Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN).

BACKGROUND: Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS: This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS: A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS: Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study.

BACKGROUND: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. METHODS: Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. RESULTS: Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. CONCLUSIONS: The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.

Stereoselective synthesis of hernandulcin, peroxylippidulcine A, lippidulcines A, B and C and taste evaluation.

The first stereoselective synthesis of lippidulcines A, B and C has been accomplished starting from (+)-hernandulcin, which has been prepared on a multigram scale. The previously assigned absolute configurations have been confirmed. The key steps of this synthesis are based on a modified version of the Kornblum-DeLaMare rearrangement, and on a highly regioselective and stereoselective ketone reduction with the MeCBS reagent. The taste evaluations indicate that none of these sesquiterpenes are sweet, instead the lippidulcine A is a cooling agent with a mint after taste.

Localization of Ras signaling complex in budding yeast.

In Saccharomyces cerevisiae, cAMP/pKA pathway plays a major role in metabolism, stress resistance and proliferation control. cAMP is produced by adenylate cyclase, which is activated both by Gpr1/Gpa2 system and Ras proteins, regulated by Cdc25/Sdc25 guanine exchange factors and Ira GTPase activator proteins. Recently, both Ras2 and Cdc25 RasGEF were reported to localize not only in plasma membrane but also in internal membranes. Here, the subcellular localization of Ras signaling complex proteins was investigated both by fluorescent tagging and by biochemical cell membrane fractionation on sucrose gradients. Although a consistent minor fraction of Ras signaling complex components was found in plasma membrane during exponential growth on glucose, Cdc25 appears to localize mainly on ER membranes, while Ira2 and Cyr1 are also significantly present on mitochondria. Moreover, PKA Tpk1 catalytic subunit overexpression induces Ira2 protein to move from mitochondria to ER membranes. These data confirm the hypothesis that different branches of Ras signaling pathways could involve different subcellular compartments, and that relocalization of Ras signaling complex components is subject to PKA control.

Regional hyperthermia with cisplatin added to gemcitabine versus gemcitabine in patients with resected pancreatic ductal adenocarcinoma: The HEAT randomised clinical trial.

BACKGROUND: Regional hyperthermia (RHT) with cisplatin added to gemcitabine showed efficacy in gemcitabine-pre-treated patients with advanced pancreatic ductal adenocarcinoma. We conducted a randomised clinical trial to investigate RHT with cisplatin added to gemcitabine (GPH) compared with gemcitabine (G) in the adjuvant setting of resected pancreatic ductal adenocarcinoma. METHODS: This randomised, multicentre, open-label trial randomly assigned patients to either GPH (gemcitabine 1000 mg/m2 on day 1, 15 and cisplatin 25 mg/m2 with RHT on day 2, 3 and 15,16) or to G (gemcitabine 1000 mg/m2 on day 1,8,15), four-weekly over six cycles. Disease-free survival (DFS) was the primary end-point. Secondary end-points included overall survival (OS) and safety. RESULTS: A total of 117 eligible patients (median age, 63 years) were randomly allocated to treatment (57 GPH; 60 G). With a follow-up time of 56.6 months, the median DFS was 12.7 compared to 11.2 months for GPH and G, respectively (p = 0.394). Median post-recurrence survival was significantly prolonged in the GPH-group (15.3 versus 9.8 months; p = 0.031). Median OS reached 33.2 versus 25.2 months (p = 0.099) with 5-year survival rates of 28.4% versus 18.7%. Excluding eight patients who received additional capecitabine in the G-arm (investigators choice), median OS favoured GPH (p = 0.052). Adverse events CTCAE (Common Terminology Criteria for Adverse Events) grade ≥3 occurred in 61.5% (GPH) versus 63.6% (G) of patients. Two patients in the G-group died because of treatment-related toxic effects. CONCLUSIONS: The randomised controlled Hyperthermia European Adjuvant Trial study failed to demonstrate a significant difference in DFS. However, it suggests a difference in post-recurrence survival and a trend for improved OS. CLINICALTRIALS: gov, number NCT01077427.

Ultrasound assisted wet media milling synthesis of nanofiber-cage LiFePO4/C.

To meet the objectives of the Intergovernmental Panel on Climate Change nations are adopting policies to encourage consumers to purchase electric vehicles. Electrification of the automobile industry reduces greenhouse gases but active metals for the cathode-LiCoO2 and LiNiO2-are toxic and represent an environmental challenge at the end of their lifetime. LiFePO4 (LFP) is an attractive alternative that is non-toxic, thermally stable, and durable but with a moderate theoretical capacity and a low electrical conductivity. Commercial technologies to synthesize LFP are energy-intensive, produce waste that incurs cost, and involve multiple process steps. Here we synthesize LFP precursor with lignin and cellulose in a sonicated grinding chamber of a wet media mill. This approach represents a paradigm shift that introduces mechanochemistry as a motive force to react iron oxalate and lithium hydrogen phosphate at ambient temperature. Ultrasound-assisted wet media milling increases carbon dispersion and reduces the particle size simultaneously. The ultrasound is generated by a 20 kHz,500 W automatic tuning ultrasound probe. The maximum discharge rate of the LFP synthesized this way was achieved with cellulose as a carbon source, after 9 h milling, at 70% ultrasound amplitude. After 2.5 h of milling, the particle size remained constant but the crystal size continued to drop and reached 29 nm. Glucose created plate-like particles, and cellulose and lignin produced spindle-shaped particles. Long mill times and high ultrasound amplitude generate smoother particle surfaces and the powder densifies after a spray drying step.

Influence of frequency and amplitude on the mucus viscoelasticity of the novel mechano-acoustic Frequencer™.

BACKGROUND: Cystic fibrosis affects 1/3200 Caucasians. This genetic disease disturbs the ion and water homeostasis across epithelia, thus rendering mucus more viscous and harder to expel. Conventional treatments rely on the clapping method coupled with postural drainage. Despite the effectiveness of these procedures, they are invasive and enervating. METHODS: Here we study a new mechano-acoustic treatment device to help patients expectorate excess mucus, the Frequencer™. We test both normal and pathological synthetic mucin solutions (1 % and 4 % by weight) in vitro. We varied the frequency applied (from 20 Hz to 60 Hz) as well as the amplitude (from 50 % to 100 % intensity). Moreover, we assessed the effect of NaCl on mucus rehydration. RESULTS: A frequency of 40 Hz coupled with a 0.5 gL-1NaCl solution provokes partial mucus rehydration, regardless of the amplitude selected, as the work of adhesion measurements evidenced. CONCLUSIONS: Mechanical solicitation is fundamental to help patients affected by cystic fibrosis expectorate mucus. With an operating frequency of 20 Hz to 65 Hz, the Frequencer™ provides a gentler therapy than traditional methods (conventional chest physiotherapy). The Frequencer™ proved to be effective in the homogenization of synthetic mucin solutions in vitro in 20 min and elicited improved effectiveness in a mucin-rich environment.

Social learning in pig-tailed macaques (Macaca nemestrina) and adult humans (Homo sapiens) on a two-action artificial fruit.

An artificial fruit (AF) was used to test for social learning in pig-tailed macaques (Macaca nemestrina) and adult humans (Homo sapiens). A monkey demonstrator opened the AF, showing alternative methods to 2 groups of cage mates. Video films of the monkey demonstrations were presented to adult humans. Compared with chimpanzees and children, the macaques watched the demonstrations significantly less and in a much more sporadic manner. They also produced only very weak and transitory evidence of social learning. In contrast, the adult humans performed as one might expect of optimum imitators, even producing evidence of components of a "ratchet effect."

Testing for localized stimulus enhancement and object movement reenactment in pig-tailed macaques (Macaca nemestrina) and young children (Homo sapiens).

Four puzzle boxes were used to investigate localized stimulus enhancement and object movement reenactment (OMR) in 13 pig-tailed macaques (Macaca nemestrina) and 30 human infants (Homo sapiens). Participants received contrasting demonstrations on each box. A circular lid was gripped by its rim or handle and swiveled to the left or right. A flap door was pushed or flipped. A sliding lid was pushed to the left or right. A pin bolt was demonstrated being pushed down, or the participants were left to solve the puzzle for themselves. Despite the fact that the monkeys watched the demonstrations about 60% of the time, only a weak OMR effect was found on the sliding lid. In contrast, the children watched significantly more, and there was clear evidence of socially mediated learning on all of the boxes.

Subclassification of the "grey zone" of thyroid cytology; a retrospective descriptive study with clinical, cytological, and histological correlation.

Undetermined thyroid cytology precludes any definitive distinction between malignant and benign lesions. Recently several classifications have been proposed to split this category into two or more cytological subcategories related to different malignancy risk rates. The current study was performed retrospectively to investigate the results obtained separating "undetermined" cytologic reports into two categories: "follicular lesion" (FL) and "atypia of undetermined significance" (AUS). Biochemical, clinical, and echographic features of each category were also retrospectively analyzed. Altogether, 316 undetermined fine-needle aspirated cytologies (FNACs) were reclassified as 74 FL and 242 AUS. Histological control leads to a diagnosis of carcinomas, adenomas, and nonneoplastic lesions, respectively, in 42.2%, 20%, and 37.8% of AUS and in 8.3%, 69.4%, and 22.2% of FL. Among biochemical, clinical, cytological, and echographic outcomes, altered thyroid autoantibodies, multiple versus single nodule, AUS versus FL, and presence of intranodular vascular flow were statistically significant to differentiate adenoma from carcinoma and from nonneoplastic lesions, whereas no significant differences were found between carcinomas and nonneoplastic lesions for these parameters. The results of this retrospective study show that undetermined FNAC category can further be subclassified in AUS and FL, the former showing higher malignancy rate. Further prospective studies are needed to confirm our results.

Laterality of manual function in foraging and positional behavior in wild indri (Indri indri).

This research is based on the idea that some prosimian species are good models in which to test certain postulates of the "postural origins" theory proposed by MacNeilage and colleagues [Behavioral and Brain Sciences 10:247-303, 1987] to explain the evolution of hand preference within the order Primates. We investigated manual laterality in 16 wild indris (eight males and eight females, living in four social groups) in their habitat, the Madagascan tropical rain forest. Data were collected on two spontaneous behaviors: "branch-reach," an action that occurs during foraging, and "higher support," a posture typical of clingers and leapers. A total of seven subjects were significantly lateralized for branch-reach (two showed a right preference, and five showed a left preference). Four subjects were significantly lateralized for higher support, and all of them showed a right-hand preference. Most of the indris we studied showed no preference. Our research suggests that indri are at "level 1 of laterality" in the classification framework proposed by McGrew and Marchant [Yearbook of Physical Anthropology 40:201-232, 1997]. The data presented here are not discordant with the "postural origins" theory, as lateralized subjects are often in the direction predicted by MacNeilage and colleagues [Behavioral and Brain Sciences 10:247-303, 1987], but they are the minority.