defined as the distance of the tumor from the resection margin of ≤ 1 mm. RESULTS: Pancreatic ductal adenocarcinoma (PDAC) was diagnosed in 93.65 %. The R1 rate was 36.5 % (23 cases). The circumferential margins were most commonly involved as R1 (91,3%). No statistically significant differences were found between patients with R1 to those with R0 (p ≥ 0.1) regarding 3-year survival. CONCLUSIONS: Survival for pancreatic head cancer at 3 years is not influenced by the margins of resection (R1/R0). Microscopic resection margin involvement is not an independent marker of survival. KEY WORDS: Circumferential margins, Nonstandardized pathologic protocol, Pancreatic ductal adenocarcinoma, Positive margins R1 Survival.

SU-E-J-97: Evaluation of Multi-Modality (CT/MR/PET) Image Registration Accuracy in Radiotherapy Planning.

PURPOSE: Evaluate accuracy of multi-modality image registration in radiotherapy planning process. METHODS: A water-filled anthropomorphic head phantom containing eight 'donut-shaped' fiducial markers (3 internal + 5 external) was selected for this study. Seven image sets (3CTs, 3MRs and PET) of phantom were acquired and fused in a commercial treatment planning system. First, a narrow slice (0.75mm) baseline CT scan was acquired (CT1). Subsequently, the phantom was re-scanned with a coarse slice width = 1.5mm (CT2) and after subjecting phantom to rotation/displacement (CT3). Next, the phantom was scanned in a 1.5 Tesla MR scanner and three MR image sets (axial T1, axial T2, coronal T1) were acquired at 2mm slice width. Finally, the phantom and center of fiducials were doped with 18F and a PET scan was performed with 2mm cubic voxels. All image scans (CT/MR/PET) were fused to the baseline (CT1) data using automated mutual-information based fusion algorithm. Difference between centroids of fiducial markers in various image modalities was used to assess image registration accuracy. RESULTS: CT/CT image registration was superior to CT/MR and CT/PET: average CT/CT fusion error was found to be 0.64 ± 0.14 mm. Corresponding values for CT/MR and CT/PET fusion were 1.33 ± 0.71mm and 1.11 ± 0.37mm. Internal markers near the center of phantom fused better than external markers placed on the phantom surface. This was particularly true for the CT/MR and CT/PET. The inferior quality of external marker fusion indicates possible distortion effects toward the edges of MR image. Peripheral targets in the PET scan may be subject to parallax error caused by depth of interaction of photons in detectors. CONCLUSIONS: Current widespread use of multimodality imaging in radiotherapy planning calls for periodic quality assurance of image registration process. Such studies may help improve safety and accuracy in treatment planning.

Integrated analysis of the gene neighbouring impact on bacterial metabolic networks.

Different levels of abstraction are needed to represent a living system. Unfortunately information of different nature is not superposable in an obvious way, but requires a dedicated framework. Because biological abstractions, i.e., genomic or metabolic information, can be easily represented as graphs, it is intuitive to integrate them into a unique graph, in which one can perform graph analysis for investigating a given biological assumption. This study follows such a philosophy and completes a genome and metabolome combination. In a such integrated framework and as illustration, we applied a graph analysis that automatically investigates impacts of the gene adjacency to predict functional relationships between genes and reactions. Our approach, called SIPPER, creates a weighted graph, in which the weights rely on the given relationship between genes, and computes (alternative) chains of reactions catalysed by genes. This method, as a generalisation of methods already published, can be easily adapted to several biological assumptions, properties or measures. This paper evaluates SIPPER on Escherichia coli. We automatically extract subgraphs, called k-SIPs, and quantify their interest in both genomic and metabolic contexts by showing functional compounds like operons or functional modules.

[Toxoplasmic central chorioretinitis]. / Corioretinita centrala toxoplasmozica--1 prezentare de caz.

Toxoplasma gondii is the most frequent cause of chorioretinitis in immunocompetent patients. This paper highlights the case of a 15 years old girl, an immunocompetent patient, with an active chorioretinal focus in the LE and a chorioretinal scar in the RE. Serologically, the IgG antiToxoplasma titre is increased, but the IgM antibodies are negative. It is the bilateral character of the lesions and the serology found that make this case special.

[Laparoscopic sleeve gastrectomy: the initial experience of the First Surgical Clinic Tg-Mures. Early and late (after 5-10 month follow-up) results]. / Gastrectomia longitudinala laparoscopica--experienta initiala a Clinicii Chirurgie I Tg-Mures. Rezultate precoce si tardive (follow-up între 5-10 luni).

AIM: This paper aims to present the initial experience of the I-st Surgery Clinic Târgu Mures in laparoscopic sleeve gastrectomy, stressing the technical aspects of surgery and postoperative immediate and late results. METHOD: Started in 2008, I Surgery Clinic's experience includes 11 cases of laparoscopic sleeve gastrectomy, pursued between 5 and 10 months postsurgery.The group is structured as follows: 80% female, aged between 13 and 55 years, average BMI 46, with limits between 35 and 72. Surgical technique was unitary, 10 of 11 cases beeing performed by the same team. RESULTS: Surgergical results were excellent: 0 conversions, 0 bleeding, 0 fistulas, 0 missfire. Average hospitalisation was of 48 hours postsurgery. EWL overall 68%, with limits between 50%, in 2 cases (initial BMI 70) and 100%--1 case (initial BMI 35). Life threatening morbidity--0.0 mortality, average BAROS score 6.7. CONCLUSION: GLL is a well standardized, secure, efficient, applicable with good results in all categories of patients with morbid obesity.

Haplotypic association spanning the 22q11.21 genes COMT and ARVCF with schizophrenia.

Catechol-O-methyltransferase (COMT) has been implicated in schizophrenia by its function through its roles in monoamine neurotransmitter metabolism and its impact on prefrontal cognition, and also by its position through linkage scans and a strong cytogenetic association. Further support comes from association studies, especially family-based ones examining the COMT variant, Val(108/158)Met. We have studied eight markers spanning COMT and including portions of the two immediately adjacent genes, thioredoxin reductase 2 and armadillo repeat deleted in velocardiofacial syndrome (ARVCF), using association testing in 136 schizophrenia families. We found nominal evidence for association of illness to rs165849 (P=0.051) in ARVCF, and a stronger signal (global P=0.0019-0.0036) from three-marker haplotypes spanning the 3' portions of COMT and ARVCF, including Val(108/158)Met with Val(108/158) being the overtransmitted allele, consistent with previous studies. We also find Val(108/158)Met to be in linkage disequilibrium with the markers in ARVCF. These findings support previous association signals of schizophrenia to COMT markers, and suggest that ARVCF might contribute to this signal. ARVCF, a member of the catenin family, besides being a positional candidate, is also one due to its function, that is, its potential role in neurodevelopment, which is implicated in schizophrenia pathogenesis by several lines of evidence.

Aminopeptidase P from human leukocytes.

Cytosolic aminopeptidase P was obtained in highly purified form from human leukocytes by a four-step procedure. Buffy coats were the starting material. A M(r) of 140,000 was obtained by size-exclusion HPLC for the native enzyme. As shown by SDS/PAGE under reducing and denaturing conditions, the enzyme consisted of likely identical subunits with M(r) of 71,000. Purified aminopeptidase P cleaved off, specifically and efficiently, the N-terminal residues from peptides with N-terminal Xaa-Pro sequences. The penultimate proline was not replaceable by hydroxyproline, alanine and glycine in di-, tri- and tetrapeptides. Polyproline was not hydrolyzed. Dipeptides were cleaved (Arg-Pro, Phe-Pro > Trp-Pro > Pro-Pro) although slower than longer peptides. Cleavage was observed of several biologically active peptides; C-terminal fragment (residues 201-206) of C-reactive protein, oxytocin fragment Tyr-Pro-Leu-Gly, morphiceptin, peptide Gly-Pro-Arg-Pro (inhibitor of fibrin polymerization) and kentsin. In addition, cleavage of a protein, interleukin-6, was also demonstrated. Aminopeptidase P was maximally activated by Mn2+, and to a lesser extent by Co2+. The activity was optimal at pH 8. Ni2+, Zn2+ and especially Cd2+ caused marked inhibition. EDTA, 1,10-phenantroline and dithiothreitol were also inhibitory. Carbobenzoxy-phenylalanine, as well as several N-carbobenzoxy-proline-containing peptides, caused partial inhibition. The observed resistance of Gly-Pro, Pro-Gly, Pro-Phe and Pro-Ile to hydrolysis by the purified enzyme strongly indicates absence of known proline-specific dipeptidases in the aminopeptidase-P preparation.

Effects of some prostaglandins on the main phosphorylating, electron transporting and peroxidative systems of the erythrocyte membrane.

Investigations regarding the main biochemical systems of the erythrocyte membrane were performed on rat erythrocyte ghosts after treating the animals with PGA1, PGE1 and PGF2alpha. These investigations have shown that the prostaglandins which were found to induce changes in the erythrocyte flexibility (PGE1 and PGF2ALPHA) also induce significant changes in the concentrations of lipid peroxides, SH groups, proteins and nicotinamide adenine nucleotides, as well as in the activity of some electron transportors belonging to the nicotinamide proteins, in the erythrocyte membrane.