Exosomes are small, lipid-bilayer bound extracellular vesicles of 40‒160 nanometers in size that carry important information for intercellular communication. Exosomes are produced more by tumor cells than normal cells and carry tumor-specific content, such as DNA, RNA, and proteins, which have been implicated in tumorigenesis, tumor progression, and treatment response. Due to the critical role of exosomes in cancer development and progression, they can be exploited to develop specific biomarkers and therapeutic targets. Since exosomes are present in various biofluids, such as blood, saliva, urine, and peritoneal fluid, they are ideally suited to be developed as liquid biopsy tools for early diagnosis, molecular profiling, disease surveillance, and treatment response monitoring. In the past decade, numerous studies have been published about the functional significance of exosomes in a wide variety of cancers, with a particular focus on exosome‑derived RNAs and proteins as biomarkers. In this review, utilizing human studies on exosomes, we highlight their potential as diagnostic, prognostic, and predictive biomarkers in gastrointestinal cancers.

Background: Controversy exists regarding the safety and feasibility of minimally invasive resection for lesions in segments 7 or 8. We compare outcomes of minimally invasive surgery (MIS) and Open parenchymal sparing liver resections at two high-volume centers. Methods: From 2003 to 2016 we identified patients who underwent MIS or Open resections for lesions in segments 7 or 8 at two institutions (MSKCC and SGH). Outcomes were compared using univariate and multivariate analyses. Results: Two-hundred and forty-five patients underwent resection of lesions in segments 7 or 8 (MIS 30% and Open 70%). Compared to the Open group, the MIS group had longer operative time (223 ± 88 vs 188 ± 72 minutes, P = .003), lower blood loss (297 ± 287 vs 448 ± 670 mL, P = .03), and shorter mean length of stay (5.2 ± 7.4 vs 8.3 ± 11.7 days, P < .001), which remained significant on multivariate analysis. No differences in Pringle time, rate of postoperative complications, or R0 resections were detected. Conclusions: With appropriately selected patients treated by experienced MIS hepatopancreatobiliary surgeons, MIS resection of segments 7 or 8 is safe with similar rates of complications and R0 resections, with significantly less blood loss and shorter length of stay.

Severe thoracic injury secondary to penetrating trauma requires prompt resources and rapid decisionmaking by trauma centers and teams. Implementing trauma systems has significantly impacted medical and critical care quality and outcomes, including managing rare trauma injuries. We describe a report of a rare case of a 21-year-old man with a gunshot wound to the chest with injuries to the right pulmonary hilum requiring pneumonectomy and to the left atrium with bullet embolism to the right common iliac artery. In addition, the systematic approach where each phase of the individual's treatment --prehospital, emergency room, running room, and intensive care --was positively affected by the implementation, development, and progressive maturation of a trauma system is also explained.

joining the left and right hepatic duct to form a single hepatico-jejunostomy and Roux-en-Y reconstruction with jejuno-jejunostomy. Operative recovery was uneventful and she was discharged routinely on day 5 post-operatively. Final histology revealed a Grade 2 pT1 pN0 Mx NET of size 17x13x16mm with invasion of the bile duct wall and Ki67 index of 15%. Immunohistochemistry showed expression of chromogranin and synaptophysin. Post-operative Ga68-DOTATATE PET scan demonstrated no evidence of tracer avid disease and therefore final diagnosis was documented as primary common hepatic duct NET. 10 months post operatively she was well with no disease recurrence. Conclusion: Here we describe a rare condition managed with a limited resection and reconstruction resulting in an R0 resection. The first reported case of a bile duct neuroendocrine tumour was in 1959 and since then there has been roughly 150 cases reported in the literature. They are exceedingly difficult to diagnose pre-operatively due to their rarity and lack of distinguishing features. The mean age of diagnosis is 47.04 AE 17.62 years (6-79 years). To our knowledge, this is only the 8th case reported in children or adolescents and the first case diagnosed with frozen section intra-operatively. Previous studies have demonstrated a possible link between GI NETs and minimal change glomerulonephritis but there is no reported literature stating a link with bile duct NETs. A systematic reviewed showed a mean follow up range of 35.28 AE 42.3 months with no reported cases of recurrence in this time.

No abstract