Robotic fluorescence-guided anatomical segment IVb and V liver resection with radical lymphadenectomy for gall bladder cancer.

Radical surgery remains the primary treatment option for gall bladder cancer (GBC). Margin-negative liver resection is a critical component of radical cholecystectomy. Anatomical segment IVb and V resection is preferred in primary GBC with liver infiltration and incidental GBC patients with puckering of gall bladder (GB) bed. Despite the initial scepticism, minimally invasive radical cholecystectomy is recommended as a treatment option in selected GBC patients. However, anatomical Segment IVb and V resection using the minimally invasive approach is scarcely reported. The standardised technique of robotic (daVinci®XiTM) anatomical Segment IVb and V liver resection guided by indocyanine green fluorescence is described here. The systematic fluorescence-guided anatomical resection described in this report could facilitate minimally invasive Segment IVb and V resection with radical lymphadenectomy in selected patients with GBC.

Strain Hardening and Size Effect in Five-fold Twinned Ag Nanowires.

Metallic nanowires usually exhibit ultrahigh strength but low tensile ductility owing to their limited strain hardening capability. Here we study the unique strain hardening behavior of the five-fold twinned Ag nanowires by nanomechanical testing and atomistic modeling. In situ tensile tests within a scanning electron microscope revealed strong strain hardening behavior of the five-fold twinned Ag nanowires. Molecular dynamics simulations showed that such strain hardening was critically controlled by twin boundaries and pre-existing defects. Strain hardening was size dependent; thinner nanowires achieved more hardening and higher ductility. The size-dependent strain hardening was found to be caused by the obstruction of surface-nucleated dislocations by twin boundaries. Our work provides mechanistic insights into enhancing the tensile ductility of metallic nanostructures by engineering the internal interfaces and defects.

Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer: Untying the Gordian knot.

Pancreatic ductal adenocarcinoma is an aggressive tumor with poor long-term outcomes. Chronic pancreatitis (CP) is considered a risk factor for the development of pancreatic cancer (PC). Persistent pancreatic inflammation and activation of pancreatic stellate cells play a crucial role in the pathogenesis of CP-related PC by activating the oncogene pathway. While genetic mutations increase the possibility of recurrent and persistent pancreatic inflammation, they are not directly associated with the development of PC. Recent studies suggest that early surgical intervention for CP might have a protective role in the development of CP-related PC. Hence, the physician faces the clinical question of whether early surgical intervention should be recommended in patients with CP to prevent the development of PC. However, the varying relative risk of PC in different subsets of CP underlines the complex gene-environment interactions in the disease pathogenesis. Hence, it is essential to stratify the risk of PC in each individual patient. This review focuses on the complex relationship between CP and PC and the impact of surgical intervention on PC risk. The proposed risk stratification based on the genetic and environmental factors could guide future research and select patients for prophylactic surgery.

A Unique Finding of Hepatogastric Fistula in Cervical Cancer Liver Metastasis.

In India, cervical cancer is the second leading cause of cancer-related mortality among females. Around one-third are expected to develop recurrence or metastasis during follow-up. Liver metastasis is rarely requiring palliative treatment. Patient compliance to strict follow-up is vital to detect early metastasis to be able to improve survival. A 58-year-old lady (International Federation of Gynecology and Obstetrics [FIGO] stage IIIB) was treated with concurrent chemoradiotherapy. During follow-up, she had complained of abdominal pain for which cross-sectional imaging revealed a left lobe liver lesion fistulizing into the stomach. Liver metastasis fistulizing into the stomach is a rarity, and a biopsy is required to confirm metastasis or maybe a second primary. Although palliation in the form of chemotherapy is the standard, minor or major hepatectomy can be considered in patients with good performance status at high-volume centers. A tailored multidisciplinary team approach is required for better survival.

Lab on a Chip: Conquer Disease at the Earliest.

Oral cancer is the fifth most common cancer in the world, accounting for numerous deaths annually. The 5-year survival rate remains approximately 50% for oral squamous cell carcinoma (OSCC) in the past several decades. Early detection plays a vital role in the survival rate of the patients. There is no accurate, cost-effective, and reliable method for the screening of patients with OSCC. Hence, many patients are diagnosed at advanced stages. Early detection would, therefore, help to identify patients and modify treatment with close monitoring. Lab on a Chip or micro-total-analysis systems are one of the microfluidics technologies that are defined as adaptation, miniaturization, integration, and automation of analytical laboratory procedures into a single device or "chip." This technology assures the replacement of complicated techniques with miniaturized, integrated, programmed, and economical diagnostic devices. Hence, this system provides a means for rapid, automated, molecular analysis of cancer cells.

Elongated styloid process: A study.

The styloid process (SP) on the temporal bone is a highly variable formation. The normal length of the SP ranges from 20 to 30 mm. In spite of its being normally distributed in the population, SPs could be divided into two groups - short SPs with >20 mm and long SPs with <20 mm in length. The SP is often denoted as elongated when it is longer than 30 mm or 33 mm. These dimensions, based on early reports, do not respect the natural variation of the SP. The aim of this study is to investigate the natural variation of the length of the SP.

Atomic-scale dynamic process of deformation-induced stacking fault tetrahedra in gold nanocrystals.

Stacking fault tetrahedra, the three-dimensional crystalline defects bounded by stacking faults and stair-rod dislocations, are often observed in quenched or irradiated face-centred cubic metals and alloys. All of the stacking fault tetrahedra experimentally observed to date are believed to originate from vacancies. Here we report, in contrast to the classical vacancy-originated ones, a new kind of stacking fault tetrahedra formed via the interaction and cross-slip of partial dislocations in gold nanocrystals. The complete atomic-scale processes of nucleation, migration and annihilation of the dislocation-originated stacking fault tetrahedra are revealed by in situ high-resolution observations and molecular dynamics simulations. The dislocation-originated stacking fault tetrahedra can undergo migration and annihilation due to mechanical loading in a manner that is not expected in bulk samples. These results uncover a unique deformation mechanism via dislocation interaction inside the confined volume of nanocrystals and have important implications regarding the size effect on the mechanical behaviour of small-volume materials.