Purpose Laparoscopy is the approach of choice for the majority of colorectal disorders that require a minimally invasive abdominal operation. As the emphasis on minimizing the technique continues, ...natural orifice surgery is quickly evolving. The authors utilized an embryologic natural orifice, the umbilicus, as sole access to the abdomen to perform a colorectal procedure. Herein, we present our initial experience of single‐port laparoscopic colorectal surgery using a Uni‐X™ Single‐Port Access Laparoscopic System (Pnavel Systems, Morganville, New Jersey, USA) with a multi‐channel cannula and specially designed curved laparoscopic instrumentation.
Method The abdomen was approached through a 3.5 cm incision via the umbilicus and a single‐port access device was utilized to perform a right hemicolectomy on a patient with an unresectable caecal polyp and a body mass index of 35. Ligation of the ileocolic artery was done with a LigaSure Device™ (Covidien Ltd, Norwalk, Connecticut, USA), and was followed by colonic mobilization, extraction and extracorporeal ileocolic anastomosis.
Results The total operative time was 115 min with minimal blood loss. Hospital stay was 4 days with no undue sequelae.
Conclusion Single‐port laparoscopic surgery may allow common colorectal laparoscopic operations to be performed entirely through the patient’s umbilicus and enable an essentially scarless procedure. Additional experience and continued investigation are warranted.
Mutations or deletions in TP53 or ATM are well-known determinants of poor prognosis in chronic lymphocytic leukemia (CLL), but only account for approximately 40% of chemo-resistant patients. ...Genome-wide sequencing has uncovered novel mutations in the splicing factor sf3b1, that were in part associated with ATM aberrations, suggesting functional synergy. We first performed detailed genetic analyses in a CLL cohort (n=110) containing ATM, SF3B1 and TP53 gene defects. Next, we applied a newly developed multiplex assay for p53/ATM target gene induction and measured apoptotic responses to DNA damage. Interestingly, SF3B1 mutated samples without concurrent ATM and TP53 aberrations (sole SF3B1) displayed partially defective ATM/p53 transcriptional and apoptotic responses to various DNA-damaging regimens. In contrast, NOTCH1 or K/N-RAS mutated CLL displayed normal responses in p53/ATM target gene induction and apoptosis. In sole SF3B1 mutated cases, ATM kinase function remained intact, and γH2AX formation, a marker for DNA damage, was increased at baseline and upon irradiation. Our data demonstrate that single mutations in sf3b1 are associated with increased DNA damage and/or an aberrant response to DNA damage. Together, our observations may offer an explanation for the poor prognosis associated with SF3B1 mutations.
The human brain manages to correctly interpret almost every visual image it receives from the environment. Underlying this ability are contour grouping mechanisms that appropriately link local edge ...elements into global contours. Although a general view of how the brain achieves effective contour grouping has emerged, there have been a number of different specific proposals and few successes at quantitatively predicting performance. These previous proposals have been developed largely by intuition and computational trial and error. A more principled approach is to begin with an examination of the statistical properties of contours that exist in natural images, because it is these statistics that drove the evolution of the grouping mechanisms. Here we report measurements of both absolute and Bayesian edge co-occurrence statistics in natural images, as well as human performance for detecting natural-shaped contours in complex backgrounds. We find that contour detection performance is quantitatively predicted by a local grouping rule derived directly from the co-occurrence statistics, in combination with a very simple integration rule (a transitivity rule) that links the locally grouped contour elements into longer contours.
Retrospective, longitudinal analysis of motor recovery data from individuals with cervical (C4-C7) sensorimotor complete spinal cord injury (SCI) according to the International Standards for ...Neurological Classification of Spinal Cord Injury (ISNCSCI).
To analyze the extent and patterns of spontaneous motor recovery over the first year after traumatic cervical sensorimotor complete SCI.
Datasets from the European multicenter study about SCI (EMSCI) and the Sygen randomized clinical trial were examined for conversion of American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade, change in upper extremity motor score (UEMS) or motor level, as well as relationships between these measures.
There were no overall differences between the EMSCI and Sygen datasets in motor recovery patterns. After 1 year, up to 70% of subjects spontaneously recovered at least one motor level, but only 30% recovered two or more motor levels, with lesser values at intermediate time points. AIS grade conversion did not significantly influence motor level changes. At 1 year, the average spontaneous improvement in bilateral UEMS was 10-11 motor points. There was only moderate relationship between a change in UEMS and a change in cervical motor level (r(2)=0.30, P<0.05). Regardless of initial cervical motor level, most individuals recover a similar number of motor points or motor levels.
Careful tracking of cervical motor recovery outcomes may provide the necessary sensitivity and accuracy to reliably detect a subtle, but meaningful treatment effect after sensorimotor complete cervical SCI. The distribution of the UEMS change may be more important functionally than the total UEMS recovered.
Aim We present our initial experience of a single port laparoscopic total proctocolectomy with ileoanal J pouch anastomosis. The single incision laparoscopic surgery (SIL), (Covidien, Norwalk, ...Connecticut, USA) device with a multichannel cannula and specially designed curved laparoscopic instrumentation were used.
Method A patient with familial adenomatous polyposis underwent restorative proctocoectomy. A colonoscopy had demonstrated nearly 1000 polyps in the colon with several 1‐cm polyps in the rectum. The abdomen was entered through a 2.5 cm incision sited preoperatively for the temporary ileostomy. The single port device was inserted and a total proctocolectomy was performed. Ligation of the vessels was performed with the Ligasure (Covidien). The colon and rectum were extracted through the SIL site. An 18‐cm ileoanal J pouch was created extracorporeally. The pouch anal anastomosis was performed intracorporeally and a diverting loop ileostomy created through the SIL port site.
Results The operating time was 172 min. Blood loss was 100 ml and the hospital stay was 4 days without any complication. The patient had a virtually scar‐less abdomen other than the site of the loop ileostomy.
Conclusion Single port laparoscopic surgery may allow complex colorectal surgery to be performed resulting in a virtually scar‐less procedure.
Several types of pathogenic bacteria produce genotoxins that induce DNA damage in host cells. Accumulating evidence suggests that a central function of these genotoxins is to dysregulate the host’s ...immune response, but the underlying mechanisms remain unclear. To address this issue, we investigated the effects of the most widely expressed bacterial genotoxin, the cytolethal distending toxin (CDT), on T cells—the key mediators of adaptive immunity. We show that CDT induces premature senescence in activated CD4 T cells in vitro and provide evidence suggesting that infection with genotoxin-producing bacteria promotes T cell senescence in vivo. Moreover, we demonstrate that genotoxin-induced senescent CD4 T cells assume a senescence-associated secretory phenotype (SASP) which, at least partly, is orchestrated by the ATM-p38 signaling axis. These findings provide insight into the immunomodulatory properties of bacterial genotoxins and uncover a putative link between bacterial infections and T cell senescence.
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•The bacterial genotoxin CDT induces senescence and a SASP in activated CD4 T cells•ATM plays a key role in orchestrating the SASP but not in the induction of senescence•ATM orchestrates the SASP via downstream activation of the p38 MAPK•Infection with genotoxigenic bacteria increases the proportion of GL13+ T cells in vivo
Mathiasen et al. show that the bacterial genotoxin CDT induces senescence and a senescence-associated secretory phenotype (SASP) in T cells. The SASP is orchestrated by the ATM-p38 axis, whereas the induction of senescence is ATM independent. Together, the findings uncover a putative link between genotoxigenic bacteria, T cell senescence, and immunomodulation.
Engineering light–matter interactions up to the strong-coupling regime at room temperature is one of the cornerstones of modern nanophotonics. Achieving this goal could enable new platforms for ...potential applications such as quantum information processing, quantum light sources, and even quantum metrology. Layered materials like transition metal dichalcogenides (TMDCs) and, in particular, tungsten disulfide (WS2), possess strong dipole moments which are comparable to semiconductor-based quantum dots, but the former also exhibit large exciton binding energies, thereby making TMDCs suitable candidates for exploring light–matter interactions at ambient conditions. Furthermore, the combination of TMDCs with plasmonic nanocavities, which tightly confine light down to nanometer scale, has recently emerged as a suitable platform for achieving strong coupling between plasmons and excitons at room temperature. Here, we use ultrathin single-crystalline gold nanodisks featuring large in-plane electric dipole moments aligned with the exciton’s dipole moments in monolayer WS2. By performing both scattering and reflection spectroscopy, we demonstrate strong coupling at room temperature with a Rabi splitting of ∼108 meV. In addition, when the plasmonic resonance of these nanodisks is coupled with few-layer WS2, a Rabi splitting of ∼175 meV is observed, with a major increase of 62% relative to the monolayer configuration. Our results therefore suggest that ultrathin single-crystalline gold nanodisks coupled to WS2 constitute an attractive platform to explore light–matter interactions in the strong-coupling regime.
Background
Single-port laparoscopic surgery can be performed via one incision hidden in the umbilicus. Herein, we report a patient with a sigmoid colon cancer undergoing single-port laparoscopic ...sigmoid colectomy.
Methods
Laparoscopic single-port sigmoid colectomy through a 3-cm umbilical incision was performed on a patient with a diagnosis of sigmoid cancer. Patient was 54-year-old female with a body mass index of 25.8 kg/m
2
. Preoperatively, a CAT scan in the metastasis evaluation did not show any lesion.
Results
The total operative time was 198 min. Estimated blood loss was 300 ml. Length of hospital stay was 3 days. Patient had no intraoperative or postoperative complications. Examination of pathological specimen showed a specimen containing a circumferential lesion measuring 5 cm × 2.5 cm × 2.5 cm with adequate surgical margins (10 and 5.5 cm), and no regional lymph node metastases in 14 lymph nodes collected. Patient did not receive adjuvant chemotherapy after surgery. Colonoscopy performed 1 year after surgery showed no neoplasm or polyp identified. Abdomen and pelvis CT also found no evidence of recurrence or metastatic disease.
Conclusion
Single-port laparoscopic surgery may allow common benign procedures via an incision in the umbilicus. It can also be performed with good surgical and oncologic results in selected patients with a colorectal cancer.
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