GI Surgery Annual

Cancer is constituted by mutated cells that have escaped the normal checks and balances of regulated cell growth. It is initially localized to the organ of origin and thereafter spreads through the body, and ultimately becomes the cause of unnatural death of the patient. In the natural history of any cancer three distinct phases can be described: (i) limited to the organ of origin (localized phase); (ii) limited to the region of origin (regional phase); and (iii) spread to distant organs (metastatic phase) . Regional phase/stage is usually described as spread limited to the regional lymph node basin. The philosophy of surgical lymphadenectomy, along with extirpation of the primary tumour, is meant to treat the regional stage of the disease. It will be obvious to those familiar with this feld, that high quality evidence to evaluate lymphadenectomy in oesophageal carcinoma is diffcult to come by, else there would be no need for reviews like this. To the GI Surgery fellows taking their fnal examinations this represents a treacherous minefeld due to the varying practices followed by surgeons across the world. In this review we attempt to introduce the reader to the concept, guidelines, evidence and practice of lymphadenectomy in the surgical treatment of oesophageal carcinoma.[]

Good Practice in Pediatric and Adolescent Gynecology

Vulvovaginal complaints account for 80–90% of outpatient pediatric gynecologic visits . Most cases may be attributed to vulvovaginitis but other less common conditions, such as vulvar diseases or vulvar manifestations of systemic disease, should be taken into account. Rare causes of vulvovaginitis have to be considered especially when symptoms are recurrent or not responsive to standard treatment. In this chapter, the causes, manifestations, and management options of vulvovaginitis in childhood will be reviewed. Furthermore, common vulvar diseases affecting children were outlined, since their knowledge is essential for differential diagnosis. The prepubertal child is particularly susceptible to vulvovaginitis for anatomic, physiologic, and behavioral factors: absence of hair and minimal labial development; close oximity of the vagina to the anus; physiological hypoestrogenism which causes atrophic genital mucosa; neutral pH and unbalanced vaginal flora; absence of cervical mucus; and lack of antibodies ; furthermore, children’s tendency to have poor local hygiene and to explore their bodies increases the risk of developing this conditions. Germs may easily reach the genital area as a result of contiguity from the rectum, urethra, or the surrounding skin. Diffusion of bacteria from the upper airways is also possible through autoinoculation and occasionally hematic spread . Obesity, diabetes, anatomic anomalies, and use of antibiotics may play a role in facilitating vulvovaginitis.

Innate Antiviral Immunity

The symbiosis between humans and viruses has allowed human tropic pathogens to evolve intricate means of modulating the human immune response to ensure its survival among the human population. In doing so, these viruses have developed profound mechanisms that mesh closely with our human biology. The establishment of this intimate relationship has created a species-specific barrier to infection, restricting the virus-associated pathologies to humans. This specificity diminishes the utility of traditional animal models. Humanized mice offer a model unique to all other means of study, providing an in vivo platform for the careful examination of human tropic viruses and their interaction with human cells and tissues. These types of animal models have provided a reliable medium for the study of human-virus interactions, a relationship that could otherwise not be investigated without questionable relevance to humans.
فرآیند اسمز معکوس (RO).[]

پارامتر های موثر بر فرآیند اسمز معکوس (RO)در تصفیه فاضلاب

امروزه یکی از نیازهای اساسی زندگی انسان، نیاز به آب است. با توجه به استفاده بی رویه مردم از آب، این نعمت الهی رو به پایان است و مردم در آینده ای نه چندان دور با کمبود آب مواجه خواهند شد. عوامل آلوده کننده آب بسیار گوناگونند می توانند هم منابع آب های زیرزمینی و هم آب های سطحی را آلوده کنند. با توجه به استفاده آب در صنایع و معادن و آلوده شدن آب به فلزات سنگین، قبل از ورود فلزات به چرخه غذایی باید آن را تصفیه کرد تا وارد بدن انسان ها نشوند. فلزات سنگین، یکی از آلاینده های غیر قابل تجزیه بیولوژیکی هستند که می توانند به راحتی وارد آب و خاک شوند و آنها را آلوده کنند. روش های مختلفی برای حذف فلزات سنگین وجود دارد که شامل نانوفیلتراسیون، اولترافیلتراسیون، الکترودیالیز، جذب سطحی و ... می باشد. یکی از این روش ها روش اسمز معکوس است. این روش بخاطر انعطاف در هزینه و نتایج مطلوب کاربرد وسیعی دارد. در این تحقیق تاثیر پارامترهای مختلف نظیر دما، فشار، غلظت و ... در حذف فلزات سنگین با روش اسمز معکوس مورد بررسی قرار می گیرد.
انتگراسیون حرارتی, تکنولوژی پینچ, پالایشگاه گاز.[]

تحلیل و بررسی مبدل های افزوده شده ناشی از آنالیز پینچ در فرایند نم زدایی پالایشگاه گازی بکمک نرم افزار Aspen Energy Analyzing8.8

نقطه آغازین انتگراسیون فرایند به سال 1980 در جهت کاهش مصرف انرژی بر می گردد. از سال 1990 به بعد روش هایی برای کاربردهای صنعتی آن از قبیل کل هزینه های سالانه، کاربرد در واحد و انعظاف پذیری واحد، توسعه داده شد و از این رو انتگراسیون حرارتی روشی جهت بهسازی فرایندی ها و سیستم ها و کاهش مصرف انرژی و افزایش بازده فرایند و کاهش آلودگی های محیط زیستی است. حذف آب یکی از مهمترین مراحل تصفیه گاز می باشد چرا که وجود آب در گاز حتی به میزان خیلی کم؛ باعث تشکیل هیدرات گازی در خط در شرایط فشاری بالا و دمایی پایین می گردد. در واحدهایی که فرایند نم زدایی بکمک بسترهای مولکولارسیو انجام می پذیرد لذا پس از مدت زمان بستر اشباع می شود و نیازمند احیای با گاز گرم بصورت عکس جریان فرایندی دارد که در این مقاله با قرار گرفتن مبدل حرارتی بر روی جریان ورودی به احیاء و جریان خروجی از احیاء واحد نم زدایی پالایشگاه به کمک آنالیز پینچ در مبدل های حرارتی با محاسبات دستی و نرم افزاری، با استفاده از نرم افزار Aspen Energy Analyzing8.8 بهینه سازی شده است. در این فرایند با افزودن یک دستگاه مبدل حرارتی میزان 19065200kj/hr انرژی برای جریان های گرم به سرد از بار حرارتی کولرها کاسته می شود.

Neurological Regeneration

Stem cells are self-renewing and pluripotent, meaning that they are capable of continuous proliferation and terminal differentiation into various cell types. Stem cells are classifed as either embryonic or adult based on their origin, and give rise to various organs and tissues (Thomson et al. 1998; Shamblott et al. 1998). Recent studies indicated that induced pluripotent stem cells (iPSCs) and directly induced neurons are included in the category of stem cells (Takahashi and Yamanaka 2006; Pang et al. 2011). Stem cell transplantation has enabled powerful new therapeutic strategies in research for the treatment of various human neurological diseases such as Alzheimer’s disease (AD) and Huntington’s disease (HD) (Kim et al. 2013; Nikolic et al. 2008). The identifcation, generation, and optimization of suitable stem cell types for cell therapy is necessary for the full utilization of this promising therapeutic approach in neurological disease (Kim et al. 2013). In this chapter, we review the utility and limitations of different stem cell types and discuss recent advances in the therapeutic use of stem cells in neurological and neurodegenerative disease.


While analysis of the genome or proteome can be predictive of the fate of an organism, its metabolome is informative of the outcome of events on an organism. The metabolome can thus be regarded as closer to the actual phenotype than either the genome or proteome. Lipids represent a major component of the metabolome and their hydrophobic and amphipathic nature dictates their separate analysis from more water- soluble metabolites; hence, the discipline of lipidomics has emerged. In this short chapter, we will highlight the different strategies in lipidomics which have now reached maturity, i.e., shotgun and chromatography-based mass spectrometry approaches. We will discuss some of the newer technologies coming to the forefront e.g., the use of derivatization chemistry, and comment on exciting developments now being made in the lipidomic feld, e.g., surface analysis and lipid imaging. Finally, we will comment on some of the dangers encountered using an “omics” approach in biochemical analysis.

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

Non-alcoholic steatohepatitis (NASH) is growing into global problem, mainly due to NASH-induced cirrhosis and hepatocellular carcinoma (HCC), that can develop either subsequently to cirrhosis or preceding it. In addition, NASH-induced cirrhosis constitutes a signifcant fraction of cases diagnosed as cryptogenic cirrhosis. Thus, there is a need for deeper understanding of the molecular basis, leading to liver steatosis, then—to the associated inflammation seen in NASH, loss of liver architecture and cirrhosis, followed or paralleled by carcinogenesis and HCC. Insulin resistance, increased hepatic iron level, and certain cytokines, including TNF-α and IL-6 derived from extrahepatic adipose tissues, can trigger the chain of events. The imbalance between leptin and adiponectin is important as well. These markers remain important during the whole course from NASH through liver cirrhosis to HCC. The molecular pathogenesis substantiates treatment: hypertriglyceridemia can be lowered by low calorie diet; mTOR complex can become inhibited by physical activity and metformin; cholesterol synthesis, RAF/ MAPK1/ERK and p21 pathway by statins; inflammation by pentoxyfllin, and kinases (in HCC) by sorafenib. Bidirectional regulation of telomere atrition, senescence and p21 pathway, restoration of wild-type p53 activity and regulation of miRNA network represent atractive future treatment options. Focusing on relevant molecular pathways allows deeper understanding of NASH pathogenesis, leading to identifcation of predictive markers and treatment targets.

Malignancies of the Groin

Cancer of the penis has been recognized for centuries, and its management was frst described by Celsus in the seventeenth century when he recommended an amputation for a penile carcinoma with cauterization of the raw stump to control bleeding. However, only in the 1800s was inguinal lymphadenectomy recognized as a routine to treat inguinal metastases . Almost 200 years from the frst procedure to treat penile cancer, Young, in 1907, recommended bilateral inguinal lymphadenectomy simultaneously with the penectomy for penile carcinoma . Daseler and associates, in 1948, after the dissection of 450 cadavers, found the precise inguinal anatomic parameters, and Baronofsky, in the same year, advocated one technique that is still widely employed, the transposition of sartorius muscle over the femoral vessels . The frst technique described for inguinal lymph node dissection (ILND) for penile cancer found in Medline resources was attributed to Zenker and Pichlmaier in 1966 . Since then, hundreds of modifcations and new approaches have been published. Fegen and Persky frst associated the success of a complete inguinal dissection with an increase in penile cancer survival rates. Johnson and Lo, in 1984, reported that the most important factor determining survival in patients with penile cancer is the extent of lymph node metastases , and an aggressive lymphadenectomy is associated with improved long-term survival and potential cure.

Malignant Brain Tumors

Task-based blood oxygen-dependent (BOLD) fMRI measures relative changes in regional blood oxygenation during a behavioral task. Increases in net neuronal activity in a cortical or subcortical region lead to increased regional blood flow through specific metabolic signals that dilate local arterioles. This increase in perfusion of oxygenated blood to typically exceeds the increased metabolic demand, resulting in a radoxical rise in oxygen saturation (the fraction of hemoglobin carrying oxygen) within the capillary bed and draining veins of brain regions that are neuronally active. Because oxyhemoglobin and deoxyhemoglobin differ in their magnetic susceptibility, rising oxygen saturation alters the local magnetic field: As oxyhemoglobin arrives in the capillary beds, the local magnetic field becomes more homogeneous, MR T2* relaxation becomes longer, and MR signal intensity increases. It is this contrast in T2* signal between baseline and task periods that is the basis of the BOLD fMRI mapping. The activity-driven fMRI signal (or hemodynamic response function) is transient on the order of seconds and is small: only approximately a 5% change from baseline in the healthy brain . A proportionally longer resting epoch is often used to allow the hemodynamic response to recover more completely, and task/rest epochs are repeated and the results averaged in order to increase the contrast between the two behavioral states and increase detection of the fMRI signal.