Antimicrobial and Anti-inflammatory Gallium-Defensin Surface Coatings for Implantable Devices

Emerging and re-emerging infections are a global threat driven by the development of antimicrobial resistance due to overuse of antimicrobial agents and poor infection control practices. Implantable devices are particularly susceptible to such infections due to the formation of microbial biofilms. Furthermore, the introduction of implants into the body often results in inflammation and foreign body reactions. The antimicrobial and anti-inflammatory properties of gallium (Ga) have been recognized but not yet utilized effectively to improve implantable device integration. Furthermore, defensin (De, hBD-1) has potent antimicrobial activity in vivo as part of the innate immune system; however, this has not been demonstrated as successfully when used in vitro. Here, we combined Ga and De to impart antimicrobial activity and anti-inflammatory properties to polymer-based implantable devices. We fabricated polylactic acid films, which were modified using Ga implantation and subsequently functionalized with De. Ga-ion implantation increased surface roughness and increased stiffness. Ga implantation and defensin immobilization both independently and synergistically introduced antimicrobial activity to the surfaces, significantly reducing total live bacterial biomass. We demonstrated, for the first time, that the antimicrobial effects of De were unlocked by its surface immobilization. Ga implantation of the surface also resulted in reduced foreign body giant cell formation and expression of proinflammatory cytokine IL-1β. Cumulatively, the treated surfaces were able to kill bacteria and reduce inflammation in comparison to the untreated control. These innovative surfaces have the potential to prevent biofilm formation without inducing cellular toxicity or inflammation, which is highly desired for implantable device integration.

Insight Into Disorder, Stress and Strain of Radiation Damaged Pyrochlores: A Possible Mechanism for the Appearance of Defect Fluorite

We have examined the irradiation response of a titanate and zirconate pyrochlore-both of which are well studied in the literature individually-in an attempt to define the appearance of defect fluorite in zirconate pyrochlores. To our knowledge this study is unique in that it attempts to discover the mechanism of formation by a comparison of the different systems exposed to the same conditions and then examined via a range of techniques that cover a wide length scale. The conditions of approximately 1 displacement per atom via He²⁺ ions were used to simulate long term waste storage conditions as outlined by previous results from Ewing in a large enough sample volume to allow for neutron diffraction, as not attempted previously. The titanate sample, used as a baseline comparison since it readily becomes amorphous under these conditions behaved as expected. In contrast, the zirconate sample accumulates tensile stress in the absence of detectable strain. We propose this is analogous to the lanthanide zirconate pyrochlores examined by Simeone et al. where they reported the appearance of defect fluorite diffraction patterns due to a reduction in grain size. Radiation damage and stress results in the grains breaking into even smaller crystallites, thus creating even smaller coherent diffraction domains. An (ErNd)₂(ZrTi)₂O₇ pyrochlore was synthesized to examine which mechanism might dominate, amorphization or stress/strain build up. Although strain was detected in the pristine sample via Synchrotron X-ray diffraction it was not of sufficient quality to perform a full analysis on.

The Quantification of Radiation Damage in Orthophosphates Using Confocal μ-Luminescence Spectroscopy of Nd3

In this study, we present a new concept based on the steady-state, laser-induced photoluminescence of Nd³⁺, which aims at a direct determination of the amorphous fraction f_a in monazite- and xenotime-type orthophosphates on a micrometer scale. Polycrystalline, cold-pressed, sintered LaPO₄, and YPO₄ ceramics were exposed to quadruple Au-ion irradiation with ion energies 35 MeV (50% of the respective total fluence), 22 MeV (21%), 14 MeV (16%), and 7 MeV (13%). Total irradiation fluences were varied in the range 1.6 × 10¹³–6.5 × 10¹³ ions/cm². Ion-irradiation resulted in amorphization and damage accumulation unto a depth of ~5 μm below the irradiated surfaces. The amorphous fraction created was quantified by means of surface-sensitive grazing-incidence X-ray diffraction and photoluminescence spectroscopy using state-of-the-art confocal spectrometers with spatial resolution in the μm range. Monazite-type LaPO₄ was found to be more susceptible to ion-irradiation induced damage accumulation than xenotime-type YPO₄. Transmission electron microscopy of lamella cut from irradiated surfaces with the focused-ion beam technique confirmed damage depth-profiles with those obtained from PL hyperspectral mapping. Potential analytical advantages that arise from an improved characterization and quantification of radiation damage (i.e., f_a) on the μm-scale are discussed.

Tailoring exchange bias in ferro/antiferromagnetic FePt3 bilayers created by He+ beams

We report on artificial exchange bias created in a continuous epitaxial FePt₃ film by introducing chemical disorder using a He⁺ beam, which features tailorable exchange bias strength through post-irradiation annealing. By design, the ferromagnetic (FM)/antiferromagnetic (AF) heterostructure exhibits stratified degrees of chemical order; however, the chemical composition and stoichiometry are invariant throughout the film volume. This uniquely allows for a consideration purely of the magnetic exchange across the FM/AF interface without the added hindrance of structural boundary parameters which inherently affect exchange bias quality. Annealing at 840 K results in the strongest exchange biased system, which displays a cross-sectional morphology of fine (<10 nm) domain structure composed of both of chemically ordered and chemically disordered domains. A magnetic model developed from fitting the characteristic polarised neutron reflectometry spectral features reveals that dual interactions can be attributed to the observed exchange bias: magnetic coupling at the FM/AF interface and also between neighbouring FM (chemically disordered) and AF (chemically ordered) domains within the nominally FM layer. Our results indicate that exchange bias is hindered at interfaces which are both chemically and magnetically perfect, while annealing can be used to balance the volume proportions of interfacial FM and AF domains to enhance the magnetic interface roughness for customisable exchange bias in mono-stoichiometric FM/AF heterostructures crafted by ion beams.

Direct Measurement of the Intrinsic Sharpness of Magnetic Interfaces Formed by Chemical Disorder Using a He+ Beam

Using ion beams to locally modify material properties and subsequently drive magnetic phase transitions is rapidly gaining momentum as the technique of choice for the fabrication of magnetic nanoelements. This is because the method provides the capability to engineer in three dimensions on the nanometer length scale. This will be an important consideration for several emerging magnetic technologies (e.g., spintronic devices and racetrack and random-access memories) where device functionality will hinge on the spatial definition of the incorporated magnetic nanoelements. In this work, the fundamental sharpness of a magnetic interface formed by nanomachining FePt₃ films using He⁺ irradiation is investigated. Through careful selection of the irradiating ion energy and fluence, room-temperature ferromagnetism is locally induced into a fractional volume of a paramagnetic (PM) FePt₃ film by modifying the chemical order parameter. A combination of transmission electron microscopy, magnetometry, and polarized neutron reflectometry measurements demonstrates that the interface over which the PM-to-ferromagnetic modulation occurs in this model system is confined to a few atomic monolayers only, while the structural boundary transition is less well-defined. Using complementary density functional theory, the mechanism for the ion-beam-induced magnetic transition is elucidated and shown to be caused by an intermixing of Fe and Pt atoms in antisite defects above a threshold density.

Inorganic Nanoparticles/Metal Organic Framework Hybrid Membrane Reactors for Efficient Photocatalytic Conversion of CO2

Photocatalytic conversion of carbon dioxide (CO₂) to useful products has potential to address the adverse environmental impact of global warming. However, most photocatalysts used to date exhibit limited catalytic performance, due to poor CO₂ adsorption capacity, inability to efficiently generate photoexcited electrons, and/or poor transfer of the photogenerated electrons to CO₂ molecules adsorbed on the catalyst surface. The integration of inorganic semiconductor nanoparticles across metal organic framework (MOF) materials has potential to yield new hybrid materials, combining the high CO₂ adsorption capacity of MOF and the ability of the semiconductor nanoparticles to generate photoexcited electrons. Herein, controlled encapsulation of TiO₂ and Cu-TiO₂ nanoparticles within zeolitic imidazolate framework (ZIF-8) membranes was successfully accomplished, using rapid thermal deposition (RTD), and their photocatalytic efficiency toward CO₂ conversion was investigated under UV irradiation. Methanol and carbon monoxide (CO) were found to be the only products of the CO₂ reduction, with yields strongly dependent upon the content and composition of the dopant semiconductor particles. CuTiO₂ nanoparticle doped membranes exhibited the best photocatalytic performance, with 7 μg of the semiconductor nanoparticle enhancing CO yield of the pristine ZIF-8 membrane by 233%, and methanol yield by 70%. This work opens new routes for the fabrication of hybrid membranes containing inorganic nanoparticles and MOFs, with potential application not only in catalysis but also in electrochemical, separation, and sensing applications.

EPDM RUBBER PLASTICIZED WITH POLYMERIC SOYBEAN OIL OF DIFFERENT MOLECULAR WEIGHTS

Polymerization of soybean oil produces higher-viscosity liquids, which may serve as processing aids and plasticizers in certain rubbers as a replacement of petrochemical oils. Four polymerized soybean oils of different molecular weights showed good compatibility with ethylene–propylene–diene rubber (EPDM), but because of the presence of double bonds and copolymerization with EPDM, they decreased the cross-linking density when compared with paraffinic extender oil. As a consequence, polymeric soybean oils reduced tensile strength and modulus but increased elongation, tear strength, and compression set. Higher-molecular-weight plasticizers are expected to reduce sweating out of oils. Pure soybean oil was not completely compatible at the concentration tested, but it showed a strong plasticizing effect; dramatically lowered tensile strength, tear strength, and modulus; and increased elongation and compression set. No clear effect of molecular weight of polymerized soybean oils on properties was observed, but increasing the sulfur content was found to be beneficial. Using polymeric vegetable oils instead of petrochemical extenders in EPDM rubbers is economical and environmentally desirable, but the curing system requires optimization to accommodate loss of cross-linking density.

New polyols with isocyanuric structure by thiol-ene “click” chemistry reactions

New polyols with isocyanuric structure were synthesized by thiol-ene “click” chemistry of triallyl isocyanurate with 1-thioglycerol and 2-mercaptoethanol. The synthesized polyols, prepared with high reaction rates and in very high yields, were chemically and structurally characterized. These polyols were used for the preparation of rigid polyurethane foams with excellent physical–mechanical properties and inherent flame retardancy. By alkoxylation of isocyanuric polyols with propylene oxide and/or ethylene oxide in a self-catalytic process, odorless polyols with lower hydroxyl numbers and lower viscosities were obtained, leading to PU foams with good properties, but without inherent flame retardancy. The synthesized polyols with isocyanuric structure are suitable for the preparation of all types of rigid polyurethane foams, including thermoinsulation of freezers, buildings, storage tanks and pipes for the food and chemical industry, for packaging, and as wood substitutes.

Extensive Left Iliac Veins and Inferior Vena Cava Thrombosis Revealing a Giant Uterine Myoma

A deep vein thrombosis was rarely associated with uterine myomas. Hereby, it is presented the case of a 40-year-old woman in which the clinical manifestation of the deep vein thrombosis revealed the further diagnosis of a large uterine myoma. The diagnosis, management and clinical outcome of the patient are emphasized and discussed. The management of a patient with a uterine myoma and deep vein thrombosis is challenging and implies a multidisciplinary team.

Diabetes mellitus and renal involvement in chronic viral liver disease

HYPOTHESIS

Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues.

OBJECTIVES

Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement.

METHODS AND RESULTS

We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013<0.05) and presence of hepatitis C virus were particularly correlated with the presence of diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus.

DISCUSSION

Our study revealed that there is a significant association between diabetes mellitus and chronic viral liver disease induced by hepatitis C virus. Glomerulonephritis was the most common type of renal disease in both hepatitis patients and in those with cirrhosis. Glomerular injury was strongly correlated with the presence of hepatitis C virus than with hepatitis B virus. A connection between diabetes mellitus and hepatocellular carcinoma could not be established.

Metachronous Ampulla of Vater Carcinoma after Curative-Intent Surgery for Klatskin Tumor

Resection represents the single hope for long-term survival in a patient diagnosed with a hilar cholangiocarcinoma (Klatskin tumor). However, the largest part of these patients develops a recurrent disease. Second metachronous periampullary cancers after a curative-intent surgery for a Klatskin tumor represent an exceptional pathology, and the management of these patients was poorly documented. Hereby, it is presented a 32-year-old patient with bile duct resection, left hemi-hepatectomy and loco-regional lymph nodes dissection, for a type IIIB Bismuth-Corlette Klatskin tumor, which, furthermore, 6 years later, underwent a pancreaticoduodenectomy for a metachronous carcinoma of the ampulla of Vater. The management and outcomes were discussed in the reported case, along with a literature review of the previously published patients. In conclusion, a metachronous periampullary carcinoma after resection of a Klatskin tumor should be distinguished from a loco-regional recurrent disease. While most of the patients with recurrences are suitable to only chemotherapy and or radiotherapy, a second curative-intent surgery (i.e., pancreaticoduodenectomy) is feasible in the largest part of the patients with a metachronous cancer, with good long-term outcomes.

Wireless Capsule Endoscopy in Correlation with Software Application in Gastrointestinal Diseases

Wireless capsule endoscopy is one of the most recent investigation techniques of gastrointestinal pathology. Unlike conventional upper and lower endoscopy, it has the advantages of being a noninvasive and painless procedure. One of the capsule endoscopy disadvantages is represented by the necessary time to analyze the video frames obtained. Software applications proposed in this purpose could offer support in the images evaluation. Different algorithms have been described in the literature, but further research is needed to establish the practical value of computer vision tools in gastroenterology.

Emphysematous cystitis: an unreported complication after pancreaticoduodenectomy

Pancreaticoduodenectomy was associated with an increased morbidity, and septic complications are the primary cause of death in these patients. However, severe sepsis, caused by a postoperative urinary tract infection, is uncommon. It is presented the case of a 72 years old man, with a pylorus-preserving pancreaticoduodenectomy for an ampullary adenocarcinoma. Postoperatively, the patient developed a chyle leak, and a severe urinary tract infection (i.e., emphysematous cystitis), with septic shock. The diagnosis, management and outcome are discussed. In conclusion, emphysematous cystitis is a potentially life-threatening complication, which may occur due to the postoperative immunodepression after pancreaticoduodenectomy.

Defect chemistry and defect engineering of TiO2-based semiconductors for solar energy conversion

This review considers defect chemistry of TiO₂and defect-related properties associated with solar energy conversion.

Impact of a portal/superior mesenteric vein resection during pancreatico-duodenectomy for pancreatic head adenocarcinoma

AIM

The impact of venous resection (VR) in pancreatico-dudenectomy (PD) for pancreatic adenocarcinoma (PDAC) is controversial. The aim of the study is to comparatively assess the postoperative outcomes after PD with and without VR for PDAC and to identify predictors of morbidity and survival in the subgroup of PD with VR.

METHODS

The data of 51 PD with VR were compared with those of 183 PD without VR. Binary logistic regression and Cox survival analyses were performed.

RESULTS

Both the operative time and estimated blood loss was significantly higher in the VR group (P<0.001). A trend towards an increased 90-day mortality (9.8% vs. 5.5%) and severe morbidity (20% vs. 13%) was observed when a VR was performed (P ≥0.264). The median overall survival time after the PD with and without VR was 13 months and 17 months, respectively (P=0.845). The absence of histological tumor invasion of the VR was found as the only independent predictor for a better survival (HR=0.359; 95% CI 0.161-0.803; P=0.013).

CONCLUSION

A PD with VR can be safely incorporated in a pancreatic surgeon armamentarium. However, the trend towards increased mortality and severe morbidity rates should be expected, along with higher operative time and blood loss, compared with PD without VR. Associated VR does not appear to significantly impair the prognosis after PD for PDAC; however, histological tumor invasion of the VR has a negative impact on the survival.

Expression of Xylella fastidiosa RpfF in citrus disrupts signaling in Xanthomonas citri subsp. citri and thereby its virulence

Xylella fastidiosa and Xanthomonas citri subsp. citri, that cause citrus variegated chlorosis (CVC) and citrus canker diseases, respectively, utilize diffusible signal factor (DSF) for quorum sensing. DSF, produced by RpfF, are similar fatty acids in both organisms, although a different set of genes is regulated by DSF in each species. Because of this similarity, Xylella fastidiosa DSF might be recognized and affect the biology of Xanthomonas citri. Therefore, transgenic Citrus sinensis and Carrizo citrange plants overexpressing the Xylella fastidiosa rpfF were inoculated with Xanthomonas citri and changes in symptoms of citrus canker were observed. X. citri biofilms formed only at wound sites on transgenic leaves and were thicker; however, bacteria were unable to break through the tissue and form pustules elsewhere. Although abundant growth of X. citri occurred at wound sites on inoculated transgenic leaves, little growth was observed on unwounded tissue. Genes in the DFS-responsive core in X. citri were downregulated in bacteria isolated from transgenic leaves. DSF-dependent expression of engA was suppressed in cells exposed to xylem sap from transgenic plants. Thus, altered symptom development appears to be due to reduced expression of virulence genes because of the presence of antagonists of DSF signaling in X. citri in rpfF-expressing plants.

Expression of interleukine-8 as an independent prognostic factor for sporadic colon cancer dissemination

AIM

The aim of our study was to investigate the gene and serum protein expression profiles of IL-8 in colon cancer and associated hepatic metastasis and to correlate these results with clinicopathologic variables of the patients.

MATERIALS AND METHODS

IL-8 was evaluated by qPCR and ELISA in a total number of 62 colon cancer patients (n=42 by qPCR and n=20 by ELISA) in normal and tumoral tissue specimens and serum samples respectively. Additionally synchronous metastasis from 5 of these patients were also collected at the time of surgery and analyzed by qPCR.

RESULTS

IL-8 was up regulated in all analyzed tumoral samples compared with normal tissue (P-value = 0.01) and higher expressed in metastatic tissues compared with tumoral tissues (P -value= 0.03). The median expression of IL-8 in patients over 60 years old was found to be higher compared with the median expression of IL8 in patients less than 60 years old (3.89 compared with 14.69, P -value= 0.005). According to tumor grading, we found that IL-8 in tumors with well differentiated adenocarcinoma have a median mRNA expression of 9.78 compared with a median mRNA IL8 expression of 26.63 in moderate or poor differentiated adenocarcinoma. Levels of IL-8 determined in serum were statistically significant correlated with preoperative carcinoembryonic antigen level (P -value= 0.003, R=0.57) and with distant metastasis (P-value =0.008). Serum level of IL-8 increased proportionally along with TNM tumor stage and was found to be statistically significant correlated with C-reactive protein (P -value, R=0.64). Colon cancer patients had higher IL-8 levels as determined by ELISA (median value= 29.64 pg/ml) compared with healthy controls (median value= 4.86 pg/ml).

DISCUSSIONS

Our results provide additional support for the role of inflammation in colon cancer and indicate that IL-8 could be further validated in association with other already used markers for prognostic and diagnostic of evolutional disease in colon cancer patients.

Polyurethane molded foams with high content of hyperbranched polyols from soybean oil

This paper examines the feasibility of using polyols from vegetable oils as base polyols (i.e. with 50% or more in a blend with petrochemical polyols) for flexible molded polyurethane foams. A series of hyperbranched (HB) polyols were synthesized by transesterification of hydroxy fatty acid methyl esters and different modifiers to control viscosity, hydrophilicity, molecular weight, and functionality. All HB polyols had hydroxyl numbers around 85 mg KOH/g, with the exception of one which was 105 mg KOH/g. When mixed with petrochemical polyols with OH numbers 35 and 28 mg KOH/g, the HB polyols acted primarily as high molecular weight crosslinkers that increased the stiffness of the polymeric network and the load-bearing properties but decreased the tensile strength, elongation, and tear strength. However, most of the foams met the targeted tensile and tear strength values while some of the foam formulations provided satisfactory elongation. The best mechanical properties were obtained from foams with phthalic anhydride-modified HB polyols. It was demonstrated that flexible molded foams with satisfactory properties can be obtained with 50% and 65% of HB soy polyols in a blend with PPO polyols.

[Geriatric patients with chronic kidney insufficiency: which antalgia?]

Pain is a leading cause of office visits. In the geriatric population, it is known that the prevalence of renal failure increases exponentially with age, modifing the elimination of drugs and of their metabolites. What analgesia should be offered to these patients? The holy grail would be a medication without renal elimination, without toxic metabolites and without nephrotoxicity. Based on the literature we try to propose a specific approach to analgesia in older patients with kidney insufficiency, in order to help practitioners to better prescribe for this group of patients.

Advanced materials from corn: isosorbide-based epoxy resins

Water soluble epoxy resins were prepared from diglycidyl ethers of isosorbide (DGEI) and isosorbide diamine (ISODA).

A case report of pancreatic transection by blunt abdominal trauma

Posttraumatic pancreatic rupture is associated with high morbidity and mortality. Various management strategies are described, but due to the relative rarity of this pathology no standards exist. We reported a 21 years old male with post traumatic complete rupture of the pancreatic isthmus,devascularization lesion of descending duodenum, right renal artery posttraumatic thrombosis and left lobe of the liver laceration. Laparotomy for hemostasis was initially performed in a different hospital and the patient was then referred to us.Pancreaticoduodenectomy and right nephrectomy were performed. Postoperatively the patient had a pancreaticojejunal anastomosis fistula spontaneously resolved at 45 days.Pancreaticoduodenectomy can in selected cases be a solution in pancreatic trauma.

An unclassified congenital bile duct cyst

Congenital bile duct cysts are rare in adulthood. The most frequently used classification was proposed by Todani in 1977. However, in rare cases, not all the bile duct cysts are suitable to this classification. Hereby, we describe the case of an unclassified and very rare form of congenital bile duct cyst--isolated cystic duct cyst. En-block resection of the cyst, along with gallbladder, is the treatment of choice. Although exceptional, cystic duct cysts should be included in Todani classification so that the surgeons to be aware for this variation.

SOYBEAN OIL PLASTICIZERS AS REPLACEMENT OF PETROLEUM OIL IN RUBBER

Polymerized soybean oils of different molecular weights were used as plasticizers in NR/SBR compositions. The oils of different molecular weights and viscosities were synthesized by cationic polymerization using a proprietary technology. Because vegetable oils have double bonds, they are not only viscosity depressants but also active participants in cross-linking reactions. Properties of elastomers extended with different concentrations of mineral oil or pure soybean oil were compared with elastomers extended by polymerized oils of different molecular weights at the same concentrations. It was found that polymerized soybean oil could be substituted for naphthenic process oil with minimal differences in mechanical and dynamic properties.

The Todani classification for bile duct cysts: an overview

Bile duct cysts are a rare medical condition and are more frequent in children. However, the disease is becoming increasingly common in adults. The modified Todani classification, which is based on anatomical characteristics, is the current standard classification method. However, this classification does not take the following factors into consideration: different epidemiology, pathogenesis, risk of malignant transformation, clinical and imaging aspects, and different therapeutical approaches for all the bile duct cysts. Thus, some clinicians denied its clinical significance and viability. Moreover, some rare variants (i.e., cystic duct cysts) of bile duct cysts were initially not included and were subsequently categorized as type VI. Although it clusters different diseases, the Todani classification of bile duct cysts should also be used in clinical practice because it is simple, reproducible and widely agreed upon, thereby allowing an appropriate comparative analysis between different series of patients who are classified based on this scheme. Exceptional, cystic duct cysts should be included in the Todani classification (as a subtype of type II BDC rather than as a "new" type VI) so that the gastroenterologists, radiologists and surgeons are aware of this variation.

POSSUM, a potentially useful tool for prediction of morbidity in patients undergoing central pancreatectomy

AIM

Central pancreatectomy is a pancreas-sparing alternative to standard pancreatic resections, and it is associated with substantial morbidity. The aim of the present study is to assess the utility of the POSSUM scoring system in the prediction of the postoperative complications after central pancreatectomy, which would help identify the patients who are at the highest risk of developing complications.

METHODS

A retrospective analysis of 24 patients who underwent central pancreatectomies (2002-2010) was performed. The POSSUM score was calculated for each patient and was correlated with observed morbidity.

RESULTS

The mean POSSUM score was 32, thus predicting morbidity in 9 out of 24 patients. This risk assessment proved to be quite accurate, as 13 patients (54%) actually developed postoperative complications (chi-squared = 3.2101, p = 0.073). The predictive value of the POSSUM was strongest for the < or = 20%, 60-80% and > or = 80% morbidity risk cohorts (O/E ratio 1).

CONCLUSIONS

The identification of a scoring system to predict the development of severe complications after central pancreatectomy may stratify the patients' risk and lead to a tailored approach of this surgical procedure. Although POSSUM seems to predict morbidity after central pancreatectomy, further studies involving larger numbers of patients should be conducted to confirm this effect.

Dorsal pancreas agenesis and ductal adenocarcinoma: surgical implications of an extremely rare association

It is presented the case of a 44-year-old woman with ductal adenocarcinoma of the pancreatic head with associated dorsal pancreas agenesis. In this case, curative intent surgery implies removal of the whole pancreas with its consequences--parental insulin requirement and exocrine pancreatic insufficiency. A review of the literature on the previously reported cases was performed.

[Gastrointestinal stromal tumor with primary hepatic unique location--clinical case]

The gastrointestinal stromal tumors are mesenchymal tumors whose primary extradigestive location is very rare (less than 10% primary liver localization). We present a clinical case of primary hepatic location of GIST in a 28 year-old patient. The discovery of this tumor is a chance, the patient presenting for non-specific dyspeptic syndrome and epigastralgia. During the presentation an abdominal ultrasound is performed which identifies an whell-delineated hepatic mass - 5/4 cm. Clinical and paraclinical investigations (CT, EDS, EDI, examination of the intestinal lumen with the videocapsula), confirm the diagnosis of unique hepatic mass of segments III-IV. The diagnosis is confirmed intraoperatory and we perform an atypical liver resection of segments III-IV (with 1 cm safety-margin). The histopatologic exam: GIST.

[Biliary complications following liver transplantation]

The biliary complications (BC) were always considered the "Achilles heel" of liver transplantation, being one of the leading causes of postoperative morbidity. The technique of the biliary reconstruction depends on the surgical procedure and it has a major impact on the patients and the graft evolution. The most frequent types of BC were stenoses, leaks, bilomas, cholangitis, etc. As an incidence, there is a peak of BC in the first 6 months after the transplant, a third of them appearing in the first month. Among the major BC risk factors, the most important are: hepatic artery pathology, the use of partial liver graft, bilioplasty and the number of biliary ducts and anastomoses. The BC management can be conservative, interventional or surgical depending on the type of BC. Along with the improvement of the interventional radiological and endoscopic methods, a large number of BCs are successfully treated non-surgically. There are still a few circumstances in which surgery is mandatory such as important persistent biliary leaks, even more when a partial liver graft was used or in association with hepatic artery pathology when re-transplantation is required. Multiple or serial biliary stenoses can lead to surgical revision. Although BC plays an important role in the patients postoperative morbidity, by early diagnosis and through numerous therapeutic methods promptly applied, there is no major impact on mortality.

Prognostic and predictive potential molecular biomarkers in colon cancer

An important objective in nowadays research is the discovery of new biomarkers that can detect colon tumours in early stages and indicate with accuracy the status of the disease. The aim of our study was to identify potential biomarkers for colon cancer onset and progression. We assessed gene expression profiles of a list of 10 candidate genes (MMP-1, MMP-3, MMP-7, DEFA 1, DEFA-5, DEFA-6, IL-8, CXCL-1, SPP-1, CTHRC-1) by quantitative real time PCR in triplets of colonic mucosa (normal, adenoma, tumoral tissue) collected from the same patient during surgery for a group of 20 patients. Additionally we performed immunohistochemistry for DEFA1-3 and SPP1. We remarked that DEFA5 and DEFA6 are key factors in adenoma formation (p<0.05). MMP7 is important in the transition from a benign to a malignant status (p <0.01) and further in metastasis being a prognostic indicator for tumor transformation and for the metastatic potential of cancer cells. IL8, irrespective of tumor stage, has a high mRNA level in adenocarcinoma (p< 0.05). The level of expression for SPP1 is correlated with tumor level. We suggest that high levels of DEFAS, DEFA6 (key elements in adenoma formation), MMP7 (marker of colon cancer onset and progression to metastasis), SPP1 (marker of progression) and IL8 could be used to diagnose an early stage colon cancer and to evaluate the prognostic of progression for colon tumors. Further, if DEFA5 and DEFA6 level of expression are low but MMP7, SPP1 and IL8 level are high we could point out that the transition from adenoma to adenocarcinoma had already occurred. Thus, DEFA5, DEFA6, MMP7, IL8 and SPP1 consist in a valuable panel of biomarkers, whose detection can be used in early detection and progressive disease and also in prognostic of colon cancer.