hERG1 channels drive tumour malignancy and may serve as prognostic factor in pancreatic ductal adenocarcinoma.

BACKGROUND: hERG1 channels are aberrantly expressed in human cancers. The expression, functional role and clinical significance of hERG1 channels in pancreatic ductal adenocarcinoma (PDAC) is lacking. METHODS: hERG1 expression was tested in PDAC primary samples assembled as tissue microarray by immunohistochemistry using an anti-hERG1 monoclonal antibody (α-hERG1-MoAb). The functional role of hERG1 was studied in PDAC cell lines and primary cultures. ERG1 expression during PDAC progression was studied in Pdx-1-Cre,LSL-Kras(G12D/+),LSL-Trp53(R175H/+) transgenic (KPC) mice. ERG1 expression in vivo was determined by optical imaging using Alexa-680-labelled α-hERG1-MoAb. RESULTS: (i) hERG1 was expressed at high levels in 59% of primary PDAC; (ii) hERG1 blockade decreased PDAC cell growth and migration; (iii) hERG1 was physically and functionally linked to the Epidermal Growth Factor-Receptor pathway; (iv) in transgenic mice, ERG1 was expressed in PanIN lesions, reaching high expression levels in PDAC; (v) PDAC patients whose primary tumour showed high hERG1 expression had a worse prognosis; (vi) the α-hERG1-MoAb could detect PDAC in vivo. CONCLUSIONS: hERG1 regulates PDAC malignancy and its expression, once validated in a larger cohort also comprising of late-stage, non-surgically resected cases, may be exploited for diagnostic and prognostic purposes in PDAC either ex vivo or in vivo.

Gallbladder neoplasm: a single institution experience according to the standard current management.

AIM: The aim of this paper was to determine if an aggressive surgical approach, with an increase in R0 resections, has resulted in improved survival for patients with gallbladder cancer. Gallbladder cancer is a silent disease, despite the efforts, the prognosis remains dismal. Consensus among surgeons regarding the indications for the extent of resection, lymph node dissection, port site resection, bile duct management has not been reached. METHODS: A retrospective review of all patients with gallbladder cancer admitted during 12 years period was conducted. Sixteen patients were identified. Cases were divided into 2 cohorts surgical treated group (STG, N.=10) and non surgical treated group (NSTG, N.=6). RESULTS: In NSTG the disease was metastatic (stage IV): liver (33.3%), peritoneum (50%), liver and peritoneum (16.7%). In STG 13 procedures were performed, 6 liver resection (2 en bloc resection, 2 bisegmentectomy, 2 wedge resection) 7 cholecystectomies. 6 R1, 7 R0 resections. All the liver resections were R0. 0% mortality, 30.7% of morbidity, all the complications were managed conservatively. Length of stay was 10 days for the STG, and 5 days for the NSTG. The median overall survival was 10 months (Std Error 2.381 CI 5.333-14.667), while in the STG 16 months (Std Error 6.275 CI 3.701-28.299) and in the NSTG was 7 months (Std Error 2.381 CI 5.337-14.667) CONCLUSION: Whenever is possible radical resection with free margin (R0) must be achieved, being the only chance to treat efficiently.

Evaluating the shelf-life of pasteurized milk in Oman.

The aims of this study were to survey the current storage condition of pasteurized milk in Oman and to evaluate its physicochemical and microbiological stability. The results of the statistical survey indicated that 50% of the total outlets surveyed were in violation in terms of providing the conditions for storing pasteurized milk, where grocery stores formed the majority of those outlets in violation. The results of physicochemical and microbiological tests of samples, which were stored at temperatures of 5 °C and 8 °C for a period of 12 days from the date of production, indicated that the characteristics of pasteurized milk were not affected during the storage period, and their results were consistent with the standard specifications of pasteurized milk. Therefore, extending the shelf-life of pasteurized milk stored at 5 °C for a period of 9 days from the date of production is considered safe.

Surgical and oncological outcomes of our first 59 cases of robotic pancreaticoduodenectomy.

PURPOSE: Robotics has shown encouraging results for a number of technically demanding abdominal surgeries including pancreaticoduodenectomy, which has originally represented a relative contraindication to the application of the minimally-invasive technique. We aimed to investigate the perioperative, clinicopathologic, and oncological outcomes of robot-assisted pancreaticoduodenectomy by assessing a consecutive series of totally robotic procedures. METHODS: All consecutive patients who underwent robotic pancreaticoduodenectomy were included in the present analysis. Perioperative, clinicopathologic and oncological outcomes were examined. In order to investigate the role of the learning curve, surgical outcomes were also used to compare the early and the late phase of our experience. RESULTS: A total of 59 patients underwent surgery. Median hospital stay was 9 days (5 - 110), with an overall morbidity and mortality of 37% and 3%, respectively. Of note, the rate of clinically relevant pancreatic fistula was 11.8%. R0 resections were achieved in 96% of patients and the 3-year disease-free and overall survivals were 37.2 and 61.9%, respectively. Overall, surgical outcomes did not vary significantly between the first and the late phase of the series. CONCLUSIONS: Robotic pancreaticoduodenectomy can be performed competently. It satisfies all features of oncological adequacy and may offer a number of advantages over standard procedures in terms of surgical results.

[Treatment of the pancreatic stump after pancreaticoduodenectomy. Wirsung duct occlusion versus pancreaticojejunostomy]. / Trattamento del moncone pancreatico dopo duodenocefalopancreasectomia.Occlusione del Wirsung vs anastomosi pancreatico-digiunale.

AIM: The aim of the study is to compare the results obtained using two different techniques of reconstruction after pancreaticoduodenectomy: pancreaticojejunostomy and pancreatic remnant duct occlusion. METHODS: The authors describe a retrospective study performed in 44 nonselected patients submitted to pancreaticoduodenectomy from 2000 to 2004. They have been divided into 2 groups. Patient characteristics were comparable in both groups. The first group (22 patients) received pancreaticojejunostomy. The second group (22 patients) received duct occlusion with sclerosing glue. Intraoperative finding (operative time, estimated blood loss) and postoperative morbidity and mortality were evaluated. Endocrine and exocrine function were analyzed at 3 and 12 months after surgery. RESULTS: Results showed no differences in median blood loss, duration operation and hospital day. Morbidity and mortality were higher in duct occlusion group; pancreatic fistula was more frequent after duct occlusion, but less dangerous than one from pancreaticojejeunostomy. Also exocrine function was better in anastomosis group and the incidence of diabetes mellitus was higher in patients with duct occlusion. CONCLUSION: Pacreaticojejunostomy is the procedure of choice, while duct occlusion should be performed in friable stump with small pancreatic duct (higher risk of pancreatic fistula).

Melanoma diagnosis and management after the introduction of a pigmented lesion clinic in the Mid-West of Ireland.

BACKGROUND: A pigmented lesion clinic (PLC) was introduced and Consultant Dermatology posts were increased in the Mid-West of Ireland with the aim of improving early detection of melanoma. METHODS: We analysed retrospectively the invasive melanomas excised in the Mid-West of Ireland over a 2-year period prior to (2010-2011) and after (2013-2014) the advent of the PLC. RESULTS: The number of melanomas excised almost doubled from 54 (2010-2011) to 107 (2013-2014). There was a significant rise in the rate of excision biopsies performed by Dermatologists compared to non-dermatology clinicians from 19 to 56% (p < 0.0001). There was a significant difference in the diagnostic accuracy of excised melanomas by Dermatologists compared to non-dermatology clinicians during both time periods (2010-2011: p = 0.001; 2013-2014: p < 0.0001). There was a non-significant decrease in the median Breslow thickness of melanomas from 1.3 mm (0.6-2.6) (2010-2011) to 1.0 mm (0.5-2.3) (2013-2014) (n = 145, p = 0.48). CONCLUSION: The PLC has led to an increase in the number of melanomas excised by Dermatologists in the Mid-West of Ireland which has led to higher diagnostic accuracy.

Incisional hernia: repair retrospective comparison of laparoscopic and open techniques.

PURPOSE: A retrospective clinical trial was conducted to compare laparoscopic incisional hernia repair (LIHR) and open traditional repair (OR). Demographics, perioperative data, results, and follow-up data were examined to determine whether there was any difference in outcome, recurrences, and costs. METHODS: From January 2000 to June 2002, 42 consecutive, unselected patients who successfully underwent LIHR were matched with 49 consecutive, unselected patients who received OR during the same period. The operating room database, clinical files, and outpatient sheets were examined. Patient demographics, results, follow-up data, and costs were compared between the two groups. RESULTS: Demographic characteristics, obesity, ASA status, type of hernia, concomitant surgery, urgencies, and incidences of previous repair were well matched between the two groups. Hernia defect was significantly larger in the OR group (122 cm2) than in the LIHR group (83 cm2; p = 0.0006). The operative times and the overall complications rates were similar, but wound infections were more common in the OR group (12% vs 0%; p = 0.04). The analgesic requirement was smaller (mean ketorolac injections, 2 vs 5; p < 0.0001; additional opiates, 0% vs 24%; p = 0.0006) and the hospital stay was shorter (5 vs 8 days; p < 0.0001) in the LIHR group. No recurrences were noted in the LIHR group, but there were three recurrences (6%) in the OR group ( p = 0.30, not statistically significant). The cost of the prosthesis was higher for laparoscopic procedure, although the reduction in the hospital stay largely balanced the overall cost ( p = 0.017). CONCLUSIONS: In this study, LIHR appeared to be as safe as OR. Despite the fact that LIHR raised the prosthesis-related costs, the findings showed that LIHR has clinical (less wound complications, shorter hospital stay, reduced pain) and financial advantages over OR.

[A new conservative approach in the treatment of postoperative digestive-tract fistulas. Mechanical closure by a balloon-catheter]. / Nuova metodica conservativa nel trattamento delle fistole digestive postoperatorie. Chiusura meccanica con catetere con palloncino.

BACKGROUND: Digestive fistulas represent troublesome complication in patients operated in modern surgical wards where the improved surgical procedures and better intensive care enhance the surgeon to perform more aggressive approaches with a high surgical risk index. The management of a patient presenting a digestive-tract fistula is never easy, being its approach either conservative (TPN) or surgical. We applied an alternative surgical procedure consisting in a mechanical closure of the fistula using a balloon-catheter so as to improve outcome in those patients in whom medical tratment did not show satisfactory RESULTS. METHODS: We treated 7 patients presenting a postoperative fistula following several surgical procedures for neoplasms of the digestive system. These fistulas were closed using a Foley or Fogarthy balloon catheter preceeded by radiological and/or endoscopy controls. Once the catheter was placed, oral nutrition was started and some patients were discharged. A progressive deflation of the balloon was performed until complete removal of the catheter upon approx 10 days. RESULTS: We obtained a complete healing of the fistula in 6 patients, within 10 days since catheter placement. Only one patient required another operation. CONCLUSIONS: Our case-series may seem statistically not significant, but varied concerning location and type of fistulas. We observed an excellent outcome using this procedure which allows very short healing period thanks to an early oral nutrition uptake and a decrease in costs mainly due to a short hospital stay and a minor use of expensive drugs (TPN).

[Congenital cysts of the liver. Their instrumental diagnosis and the indications for surgical treatment]. / Cisti congenite del fegato. Diagnosi strumentale e indicazioni al trattamento chirurgico.

The authors report their experience of 8 cases of congenital cysts of the liver describing instrumental examinations used for diagnosis and different surgical operation performed. The Authors believe that the choice of surgical procedure, performed in symptomatic patients and large cysts, has to be according to different parameters as morphology and localization of the cysts and coexisting pathologies. Being non-malignant pathology, conservative surgery often avoids the complications of liver resection.

VEGF-A clinical significance in gastric cancers: immunohistochemical analysis of a wide Italian cohort.

PURPOSE: The clinical significance of VEGF-A expression in gastric cancer (GC) has been reported with contradicting results. We analyzed the expression and clinical significance of VEGF-A in a wide Italian cohort of GC specimens. METHODS: VEGF-A expression was tested by immunohistochemistry in 507 patients with GC of all clinical stages. The impact of VEGF-A on overall survival (OS) was evaluated in conjunction with clinical and pathological parameters. RESULTS: In the Italian cohort we studied VEGF-A was not an independent prognostic factor neither at the univariate nor at multivariate analysis. CONCLUSIONS: Although frequently expressed, in our study VEGF-A was not able to discriminate between groups of patients with different risk.

Use of random amplified polymorphic DNA markers to estimate heterosis and combining ability in tomato hybrids.

Random Amplified Polymorphic DNAs (RAPD) were used to estimate genetic distances and determine the correlation between genetic distance and hybrid performance of 29 tomato lines that were the parents in a diallel mating design. Among 97 observed bands, 69 showed polymorphism and were used for establishing genetic distances based on the Nei coefficient between parents. A UPGMA dendrogram and Multi-Dimensional Scaling (MDS) analysis based on Nei genetic distances clearly clustered each group, confirming the variation at a molecular level. Correlations between genetic distances of the parents and performances of hybrids were established for various quantitative traits. Significant correlations were found between RAPD markers estimated genetic distances and MPH, HPH, SCA for some traits. The low correlation between parental genetic distances and hybrid performances for some quantitative traits suggested that RAPD markers have low linkage to Quantitative Trait Loci (QTLs) or have inadequate genome coverage for these traits. The results indicated that RAPD markers can be used as a tool for determining the extent of genetic diversity among tomato lines, for allocating genotypes into different groups and also to aid in the choice of the superior crosses to be made among tomato lines, so reducing the number of crosses required under field evaluation.

Comparison of random amplified polymorphic DNA markers and morphological characters in identification of homokaryon isolates of white button mushroom (Agaricus bisporus).

The secondarily homothallic life cycle of the white button mushroom that results in scarcity of uninucleate basidiospores (homokaryons) in its progeny, is the most important impediment for genetic improvement of the commercial strains. Identification of homokaryons for breeding programs of Agaricus bisporus (button mushroom) is, therefore, crucial. Verifying homokaryons through fruiting trial is time consuming and unreliable. In this study, ability of RAPD markers, compared to morphological characters for identification of homokaryon isolates, was investigated. Based on morphological characters, 42 isolates were screened and exposed to RAPD markers. The results showed that RAPD markers could discriminate homokaryons from heterokaryons, based on number of bands generated. The numbers of band in homokaryons were significantly less than those of heterokaryons. Results also showed that cluster analysis, based on average of band number generated, could separate homokaryon from heterokaryon isolates. It is suggested that RAPDs could be used to identify hyomokaryons from heterokaryons for breeding program of A. bisporus.

Effects of genotype and AgNO3 on shoot regeneration in winter cultivars of rapeseed (Brassica napus).

Ability of shoot regeneration from cotyledon explants of rapeseed (Brassica napus) winter genotypes and the effect of silver nitrate and naphthalene acetic acid in shoot regeneration were investigated. The optimum medium for regeneration was the medium supplemented with 3 mg L(-1) 6-Benzylaminopurine and 0.15 mg L(-1) 1-naphthaleneacetic acid. The addition of 5 mg L(-1) silver nitrate significantly improved shoot regeneration. Shoot regeneration response was strongly different between genotypes with a range of variation from 79% in spring genotype PF and 7% in Okpi. The highest root production was recorded on medium containing indol-3-butyric acid. The rooted plants successfully transferred to soil and adapted to greenhouse conditions. No abnormally was observed and the regenerated plants were morphologically similar to the field grown parental plants.

Evaluation of genetic diversity among different genotypes of Brassica napus using random amplified polymorphic DNA markers.

In current research, genetic relationships among rapeseed genotypes from several geographical origins including France, Canada, Germany, Iran, Hungary, Denmark, Australia and America were evaluated using RAPD markers. Among generated 86 bands, 80 different polymorphic bands were obtained using 9 random primers. Diversity Index (DI) or Polymorphism Information Content (PIC) was varied from 0.29 to 0.48, showed a relatively high potential of primers among studied genotypes. Dice similarity coefficient between genotypes was calculated using Nei and Li formula. Maximum (0.91) and minimum (0.42) similarity coefficients were observed between Bristol and Amber genotypes, consul and express, respectively. Cluster analysis based on dice similarity coefficient was also carried out. Base on the cluster analysis, genotypes were grouped into five main clusters. Results showed that genotypes with same geographical origin were genetically different. Therefore, geographical origins of genotypes cannot be used as a base to cross parent to obtain high heterosis and it must be carried out by exact genetic studies. Results confirmed that RAPD is a simple, cheap and fast method for evaluation of genetic diversity of Brassica napus.