The pancreas as a target of metastasis from renal cell carcinoma: Results of surgical treatment in a single institution

Juan Glinka,Rodrigo Sanchez Claria,Victoria Ardiles,Eduardo de Santibanes,Juan Pekolj,Martin de Santibanes,Oscar Mazza 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.3

Backgrounds/Aims: Metastasis in the pancreatic gland is infrequent, representing between 2-5% of the tumors that affect this organ. However, secondary lesions of clear cell renal carcinoma (CCRC) can occur mainly in this location and it is frequently the only site of dissemination. Treatment of choice is resection in surgically fit patients, as it has been shown that it improves the quality of life and prognosis substantially. We retrospectively reviewed the clinical data of patients with pancreatic resections for metastatic CCRC since there are no reports of the treatment modality of this singular entity in Argentina. Methods: Retrospective cohort analysis over a 10-year period including eight patients who underwent pancreatic resection for metastatic CCRC. Results: 75% of patients were male with an average age of 65.5 years. The pancreatic surgery occurred at a median time of 9.2 years (1-24.8) from the renal operation. The pancreatic lesions were mostly solitary and asymptomatic. A pancreaticoduodenectomy (PD) was performed in 4 patients (50%). Distal pancreatectomy (DP) was performed in 3 patients (37.3%) and one patient (12.5%) underwent a total pancreaticoduodenectomy. All the patients presented a confirmatory biopsy of pancreatic metastasis of CCRC. Complications were recorded in 3 patients (42.85%). No intraoperative or postoperative mortality was registered. With a median follow-up of 45 months, three patients presented recurrence at 32, 46 and 51 months, respectively. Only one patient showed death due to recurrence at 7.8 month. Conclusions: CCRC pancreatic metastases treated surgically have a low morbidity and mortality rate in high volume centers, showing excellent long-term survival.

Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases

( San Juan Lopez Cristina ),( Casado Martin Marta ),( Gonzalez Sanchez Mercedes ),( Porcel Martin Almudena ),( Hernandez Martinez Alvaro ),( Vega Saenz Jose Luis ),( Parron Carreno Tesifon ) 대한간학회 2018 Clinical and Molecular Hepatology(대한간학회지) Vol.24 No.4

Backgrounds/Aims: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. Methods: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. Results: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/㎡. During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/㎡ versus 56% of patients without SF (P<0.05). Conclusions: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients. (Clin Mol Hepatol 2018;24:384-391)

Use of radiotherapy in patients with palliative double bypass for locally advanced pancreatic adenocarcinoma

Glinka, Juan,Diaz, Federico,Alva, Augusto,Mazza, Oscar,Claria, Rodrigo Sanchez,Ardiles, Victoria,Santibanes, Eduardo de,Pekolj, Juan,Santibanes, Martin de The Korean Society for Radiation Oncology 2018 Radiation Oncology Journal Vol.36 No.3

Purpose: Pancreatic cancer (PC) has not changed overall survival in recent years despite therapeutic efforts. Surgery with curative intent has shown the best long-term oncological results. However, 80%-85% of patients with these tumors are unresectable at the time of diagnosis. In those patients, first therapeutic attempts are minimally invasive or surgical procedures to alleviate symptoms. The addition of radiotherapy (RT) to standard chemotherapy, ergo chemoradiation, in patients with locally advanced pancreatic cancer (LAPC) is still controversial. The study aims to compare outcomes in patients with a double bypass surgery due to LAPC treated or not with RT. Materials and Methods: A retrospective cohort study of patients with double bypass for LAPC were registered and divided into two groups: treated or not with postoperative RT. Baseline characteristics, postoperative complications, those related to RT and their relation to the main event (mortality) were compared. Results: Seventy-four patients were included. Surgical complications between the groups did not offer significant differences. Complications related to RT were mostly mild, and 86% of patients completed the treatment. Overall survival at 1 and 2 years for patients in the exposed group was 64% and 35% vs. 50% and 28% in the non-exposed group, respectively (p = 0.11; power 72%; hazard ratio = 0.53; 95% confidence interval, 0.24-1.18). Conclusion: We observed a tendency for survival improvement in patients with postoperative RT. However, we've not had enough power to demonstrate this difference, possibly due to the small sample size. It is indispensable to develop randomized and prospective trials to guide more specific treatment lines in this patients.

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

Salguero Joseba,Gómez-Gómez Enrique,Valero-Rosa José,Carrasco-Valiente Julia,Mesa Juan,Martin Cristina,Campos-Hernández Juan Pablo,Rubio Juan Manuel,López Daniel,Requena María José 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.4

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imagingreporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

Low-Voltage Tunable Pseudo-Differential Transconductor with High Linearity

Juan Antonio Gómez,Melita Pennisi,Antonio Lopez Martin,Ramon González Carvajal,Jaime Ramírez-Angulo,Manuel Pedro Carrasco 한국전자통신연구원 2009 ETRI Journal Vol.31 No.5

A novel tunable transconductor is presented. Input transistors operate in the triode region to achieve programmable voltage-to-current conversion. These transistors are kept in the triode region by a novel negative feedback loop which features simplicity, low voltage requirements, and high output resistance. A linearity analysis is carried out which demonstrates how the proposed transconductance tuning scheme leads to high linearity in a wide transconductance range. Measurement results for a 0.5 μm CMOS implementation of the transconductor show a transconductance tuning range of more than a decade (15 μA/V to 165 μA/V) and a total harmonic distortion of -67 dB at 1 MHz for an input of 1 Vpp and a supply voltage of 1.8 V.

Effect of energy density and virginiamycin supplementation in diets on growth performance and digestive function of finishing steers

Navarrete, Juan D.,Montano, Martin F.,Raymundo, Constantino,Salinas-Chavira, Jaime,Torrentera, Noemi,Zinn, Richard A. Asian Australasian Association of Animal Productio 2017 Animal Bioscience Vol.30 No.10

Objective: This study was determined the influence of virginiamycin supplementation on growth-performance and characteristics of digestion of cattle with decreasing dietary net energy value of the diet for maintenance ($NE_m$) from 2.22 to 2.10 Mcal/kg. Methods: Eighty crossbred beef steers ($298.2{\pm}6.3kg$) were used in a 152-d performance evaluation consisting of a 28-d adaptation period followed by a 124-d growing-finishing period. During the 124-d period steers were fed either a lesser energy dense (LED, $2.10Mcal/kg\;NE_m$) or higher energy dense (HED, $2.22Mcal/kg\;NE_m$) diet. Diets were fed with or without 28 mg/kg (dry matter [DM] basis) virginiamycin in a $2{\times}2$ factorial arrangement. Four Holstein steers ($170.4{\pm}5.6kg$) with cannulas in the rumen (3.8 cm internal diameter) and proximal duodenum were used in $4{\times}4$ Latin square experiment to study treatment effects on characteristics of digestion. Results: Neither diet energy density nor virginiamycin affected average daily gain (p>0.10). As expected, dry matter intake and gain efficiency were greater (p<0.01) for LED- than for HED-fed steers. Virginiamycin did not affect estimated net energy value of the LED diet. Virginiamycin increased estimated NE of the HED diet. During daylight hours when the temperature humidity index averaged $81.3{\pm}2.7$, virginiamycin decreased (p<0.05) ruminal temperature. Virginiamycin did not influence (p>0.10) ruminal or total tract digestion. Ruminal (p = 0.02) and total tract digestion (p<0.01) of organic matter, and digestible energy (p<0.01) were greater for HED vs LED. Ruminal microbial efficiency was lower (p<0.01) for HED vs LED diets. Conclusion: The positive effect of virginiamycin on growth performance of cattle is due to increased efficiency of energy utilization, as effects of virginiamycin on characteristics of digestion were not appreciable. Under conditions of high ambient temperature virginiamycin may reduce body temperature.

Structural Basis for Selective Recognition of Endogenous and Microbial Polysaccharides by Macrophage Receptor SIGN-R1

Silva-Martin, N.,Bartual, Sergio G.,Ramirez-Aportela, E.,Chacon, P.,Park, C.,Hermoso, Juan A. Current Biology 2014 Structure Vol.22 No.11

SIGN-R1 is a principal receptor for microbial polysaccharides uptake and is responsible for C3 fixation via an unusual complement activation pathway on splenic marginal zone macrophages. In these macrophages, SIGN-R1 is also involved in anti-inflammatory activity of intravenous immunoglobulin by direct interaction with sialylated Fcs. The high-resolution crystal structures of SIGN-R1 carbohydrate recognition domain and its complexes with dextran sulfate or sialic acid, and of the sialylated Fc antibody provide insights into SIGN-R1's selective recognition of α-2,6-sialylated glycoproteins. Unexpectedly, an additional binding site has been found in the SIGN-R1 carbohydrate recognition domain, structurally separate from the calcium-dependent carbohydrate-binding site. This secondary binding site could bind repetitive molecular patterns, as observed in microbial polysaccharides, in a calcium-independent manner. These two binding sites may allow SIGN-R1 to simultaneously bind both immune glycoproteins and microbial polysaccharide components, accommodating SIGN-R1's ability to relate the recognition of microbes to the activation of the classical complement pathway.

Internal maxillary artery (IMax) – middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report

Javier Degollado-García,Martin R. Casas-Martínez,Bill Roy Ferrufino Mejia,Juan C. Balcázar-Padrón,Héctor A. Rodríguez-Rubio,Edgar Nathal 대한뇌혈관외과학회 2024 Journal of Cerebrovascular and Endovascular Neuros Vol.26 No.1

Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease.We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft’s free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits.The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.

A Linear Approach for Sizing Optimization of Isostatic Trussed Structures Subjected to External and Self-Weight Loads

Flavio Avila Correia Martins,Juan Pablo Julca Avila,Marcelo Araujo da Silva 한국강구조학회 2019 International Journal of Steel Structures Vol.19 No.4

The implementation of a new linear method to optimum weight design of trussed structures subjected to external and selfweight loads is proposed. Design variables are the cross-section areas of the members. Inequality constraints are written based on the force-method for isostatic structures considering maximum and minimum axial stress criteria. The novelty of the proposed approach is the benefi t created from the combination of a linear inequality-constrained formulation with interior-point methods to tunnel the solution rapidly and monotonically towards the minimum value through feasible space, also eliminating the need to directly explore the fi nite-element model. To evaluate the performance of the algorithm, trusses are subject to optimization processes based on diff erent techniques: (i) the proposed method, called by “indirect-method”; (ii) a design problem with constraint evaluated directly from the fi nite-element model; (iii) optimization based on Genetic Algorithms. The three methods are compared using trusses with 10, 37 and 1240 bar-elements. The results showed that the indirect-method was able to provide great performance for complex topologies, returning weight designs up to 70 times lighter in 1% of the time required by a Genetic Algorithm.

New Approach to Inter-domain Multicast Protocols

Raquel Perez Leal,Juan A. Cachinero,Encarna Pastor Martin 한국전자통신연구원 2011 ETRI Journal Vol.33 No.3

IPTV broadcast channels and video content distribution are increasingly saturating network paths. New solutions based on inter-domain multicast protocols could contribute to the enhancement of multimedia content distribution over the Internet. The aim of this paper is to propose new capabilities for an existing inter-domain multicast protocol, the Protocol Independent Multicast-Sparse Mode. We describe the modified protocol and analyze its behavior using newly developed tools based on an open-source software simulator. The resulting protocol does not require topology information, which is advantageous for easier deployment. In addition, the adopted solution avoids inherent problems with inter-domain multicast routing, such as multiple paths and path asymmetries.