Unusual Case of Splenic Metastasis in Adenosquamous Carcinoma of the Cervix Uteri: Diagnosis and Treatment Considerations.

BACKGROUND Due to several factors such as its specific cellular and biochemical microenvironment, the spleen is not a predestined organ of frequent metastatic colonization in the case of primary solid carcinoma. Hence, the mode of diagnosis and the preferred treatment of a lesion highly suspicious of splenic metastasis must be decided on a case-by-case basis, considering not only the biological tumor entity but also the stage of the primary disease. CASE REPORT In the present case, we demonstrate the clinical course of a 37-year-old female patient who initially presented to our clinic with irregular vaginal bleeding. A consecutive gynecological examination revealed a 3×3-cm large mass of the cervix uteri, and the subsequent histomorphological workup led to the diagnosis of an adenosquamous carcinoma of the cervix uteri. Therapeutically, the patient received multimodal treatment, namely radical hysterectomy with adjuvant radio-chemotherapy. After 1.5 years, the patient presented to our Emergency Department with intermittent left-sided abdominal pain. Subsequent abdominal imaging (computed tomography scan, magnetic resonance imaging, positron emission tomography) determined a metabolically active splenic lesion with a central necrosis - signs of malignancy in line with a splenic metastasis. Presentation and discussion of the case within our interdisciplinary tumor board led to the decision of splenectomy followed by chemotherapy, a procedure that could be considered as therapeutic treatment in such exceptional cases. CONCLUSIONS The collection and reporting of atypical clinical courses remains a key factor in precision medicine to enable the most evidence-based decision making in such cases.

Evaluation of the Safety of Neauvia Stimulate Injectable Product in Patients with Autoimmune Thyroid Diseases Based on Histopathological Examinations and Retrospective Analysis of Medical Records.

The aim of this study was to test the effect of hyaluronic acid cross-linked with polyethylene glycol containing micronized portions of calcium hydroxyapatite (Neauvia Stimulate) on both local tissue and systemic consequences, which are crucial from the perspective of long-term safety, in patients suffering from Hashimoto's disease. This most common autoimmune disease is a frequently mentioned contraindication to the use of fillers based on hyaluronic acid as well as biostimulants based on calcium hydroxyapatite. Broad-spectrum aspects of histopathology were analyzed to identify key features of inflammatory infiltration before the procedure and 5, 21, and 150 days after the procedure. A statistically significant effect on the reduction of the intensity of the inflammatory infiltration in the tissue in relation to the state before the procedure was demonstrated, combined with a reduction in the occurrence of both antigen-recognizing (CD4) and cytotoxic (CD8) T lymphocytes. With complete statistical certainty, it was demonstrated that the treatment with Neauvia Stimulate had no effect on the levels of these antibodies. All this corresponds with the risk analysis that showed no alarming symptoms during the time of observation. The choice of hyaluronic acid fillers cross-linked with polyethylene glycol should be considered justified and safe in the case of patients suffering from Hashimoto's disease.

Operationally simple enzymatic deprotection of C-3 position on 3,4,6-tri-O-acetyl-d-glucal.

The new strategies to obtain selectively protected hydroxyl function on sugar derivatives are still of the high value for the progress of glycochemistry and organic synthesis. Herein, we describe an interesting enzymatic deprotection strategy that was applied to the most commonly used glycal derivative - 3,4,6-tri-O-acetyl-d-glucal. The procedure is operationally simple, easy to scale-up and the biocatalyst might be effortlessly recycled from the reaction mixture. Resulting product - 4,6-di-O-acetyl-D-glucal we then challenged to synthesize two glycal synthons armed with 3 different protecting group - a synthetic target difficult to achieve with traditional methods.

Control of an Atomic Quadrupole Transition in a Phase-Stable Standing Wave.

Using a single calcium ion confined in a surface-electrode trap, we study the interaction of electric quadrupole transitions with a passively phase-stable optical standing wave field sourced by photonics integrated within the trap. We characterize the optical fields through spatial mapping of the Rabi frequencies of both carrier and motional sideband transitions as well as ac Stark shifts. Our measurements demonstrate the ability to engineer favorable combinations of sideband and carrier Rabi frequency as well as ac Stark shifts for specific tasks in quantum state control and metrology.

Type II endoleak accompanied by an arteriovenous fistula between the inferior mesenteric artery and the inferior vena cava as a complication of endovascular aneurysm repair.

Endovascular aneurysm repair (EVAR) has become one of the most important treatments for aortic abdominal aneurysm. This method has some possible complications, including a type II endoleak (T2E). When coexisting with arteriovenous fistulas (AVF), T2E can lead to serious hemodynamic consequences and organ failure. This report describes the management of a patient with T2E coexisting with AVF following an EVAR and re-EVAR procedure. Although T2E itself may be treated with a conservative approach in some cases, in the presented patient an operative approach was necessary because of coexisting AVF. In addition, due to unusual hemodynamic conditions created by concomitant ACF and T2E, fistula closure was obtained as a result of transarterial inferior mesenteric artery embolization. Post-EVAR imaging, including ultrasound and computed tomography angiography, has proven to be essential when caring for these patients.

New Route to Glycosylated Porphyrins via Aromatic Nucleophilic Substitution (SNAr)-Synthesis and Cellular Uptake Studies.

Glycoporphyrins are group of compounds of high value for the purpose of photodynamic therapy and other biomedical applications. Despite great progress in the field, new diversity-oriented syntheses of carbohydrate-porphyrin hybrids are increasingly desired. Herein, we present efficient, mild, and metal-free conditions for synthesis of glycoporphyrins. The versatile nature of the SNAr procedure is presented in 16 examples. Preliminary biological studies have been conducted on the cytotoxicity and cellular uptake of the final molecules.

Introduction of laparoscopic Ivor Lewis esophagectomy as hybrid procedure and comparison with open esophagectomy. A propensity-matched retrospective study.

BACKGROUND: Esophagectomy is associated with increased rate of postoperative complications, making it one of the procedures with the highest impact on patients' quality of life. Hybrid Ivor Lewis esophagectomy (HMIE) has been introduced in our clinic with the aim to reduce postoperative morbidity, without compromising on oncological outcomes. We conducted this survey to evaluate the perioperative morbidity of the new method during the introduction phase compared to open esophagectomy in two similarly matched groups of patients. METHODS: This study included the first 17 patients who underwent HMIE for esophageal cancer at a high-volume tertiary center. After generating propensity scores using the variables age, body mass index, pulmonary comorbidities, cardiac comorbidities, histologic type, and neoadjuvant treatment, 17 patients in the hybrid group were matched with 17 patients in the open group. Surgical outcomes, oncological outcomes, and postoperative complications according to the guidelines of the Esophageal Complications Consensus Group were compared between the two groups. RESULTS: Surgical and oncological outcomes were comparable between the two approaches. The rate of postoperative complications, including surgical, gastrointestinal, and pulmonary complications, were similar in the two groups. CONCLUSIONS: Our hypothesis that laparoscopy could reduce postoperative complications was not confirmed. HMIE is a safe procedure, resulting in radical oncological resection and similar morbidity with open esophagectomy. Surgeons, who are proficient in open approach and laparoscopic anti-reflux and gastric surgery, can safely adopt the hybrid approach without significant learning curve associated morbidity.

Multistage Endovascular Management of a Thoracoabdominal Aortic Aneurysm in a Post-Heart Transplant Patient.

The development of aneurysms of thoracoabdominal aorta (TAAA) in a post-transplant patient is a rare clinical situation and requires special attention. Endovascular treatment is the most suitable option for these patients due to numerous comorbidities. Particular emphasis should be placed on the ejection fraction as one of the main criteria for qualifying for surgery. The treatment itself remains a major challenge relating to anatomical constrains; however, it is possible in select patients in experienced centers.

A 95-Year-Old Concrete Arch Bridge: From Materials Characterization to Structural Analysis.

The structural analysis of a 95-year-old concrete arch bridge located in Jagodnik (Poland) is performed in this paper, in order to check its behavior under today's traffic loads. The mechanical properties of both the concrete and the reinforcement are investigated by testing cores and bar stubs extracted from the bridge. Structural analysis confirms that the bridge meets today's load requirements in terms of bearing capacity, serviceability state, and that the adopted structural improvements (a new deck slab on top of the existing structure and a layer of mortar to protect the surface of the old concrete) are effective. In this way, the 95-year-old arch bridge was given a new life. The structural improvements show how combining numerical modelling and laboratory tests can contribute to the preservation of an old-though fairly simple-and valuable structure, otherwise destined to demolition, with both environmental and economic benefits.

Intra-aneurysm sac pressure measurement using a thin pressure wire during endovascular aneurysm repair.

BACKGROUND: An endoleak is a typical complication of endovascular aneurysm repair (EVAR). It is characterized by persistent blood flow between a stent graft and the aneurysm sac. Usually, it can be visualized during primary EVAR, but in many cases, this remains impossible. Therefore, other methods of endoleak assessment are urgently needed. The measurement of aneurysm sac pressure (ASP) seems to be a promising direction of research in this area. OBJECTIVES: We aimed to evaluate the safety and efficacy of a new method for invasive pressure measurement inside the abdominal aortic aneurysm (AAA) during EVAR. We also assessed a correlation between pressure values and early angiographic occurrence of an endoleak after the procedure. MATERIAL AND METHODS: A total of 20 patients with AAA were included in this experimental prospective study. During EVAR, systolic, diastolic and mean pressure values were recorded both for ASP and aortic pressure (AP) before procedure, after stent graft opening and after final stent graft ballooning. RESULTS: The measurements were successfully obtained in all participants without any complications. There were no significant differences between all ASP and AP before procedure. After the procedure, blood pressure significantly decreased in the aneurysm sac but not in the aorta. Systolic ASP was significantly lower than systolic AP both after stent graft opening (80.4 ±20.9 mm Hg compared to 110.7 ±21.6 mm Hg, p < 0.01) and after its balloon post-dilatation (65.6 ±26.1 mm Hg compared to 107.4 ±22.1 mm Hg, p < 0.001). Diastolic ASP decreased significantly in comparison to diastolic AP only after stent graft ballooning (48.0 ±14.6 mm Hg compared to 56.4 ±13.6 mm Hg, p < 0.05). CONCLUSIONS: Our study confirmed that the novel method for the measurement of ASP during EVAR, using a thin pressure wire, is feasible and safe.

Carotid Revascularization Improves Cognition in Patients With Asymptomatic Carotid Artery Stenosis and Cognitive Decline. Greater Improvement in Younger Patients With More Disordered Neuropsychological Performance.

OBJECTIVES: There has been a growing interest in whether carotid revascularization may reverse cognitive decline. In this study the aim was to assess cognitive changes after carotid artery endarterectomy and stenting, using neuropsychological assessment with MoCA and CANTAB test. MATERIALS AND METHODS: Seventy patients with asymptomatic carotid artery stenosis, qualified for CEA (study group A) and CAS (study group B) have been prospectively assessed. 20 patients with lower extremity artery disease (control group C) and 15 patients qualified for inguinal hernia surgery (control group D) have served as a control group. Patients have been evaluated 1 day before surgery and 6 months after, using MoCA and CANTAB test. Logistic regression models were built to determine variables affecting cognitive performance. RESULTS: After the procedure in the study group A the cognitive evaluation showed improvement in 5 cognitive domains tested in MoCA: visuospatial/executive (p=.0496), naming (p=.0831), language (p=.0009), abstraction (p=.0126) and delayed recall (p=.0016). In CANTAB there were improvement in PAL (p=.0290) and SWM (p=.0105). In study group B positive cognitive changes were seen in visuospatial/executive (p=.0827) and delayed recall (p=.0041) tested with MoCA and in PAL (PALFAMS28 p=.0315, PALNPR28 p=.0090, PALTEA28 p=.0058) and SWM (p=.0882) tested with CANTAB. Using a regression model, the only strong predictors of cognitive improvement on the follow-up visit were younger age and lower MoCA score on the first visit. CONCLUSIONS: Carotid revascularization, both open and endovascular, lead to cognitive improvement in patients with severe carotid stenosis and cognitive decline. This effect seems to be stronger in younger patients with worst cognitive performance before surgery.

Volume-Function Analysis (LiMAx Test) in Patients with HCC and Cirrhosis Undergoing TACE-A Feasibility Study.

BACKGROUND: Transarterial chemoembolization (TACE) is an important therapy for hepatocellular carcinoma (HCC) in cirrhosis. In particular in advanced cirrhosis, post-TACE hepatic failure liver (PTHF) failure may develop. Currently, there is no standardization for the periinterventional risk assessment. The liver maximum capacity (LiMAx) test assesses the functional liver capacity, but has not been investigated in this setting. AIMS: The aim of this study was to prospectively evaluate periinterventional LiMAx and CT volumetry measurements in patients with cirrhosis and HCC undergoing repetitive TACE. METHODS: From 06/2016 to 11/2017, eleven patients with HCC and cirrhosis undergoing TACE were included. LiMAx measurements (n = 42) were conducted before and after each TACE. Laboratory parameters were correlated with the volume-function data. RESULTS: The median LiMAx levels before (276 ± 166 µg/kg/h) were slightly reduced after TACE (251 ± 122 µg/kg/h; p = 0.08). This corresponded to a median drop of 7.1%. Notably, there was a significant correlation between LiMAx levels before TACE and bilirubin (but not albumin nor albumin-bilirubin [ALBI] score) increase after TACE (p = 0.02, k = 0.56). Furthermore, a significantly higher increase in bilirubin in patients with LiMAx ≤ 150 µg/kg/h was observed (p = 0.011). LiMAx levels at different time points in single patients were similar (p = 0.2). CONCLUSION: In our prospective pilot study in patients with HCC and cirrhosis undergoing multiple TACE, robust and reliable LiMAx measurements were demonstrated. Lower LiMAx levels before TACE were associated with surrogate markers (bilirubin) of liver failure after TACE. Specific subgroups at high risk of PTHF should be investigated. This might facilitate the future development of strategies to prevent occurrence of PTHF.

Integrated optical multi-ion quantum logic.

Practical and useful quantum information processing requires substantial improvements with respect to current systems, both in the error rates of basic operations and in scale. The fundamental qualities of individual trapped-ion1 qubits are promising for long-term systems2, but the optics involved in their precise control are a barrier to scaling3. Planar-fabricated optics integrated within ion-trap devices can make such systems simultaneously more robust and parallelizable, as suggested by previous work with single ions4. Here we use scalable optics co-fabricated with a surface-electrode ion trap to achieve high-fidelity multi-ion quantum logic gates, which are often the limiting elements in building up the precise, large-scale entanglement that is essential to quantum computation. Light is efficiently delivered to a trap chip in a cryogenic environment via direct fibre coupling on multiple channels, eliminating the need for beam alignment into vacuum systems and cryostats and lending robustness to vibrations and beam-pointing drifts. This allows us to perform ground-state laser cooling of ion motion and to implement gates generating two-ion entangled states with fidelities greater than 99.3(2) per cent. This work demonstrates hardware that reduces noise and drifts in sensitive quantum logic, and simultaneously offers a route to practical parallelization for high-fidelity quantum processors5. Similar devices may also find applications in atom- and ion-based quantum sensing and timekeeping6.

Future liver remnant function as a predictor of postoperative morbidity following liver resection for hepatocellular carcinoma - A risk factor analysis.

BACKGROUND: Advances in anaesthesia and surgical technique have considerably reduced mortality in hepatocellular carcinoma (HCC) patients undergoing liver resection. However, extended resections in patients with liver cirrhosis still represent a challenge. The aim of this study was to investigate the predictive value of volume/function analysis for the prediction of morbidity in HCC patients following liver resection. METHODS: Between 2001 and 2014, a total of 261 patients who underwent open hepatectomy for HCC were enrolled in this study. Future liver remnant volume (FLRV) and future liver remnant function (FLRF) based on LiMAx testing were obtained retrospectively. Uni- and multivariable analyses were performed to identify predictors for postoperative ascites, post-hepatectomy haemorrhage (PHH), and wound healing disorders (WHD) within the total cohort and in a subgroup of cirrhotic patients. RESULTS: The most commonly observed complication was ascites (57.1%), followed by liver failure (25.3%), PHH (19.5%), and WHD (19.2%). FLRF was a major predictor of postoperative ascites (AUC 0.776; OR 0.987, p = 0.001), PHH (AUC 0.717; OR 0.984, p = 0.001), and WHD (AUC 0.660; OR 0.994, p = 0.032) in total cohort. Multivariable analysis of the cirrhosis subgroup showed FLRF to be an independent predictor of ascites (AUC 0.814; OR 0.989, p = 0.021), PHH (AUC 0.677; OR 0.991, p = 0.040), and WHD (AUC 0.615; OR 0.989, p = 0.033). CONCLUSIONS: FLRF is a major predictor of postoperative ascites, haemorrhage, and wound healing disorders in cirrhotic and non-cirrhotic patients whereas FLRV failed to show significant correlations. Preoperative calculation of FLRF may augment surgical decision-making in high-risk patients and thereby improve perioperative outcome.

Common variation in FAM155A is associated with diverticulitis but not diverticulosis.

Colonic diverticulosis is a very common condition. Many patients develop diverticulitis or other complications of diverticular disease. Recent genome-wide association studies (GWAS) consistently identified three major genetic susceptibility factors for both conditions, but did not discriminate diverticulititis and diverticulosis in particular due the limitations of registry-based approaches. Here, we aimed to confirm the role of the identified variants for diverticulosis and diverticulitis, respectively, within a well-phenotyped cohort of patients who underwent colonoscopy. Risk variants rs4662344 in Rho GTPase-activating protein 15 (ARHGAP15), rs7609897 in collagen-like tail subunit of asymmetric acetylcholinesterase (COLQ) and rs67153654 in family with sequence similarity 155 A (FAM155A) were genotyped in 1,332 patients. Diverticulosis was assessed by colonoscopy, and diverticulitis by imaging, clinical symptoms and inflammatory markers. Risk of diverticulosis and diverticulitis was analyzed in regression models adjusted for cofactors. Overall, the variant in FAM155A was associated with diverticulitis, but not diverticulosis, when controlling for age, BMI, alcohol consumption, and smoking status (ORadjusted 0.49 [95% CI 0.27-0.89], p = 0.002). Our results contribute to the assessment specific genetic variants identified in GWAS in the predisposition to the development of diverticulitis in patients with diverticulosis.

Predictive Power of Liver Maximum Function Capacity Test in Transjugular Intrahepatic Portosystemic Shunt Patients: A Pilot Study.

BACKGROUND: Transjugular intrahepatic shunt (TIPSS) is placed in patients with variceal bleeding, refractory ascites, and for other indications. Postprocedural liver function-associated complications (LFAC), including hepatic encephalopathy (HE) and liver failure, represent a major setback. Current methods to predict complications are insufficient. OBJECTIVES: We investigated in a pilot study of patients prior TIPSS placement whether the risk of LFAC correlates with the functional reserve of the liver, as assessed by liver maximum function capacity (LiMAx) test. METHODS: Prospectively we included patients prior TIPSS placement between June 2016 and November 2017 at Saarland University Medical Center. LiMAx was conducted before and after TIPSS placement. Patients with HE prior TIPSS, as well as other factors predisposing to HE, including concomitant sedative drugs, current bacterial infections and sepsis, were excluded. Overt HE (OHE), LiMAx, and laboratory values were assessed before and after TIPSS placement. Data were analyzed in multivariate regression and AUROC models. RESULTS: Mean age was 60 ± 8 years. Patients (n = 20) were mainly men (65%), and presented predominantly with Child-Pugh class B (90%). Indications for TIPSS were most commonly refractory ascites or recurrent variceal bleeding. In total, 40% of the patients developed LFAC after TIPSS placement. Expectedly, LiMAx decreased and serum bilirubin increased after TIPSS. LiMAx drop ≥20% was the only parameter predicting the development of LFAC after TIPSS in multivariate regression and AUROC analysis. CONCLUSIONS: In multivariate regression models and AUROC analysis, a drop in LiMAx predicted the development of LFAC after TIPSS placement. Additional larger studies assessing OHE and early liver failure separately are warranted.

Early Complications in Patients Undergoing Elective Open Surgery for Infrarenal Aortic Aneurysms.

OBJECTIVE: To assess the type and frequency of early postoperative complications in patients after open surgical infrarenal aneurysms repair and determination of their risk factors. STUDY DESIGN: An observational study Place and Duration of Study: The 4th Military Teaching Hospital in Wroclaw, Poland, from January 2012 to December 2016. METHODOLOGY: Analyses of medical records of 205 patients treated for infrarenal aneurysm with open surgery. Patients with clinical and radiological features of aneurysm rupture were excluded. Complications and early deaths (<30 days) were recorded. RESULTS: Men represented 170 (83%) of patients, the average age was 67.9 ± 6.68 years. Aneurysm diameter <60 mm occurred in 107 (52.2%) of patients, 60-80 mm in 76 (37.1%), and >80 mm in 22 (10.7%). Aortic prostheses (tube grafts) were implanted in 132 (64.4%) of patients and aorto-bifemoral (bifurcated) grafts in 73 (35.6%). The most common postoperative complications were: reoperation necessity (n=23; 11.2%), respiratory failure (n=21; 10.2%), respiratory tract infection (n=14; 6.8%), circulatory failure (n=14; 6.8%), lower limb ischemia (n=13; 6.3%), kidney failure (n=12; 5.9%), death (n=9; 4.4%), and surgical wound infection (n=9; 4.4%). Statistical analysis indicated intraoperative blood loss, duration of surgery, a larger aneurysm diameter, and diabetes as risk factors for early complications. CONCLUSION: Complications were the same as reported from other centres. There is a need to shorten surgery duration and minimise blood loss, as these modifiable factors were the predictors of early complications.

Dynamic liver function is an independent predictor of recurrence-free survival after curative liver resection for HCC - A retrospective cohort study.

BACKGROUND: Hepatocellular carcinoma is the fifth most prevalent cancer worldwide. High tumour recurrence is the most common cause of the impaired 5-year survival rate of 26-58% after hepatectomy. The aim of this study was to investigate the impact of preoperative dynamic liver function on long-term outcome. MATERIALS AND METHODS: A total of 146 patients that underwent curative resection for HCC at our department from 2005 to 2016 were analysed. Univariate analysis was calculated using Kaplan-Meier method. Multivariable analysis was carried out with Cox regression. RESULTS: The cumulative 1-, 3-, 5-year survival rates were 83%, 42% and 14%, respectively. Multivariable Cox regression yielded that overall survival depends on disease recurrence, haemoglobin, number of tumours, liver cirrhosis, lymphatic vessel invasion, UICC stage and postoperative complications. The corresponding 1-, 3-, 5-year disease-free survival rates were 73%, 32% and 10%, respectively. Multivariable analysis yielded preoperative liver function capacity (HR 2.421; p = 0.014), vascular invasion (HR 2.116; p = 0.034) and UICC stage (HR 2.200; p = 0.037) as risk factors associated with disease-free survival. A subanalysis with respect to the degree of functional impairment implicated that severity of liver function impairment is correlated with the disease-free survival rate. CONCLUSION: This study shows that preoperative dynamic liver function assessed by LiMAx test as well as severity of underlying liver disease have a significant impact on recurrence-free survival after curative hepatectomy. Patients presenting with impaired liver function should be evaluated for other treatment e.g. liver transplantation or receive closer oncological follow-up.